The HBeAg negative form of chronic hepatitis B (CHB) predominates in the Mediterranean area and has a rising frequency in Europe and North America. At present there are three approved therapies for ...patients with CHB: interferon-alpha (IFN-alpha), lamivudine and adefovir dipivoxil. Unfortunately, none of these drugs are effective in achieving a sustained response in patients with HBeAg negative CHB. Therefore, new therapeutic approaches have been examined. Our aim was to investigate the efficacy of combination treatment of IFN-alpha and lamivudine compared to lamivudine monotherapy, after 24 mo of administration in HBeAg-negative hepatitis B patients.
Fifty consecutive patients were randomly assigned to receive IFN-alpha-2b (5 MU thrice per week, n = 24) plus lamivudine (100 mg daily) or lamivudine only (n = 26) for 24 mo. Patients were followed up for further 6 mo. The primary outcome was the proportion with sustained virological response (undetectable serum HBV DNA concentrations) and or sustained biochemical response (transaminase levels within normal range) at 30 mo (6 mo after the end of therapy). Secondary end-points were timed from initial virological (biochemical) response to VBR (BBR, respectively) and the emergence of YMDD mutants across the two arms.
Five of twenty-four (21%) patients in the combination arm vs 3/26 (12%) in the lamivudine arm had sustained response (i.e., normal serum transaminase levels and undetectable HBV DNA by PCR assay) 6 mo after treatment discontinuation. A reduction in the emergence of YMDD mutants and in the development of virological breakthroughs was observed in patients receiving combination treatment (10% vs 46%, P = 0.01 and 14% vs 46%, P = 0.03, respectively). Time from initial virologic response to virologic breakthrough (VBR) was greater among initial responders receiving combination treatment compared to those receiving lamivudine (22.9 mo vs 15.9 mo, respectively; P = 0.005).
Our results demonstrate that IFN-alpha plus lamivudine combination therapy did not increase the sustained response, compared to lamivudine. However, combination therapy reduces the likelihood of VBR due to YMDD mutants and prolongs the time period until the breakthrough development.
Aim: Therapy for chronic hepatitis C (HCV) has mainly been evaluated in large clinical, select population, trials. We sought to evaluate whether prognostic factors of therapeutic response are similar ...in clinical practice, where treated population is more diverse.
Methods: Retrospective study of HCV‐infected patients who completed >6 months of treatment/retreatment with various therapeutic regimens, in a single reference centre over a 10‐year period. Adjuvant treatment with hemopoetic growth factors was used when warranted by treatment side effects.
Results: Overall, 77/125 patients (61.6%) achieved sustained virological response (SVR). Fifty‐four naïve patients (43.2%) achieved SVR; 19 (26%) with interferon‐α (IFN‐α), 13 (59.1%) with IFN‐α and ribavirin, and 22 (73.3%) with pegylated IFN‐α and ribavirin. Seventeen patients responded after two courses of therapy and six after more than three courses, achieving a total SVR of 32%. Patients with genotype‐1 were less probable to achieve SVR odds ratio (OR)=6.23, while younger patients were more possible to achieve SVR, OR=0.97. Most non‐responders after >2 regimens were genotype‐1 patients (90%).
Conclusions: In clinical practice, where strict selection criteria cannot be applied, genotype‐1 remains the most significant prognostic factor of response failure. Addition of adjuvant hemopoetic growth factors, when warranted, may increase compliance and thus overall SVR.
Preoperative optimization of cardiac failure (CF) patients undergoing non-cardiac surgery is of utmost importance. Levosimendan is a promising adjunct in our therapeutic repertoire for the treatment ...of CF; however, it has not been evaluated in CF patients undergoing non-cardiac surgery. Our objective was to evaluate the safety and efficacy of prophylactic preoperative levosimendan administration in these patients.
CF patients with ejection fraction <35% undergoing elective non-cardiac (abdominal) surgery during a 6-month-period were included in this prospective study. All patients, admitted to the Surgical Intensive Care Unit (SICU) one day preoperatively for levosimendan administration, received a bolus infusion (2.4 Ig/kg) for 10 min followed by a 24-hour continuous infusion (0.1 Ig/kg/min) at the end of which they were operated. Patients were under continuous hemodynamic monitoring in the SICU during levosimendan infusion and for 24 h post-infusion. Hemodynamic parameters, including heart rate, arterial pressure and pulmonary artery catheter data, were recorded before treatment, 10 min after drug initiation, and at 3-hour intervals to 24 h post-infusion. Echocardiography was performed before infusion and on the 7th post-infusion day.
Nine patients were enrolled. Cardiac index (0-48 h, 95% CI: -2.790-0.432, p<0.001) and stroke volume index (0-48 h, 95% CI: -32.53-0.91, p=0.01) increased significantly at 24 h after drug initiation and remained increased for 24 h post-infusion. Systemic vascular resistance index decreased at 10 min and remained reduced during the whole observation period (0-48 h, 95% CI: 875.64-2378.14, p<0.001). Ejection fraction was significantly increased on the 7th post-infusion day (32.65 +/- 7.32 vs. 20.89 +/- 6.24, p<0.05). No adverse reactions, complications or deaths occurred during 30 days' follow up.
Prophylactic preoperative levosimendan treatment may be safe and efficient for the perioperative optimization of heart failure patients undergoing non-cardiac surgery.
Background: The study evaluates the effect of a high supplemental dose of ascorbic acid (AA) on plasma concentrations of total cholesterol (TC), triglycerides (TG), total lipids (TL), and lipoprotein ...fractions high-density, very-low-density-, and low-density lipoprotein (HDL, VLDL, LDL) in guinea pigs fed with atherogenic diet. Methods: Group I consisted of 5 normally fed guinea pigs plus a low dose of AA (1 mg/100 g/day), group II consisted of 7 guinea pigs fed with food enriched with 2% cholesterol plus a low dose of AA (1 mg/100 g/day), and group III consisted of 7 guinea pigs fed with food enriched with 2% cholesterol plus a high dose of AA (30 mg/100 g/day). Cholesterolemic factors concentrations were determined after nine weeks. Results: Concentrations of TC, TG, TL, LDL, and VLDL were increased in group II compared to group I (p < 0.01 for all differences). Supplementation with a high dose of AA resulted in decreased concentrations of TC (p < 0.01), TG (p < 0.01), TL (p < 0.01), and LDL (p < 0.01) in group III compared to group II. Additionally, concentration of HDL was increased in group III compared to group II (p < 0.01). Conclusion: High-dose AA supplementation to an atherogenic diet decreases concentrations of TC, TG, TL, and LDL and increases concentration of HDL compared to low-dose AA.
Obesity is a complex disease and its prevalence depends on multiple factors related to the local socioeconomic, cultural and urban context of individuals. Many obesity prevention strategies and ...policies, however, are horizontal measures that do not depend on context-specific evidence. In this paper we present an overview of BigO (http://bigoprogram.eu), a system designed to collect objective behavioral data from children and adolescent populations as well as their environment in order to support public health authorities in formulating effective, context-specific policies and interventions addressing childhood obesity. We present an overview of the data acquisition, indicator extraction, data exploration and analysis components of the BigO system, as well as an account of its preliminary pilot application in 33 schools and 2 clinics in four European countries, involving over 4,200 participants.
This study evaluates the correlation of ultrasound determined carotid plaque morphology with coronary risk and cardiac damage after carotid endarterectomy.
Fifty patients (in a series of 162) ...scheduled for carotid endarterectomy had the indication for coronary CT-angiography preoperatively and were included in this study. Patients were classified according to ultrasonographic characteristics of carotid plaque. The Duke Criteria were used to assess the degree of coronary risk (low, medium and high risk). Cardiac damage after carotid endarterectomy was evaluated based on symptoms, cardiac Troponin I measurement and electrocardiographic findings.
There were no deaths, strokes or symptomatic myocardial infarctions postoperatively (30-day results). Ten patients (20%) showed asymptomatic cardiac damage postoperatively. Cardiac damage after surgery did not show any difference between the three cardiac risk groups. Echogenic and specifically Type IV carotid artery plaques (Gray-Weale Criteria) were associated with high cardiac risk preoperatively and with postoperative cardiac damage. The degree of carotid artery stenosis, and echolucent carotid plaques were not associated with postoperative cardiac damage.
Asymptomatic postoperative cardiac damage occurs often after carotid endarterectomy and presents independently from coronary risk. Carotid plaques of higher echogenicity are associated with severity of coronary artery disease and cardiac damage after carotid endarterectomy.
Obesity is a complex disease and its prevalence depends on multiple factors related to the local socioeconomic, cultural and urban context of individuals. Many obesity prevention strategies and ...policies, however, are horizontal measures that do not depend on context-specific evidence. In this paper we present an overview of BigO (http://bigoprogram.eu), a system designed to collect objective behavioral data from children and adolescent populations as well as their environment in order to support public health authorities in formulating effective, context-specific policies and interventions addressing childhood obesity. We present an overview of the data acquisition, indicator extraction, data exploration and analysis components of the BigO system, as well as an account of its preliminary pilot application in 33 schools and 2 clinics in four European countries, involving over 4,200 participants.
latrogenic vascular trauma is more frequent today as a result of the increase in diagnostic and therapeutic femoral catheterizations. Management of related complications is elective or urgent and ...sometimes needs complex vascular reconstruction. The present study evaluated when and whether conservative, urgent surgical, or elective surgical treatment is appropriate.
A retrospective analysis was made of 45 consecutive iatrogenic vascular trauma patients, among 10,450 cardiac diagnostic or therapeutic catheterizations. Patients' demographics, type of catheterization, time from catheterization to initial diagnosis, the type of complication (thrombosis, infection, bleeding, pseudoaneurysm, etc.), time from presentation of the complication to definite treatment, diagnostic imaging and decision making, the surgical or conservative management, the length of stay and the clinical outcome were determined and analyzed.
We identified and treated 30 early and 15 late (after patient's discharge) arterial complications: 18 pseudoaneurysms, 6 bleedings, 9 hematomas, 5 deep vein thromboses, 3 arteriovenous fistulas, 2 arterial embolisms and 2 arterial thromboses. Eight patients underwent emergency surgical repair, three elective surgical repair and 31 were managed conservatively. Decision making was based only on clinical evaluation in 12 patients, whereas vascular ultrasound was the most frequent diagnostic imaging modality in the remainder. A total of 10 (22.2%) minor secondary complications were identified after the initial management with no limb loss and zero mortality.
Close clinical observation and conservative management of vascular trauma complications resulted in a low incidence of the necessity for surgical repair (25% of cases). Bleeding and acute leg ischemia were the most frequent indication for emergency surgical treatment, whereas the majority of pseudoaneurysms, fistulas and vein thrombosis were successfully treated conservatively. Late vascular complications do occur and add an important morbidity factor to early catheterization complications.
Chest wall ectopic synovial bursa cyst MICHAIL, P; FILIS, C; PIKOULIS, E ...
Southern medical journal (Birmingham),
11/1999, Letnik:
92, Številka:
11
Conference Proceeding, Journal Article
Recenzirano
We report an unusual case of chest wall tumor in a 27-year-old patient. A complete resection was accomplished, and the patient had an excellent postoperative course. Histologically, the mass was ...confirmed to be an ectopic synovial bursa cyst. Although rare, synovial cysts should be considered in any case of a fluctuating chest wall mass. We also discuss the etiology and diagnostic approach of cystic masses of the chest wall.
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