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Vincenzo J Greco - One of the best experts on this subject based on the ideXlab platform.
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optimal Treatment Duration of glyceryl trinitrate for chronic anal fissure results of a prospective randomized multicenter trial
Techniques in Coloproctology, 2010Co-Authors: G Gagliardi, F Arcana, Donato Francesco Altomare, A Pascariello, Danilo Cafaro, F La Torre, P De Nardi, L Basso, I De Stefano, Vincenzo J GrecoAbstract:Background Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical Treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal Treatment Duration is unknown.
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Optimal Treatment Duration of glyceryl trinitrate for chronic anal fissure: Results of a prospective randomized multicenter trial
'Springer Science and Business Media LLC', 2010Co-Authors: G Gagliardi, F Arcana, Donato Francesco Altomare, A Pascariello, Danilo Cafaro, F La Torre, P De Nardi, L Basso, I De Stefano, Vincenzo J GrecoAbstract:Background: Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical Treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal Treatment Duration is unknown. Methods: To assess the effect of different Treatment Durations on CAF, we designed a prospective randomized trial comparing 40 versus 80 days with twice daily topical 0.4% GTN Treatment (Rectogesic®, Prostrakan Group). Chronicity was defined by the presence of both morphological (fibrosis, skin tag, exposed sphincter, hypertrophied anal papilla) and time criteria (symptoms present for more than 2 months or pain of less Duration but similar episodes in the past). A gravity score (1 = no visible sphincter; 2 = visible sphincter; 3 = visible sphincter and fibrosis) was used at baseline. Fissure healing, the primary endpoint of the study, maximum pain at defecation measured with VAS and maximum anal resting pressure were assessed at baseline and at 14, 28, 40 and 80 days. Data was gathered at the end of the assigned Treatment. Results: Of 188 patients with chronic fissure, 96 were randomized to the 40-day group and 92 to the 80-day group. Patients were well matched for sex, age, VAS and fissure score. There were 34 (19%) patients who did not complete Treatment, 18 (10%) because of side effects. Of 154 patients who completed Treatment, 90 (58%) had their fissures healed and 105 (68%) were pain free. There was no difference in healing or symptoms between the 40- and the 80-day group. There was no predictor of fissure healing. A low fissure gravity score correlated with increased resolution of pain (P < 0.05) and improvement of VAS score (P < 0.05) on both univariate and multivariate analysis. A lower baseline resting pressure was associated with better pain resolution on univariate analysis (P < 0.01). VAS at defecation and fissure healing significantly improved until 40 days (P < 0.001), while the difference between 40 and 80 days was not significant. Conclusion: We found no benefits in treating CAF with topical GTN for 80 days compared to 40 days. Fissure healing and VAS improvement continue until 6 weeks of Treatment but are unlikely thereafter. © 2010 Springer-Verlag
G Gagliardi - One of the best experts on this subject based on the ideXlab platform.
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optimal Treatment Duration of glyceryl trinitrate for chronic anal fissure results of a prospective randomized multicenter trial
Techniques in Coloproctology, 2010Co-Authors: G Gagliardi, F Arcana, Donato Francesco Altomare, A Pascariello, Danilo Cafaro, F La Torre, P De Nardi, L Basso, I De Stefano, Vincenzo J GrecoAbstract:Background Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical Treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal Treatment Duration is unknown.
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Optimal Treatment Duration of glyceryl trinitrate for chronic anal fissure: Results of a prospective randomized multicenter trial
'Springer Science and Business Media LLC', 2010Co-Authors: G Gagliardi, F Arcana, Donato Francesco Altomare, A Pascariello, Danilo Cafaro, F La Torre, P De Nardi, L Basso, I De Stefano, Vincenzo J GrecoAbstract:Background: Chronic anal fissure (CAF) is a painful condition that is unlikely to resolve with conventional conservative management. Previous studies have reported that topical Treatment of CAF with glyceryl trinitrate (GTN) reduces pain and promotes healing, but optimal Treatment Duration is unknown. Methods: To assess the effect of different Treatment Durations on CAF, we designed a prospective randomized trial comparing 40 versus 80 days with twice daily topical 0.4% GTN Treatment (Rectogesic®, Prostrakan Group). Chronicity was defined by the presence of both morphological (fibrosis, skin tag, exposed sphincter, hypertrophied anal papilla) and time criteria (symptoms present for more than 2 months or pain of less Duration but similar episodes in the past). A gravity score (1 = no visible sphincter; 2 = visible sphincter; 3 = visible sphincter and fibrosis) was used at baseline. Fissure healing, the primary endpoint of the study, maximum pain at defecation measured with VAS and maximum anal resting pressure were assessed at baseline and at 14, 28, 40 and 80 days. Data was gathered at the end of the assigned Treatment. Results: Of 188 patients with chronic fissure, 96 were randomized to the 40-day group and 92 to the 80-day group. Patients were well matched for sex, age, VAS and fissure score. There were 34 (19%) patients who did not complete Treatment, 18 (10%) because of side effects. Of 154 patients who completed Treatment, 90 (58%) had their fissures healed and 105 (68%) were pain free. There was no difference in healing or symptoms between the 40- and the 80-day group. There was no predictor of fissure healing. A low fissure gravity score correlated with increased resolution of pain (P < 0.05) and improvement of VAS score (P < 0.05) on both univariate and multivariate analysis. A lower baseline resting pressure was associated with better pain resolution on univariate analysis (P < 0.01). VAS at defecation and fissure healing significantly improved until 40 days (P < 0.001), while the difference between 40 and 80 days was not significant. Conclusion: We found no benefits in treating CAF with topical GTN for 80 days compared to 40 days. Fissure healing and VAS improvement continue until 6 weeks of Treatment but are unlikely thereafter. © 2010 Springer-Verlag
Jeanmichel Pawlotsky - One of the best experts on this subject based on the ideXlab platform.
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long term hepatitis b surface antigen hbsag kinetics during nucleoside nucleotide analogue therapy finite Treatment Duration unlikely
Journal of Hepatology, 2013Co-Authors: Jeanmichel Pawlotsky, Stephane Chevaliez, Christophe Hezode, Stephane Bahrami Bahrami, Marion GrareAbstract:Background & Aims Information regarding long-term HBsAg kinetics during Treatment with nucleoside/nucleotide analogues is limited. The aim of the present study was to assess whether finite nucleoside/nucleotide analogue Treatment Duration could be envisaged during the patient's lifetime. Methods Patients with chronic hepatitis B receiving different schedules of nucleoside/nucleotide analogues were followed for a median Duration of 102months, i.e., 8.5years (interquartile range: 88–119months). Long-term HBV DNA and HBsAg level kinetics were modeled in order to estimate time to clear HBsAg during therapy in patients with undetectable HBV DNA. Results Antiviral therapy was associated with a slow but consistent reduction in the level of HBsAg in most of the patients. Three patterns of HBsAg level declines were identified: decline during both the detectable and undetectable HBV DNA phases; decline during the HBV DNA detectable period only; decline during the HBV DNA undetectable period only. The mean HBsAg titer at the time when HBV DNA became undetectable was 3.29±0.49Log 10 international units (IU)/ml, and the mean slope was −0.007±0.007Log 10 IU/month, i.e., an average decline of 0.084Log 10 IU/year. The corresponding calculated median number of years needed to clear HBsAg was 52.2years (interquartile range: 30.8–142.7). Conclusions This study, based on the very long-term follow-up of patients with chronic hepatitis B treated with potent nucleoside/nucleotide analogues, shows that HBsAg clearance is unlikely to occur during the patient's lifetime, even if HBV replication is well controlled. Thus, lifetime therapy is required in the vast majority of HBV-infected patients.
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shortened Treatment Duration in Treatment naive genotype 1 hcv patients with rapid virological response a meta analysis
Journal of Hepatology, 2010Co-Authors: Christophe Moreno, Pierre Deltenre, Jeanmichel Pawlotsky, J Henrion, M Adler, Philippe MathurinAbstract:Background & Aims In hepatitis C virus genotype 1 (HCV-1) patients with a rapid viral decline within the first month of therapy, a 24-week course of pegylated interferon (PEG-IFN) alpha and ribavirin Treatment has been claimed to be as efficient as the standard 48-week Duration. Methods We performed a meta-analysis of 7 randomized controlled trials comparing less than 48weeks to 48weeks PEG-IFN alpha/ribavirin Treatment in 807 HCV-1 patients with rapid viral decline. Results SVR was significantly less frequent with short Treatment Duration than with 48weeks of therapy, with a mean difference of −13.6% (95% CI: −22.8% to −4.4%, p= 0.004). This difference was related to a higher relapse rate (mean difference: 9.9%, 95% CI: 4.1–15.7%, p Conclusions In HCV-1 patients with a rapid virological response, 24weeks of combination therapy with PEG-IFN alpha and ribavirin should be considered only in subjects with low baseline viral load. However, the optimal cut-off defining low baseline viral load and the impact of the presence of other factors capable of altering Treatment response, remain subject to debate.
Carolyn A Emery - One of the best experts on this subject based on the ideXlab platform.
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the determinants of Treatment Duration for congenital muscular torticollis
Physical Therapy, 1994Co-Authors: Carolyn A EmeryAbstract:Background and Purpose. Although the success of conservative management of congenital muscular torticollis has been well documented, relatively little is known about the determinants of response to Treatment, such as Treatment Duration. The purpose of this study was to determine how factors such as severity of restriction of range of motion, age at initiation of Treatment, and presence of a palpable intramuscular fibrotic sternocleidomastoid muscle mass affect Treatment Duration. Subjects. One hundred one children (mean age=4 months, SD=2.87, range=0.5–15.5) who were diagnosed with congenital muscular torticollis and referred to physical therapy at British Columbia's Children's Hospital (Vancouver, British Columbia, Canada) prior to 2 years of age were included in the study. Methods. Following a standardized initial assessment, parents were taught the home Treatment program, which included passive stretches of the affected sternocleidomastoid muscle and strengthening exercises for the contralateral side, and positioning and handling skills. Evaluation at 2-week intervals included measurement of passive neck rotation and lateral flexion using an adapted standard goniometer. Treatment Duration was defined as the time between initiation of Treatment and achievement of full passive neck range of motion. Results. Complete recovery (full passive range of motion) was achieved in all but one of the children in this sample. The mean Treatment Duration was 4.7 months (SD=5.06, range=1–36). Correlations were noted between severity of restriction and Treatment Duration (r=.31) as well as between presence of a mass and Treatment Duration (r=.26). Multiple regression analysis revealed that severity of restriction was the strongest predictor of Treatment Duration. Conclusion and Discussion. The results of this study will make it possible for therapists to better predict Treatment Duration at the time of the initial assessment. By providing parents with more precise information about the length of Treatment, parents may be more willing to adhere to the exercise program.
Keiji Koda - One of the best experts on this subject based on the ideXlab platform.
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randomized phase iii trial of Treatment Duration for oral uracil and tegafur plus leucovorin as adjuvant chemotherapy for patients with stage iib iii colon cancer final results of jfmc33 0502
Annals of Oncology, 2015Co-Authors: Sotaro Sadahiro, Takashi Tsuchiya, Kazuaki Sasaki, Ken Kondo, Kenji Katsumata, Genichi Nishimura, Yoshihiro Kakeji, H Baba, Shuhei Sato, Keiji KodaAbstract:Abstract Background While adjuvant chemotherapy is preferable for high-risk colon cancer, Treatment Duration is controversial. Oral uracil and tegafur (UFT)/leucovorin (LV) is widely used as a standard adjuvant chemotherapy for colon cancer in Japan. We conducted a phase III trial to investigate the optimal Duration of adjuvant chemotherapy for stage IIB/III colon cancer. Patients and methods Patients with curatively resected stage IIB/III colon cancer were eligible for enrollment in this trial. Patients were registered within 6 weeks after surgery and were randomly assigned to receive UFT/LV for 28 of 35 days for 6 months in the control group or for 5 consecutive days per week for 18 months in the study group. The primary end point was the disease-free survival (DFS), and the secondary end points were overall survival (OS) and safety. Result A total of 1071 patients were registered from 233 centers. A statistically significant difference in DFS was not observed between the study group and the control group; the 5-year DFS was 69% in the study group and 69% in the control group. The 5-year OS was 85% in the study group and 85% in the control group. Conclusion Eighteen-month Treatment with UFT/LV did not improve DFS or OS compared with 6-month UFT/LV Treatment in patients with stage IIB/III colon cancer. The important finding from this study is that not 18 months but 6 months of Treatment is enough for postoperative UFT/LV for stage IIB/III colon cancer. Clinical trial number UMIN-CTR C000000245.
