Volume 73 - 2010 - Fasc.3 - Original articles
Covered stents are better than uncovered stents for transjugular intrahepatic portosystemic shunts in cirrhotic patients with refractory ascites : a retrospective cohort study
Abstract
Background and study aims : Transjugular intrahepatic portosystemic shunt (TIPS) is an accepted interventional technique to
treat refractory ascites in cirrhotic patients with severe portal
hypertension. The expanded-polytetrafluoroethylene (e-PTFE)
covered stent-graft (cs-TIPS) gives a better shunt patency rate
than uncovered stents (ncs-TIPS). Our aim was to retrospectively
evaluate whether cs-TIPS indeed improves refractory ascites and
overall survival in a more effective way than ncs-TIPS in patients
with cirrhosis.
Patients and methods : From 1992 to 2006, 222 cirrhotic
patients with refractory ascites underwent a TIPS-procedure. In
126 patients a ncs-TIPS was inserted, in the remaining 96 patients
a csTIPS was inserted. Liver transplantation and/or death were
the end points of the follow-up.
Biological agents in paediatric inflammatory bowel disease : a clinical observa- tion study from Greece
Objectives : Biological agents have contributed significantly in controlling inflammatory bowel disease during the last 15 years. This study aimed at recording and evaluating paediatric data regarding the efficacy and safety of infliximab and adalimumab during the last decade.
Patients and methods : A total of 31 patients (43% males) with a mean age of 13.5 ± 3.0 years were included and the majority (74%) had Crohn's disease (CD). Failure of previous treatment and steroid dependency were the main reasons for initiating anti- TNF-a therapy. Mean age at the first infusion was 11.0 ± 2.8 years, while the mean disease duration at the introduction of infliximab was 2.6 ± 2.7 years. The number of infusions per patient ranged from 1-25 (median 7, IQR : 4-13).
Results : Initial response was achieved in 82.8% of patients. After one year of treatment the estimated rate of remission was 53%. The rate of surgery-free disease at 12, 36 and 60 months, after the first dose of infliximab, was 89.6%, 89.6% and 74.7% respectively. The incidence of serious anaphylaxis was 4/268 infu- sions (1.5%) or 4/31 patients (12.3%). At three months after the first infusion only 2 children were on steroids. Adalimumab was administered to 5 patients for a mean duration of 7.4 months, as a second option after infliximab failure or infusion reaction. Two out of five patients failed to achieve remission with adalimumab and these two patients were also infliximab failures.
Conclusion : Biological agents are valuable and safe options for children with refractory IBD. The results, so far, have been satis- factory, although, long-term outcomes remain yet to be deter- mined. (Acta gastroenterol. belg., 2010, 73, 342-348).
