• Title/Summary/Keyword: Failed primary treatment

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Adalimumab Treatment in Pediatric-Onset Crohn's Disease Patients after Infliximab Failure: A Single Center Study

  • Song, Won Jae;Kang, Ben;Choi, So Yoon;Choe, Yon Ho
    • Pediatric Gastroenterology, Hepatology & Nutrition
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    • v.19 no.2
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    • pp.116-122
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    • 2016
  • Purpose: We aimed to investigate the efficacy and safety of adalimumab in pediatric-onset Crohn's disease patients who had failed treatment with infliximab. Methods: In this retrospective study, patients included were those who had been diagnosed with Crohn's disease before 18 years old, and had received treatment with adalimumab after infliximab failure. The efficacy of adalimumab treatment was investigated at 1 month and 1 year, and adverse events that had occurred during treatment with adalimumab were explored. Results: Ten patients were included in this study. The median duration from diagnosis to adalimumab treatment was 5.5 years (range: 2.4-7.9 years). At 1 month after adalimumab initiation, 80% (8/10) of patients showed clinical response, and 40% (4/10) achieved clinical remission. At 1 year, 71% (5/7) of patients showed clinical response, and 43% (3/7) were under clinical remission. Among the total included patients, 5 patients (50%) showed clinical response at 1 year. Primary non-response to adalimumab was observed in 2 patients (20%), and secondary failure to adalimumab was observed in 3 patients (30%) during 1 year treatment with adalimumab. No serious adverse event had occurred during adalimumab treatment. Conclusion: Adalimumab was effective for 1 year without serious adverse events in half of pediatric-onset Crohn's disease patients who had failed treatment with infliximab.

Circumferential Resection and Reconstruction of The Mediastinal Trachea Without Prosthesis for Tracheal Stenosis: A Report of 4 Cases (기관삽입관에 의한 기관협착증 의 외과적 치료: 4례 보고)

  • 박주철
    • Journal of Chest Surgery
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    • v.10 no.1
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    • pp.17-24
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    • 1977
  • The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tube has produced, apparently with increasing frequency, three lesions which have serious ceminical manifestations such as tracheal stenosis, tracheomalasia, and localized tracheal erosion. Extensive resection and reconstruction of the trachea must be necessary because conservative treatment has generally failed in the fully developed stenotic lesion. of the mediastinal trachea following extensive resection is best accomplished by direct anastomosis of the patient`s own tracheobronchial tissue. Any replacement of the mediastinal trachea must be air tight and laterally rigid, and must heal dependably. A variety of materials has been used for substitution following circumferential excision of tracheal segments within the mediastinum. These attempts have often failed because of early leak or late stenosis. We have successfully performed circumferential resection and primary end-to-end anastomosis of the trachea for 4 cases of post-intubation tracheal stenosis located a few centimeter below the tracheostomy stoma in the period of 3 years between 1974 and 1976. The lesion in one patient was found in the upper trachea which was approached anteriorly through a cervicomediastinal incision with division of the upper sternum. Other three located in the lower half of the trachea were operated through a high transthoracic incision with appropriate hilar mobilization in addition to cervical flexion for the development of the cervical trachea into the mediastinum. There were no hospital death, but suture line granulations occurred in two patients were managed by bronchoscopic removal of granulations without difficulties.

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The Effect of Cultivated Wild Ginseng Extract on Preadipocyte Proliferation (산양산삼 추출물이 지방세포의 분화에 미치는 영향)

  • Kim, Byoung-Woo;Kwon, Ki-Rok
    • Journal of Pharmacopuncture
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    • v.10 no.3
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    • pp.29-35
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    • 2007
  • Objectives The purpose of this study is to investigate the effects of cultivated wild ginseng extract on primary cultured preadipocyte and adipocytes. Methods Diminish preadipocyte proliferation does primary role to reduce obesity. So, preadipocytes and adipocytes were performed on cell cultures with using Sprague-Dawley rats and treated with 0.01-1mg/ml cultivated wild ginseng extract. Result At all concentrations, cultivated wild ginseng extract wasn't show the suppress proliferation of preadipocytes significantly and failed to show effects on decomposition of adipocytes except high dosage. Conclusion Based on these findings, cultivated wild ginseng is not a suitable choice for the treatment of localized obesity.

A Case Report of Primary Infertility caused by Uterus Unicornis (단각 자궁으로 인한 원발성 불임 환자 1례의 임상 보고)

  • Kim, Jae-Kwan;Shin, Kyung-Ho;Park, Ki-Bum;Song, Kye-Hwa;Kang, Hee-Chul;Lee, Soon-Yee;Jo, Jin-Hyong
    • The Journal of Korean Obstetrics and Gynecology
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    • v.18 no.3
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    • pp.242-249
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    • 2005
  • Purpose : The purpose of this paper is to report the effect of oriental medicine to primary infertility caused by uterus unicornis. Methods : The patient in this case, 30 years-old female was treated with herb medication(Sosihotang, Gyejibokryeonghwan) for one month. Before oriental treatment, she had been diagnosed as primary infertility caused by uterus unicornis in Samsung Cheil Hospital and treated medication and injection for IUI(intrauterine insemination) in 2 times. But she had failed in gestation. Results : After taking herb medication she became pregnant. Conclusion : According to this result, we concluded that herb medication could improve fertility rate. After this paper, further study and clinical approach based on oriental medicine will be needed about infertility caused by uterus unicornis.

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Efficacy of methotrexate therapy in patients with tubal pregnancy and a serum human chorionic gonadotropin level above 10,000 IU/L

  • Kim, Kidong;Suh, Dong Hoon;Cheong, Hyun Hoon;Yoon, Sang Ho;Lee, Taek-Sang;No, Jae Hong;Kim, Yong-Beom
    • Clinical and Experimental Reproductive Medicine
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    • v.41 no.1
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    • pp.33-36
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    • 2014
  • Objective: To estimate the failure rate of medical treatment and to identify variables associated with treatment failure in patients with tubal pregnancy and an initial serum level of human chorionic gonadotropin (HCG) over 10,000 IU/L. Methods: The inclusion criteria were tubal pregnancy diagnosed using ultrasonography, primary treatment of intramuscular methotrexate injection at one of the four institutions between January 2003 and December 2011, a serum HCG level within two days before treatment >10,000 IU/L, and follow-up data to determine treatment success or failure. Exclusion criteria were other primary treatments besides intramuscular methotrexate injection. The clinicopathologic data of 36 patients were collected and analyzed. Results: Medical treatment failed and surgery was performed in 19 (53%) patients. In univariable analysis, age, parity, and size of the gestational sac were associated with treatment failure, but none of the variables were associated with treatment failure in multivariable analysis. The failure rate in the subgroup with age<33 years and size of gestational sac ${\geq}1.1cm$ was significantly higher than those of the other subgroups (82% vs. 41% [mean of the other subgroups], respectively). Conclusion: Patients with a serum HCG level >10,000 IU/L who received medical treatment had a high failure rate. Among them, patients aged<33 year and with a gestational sac ${\geq}1.1cm$ had an extremely high failure rate.

Treatment results of the second-line chemotherapy regimen for patients with low-risk gestational trophoblastic neoplasia treated with 5-day methotrexate and 5-day etoposide

  • Kanno, Toshiyuki;Matsui, Hideo;Akizawa, Yoshika;Usui, Hirokazu;Shozu, Makio
    • Journal of Gynecologic Oncology
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    • v.29 no.6
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    • pp.89.1-89.8
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    • 2018
  • Objective: Highly effective chemotherapy for patients with low-risk gestational trophoblastic neoplasia (GTN) is associated with almost a 100% cure rate. However, 20%-30% of patients treated with chemotherapy need to change their regimens due to severe adverse events (SAEs) or drug resistance. We examined the treatment outcomes of second-line chemotherapy for patients with low-risk GTN. Methods: Between 1980 and 2015, 281 patients with low-risk GTN were treated. Of these 281 patients, 178 patients were primarily treated with 5-day intramuscular methotrexate (MTX; n=114) or 5-day drip infusion etoposide (ETP; n=64). We examined the remission rates, the drug change rates, and the outcomes of second-line chemotherapy. Results: The primary remission rates and drug resistant rates of 5-day ETP were significantly higher (p<0.001) and significantly lower (p=0.002) than those of 5-day MTX, respectively. Forty-seven patients (26.4%) required a change in their chemotherapy regimen due to the SAEs (n=16) and drug resistance (n=31), respectively. Of these 47 patients failed the first-line regimen, 39 patients (39/47, 82.9%) were re-treated with single-agent chemotherapy, and 35 patients (35/39, 89.7%) achieved remission. Four patients failed second-line, single-agent chemotherapy and eight patients (17.0%) who failed first-line regimens were treated with combined or multi-agent chemotherapy and achieved remission. Conclusions: Patients with low-risk GTN were usually treated with single-agent chemotherapy, while 20%-30% patients had to change their chemotherapy regimen due to SAEs or drug resistance. The second-line regimens of single-agent chemotherapy were effective; however, there were several patients who needed multiple agents and combined chemotherapy to achieve remission.

Management of failed periodontal surgical intervention for a furcal lesion with a nonsurgical endodontic approach

  • Asgary, Saeed;Fazlyab, Mahta
    • Restorative Dentistry and Endodontics
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    • v.39 no.2
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    • pp.115-119
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    • 2014
  • As long as the prognosis of teeth remains a matter of concern, the endodontic-periodontal relationship will be considered a challenge for the clinician. Many etiologic factors, including bacteria, fungi, and viruses, plus other contributing factors, such as trauma, root resorptions/perforations, and dental malformations, play a role in the co-occurrence of endodontic and periodontal lesions. Whatever the cause, a correct diagnosis on which to base the treatment plan is the key to successful maintenance of the tooth. This article reports the successful endodontic management of a furcation lesion in a mandibular molar that was nonresponsive to a previous periodontal surgical graft. The case had presented a diagnostic challenge for the clinicians, and this article reviews the key points that can lead to a correct diagnosis and treatment planning.

Successful Management of a Tracheo-gastric Conduit Fistula after a Three-field Esophagectomy with Combined Sternocleidomastoid Muscle Rotation Flap and Histoacryl Injection Treatment

  • Chung, Yoon Ji;Kim, Ji Hyun;Kim, Dong Jin;Kim, Jin Jo
    • Journal of Gastric Cancer
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    • v.20 no.4
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    • pp.454-460
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    • 2020
  • Tracheo-gastric conduit fistula is an extremely rare but severe complication that is difficult to manage. Conservative care, esophageal or tracheal stent placement, or cutaneomuscular flaps have been suggested; however, no definite treatment has been proven. We report a case of tracheo-gastric conduit fistula that occurred after a minimally invasive radical three-field esophagectomy. Following the primary surgery, the diagnosis was made while evaluating the patient's frequent aspiration and coughing. Conservative management failed, and a surgical correction was undertaken to identify the multifocal mucosal defect and exposed tracheal ring. A sternocleidomastoid muscle rotation flap and subsequent Histoacryl injection into the remaining fistula were performed, and the fistula was successfully managed.

Prevalence and treatment of mandibular first molar eruption disturbances (하악 제 1대구치 맹출 장애의 빈도와 치료)

  • Son, Woo-Sung;Song, Hyo-Kyung;Kim, Seong Sik
    • The Journal of the Korean dental association
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    • v.55 no.5
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    • pp.328-338
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    • 2017
  • Introduction: The aim of the current study was to describe the prevalence and treatment of mandibular first molar eruption disturbances. Methods: A total of 38 mandibular first molars(M1mn) from 36 patients(17 males and 19 females; aged 9 years 2 months?35 years 10 months) were identified from the 13,391 patients that received orthodontic treatment from 1983?2012. The subjects were classified into 3 categories based on panoramic radiographic examination: impaction due to ectopic position of the tooth germ relative to the contra-side same tooth(Group 1), impaction due to obstruction of the eruption path with cyst or calcium mass (Group 2), and primary and secondary retention due to defects in the follicle or periodontal ligament(PDL; Group 3). The treatment outcomes were evaluated into four categories: no treatment(A), orthodontic traction(B), autotransplantation(C), and extraction due to orthodontic traction failure(D). Results: The prevalence rate of M1mn eruption disturbances in this sample was 0.27%. In Groups 1 and 2, most of the impacted M1mn were erupted successfully by orthodontic traction. In Group 3, most of the retained M1mn were failed to erupt and recommended for extraction. Conclusions: Treatment prognosis was favorable on Group 1 & 2 than Group 3. After removing an element of the cause in case of Group 1 & 2, orthodontic traction or periodic observation will be recommended.

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MANAGEMENT OF INFRAOCCLUDED MANDIBULAR SECOND PRIMARY MOLARS: CASE REPORT (저위교합된 제 2유구치에 대한 치험례)

  • Kwak, So-Youn;Park, Ki-Tae;Kim, Ji-Yeon
    • Journal of the korean academy of Pediatric Dentistry
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    • v.36 no.3
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    • pp.475-480
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    • 2009
  • An infraoccluded tooth is a tooth that has failed to erupt to be in line with adjacent teeth in the vertical plane of occlusion. Multiple complications can occur as a result of an infraoccluded tooth. Tipping of neighboring teeth, loss of space opposing teeth elongation, increased susceptibility to dental caries and abnormal eruption path, impaction and rotation of permanent successor are the consequences of infraocclusion of primary molar. Therefore, early diagnosis and treatment is the key to prevent the complications. Treatment options can be periodic follow-up, temporary restoration or extraction of the infraoccluded tooth depending on the presence of the successor, the extent of infraocclusion and the extent of tilting of the neighboring teeth. The infraoccluded primary molars with permanent successors present tend to exfoliate normally. However, failure to do periodic check up of the infraoccluded teeth may lead to serious complications. In these cases, surgical extractions are often necessary after space regaining and space maintainers should be placed until the eruption of the permanent successors are completed.

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