1,422 research outputs found
Identifying risk profiles in liver transplant candidates and implications for induction immunosuppression
No full textChanges in recipient and donor characteristics are redefining the role of induction in liver transplant recipients. Older recipients are more common, with greater concomitant comorbidity. Moderate or severe renal dysfunction is now estimated to affect 40% of liver transplant recipients. Donors are also becoming older, and other factors such as more frequent non-alcoholic fatty liver disease (NAFLD) compromise the quality of some grafts. Rejection rates are now relatively low (-10%) but some patients have a markedly increased risk such as younger recipients and those undergoing re-transplantation. Induction immunosuppression is associated with a significant reduction in rejection risk but due to various factors universal induction is not justified. Steroid-free therapy without induction increases the risk of biopsy-proven acute rejection (BPAR) but randomized trials have shown that induction with an interleukin-2 antagonist receptor (IL-2RA) agent or with rabbit antithymocyte globulin (rATG) maintains immunosuppressive efficacy in steroid-free regimens. Delayed calcineurin inhibitor (CNI) initiation (e.g. to days 4-5 post transplant) can prevent deterioration of renal function during the first year post-transplant, but requires induction with an IL-2RA agent or rATG to maintain early immunosuppressive efficacy.IL-2RA induction may be inadequate to ensure a low risk of rejection in a steroid-free regimen combined with delayed tacrolimus. Randomized trials of CNI withdrawal at month 1 post-transplant have only achieved an acceptable rate of BPAR when induction is administered. In terms of safety, an increased rate of infection does not seem to be a concern. The most recent large-scale analyses have not indicated any evidence for an increased risk of malignancy, or specifically post-transplant lymphoproliferative disease. In summary, the place of induction in the management of liver transplant patients is becoming established. Selective use in high-risk individuals to avoid graft rejection is still relevant, but the key rationale for induction is to facilitate steroid-sparing and CNI-sparing regimens to reduce long-term complications. (C) 2018 The Authors. Published by Elsevier Inc
RANDOMIZED MULTICENTER STUDY OF CETUXIMAB PLUS FOLFOX OR PLUS FOLFIRI IN NEOADJUVANT TREATMENT OF NON-RESECTABLE COLORECTAL LIVER METASTASES (CELIM-STUDY)
No full textProgression Free and Overall Survival After Neoadjuvant Treatment of Colorectal Liver Metastases With Cetuximab Plus FOLFOX or FOLFIRI - Results of the CELIM Study
No full textPrescribing and monitoring of tacrolimus in primary therapy following kidney transplantation
No full textPrescribing and monitoring of tacrolimus in primary therapy following kidney transplantation
No full textRANDOMIZED MULTICENTER STUDY OF CETUXIMAB PLUS FOLFOX OR PLUS FOLFIRI IN NEOADJUVANT TREATMENT OF NON-RESECTABLE COLORECTAL LIVER METASTASES (CELIM-STUDY)
No full textProgression Free and Overall Survival After Neoadjuvant Treatment of Colorectal Liver Metastases With Cetuximab Plus FOLFOX or FOLFIRI - Results of the CELIM Study
No full textIn-vivo 31 P Magnetresonanzspektroskopie bei repetitiver transarterieller Chemoembolisation maligner Lebertumoren
No full textMit der palliativen transarteriellen Chemoembolisation (TACE) läßt sich eine Verkleinerung von malignen Lebertumoren und eine Verlängerung des Überlebens erreichen. Im Verlauf des Therapiezyklus diente die Phosphor-Magnetresonanzspektroskopie mittels Chemical-Shift-Imaging einem nichtinvasiven Einblick in den zellulären Energie- und Membranstoffwechsel. Eine Differenzierung zwischen primären und sekundären Lebertumoren war anhand der 31P-Spektren nicht möglich. Posttherapeutisch zeigten die Patienten einen Anstieg des anorganischen Phosphats bei Abfall des ß-NTP-Signals, die sich während des sechswöchigen Intervalls vor der nächsten Intervention wieder normalisierten. Therapieansprechen und -versagen zeigten während des Therapiezyklus unterschiedliche spektroskopische Quotientenverläufe. Eine deutliche Volumenreduktion als auch eine homogene und dauerhafte Lipiodoleinlagerung im Tumor gehen zuverlässig mit einem spektroskopischen Therapieansprechen einher. Dies zeigte sich bei der ersten Patientengruppe während der Untersuchung direkt nach der Embolisation und bei der zweiten Gruppe erst vor der nächsten Intervention. Therapieversagen, Tumorprogression und geringe Lipiodoleinlagerung bzw. rasche Entspeicherung im Verlauf ließen sich spektroskopisch nach-weisen. Schwierig bleibt die Zuordnung der Patienten mit uneinheitlichen Quotienten-verläufen. Die MRS kann früher als die klinische Routinediagnostik eine Aussage über das Therapieansprechen treffen. Für den Patienten ergibt sich die Vermeidung einer ineffektiven Therapie. Bei nachgewiesenem Ansprechen hingegen profitiert der Patient durch die wiederholte Anwendung der TACE. Der hohe personelle, technische und zeitliche Aufwand für die Phosphorspektroskopie verhindert bisher den klinischen Routineeinsatz dieses Verfahrens. Im Rahmen der klinischen Forschung, insbe-sondere in der onkologischen Therapiekontrolle, hat die MRS als nichtinvasive Methode heute einen großen Stellenwert.Using palliative transarterial chemoembolization (TACE) a reduction of malignant liver neoplasms and a prolongation of survival time can be achieved. During the course of therapy phosphorous magnetic resonance spectroscopy by means of chemical-shift-imaging was used for noninvasive examination of the cellular metabolism of energy and membranes. Differentiation between primary and secondary liver tumors was not feasible using 31P-spectra. After therapy patients had shown increased inorganic phosphate signal and reduction of the ß-NTP-signals, which normalized during six week intervall before next intervention. Response and non-response to therapy showed different courses of spectroscopic quotients during therapy cycle. Prominent reduction of volume as well as homogeneous and continous retention of lipiodol within the tumor are reliable combined with spectroscopic response to therapy. The first group of patients showed these signs at the examination immediately after embolization whereas patients of the second group showed these signs not before next intervention. Failure of therapy, progression of tumor and slight retention of lipiodol or rapid elemination during course of therapy were detectable by spectroscopy. Categorization of patients with non-uniform courses of quotients remains difficult. Magnetic resonance spectroscopy is able to determine response to therapy earlier than standard diagnostic methods. As a result ineffective therapy is avoided for the patient. On the other hand the patient profits from repeated administration of TACE. Great expense of personnel, equipment and time so far prevents clinical use of phosphorous spectroscopy as a matter of routine. In conjunction with clinical research MRS is an important non-invasive method especially for oncological therapy monitoring
Comparison of the collagen haemostat Sangustop(R) versus a carrier-bound fibrin sealant during liver resection; ESSCALIVER-study
No full textBackground: Haemostasis in liver surgery remains a challenge despite improved resection techniques. Oozing from blood vessels too small to be ligated necessitate a treatment with haemostats in order to prevent complications attributed to bleeding. There is good evidence from randomised trials for the efficacy of fibrin sealants, on their own or in combination with a carrier material. A new haemostatic device is Sangustop(R). It is a collagen based material without any coagulation factors. Pre-clinical data for Sangustop(R) showed superior haemostatic effect. This present study aims to show that in the clinical situation Sangustop(R) is not inferior to a carrier-bound fibrin sealant (Tachosil(R)) as a haemostatic treatment in hepatic resection. Methods: This is a multi-centre, patient-blinded, intra-operatively randomised controlled trial. A total of 126 patients planned for an elective liver resection will be enrolled in eight surgical centres. The primary objective of this study is to show the non-inferiority of Sangustop(R) versus a carrier-bound fibrin sealant (Tachosil(R)) in achieving haemostasis after hepatic resection. The surgical intervention is standardised with regard to devices and techniques used for resection and primary haemostasis. Patients will be followed-up for three months for complications and adverse events. Discussion: This randomised controlled trial (ESSCALIVER) aims to compare the new collagen haemostat Sangustop(R) with a carrier-bound fibrin sealant which can be seen as a "gold standard" in hepatic and other visceral organ surgery. If non-inferiority is shown other criteria than the haemostatic efficacy (e.g. costs, adverse events rate) may be considered for the choice of the most appropriate treatment. Trial Registration: NCT0091861
A transitoriedade entre o mundo primitivo e o moderno nas obras The Sea-Wolf e White Fang de Jack London
No full textThe American author Jack London wrote the books The Sea-Wolf and White Fang in 1904 and 1906, respectively. The former portrays the life of a literary critic, Humphrey Van Weyden, who after the wreckage of the ship in which he was is rescued by a seal-hunting schooner, where he is obliged to work and to live with the brutal captain Wolf Larsen, and in doing so he develops a more primitive profile. The latter work portrays the life of the eponymous character, a wolf that leaves the wild world in which it was born to follow its last master in the city, thus developing features of the modern world. This paper aims to conduct an analysis of the aspects that allow the transition between the primitive and the modern world in those worksO autor norte-americano Jack London escreveu em 1904 e 1906 as obras The Sea-Wolf e White Fang, respectivamente. A primeira retrata a vida de um crítico literário, Humphrey Van Weyden, que após o naufrágio do barco em que se encontrava é resgatado por uma escuna de caça, na qual é obrigado a trabalhar e a conviver com o brutal comandante Wolf Larsen, desenvolvendo assim um perfil mais primitivo. A segunda obra retrata a vida da personagem epônima, um lobo que deixa o mundo selvagem no qual nascera para acompanhar seu último mestre na cidade grande, desenvolvendo assim características do mundo moderno. O presente trabalho visa empreender uma análise sobre os aspectos que possibilitam a transição entre o mundo primitivo e o mundo moderno nas obras citada
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