Abstract Background: Long-term data on ustekinumab in real-life Crohn’s disease patients are still missing, though randomized controlled trials demonstrated it as a favorable therapeutic option. Aims: We aimed to evaluate ustekinumab's clinical efficacy, drug sustainability, and safety in a prospective, nationwide, multicenter Crohn’s disease patient cohort with a three-year follow-up. Methods: Crohn’s disease patients on ustekinumab treatment were consecutively enrolled from 9 Hungarian Inflammatory Bowel Disease centers between January 2019 and May 2020. Patient and disease characteristics, treatment history, clinical disease activity (Harvey Bradshaw Index (HBI)), biomarkers, and endoscopic activity (Simple Endoscopic Score for Crohn’s Disease (SES-CD)) were collected for three-years’ time. Results: A total of 148 patients were included with an overall 48.9% of complex behavior of the Crohn’s disease and 97.2% of previous anti-TNF exposure. The pre-induction remission rates were 12.2% (HBI), and 5.1% (SES-CD). Clinical remission rates (HBI) were 52.2%, 55.6%, and 50.9%, whereas criteria of an endoscopic remission were fulfilled in 14.3%, 27.5%, and 35.3% of the subjects at the end of the first, second, and third year, respectively. Dose intensification was high with 84.0% of the patients on an 8-weekly and 29.9% on a 4-weekly regimen at the end of year 3. Drug sustainability was 76.9% during the follow-up period with no serious adverse events observed. Conclusion: Ustekinumab in the long-term is an effective, sustainable, and safe therapeutic option for Crohn’s disease patients with severe disease phenotype and high previous anti-TNF biological failure, requiring frequent dose intensifications.
Experiments led authors to the conclusion that neural effect influences unfavourably the mode of action of mannitol. A proof for this is that by eliminating neural effect in consequence of the unilateral clamping of the renal hilus mannitol induced polyuria arises whilst in the other kidney the reno-renal reflex acts during the injury, polyuria remains absent.
Nine cases (two of them bilateral) of renal resections for renal tumour are reviewed. The survival results of patients with bilateral renal tumours are considered particularly favourable, one of them has survived for 72, the other for 37 months. Of the patients with solitary renal tumour, one was lost 25 months postoperatively, after the development of a distant metastasis. The other patient has been free of recurrence and metastases after 31 months. The above results have proved the outdatedness of the old concept, i.e. to remove the tumorous kidney. As supported by the authors' cases, their patients have had a high survival rate after resection for renal tumour. The clear-cell tumours are well demarcated by a fibrous capsule and they can easily be resected. The granular-cell renal tumours are localized more centrally, they often infiltrate the kidney. In cases cautiously considered, the resection of the tumorous kidney can be performed under the present technical conditions by strict 6 monthly postoperative urographic, ultrasound, and angiographic examinations.
