2,464 research outputs found
Calcineurin inhibitors in renal transplantation still needed but in reduced doses: a review.
No full textDespite their contribution in the success of organ transplantation, calcineurin inhibitors (CNIs) may be responsible for frequent and severe side effects that can affect graft survival and life expectancy. In this article, we have reviewed registry studies and randomized controlled trials (RCTs) that seek to avoid, withdraw, or minimize CNIs in renal transplant recipients. Attempts to completely avoid CNIs by administering mycophenolate mofetil (MMF) and/or sirolimus (SRL) have resulted in increased risks of rejection and side effects, with small advantage to improve renal graft function. Early withdrawal of CNIs after transplantation using administration of MMF can improve graft function but may be associated with a greater risk of acute or chronic rejection and graft failure. RCTs in which CNIs were replaced a few months after transplantation by SRL reported improved graft function among SRL-treated patients, but such a treatment was complicated by iatrogenic toxicity. Late replacement of CNIs with SRL did not produce a particular advantage and again was complicated by more frequent side effects. On the basis of these trials, it seems that CNI elimination can trigger rejection or side effects. Recent RCTs showed that minimization of CNI doses in association with everolimus does not increase the risk of rejection, allows one to obtain good graft function, and is well tolerated. Such an approach seems therefore preferable to complete elimination of CNIs with substitution of the current immunosuppressive drugs
Therapy for idiopathic membranous nephropathy: tailoring the choice by decision analysis.
No full textTwo Italian controlled trials demonstrated that the difference in remission rates obtained with six months of methylprednisolone and chlorambucil (MP+Ch) compared to MP was smaller than MP+Ch Versus symptomatic therapy in the treatment of idiopathic membranous nephropathy nephrotic syndrome (NS). A decision analysis was used to compare the three treatment strategies, assuming triple probabilities and costs for MP+Ch complications compared to MP, with no risk for supportive therapy, referring to an average 40-year-old patient and using the quality-adjusted life expectancy year (QALY) as the utility scale. With MP+Ch the difference in expected QALY was 7.2 years compared to supportive therapy, and 2.6 years compared to MP. To offset the longer survival obtained with MP+Ch versus MP, it was assumed that all patients treated with MP+Ch would undergo either fatal (5% vs. 0.3% with MP) or non-fatal complications (95% vs. 15% with MP). This threshold denotes a great stability of the inequality in the expected QALY. Consequently, treatment with MP or with MP+Ch is justified if their side effects are considered to be a suitable trade-off for a five or seven QALY, respectively, longer survival. Only an absurd increase in the death rate with MP+Ch could offset the difference
Il nuovo imaging nella malattia coronarica. La parete arteriosa, il lume, la per fusione. La medicina nucleare
No full textIl nuovo imaging nella malattia coronarica. La parete arteriosa, il lume, la per fusione. La medicina nucleare
No full textControlled trial of two different methylprednisolone doses in cadaveric renal transplantation
No full textIn a controlled trial the effects of two different methylprednisolone (MP) schedules were studied in 100 cadaver kidney adult recipients followed for 18-46 months. Group A patients were given 160 mg/day i.v. for 3 days, then oral MP (0.8 mg/kg/day), which was tapered by 4 mg/week to a maintenance dose of 16 mg/day up to the 6th month. Group B patients were given 80 mg/day i.v. for 3 days followed by 0.4 mg/kg/day oral MP; the dose was reduced by 2 mg/week to 16 mg/day. In both groups, the dose was further reduced bimonthly to a final dose of 8 mg/day. No significant differences were evidenced between the two groups in patients and kidney survival or in the incidence of complications. The number of patients with at least one rejection episode was significantly higher in the lower dose group
Application of the IS-MP-IA model to the German economy and policy implications
No full textExtending the IS-MP-IA model developed by Romer (2000) and applying the GARCH (Engle, 1982, 2001) methodology, the author finds that equilibrium GDP in Germany is positively affected by stock market performance and real exchange rate appreciation, and negatively influenced by the expected inflation rate, the government deficit/GDP ratio, and the U.S. federal funds rate. The relatively low deficit/GDP ratio of 1.83% in 2003 indicates that its fiscal condition was healthy. However, some other EU members may need to exercise fiscal discipline. Because real appreciation has a positive impact on output, a stronger euro may not be a concern for Germany but may be worried by those EU member nations which depend upon exports to stimulate their economies.
Prognostic value of rest-redistribution 201TI single-photon emission computed tomography in patients with chronic coronary artery disease and left-ventricular dysfunction
No full textNon-imaging nuclear monitoring of left ventricular function: twenty-five years of technical development and clinical experience
No full textNon-imaging nuclear monitoring of left ventricular function: twenty-five years of technical development and clinical experience
No full textEverolimus and minimization of cyclosporine in renal transplantation: 24-month follow-up of the EVEREST study
No full textn
- …
