ABSTRACT
Nephrotic syndrome (NS) is a chronic renal disease that can progress into end-stage renal disease within 5 years if no remission occurs. Achieving optimal remission is important to obtain better outcomes of treating childhood steroid-resistant NS (SRNS). This study aimed to determine the survival, long-term outcomes, and factors associated with the sustained remission of SRNS patients after cyclophosphamide therapy. We retrospectively studied 33 children (24 boys) with SRNS treated with cyclophosphamide therapy over 2 years. Relapse-free survival was estimated using the Kaplan-Meier method. The determinants of long-term remission were assessed by univariate and multivariate analyses using Cox's proportional hazard models. The median age at the onset of NS was 3.0 years (range: 7 months to 14.0 years). The median age at the initiation of cyclophosphamide therapy was 5.0 years (range: 1.0-15.0 years). The mean cumulative cyclophosphamide dose was 155.61 ± 16.31 mg/kg body weight. In total, 18 of 33 (54.5%) children remained in remission for 2 years after cyclophosphamide therapy, and 10 of 15 patients who relapsed (66.67%) became steroid sensitive. Relapse-free survival after cyclophosphamide therapy was 78.8%, 69.7%, and 54.5% after 6, 12, and 24 months, respectively. Cox's proportional hazard regression identified no association between remission 2 years after cyclophosphamide therapy and other factors, such as age at the onset of SRNS, type of resistance, hypertension, hematuria, administration route of cyclophosphamide, and cumulative dose (all P >0.05). Cyclophosphamide therapy appeared to be beneficial for children with SRNS for sustaining 2-year remission with a 54.5% relapse-free survival rate.
Subject(s)
Kidney Failure, Chronic , Nephrotic Syndrome , Renal Insufficiency, Chronic , Male , Child , Humans , Infant , Child, Preschool , Adolescent , Nephrotic Syndrome/diagnosis , Nephrotic Syndrome/drug therapy , Retrospective Studies , Cyclophosphamide/adverse effects , Kidney Failure, Chronic/diagnosisABSTRACT
BACKGROUND: Doppler-guided hemorrhoid artery ligation is a minimal-invasive surgical treatment option for hemorrhoidal disease. The aim of our study was to evaluate the early and long-term results of the procedure 1 year after the operation. PATIENTS AND METHODS: In a period of 4 years, 90 patients were included in this study. The Doppler-guided hemorrhoid artery ligation was performed under either spinal anesthesia or local perianal block. We recorded the length of postoperative inpatient care, on-demand analgesics administered apart from the standard analgesic protocol, short- and long-term complications, and, finally, recurrences. RESULTS: The mean age of patients was 46 ± 12.6 years. The operation was performed under spinal anesthesia in 82 patients and under local perianal block in 8 patients. The mean operative time was 26 ± 4.1 min. On-demand analgesics administration was reported in sixteen patients (17.7%) the first postoperative day and in four patients (4.4%) the second postoperative day. A total of 58 patients (64.4%) were discharged from the hospital the day of the operation, 29 (32.2%) patients stayed overnight, and in three (3.3%) patients, a hospitalization period of 2 days was needed. Four patients (4.4%), two with grade III and two with grade IV hemorrhoids, developed early postoperative complications. Late complications were observed in three patients (3.3%). Recurrences, manifested either as bleeding or as prolapsing piles, were observed in six patients (6.6%), two patients with initial grade III and four with grade IV hemorrhoids. CONCLUSION: Doppler-guided hemorrhoid artery ligation seems to be a safe and effective treatment option for all grades of hemorrhoidal disease. Further prospective randomized comparative studies are needed in order to fully evaluate the true role of DG-HAL in the surgical armamentarium.
Subject(s)
Hemorrhoids/surgery , Ultrasonography, Interventional , Adult , Aged , Anesthesia, Spinal , Autonomic Nerve Block , Fecal Incontinence/etiology , Female , Fissure in Ano/etiology , Follow-Up Studies , Hematoma/etiology , Hemorrhoids/diagnostic imaging , Humans , Ligation/adverse effects , Male , Middle Aged , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Recurrence , Time Factors , Ultrasonography, Doppler , Young AdultABSTRACT
The effects of coating thickness, type of adhesive, and type and concentration of enhancer on the mechanical properties of two acrylic pressure-sensitive adhesives (PSAs) were investigated using a 2(4) factorial design and an optimization technique. Sixteen formulations containing 0% or 10% of either caprylic acid or methyl laurate in two different PSAs, namely Duro-Tak 87-2196 and Duro-Tak 87-2097, were prepared. The adhesive properties of these laminates were evaluated by applying the 90 degrees Dynamic Adhesive Strength Peel Test (90 degrees DASPT) and 1800 Release Liner Peel Test (180 degrees RLPT). Coating thickness, concentration of enhancer, and type of adhesive did affect the 90 degrees DASPT. For the 180 degrees RLPT, the most significant factors were coating thickness and concentration of enhancer, with a strong interaction observed between the two. Coating thickness and concentration of enhancer were also used to create mathematical models that correlated these factors with the mechanical properties of the PSAs. For this purpose, the optimization technique 3(2) was applied. It was found that the correlation of the above factors can be adequately described with polynomial equations, which can be used for predicting the mechanical properties of the laminates containing the above PSAs and methyl laurate (0%-10%).
