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4 results on '"Timothy Kinney"'

1. A Multicenter, Prospective Study of a New Fully Covered Expandable Metal Biliary Stent for the Palliative Treatment of Malignant Bile Duct Obstruction

Author

Bret T. Petersen, Michel Kahaleh, Richard A. Kozarek, David Loren, Kapil Gupta, Thomas Kowalski, Martin Freeman, Yang K. Chen, Malcolm S. Branch, Steven Edmundowicz, Michael Gluck, Kenneth Binmoeller, Todd H. Baron, Raj J. Shah, Timothy Kinney, William Ross, Paul Jowell, and David Carr-Locke

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in 98% (57/58), with demonstrated acute removability in two patients. Adequate clinical palliation until completion of followup was achievedin 98% (54/55) of evaluable patients, with 1 reintervention due to stent obstruction after 142 days. Mean total bilirubin decreased from 8.9 mg/dL to 1.2 mg/dL at 1 month. Device-related adverse events were limited and included 2 cases of cholecystitis. One stent migrated following radiation therapy. Conclusions. The WallFlex Biliary fully covered stent yielded technically successful placement with uncomplicated acute removal where required, appropriate reduction in bilirubin levels, and low rates of stent migration and occlusion. This SEMS allows successful palliation of malignant extrahepatic biliary obstruction.

Published
2013
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3. Immunomodulators and 'On Demand' Therapy with Infliximab in Crohn';s Disease: Clinical Experience with 400 Infusions

Author

Timothy Kinney, Matthew Rawlins, Richard Kozarek, Renee France, and David Patterson

Subjects
Adult, Male, musculoskeletal diseases, medicine.medical_specialty, medicine.medical_treatment, Anti-Inflammatory Agents, Azathioprine, Disease, Medical Records, Pharmacotherapy, Crohn Disease, Gastrointestinal Agents, immune system diseases, Internal medicine, Intestinal Fistula, medicine, Humans, Infusions, Intravenous, Mesalamine, skin and connective tissue diseases, Retrospective Studies, Chemotherapy, Crohn's disease, Hepatology, Mercaptopurine, business.industry, Gastroenterology, Antibodies, Monoclonal, Middle Aged, medicine.disease, Infliximab, digestive system diseases, Surgery, stomatognathic diseases, Treatment Outcome, Prednisone, Drug Therapy, Combination, Female, Methotrexate, business, Immunosuppressive Agents, medicine.drug
Abstract

Infliximab has been proven effective for treatment of active Crohn's and fistulizing Crohn's disease. We reviewed our experience with infliximab in patients with Crohn's disease to determine if its combination with immunomodulators leads to better response and longer periods of disease quiescence.We performed a retrospective chart review of 122 patients with Crohn's disease who received infliximab infusions. Data were collected on patient demographics, clinical response to infliximab, fistula response, prednisone dose, infusion reactions/side effects, concomitant immunomodulator therapy, and time intervals between infliximab infusions.Of 122 patients receiving infliximab infusions, 117 completed more than 2 wk of follow-up (400 infusions), and five patients had no follow-up. Co-therapies included azathioprine (AZA) in 47 (40.2%) patients, 6-mercaptopurine (6-MP) in 11 (9.4%), methotrexate (MTX) in 23 (19.7%), prednisone in 64 (54.7%), mesalamine in 51 (43.6%), and antibiotics in 16 (13.7%). Mean follow-up was 52 wk (14-864 days). Overall response rate to infliximab was similar between patients receiving immunomodulators (AZA/6-MP 87.9%, MTX 82.6%) and patients receiving infliximab alone (75%), although there was a trend toward higher response with AZA/6-MP (p = 0.10). More frequent drug reactions/side effects occurred in the infliximab alone group (22.2%) compared with patients receiving MTX (13.0%) and AZA/6-MP (13.8%), but this was not statistically significant. Prednisone dosage was reduced from a mean of 19.5 mg to 7.5 mg per day overall (p0.05). Fistula response and dosing intervals were not affected by concomitant immunosuppression.Concomitant use of immunomodulators with infliximab in patients with Crohn's disease did not improve patient response to several parameters measured, including clinical response rate, dose reduction of prednisone, fistula response, and mean intervals between infliximab infusions.

Published
2003

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