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1.
Article in English | MEDLINE | ID: mdl-35234902

ABSTRACT

OBJECTIVES: Transapical Neochordae implantation (NC) allows beating heart mitral valve repair in patients with degenerative mitral regurgitation. The aim of this single-centre, retrospective study was to compare outcomes of NC versus conventional surgical (CS) mitral valve repair. METHODS: Data of patients who underwent isolated mitral valve repair with NC or CS from January 2010 to December 2018 were collected. A propensity score matching analysis was performed to reduce confounding due to baseline differences between groups. The primary end point was overall all-cause mortality; secondary end points were freedom from reoperation, freedom from moderate (2+) and from severe (3+) mitral regurgitation (MR) and New York Heart Association functional class in the overall population and in patients with isolated P2 prolapse (type A anatomy). RESULTS: Propensity analysis selected 88 matched pairs. There was no 30-day mortality in the 2 groups. Kaplan-Meier analysis showed similar 5-year survival in the 2 groups. Patients undergoing NC showed worse freedom from moderate MR (≥2+) (57.6% vs 84.6%; P < 0.001) and from severe MR (3+) at 5-year follow-up: 78.1% vs 89.7% (P = 0.032). In patients with type A anatomy, freedom from moderate MR and from severe MR was similar between groups (moderate: 63.9% vs 74.6%; P = 0.21; severe: 79.3% vs 79%; P = 0.77 in NC and FS, respectively). Freedom from reoperation was lower in the NC group: 78.9% vs 92% (P = 0.022) but, in type A patients, it was similar: 79.7% and 85% (P = 0.75) in the NC and CS group, respectively. More than 90% of patients of both groups were in New York Heart Association class I and II at follow-up. CONCLUSIONS: Transapical beating-heart mitral chordae implantation can be considered as an alternative treatment to CS, especially in patients with isolated P2 prolapse.


Subject(s)
Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Mitral Valve Annuloplasty , Mitral Valve Insufficiency , Mitral Valve Prolapse , Chordae Tendineae/surgery , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Mitral Valve Prolapse/diagnostic imaging , Mitral Valve Prolapse/surgery , Prolapse , Retrospective Studies , Treatment Outcome
2.
Scand J Immunol ; 66(4): 476-83, 2007 Oct.
Article in English | MEDLINE | ID: mdl-17850593

ABSTRACT

Rheumatoid arthritis (RA) is characterized by chronic joint inflammation and destruction. B cells play important role in modulating immune responses in RA. In the present study we assessed the impact of the B cell targeting as a third line treatment option. Forty-six patients with established erosive RA non-responding to combination treatment with DMARDs and TNF-alpha inhibitors were treated with anti-CD20 antibodies (rituximab). Rituximab was given intravenously once weekly on four occasions. All patients continued with the previous DMARD. Patients were followed by DAS28, levels of circulating B cells, frequency of immunoglobulin-producing cells, immunoglobulins, and rheumatoid factor levels during the period of 12-58 months. Clinical improvement was achieved in 34 of 46 patients (73%) supported by a significant reduction in DAS28 (from 6.04 to 4.64, P < 0.001). Infusion of rituximab resulted in the elimination of circulating B cells in all but one patient. Within 12 months follow-up, B cells returned to circulation in 86% of patients. Fifty-three percent of the patients were successfully retreated with rituximab or re-started with anti-TNF-alpha treatment. Of the 11 non-responders, five were retreated with anti-CD20 within 2 months, four of them with success, four patients received TNF-alpha inhibitors, the remaining two patients received an additional DMARD. Most of the RA patients resistant to TNF-alpha inhibitors may be effectively treated with anti-CD20 antibodies. The treatment is well tolerated and may be used repeatedly in the same patient and potentially increase sensitivity to previously inefficient treatment modalities.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Antigens, CD20/immunology , Antirheumatic Agents/therapeutic use , B-Lymphocytes/immunology , Immunotherapy/methods , Rheumatic Fever/immunology , Adult , Aged , Antibodies, Monoclonal, Murine-Derived , Arthralgia/drug therapy , Arthralgia/immunology , Blood Sedimentation/drug effects , C-Reactive Protein/analysis , Drug Resistance , Female , Hemoglobins/analysis , Humans , Immunoglobulins/blood , Leukocyte Count , Longitudinal Studies , Male , Methotrexate/pharmacology , Middle Aged , Platelet Count , Rheumatic Fever/blood , Rheumatic Fever/therapy , Rheumatoid Factor/blood , Rituximab , Tumor Necrosis Factor-alpha/antagonists & inhibitors
3.
Neurochirurgie ; 41(6): 429-31, 1995.
Article in French | MEDLINE | ID: mdl-8815419

ABSTRACT

A rare case of intracerebral chondroma in a 45 years old man with a long history of headache and recent epilepsy is presented. Microscopic examination of the resected tumor revealed that it was chondroma.


Subject(s)
Brain Neoplasms/diagnosis , Chondroma/diagnosis , Aphasia, Broca/etiology , Brain Neoplasms/complications , Brain Neoplasms/surgery , Chondroma/complications , Chondroma/surgery , Epilepsies, Partial/etiology , Humans , Male , Middle Aged , Tomography, X-Ray Computed
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