Sample records for adenocarcinoma long-term results

  1. [Surgical treatment of gasto-esophageal junction adenocarcinoma: long-term results of a single Italian centre]. (United States)

    Pedrazzani, C; Pasini, F; Giacopuzzi, S; Bernini, M; Ruzzenente, A; Festini, M; Tomasi, I; Cristadoro, L; de Manzoni, G


    The present study analysed the experience of a single Italian institution in the treatment of gastro-esophageal junction (GEJ) adenocarcinoma with the aim of assessing the long-term outcome after surgical resection. The results of 132 patients who underwent resection with curative intent for GEJ adenocarcinoma at the First Division of General Surgery, University of Verona, from January 1988 to February 2004, were analysed statistically with special reference to Siewert type. The median follow-up period for the surviving patients was 37 months. Long-term survival was limited to patients who underwent RO resections (88.6%) with a 5-year survival rate of 28%. Univariate analysis showed Rp, T and pN categories to be significant prognostic factors (P<0.001), with chance of cure limited to patients with less than 6 involved lymph nodes. At multivariate analysis, R category and lymph node involvement were the most important prognostic factors while pT category lost the significance shown at univariate analysis (P=0.082). Siewert classification did not show any prognostic significance (P=0.969), but the mode of recurrence differed for the three Siewert types: in type I tumors, the majority of relapses were haematogenous (67%), while they were prevalently intra-abdominal in type III (65%) with a high rate of peritoneal carcinosis (26%). The long-term prognosis for GEJ cancer remains poor, independently from Siewert type, with cure limited to patients with less than 6 involved lymph nodes.

  2. Long-term follow-up of advanced bladder adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Karen Korkes


    Full Text Available Objective: to evaluate patients treated with primary bladder adenocarcinoma at our institution. Methods: A review of 30 patients diagnosed with bladder adenocarcinoma at a single institution from 1994 of 2005 was undertaken. Cases of primary bladder adenocarcinoma were retrospectively evaluated. Rresults: Out of 490 patients with bladder carcinoma, 30 had bladder adenocarcinoma: 22 metastatic tumors, eight (1.6% primary adenocarcinoma. Of these, three (0.6% were primary non-urachal and five (1.0% were urachal adenocarcinoma. All patients were men with mean age of 55.8 years (range 37-83. Dysuria and hematuria were the main symptoms reported. Of the total, four patients had cancer-related mortality. Cconclusion: Primary bladder adenocarcinoma is a rare neoplasm, observed in 1.6% patients with bladder malignancies. Late diagnosis limits therapeutic possibilities. Partial cystectomy seems to have unsatisfactory results and radical cystectomy, although remains as the gold standard, have no proven efficacy. New methods of adjuvant treatment must be studied to improve treatment outcomes, as high mortality is observed despite treatment.

  3. Long-term use of lithium and risk of colorectal adenocarcinoma

    DEFF Research Database (Denmark)

    Pottegård, Anton; Ennis, Zandra Nymand; Hallas, Jesper


    BACKGROUND: Lithium accumulates in the colon and inhibits the enzyme GSK-3β that possesses anti-carcinogenic effects. We therefore examined the association between lithium use and colorectal cancer risk in a nationwide study. METHODS: We used the Danish Cancer Registry to identify all patients...... diagnosed with incident colorectal adenocarcinoma during 2000-2012 (n=36 248). Using a matched case-control approach, we estimated the association between long-term use (⩾5 years) of lithium and risk of colorectal adenocarcinoma using conditional logistic regression. RESULTS: Long-term use of lithium......, 0.66-1.55; distal colon: 1.52 (95% CI, 1.05-2.20); and rectum: 0.80 (95% CI, 0.50-1.30). CONCLUSIONS: Lithium use was not associated with an overall increased risk of colorectal adenocarcinoma. The variation by subsite warrants further investigation....

  4. Long-Term Hearing Results After Ossiculoplasty. (United States)

    Cox, Matthew D; Trinidade, Aaron; Russell, James Shep; Dornhoffer, John L


    To determine if the OOPS index is predictive of long-term hearing results after ossiculoplasty. Case series with retrospective chart review. Tertiary care otology practice. Adult and pediatric patients (3-88 years of age). Ossiculoplasty with cartilage tympanoplasty, with or without mastoidectomy. Primary outcome measures included short-term hearing results (pure-tone average air-bone gap [PTA-ABG] measured between 60 days and 1 year after surgery), long-term hearing results (PTA-ABG measured ≥5 years after surgery), and the rate of successful ABG closure to ≤20 dB. Secondary measures included the need for revision surgery, delayed tympanic membrane graft failure, worsening conductive hearing loss (after an initially satisfactory hearing result), and recurrence of cholesteatoma. There was no significant difference between adults and children for short-term hearing results (average post-op PTA-ABG was 18.9 dB vs. 19.8 dB, respectively; p = 0.544), long-term hearing results (average final PTA-ABG was 19.3 dB vs. 19.4 dB, respectively; p = 0.922), or rate of ABG closure to less than 20 dB (63.1% vs. 58.0%, p = 0.282). Spearman's rank-order correlation (ρ) identified a strong positive correlation between OOPS index score and average post-operative PTA-ABG (ρ = 0.983; p hearing outcomes in adult and pediatric patients undergoing ossiculoplasty in both the short term and the long term.

  5. Long term results of mandibular distraction

    Directory of Open Access Journals (Sweden)

    Batra Puneet


    Full Text Available Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

  6. Long term results of mandibular distraction. (United States)

    Batra, Puneet; Ryan, F S; Witherow, H; Calvert, M L


    Mandibular distraction osteogenesis has become a popular surgical modality due to its many advantages over conventional orthognathic surgical procedures. However, in spite of the technique having been used for over 15 years, no concrete long term results are available regarding the stability of results. We discuss the various studies which have reported either in favour or against the stablility of results after distraction. We report a series of 6 cases (3 unilateral and 3 bilateral distraction) where distraction was carried out before puberty and followed them up to seven years after removal of distractors. This case series shows that results achieved by distraction osteogenesis are unstable or best unpredictable with respect to producing a permanent size increase in the mandible. The role of the distraction osteogenesis in overcoming the pterygomassetric sling is questionable. We suggest a multicenter study with adequate patient numbers treated with a similar protocol and documented after growth cessation to have meaningful conclusions on the debate of distraction osteogenesis versus orthognathic surgery.

  7. Long term results of childhood dysphonia treatment. (United States)

    Mackiewicz-Nartowicz, Hanna; Sinkiewicz, Anna; Bielecka, Arleta; Owczarzak, Hanna; Mackiewicz-Milewska, Magdalena; Winiarski, Piotr


    The aim of this study was to assess the long term results of treatment and rehabilitation of childhood dysphonia. This study included a group of adolescents (n=29) aged from 15 to 20 who were treated due to pediatric hyperfunctional dysphonia and soft vocal fold nodules during their pre-mutational period (i.e. between 5 and 12 years of age). The pre-mutational therapy was comprised of proper breathing pattern training, voice exercises and psychological counseling. Laryngostroboscopic examination and perceptual analysis of voice were performed in each patient before treatment and one to four years after mutation was complete. The laryngostroboscopic findings, i.e. symmetry, amplitude, mucosal wave and vocal fold closure, were graded with NAPZ scale, and the GRBAS scale was used for the perceptual voice analysis. Complete regression of the childhood dysphonia was observed in all male patients (n=14). Voice disorders regressed completely also in 8 out of 15 girls, but symptoms of dysphonia documented on perceptual scale persisted in the remaining seven patients. Complex voice therapy implemented in adolescence should be considered as either the treatment or preventive measure of persistent voice strain, especially in girls. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. [Hip revision arthroplasty (long-term results)]. (United States)

    Tarasevicius, Sarūnas; Zegunis, Vidmantas; Tarasevicius, Rimantas; Kalesinskas, Romas Jonas; Janusonis, Vinsas


    To evaluate the risk factors after total hip replacement arthroplasty for rerevision and to analyze complications after hip revision surgery. We obtained data from 117 hip revisions and 12 hip rerevision arthroplasties performed in 1992-2001 in the Department of Orthopedics of Klaipeda Hospital. Special forms were filled in for every patient who participated in the study. Name, operation date, type of implants, operative technique, revision diagnosis, intraoperative and postoperative complications were recorded. All patients were checked for death until 2003. Hip revisions were performed for 77 (66%) women and 50 (44%) men in 1992-2001. We revised 22 (19%) cups, 6 (5%) stems, 86 (74%) total hip revisions; femoral head was exchanged for 3 patients. Revision diagnoses were: aseptic loosening in 106 (90%) cases, recurrent dislocations in 7 (6%) cases, and periprosthetic fractures in 4 (4%) cases. Patients' age varied from 26-82 years, average 63.5 years. In revision group only 8% of patients were less than 50 years old, compared to 33% in rerevision group. Morselized allografts and bone impaction technique for reconstruction of bone defects were used in 70 (60%) of cases. We rerevised one cup only for which revision morselized allografts were used. Eight (67%) rerevisions were performed after first 28 (24%) hip revisions. Patients, who underwent revision surgery being younger than 50 years old, were at higher risk for rerevision surgery. Revision with morselized bone allografts and bone impaction technique decreases number of rerevisions. Learning curve was steep and had great influence to our results.

  9. Surgical versus non-surgical treatment of feline small intestinal adenocarcinoma and the influence of metastasis on long-term survival in 18 cats (2000–2007) (United States)

    Green, Michael L.; Smith, Julie D.; Kass, Philip H.


    This study retrospectively evaluated long-term outcomes of 18 cats diagnosed with small intestinal adenocarcinoma, based on surgical versus non-surgical treatment and the presence or absence of metastasis at the time of surgery. Ten cats had surgery and histopathologic confirmation of adenocarcinoma and 8 cats did not have surgery but had cytologic diagnosis of adenocarcinoma. Median survival of cats with adenocarcinoma that underwent surgical excision was 365 days and 22 days for those with suspected adenocarcinoma that did not undergo surgery (P = 0.019). Median survival of cats was 843 days for those without evidence of metastatic disease at the time of surgery and 358 days for those that had (P = 0.25). In conclusion, surgical excision is beneficial in the treatment of small intestinal adenocarcinoma in the cat, including those patients with metastasis, and may result in a significantly longer survival time compared with patients which do not have their mass surgically excised. PMID:22467965

  10. Surgical versus non-surgical treatment of feline small intestinal adenocarcinoma and the influence of metastasis on long-term survival in 18 cats (2000-2007). (United States)

    Green, Michael L; Smith, Julie D; Kass, Philip H


    This study retrospectively evaluated long-term outcomes of 18 cats diagnosed with small intestinal adenocarcinoma, based on surgical versus non-surgical treatment and the presence or absence of metastasis at the time of surgery. Ten cats had surgery and histopathologic confirmation of adenocarcinoma and 8 cats did not have surgery but had cytologic diagnosis of adenocarcinoma. Median survival of cats with adenocarcinoma that underwent surgical excision was 365 days and 22 days for those with suspected adenocarcinoma that did not undergo surgery (P = 0.019). Median survival of cats was 843 days for those without evidence of metastatic disease at the time of surgery and 358 days for those that had (P = 0.25). In conclusion, surgical excision is beneficial in the treatment of small intestinal adenocarcinoma in the cat, including those patients with metastasis, and may result in a significantly longer survival time compared with patients which do not have their mass surgically excised.

  11. Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. (United States)

    Reddy, Sushanth; Wolfgang, Christopher L; Cameron, John L; Eckhauser, Frederic; Choti, Michael A; Schulick, Richard D; Edil, Barish H; Pawlik, Timothy M


    To analyze relative perioperative and long-term outcomes of patients undergoing total pancreatectomy versus pancreaticoduodenectomy. The role of total pancreatectomy has historically been limited due to concerns over increased morbidity, mortality, and perceived worse long-term outcome. Between 1970 and 2007, patients who underwent total pancreatectomy (n = 100) or pancreaticoduodenectomy (n = 1286) for adenocarcinoma were identified. Clinicopathologic, morbidity, and survival data were collected and analyzed. Total pancreatectomy patients had larger median tumor size (4 cm vs. 3 cm; P total pancreatectomy vs. pancreaticoduodenectomy, respectively, both P > 0.05). A similar proportion of total pancreatectomy (74.7%) and pancreaticoduodenectomy (78.3%) patients had N1 disease (P = 0.45). Total pancreatectomy patients had more lymph nodes harvested (27 vs. 16) and were less likely to have positive resection margins (22.2% vs. 43.7%) (total pancreatectomy vs. pancreaticoduodenectomy, respectively, both P Total pancreatectomy was increasingly used over time (1970-1989, n = 10, 1990-1999, n = 37, 2000-2007, n = 53). Total pancreatectomy was associated with higher 30-day mortality compared with pancreaticoduodenectomy (8.0% vs. 1.5%, respectively; P = 0.0007). However, total pancreatectomy operative mortality decreased over time (1970-1989, 40%; 1990-1999, 8%; 2000-2007, 2%; P = 0.0002). While operative morbidity was higher following total pancreatectomy (69.0% vs. 38.6% for pancreaticoduodenectomy; P Total pancreatectomy and pancreaticoduodenectomy patients had comparable 5-year survival (18.9% vs. 18.5%, respectively, P = 0.32). Total pancreatectomy perioperative mortality dramatically decreased over time. Long-term survival following total pancreatectomy versus pancreaticoduodenectomy was equivalent. Total pancreatectomy should be performed when oncologically appropriate.

  12. Long-Term Results of an RTOG Phase II Trial (00-19) of External-Beam Radiation Therapy Combined With Permanent Source Brachytherapy for Intermediate-Risk Clinically Localized Adenocarcinoma of the Prostate

    Energy Technology Data Exchange (ETDEWEB)

    Lawton, Colleen A., E-mail: [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Yan, Yan [Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA (United States); Lee, W. Robert [Department of Radiation Oncology, Duke University School of Medicine, Durham, NC (United States); Gillin, Michael [Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Firat, Selim [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Baikadi, Madhava [Department of Radiation Oncology, Northeast Radiation Oncology Center, Scranton, PA (United States); Crook, Juanita [Department of Radiation Oncology, University of British Columbia, Kelowna, BC (Canada); Kuettel, Michael [Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States); Morton, Gerald [Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Center, Toronto, ON (Canada); Sandler, Howard [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA (United States)


    Purpose: External-beam radiation therapy combined with low-doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. Methods and Materials: All eligible patients received external-beam radiation (45 Gy in 25 fractions) followed 2-6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. Results: One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7-9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. Conclusion: Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high-dose external beam radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high-dose external-beam radiation alone or permanent low-doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to

  13. Long-term followup of hypospadias: functional and cosmetic results

    NARCIS (Netherlands)

    Rynja, Sybren P.; Wouters, Gerlof A.; van Schaijk, Maaike; Kok, Esther T.; de Jong, Tom P.; de Kort, Laetitia M.


    We assessed long-term results after hypospadias surgery with respect to urinary and sexual function, cosmetic appearance and intimate relationships. We contacted 116 patients who are now adults and who underwent surgery between 1987 and 1992. Participation included mailed questionnaires containing

  14. Long-term results of lower energy transurethral microwave thermotherapy

    NARCIS (Netherlands)

    Keijzers, G. B.; Francisca, E. A.; D'Ancona, F. C.; Kiemeney, L. A.; Debruyne, F. M.; de la Rosette, J. J.


    We evaluate long-term results of lower energy transurethral microwave thermotherapy (Prostasoft 2.0*) and identify pretreatment characteristics that predict a favorable outcome. Between December 1990 and December 1992, 231 patients with lower urinary tract symptoms were treated with lower energy

  15. Long-Term Results of Primary Vertical Banded Gastroplasty. (United States)

    van Wezenbeek, M R; Smulders, J F; de Zoete, J P J G M; Luyer, M D; van Montfort, G; Nienhuijs, S W


    The vertical banded gastroplasty (VBG) used to be a common restrictive bariatric procedure but has been abandoned by many due to a high failure rate, a high incidence of long-term complications, and the newer adjustable gastric band (AGB) and sleeve. However, potential favorable long-term results and the upcoming banded gastric bypass, with a similar mechanical outlet restriction and control of the pouch size, renewed our interest in the VBG. Therefore, we investigated the long-term outcome of primary VBG at the Catharina Hospital in the Netherlands. Patients that underwent a primary VBG between 1998 and 2008 were included. Patients' characteristics, operative details, evolution on weight and comorbidities, complications, and outcome of revisions were reviewed. A total of 392 patients (80 % female) were reviewed with a mean age of 40 ± 9 years and body mass index of 44 ± 5 kg/m(2). Mean follow-up after VBG was 66 ± 50 months and showed a mean excess weight loss (EWL) of 53 ± 27 % and comorbidity reduction of 54 %. One hundred fifty-two patients (39 %) out of 227 patients (58 %) with long-term complaints underwent revisional surgery. Main reasons for revision were weight regain and vomiting/food intolerance. Analysis before revision showed an outlet dilatation (17 %), pouch dilatation (16 %), and outlet stenosis (10 %). After revision, an additional EWL of 23 % and 33 % further reduction in comorbidities was seen. Primary VBG has an acceptable EWL of 53 % and 55 % of comorbidities were improved. However, the high complication rate, often necessitating revision, underlines the limits of this procedure.

  16. Long-term results after fibroid embolization; Langzeitergebnisse nach Myomembolisation

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Huelsbeck, S. [Medizinischer Klinikverbund Flensburg, Akademisches Lehrkrankenhaus des Universitaetsklinikums Schleswig-Holstein, Abt. Diagnostische und interventionelle Radiologie/Neuroradiologie, Ev.-Luth. Diakonissenanstalt zu Flensburg, Flensburg (Germany)


    Fibroids (leiomyoma) are the most frequent benign tumors of the uterus during female reproductive age. In the case of clinical symptoms, uterine artery embolization (UAE) is a well established treatment option for symptomatic fibroids, resulting in promising long-term results. In order to estimate long-term success after UAE, reduction of fibroids and uterus volume is less important than complete improvement and disappearance of fibroid-related symptoms. In addition to a high technical success rate and a low perioperative complication rate, UAE results in high short-term and long-term patient satisfaction (>87%) and improvement of symptoms (>81%). Candidates for UAE should be informed about potential reinterventions in terms of repeated UAE (up to 18% of cases) or surgical treatment options. (orig.) [German] Myome sind die haeufigsten gutartigen soliden Tumoren des weiblichen Genitaltrakts im reproduktiven Alter. Bei klinischen Beschwerden stellt die Uterusarterienembolisation (UAE) zur Therapie des symptomatischen Uterus myomatosus einen fest etabliertes Verfahren dar, das mit viel versprechenden Langzeitergebnissen aufwarten kann. Im Vordergrund der Abschaetzung eines lang andauernden Therapieerfolgs nach UAE stehen weniger die Volumenreduktion eines dominanten Myoms bzw. des gesamten Uterus nach der Behandlung, sondern vielmehr die Besserung oder das voellige Verschwinden der von der Patientin initial vor der UAE angegebenen (myombedingten) Beschwerden. Neben einer hohen technischen Erfolgsrate und geringen perioperativen Komplikationsrate fuehrt die fachkundig durchgefuehrte UAE sowohl im Kurz- als auch Langzeitverlauf zu einem hohen Mass an Patientenzufriedenheit (>87%), verbunden mit einer deutlichen Symptombesserung (>81%). Ueber eine Reintervention (in bis zu ca. 18% der Faelle) im Sinne einer erneuten UAE oder einer operativen Massnahme sollten die Patientinnen allerdings im Vorfeld aufgeklaert werden. (orig.)

  17. Long-term results of trismus release in noma patients. (United States)

    Bisseling, P; Bruhn, J; Erdsach, T; Ettema, A M; Sautter, R; Bergé, S J


    Noma, also known as cancrum oris, is an infectious disease that results in a loss of orofacial tissue, due to gangrene of soft and bony tissue. It is especially seen in young children in the sub-Saharan region. Among the sequelae of patients who survive noma, trismus is one of the most disabling. This retrospective research studied the long-term results of trismus release in noma patients. Thirty-six patients could be traced in the villages and were included in the study. The mean mouth opening in this group was 10.3mm (95% CI: 7.0; 13.6mm) and the mean period after discharge from hospital was 43 months. Better mouth opening was observed in patients who continued physiotherapy after discharge, were older, and those with a 'soft' (vs. 'hard') inner and outer cheek on palpation. The result of trismus release in noma patients in the long term was extremely poor in this study. Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Surgical versus non-surgical treatment of feline small intestinal adenocarcinoma and the influence of metastasis on long-term survival in 18 cats (2000–2007)


    Green, Michael L; Smith, Julie D.; Kass, Philip H


    This study retrospectively evaluated long-term outcomes of 18 cats diagnosed with small intestinal adenocarcinoma, based on surgical versus non-surgical treatment and the presence or absence of metastasis at the time of surgery. Ten cats had surgery and histopathologic confirmation of adenocarcinoma and 8 cats did not have surgery but had cytologic diagnosis of adenocarcinoma. Median survival of cats with adenocarcinoma that underwent surgical excision was 365 days and 22 days for those with ...

  19. [Proctectomy with external sphincter preservation: long-term functional results]. (United States)

    Vorob'ev, G I; Shelygin, Iu A; Pikunov, D Iu; Rybakov, E G; Dzhanaev, Iu A; Fomenko, O Iu


    52 patients with the lower ampullary rectal cancer with tumor localization on the dentate line level had been operated with the use of the originally developed reconstructive technique, permitting preservation of the external anal sphincter elements and, consequently, partial continence. Colonic rectal pouch and smooth muscle cuff were performed during the neorectum and neoanus plasty. A protective stoma was performed in all cases. Contractive activity of saved elements of EAS improved with a course of time and squeezing anal pressure increased as well. Consequent continence improvement occurred during the first year after the stoma closure, biofeed-back therapy provided faster rehabilitation. The achieved long-term functional results (73,4% actuarial 5-year disease-free survival) prove the oncological efficacy of the method on the strict assumption of indications observance. Thus, proctectomy with partial external anal sphincter preservation allows to avoid permanent colostomy and provides a satisfactory quality of life of the operated patients.

  20. Comparable long-term oncologic outcomes of laparoscopic versus open pancreaticoduodenectomy for adenocarcinoma: a propensity score weighting analysis. (United States)

    Conrad, Claudius; Basso, Valeria; Passot, Guillaume; Zorzi, Daria; Li, Liang; Chen, Hsiang-Chun; Fuks, David; Gayet, Brice


    To date, no study has reported long-term oncologic outcome for patients undergoing laparoscopic pancreaticoduodenectomy (LPD) compared to open surgery (OPD). The aim of this study is assess long-term oncologic outcomes for patients with adenocarcinoma undergoing LPD versus OPD using propensity score weighting modeling to minimize selection bias. All patients undergoing PD at Institut Mutualiste Montsouris between January 2000 and April 2010 were included. Propensity scores were calculated using multivariate logistic regression, relating preoperative covariates to surgical approach. Logistic regression was performed, and Cox proportional hazards models for postoperative outcomes were constructed, with and without adjustment for propensity scores weights. Among 87 patients who underwent PD, 40 underwent LPD and 25 OPD for confirmed adenocarcinoma. Preoperative covariates across both groups were comparable. The median follow-up time was 34.5 months. During follow-up, metastasis was identified in 16 (40%) LPD and 7 (28%) OPD patients. After propensity score adjustment, the median overall survival (OS) was 35.5 versus 29.6 months, respectively. The 1-, 3-, and 5-year OS rates were 80.5, 49.2, 39.7% and 77.8, 46.4, 30% in the LP and OPD groups (P = 0.41, 0.42, 0.25), respectively. The median recurrence-free survival (RFS) was 21.5 versus 13.7 months (LPD vs. OPD), and the 1-, 3-, and 5-year RFS rates were 70.9, 33.3, 21.9% and 62.3, 37.9, 25.7% in the LP and OPD groups (P = 0.27, 0.37, 0.39), respectively. Due to the early adoption of LPD, this study is the first to report on long-term oncologic safety of LPD: LPD is non-inferior to OPD with respect to long-term outcomes for patients with adenocarcinoma.

  1. Hypothenar Hammer Syndrome: Long-Term Results After Vascular Reconstruction. (United States)

    Kitzinger, Hugo B; van Schoonhoven, Joerg; Schmitt, Rainer; Hacker, Stefan; Karle, Birgit


    Hypothenar hammer syndrome is a rare vascular lesion of the distal ulnar artery in Guyon tunnel caused by acute or repetitive blunt trauma to the hypothenar eminence. Described treatment options vary greatly, from nonoperative management treatments to surgical interventions. The aim of this study was to evaluate the long-term outcomes of patients after surgical reconstruction of the ulnar artery. In this retrospective study, the results of 12 patients treated for hypothenar hammer syndrome were evaluated. Preoperative and postoperative examinations of the hand were recorded. Function impairment was assessed with the "Disabilites of the Arm, Shoulder and Hand" questionnaire. Comparisons were also made based on ulnar artery patency versus occlusion. All patients were evaluated for ulnar artery patency as determined by Allen's test and magnetic resonance angiography. All patients were men with an average age of 42.8 years. In 3 patients, a direct end-to-end anastomosis of the ulnar artery was performed, and 9 patients received a reconstruction with a reverse interpositional vein graft. Nine vascular reconstructions remained patent after a mean follow-up period of 56.9 months. These patients had a complete or at least partial relief of their pain, dysesthesia, and cold intolerance compared with preoperatively. Patients with reoccluded ulnar arteries were statistically significant younger (P = 0.036) than patients with patent ulnar artery. They also had a higher pain level (P = 0.009) and a longer follow-up period (P = 0.036) than those with patent reconstruction. There was a trend for higher functional impairment in patients with reoccluded ulnar artery (P = 0.100). Smoking habits showed no influence on ulnar artery patency. For patients with symptomatic hypothenar hammer syndrome and failed nonoperative treatment, surgical intervention is a good option. After more than 4.5 years after surgery 9 of 12 vascular reconstructions remained patent (75% patency rate


    Directory of Open Access Journals (Sweden)

    T. A. Britvin


    Full Text Available Background: Adrenocortical cancer (ACC is a rare adrenal neoplasm with aggressive clinical course and poor prognosis, and with many unresolved problems of diagnostics, treatment and predictive factors. Aim: To identify the most significant clinical and morphological predictors of the outcome based on assessment of long-term results of surgical treatment of ACC patients. Materials and methods: This retrospective study included data on diagnosis and results of treatment of 73 ACC patients from 1999 to 2015. Results: Radical surgery was performed in 59 patients, and long-term results assessed in 52 of them (maximal duration of the follow-up was 12 years. The most favorable treatment results were seen in stages I and II of the disease, with a 5-year survival rate of 87%. The 5-year overall survival in patients with ACC stage III was significantly (p=0.042, multiple comparisons lower (48%. Two patients who had been operated with ACC stage IV (adrenalectomy with excision of a solid liver metastasis and atypical lung resection died of progressive tumor within 13 months after surgery. The survival rates in patients with stage III of the tumor were evaluated depending on the main clinical characteristics of the tumor. It was shown that the 5-year overall survival in non-functioning adrenocortical carcinomas was 59%, being significantly (p<0.05 better than that in patients with functionally active malignancies (22%. In the group of patients without metastases in the regional lymphatic nodes, the 5-year overall survival was 56%, whereas all patients with regional lymphatic metastases by the time of the surgery died from progression within 4 years after the intervention. There was an association between 5-year overall survival and the size of primary tumor, with significantly (p<0.05 lower numbers of 5-year overall survivors (29% among those with tumors of more than 10 cm in diameter, compared with 65% survival rate in those with tumors of less than 10

  3. Long-term functional results of radiation after coloanal anastomosis

    Directory of Open Access Journals (Sweden)

    CAC Mathias


    Full Text Available Surgery is the only treatment that can cure most patients with colorectal cancer. Radiation therapy (pre or postoperative has been shown to improve results by decreasing local recurrence and improving survival. Our aim was to analyze whether postoperative radiation influenced long-term functional outcomes and the probability of stricture of anastomosis in patients who underwent coloanal anastomosis for rectal cancer. Methods: The records of 84 patients with coloanal anastomosis for rectal cancer were studied between 1980 and 1996. There were 82 males and 28 females. Mean age was 57.8 years (range 24 to 78 years. Mean distal resection margin was 2.6 cm (range 0 to 14cm. Twenty-three patients received postoperative irradiation therapy. Patients who received chemotherapy were not included in the study. Results were analysed by examination , telephone or questionnaire. Mean follow-up was 3.8 years (range 0 to 13 years. Results: There was no operative mortality. Functional variables were much better in non-irradiated patients. The irradiated group had more number of stools/day (p>0.05, more number of stools/ night (p>0.05, more incontinence/day (p0.05. Conclusion: Postoperative irradiation after colo-anal anastomosis for rectal cancer is safe, but may increase the risk of stricture of anastomosis and does affect functional results adversely.

  4. Long term results of radiotherapy of degenerative joint diseases

    Energy Technology Data Exchange (ETDEWEB)

    Lindner, H.; Freislederer, R.


    At the Radiologic Department of the Staedt. Krankenhaus Passau, 473 patients with degenerative diseases in the big joints and the spine were irradiated with the caesium unit between 1971 and 1979. Among these patients, 249 could be followed up during a prolonged period (1/2 to 9 years, i.e. 4.2 years on an average). According to the categories of v. Pannewitz, 11% were pain-free at this moment, 21% showed an essential improvement, 29% showed an improvement, and 39% were not influenced by the treatment. 13.5% showed recurrent pains; these were mentioned as 'not influenced' in the statistical analysis. It is proved that the relief of pain does not depend on the age of the patients, but on the anamnesis period, the results of the X-ray examiantion, and the degree of the restriction of mobility. Due to the delay of irradiation, a preliminary treatment mostly produces a less favorable radiotherapeutic result. Compared with other therapeutic methods, the long term results of radiotherapy of degenerative joint diseases are generally favorable. This conclusion is also confirmed by the results of patients checked up more than five years after the treatment.

  5. Long term results of PDR brachytherapy for lip cancer

    Directory of Open Access Journals (Sweden)

    Lennart Hardell


    Full Text Available Purpose: To evaluate the long time outcome with regard to local tumour control and side effects of a pulsed dose rate (PDR monobrachytherapy of primary or recurrent cancer of the lip. Material and methods: Between 1995 and 2007 we treated 43 patients with primary or recurrent clinical T1-T3N0 lip cancers. There were 22 T1 patients (51%, 16 T2 (37% and 5 T3 cases (12%. A median dose of 60 (55-66 Gy was given, depending on the tumour volume. The PDR treatment was delivered with 0.83 Gy/pulse every second hour for 5.5-6.5 days. The patients were followed for a median of 55 (1-158 months. Results: The 2-, 5- and 10-year rates of actuarial local control were 97.6%, 94.5% and 94.5%, overall survival 88.0%, 58.9% and 39.1%, disease free survival 92.7%, 86.4% and 86.4% respectively. The regional control rate was 93%. One patient (2% developed distant metastases. A dosimetrical analysis showed a mean treated volume of 14.9 (3.0-56.2 cm3. Long-term side effects were mild and the cosmetic outcome excellent, except for 1 case (2% of soft tissue necrosis and 1 case (2% of osteoradionecrosis. Conclusions: Local outcome is excellent and similar to other published studies of continuous low dose rate (cLDR brachytherapy.

  6. Long-term smoking results in haemostatic dysfunction in chronic ...

    African Journals Online (AJOL)

    Background: Smoking has been known to cause endothelial dysfunction and bronchial carcinoma and duration of smoking has been implicated in the effects of smoking on regular smokers. This study evaluated the effects of long-term smoking on some coagulation markers in chronic smokers. Materials and Methods: A ...

  7. Long term results of Intramedullary Nailing in childhood femur ...

    African Journals Online (AJOL)

    Six patients had lengthening; 4 had atrophy of the thigh and 7 patients had coxa valga of operated limb. All patients with coxa valga had undergone the intervention before the age of 12 years. Conclusion: intramedullary nailing using Küntschter nails to treat femoral fractures in children may have some long terms sequelae.

  8. Rhinophyma: plastic surgery, rehabilitation, and long-term results. (United States)

    Jung, H


    Rhinophymas are characterized by slowly progressive enlargement of the nasal skin that will not resolve spontaneously. The usual indication for treatment has plastic cosmetic and functional reasons, above all in advanced cases with an obstruction of the nasal respiration or reduction of the visual field. Treatment of rhinophyma consists of surgical removal of the hyperplastic alterations. It should always be carried out by an experienced rhinosurgeon, because of possible complications and injury to the more deeply situated nasal structures. Different surgical procedures have been described, such as excision with primary suture or extirpation with plastic covering of the defect by free transplants, subcutaneous rhinophyma resection, as well as decortication with peeling off the proliferations, dermal abrasion, or dermal shaving. In addition, there are various abrasion procedures with abrasive cylinders, burrs, or wire brushes. The methods of exfoliation and abrasive polishing can be effectively combined. Care should be taken to preserve follicular epidermal islets from the more deeply situated layers of the skin. The follicular epithelium left behind is the point of departure for re-epithelization of the wound surface. If decortication is too deep, injuries to the perichondrium or the nasal cartilage may arise, leading to cosmetically unattractive scar formations and necessitate plastic surgery. The author's own method, which involves a combined procedure with peeling or dermal abrasion, remodeling with abrasive cylinders, as well as preoperative injection into the nasal tumor masses and a subsequent covering of the wound area with fibrin glue, is shown with reference to several examples of more than 60 cases. The cosmetic and long-term results are excellent.

  9. Aortic Annulus Enlargement: Early and Long-Terms Results. (United States)

    Dumani, Selman; Likaj, Ermal; Dibra, Laureta; Beca, Vera; Kuci, Saimir; Refatllari, Ali


    Patient-prosthesis mismatch (PPM) is a common occurrence in aortic valve surgery. Even the discussions about the impact of this phenomenon on the results of aortic valve surgery, the management of this problem remain one of the main topics in this kind of surgery. One of the ways of a solution is aortic annulus enlargement. The main topic of this study is to evaluate the early and longterm results of this technique in our country. During the period January 2010 -January 2015, 641 patients performed aortic valve surgery. In ten patients we performed aortic annulus enlargement according to Manouguian technique to avoid severe patient-prothesis mismatch. Operative mortality and perioperative complications (low cardiac output, pulmonary complications, etc..) were considered the indicators of the early results. Survival, clinical presentation according to NYHA, quality of life were the indicators to evaluate long-term results. Preoperative and postoperative echocardiographic data were also used to evaluate our results. We collected the data from hospital registrations and periodical clinical visit and echographic examination after hospital discharge. In our group, 6 of 10 patients were diagnosed with stenotic aortic valve, two patients had aortic valve regurgitation and two mixed valve pathology. Four patients had concomitant cardiac surgery procedure, mitral or CABG. In all cases, aortic valve pathology was the primary diagnose. In the preoperative echocardiographic examination mean transvalvular gradient was 54.3 ± 6.42. We had no death during early or late postoperative period. Only one patient had pulmonary complications and long time of respiratory assistance because of his pulmonary pathology. The same patient had low cardiac output and wound infection. Early after surgery mean transprostethic gradient was 16.2 ± 3.44 and late postoperative was 15.9 ± 4.3. No patient had the severe patient-prothesis mismatch. Mean follow-up was 49 ± 20.26 months. During follow

  10. Canine porous resurfacing hip arthroplasty. Long-term results. (United States)

    Amstutz, H C; Kim, W C; O'Carroll, P F; Kabo, J M


    Long-term experimental data support the hypothesis that biologic bone ingrowth into porous surfaces in a hip-resurfacing model is a viable alternative to stem-type porous implants. Ingrowth of bone was demonstrated in long-term canine arthroplasty. The components were well fixed and stable at the time of sacrifice, although ingrowth occurred to varying degrees. The ingrowth and quality of remodeling was influenced by stress. Dislocations were overcome by a change in surgical technique. Loosening and neck fractures were associated with insufficient stability at operation or to component impingement (prevented by modifications of design). The formation of metal debris-filled cysts is a concern and appeared to be associated with the poor quality of porous sintering and possibly abrasion. The effects of increased surface area of the porous components such as increased corrosion products on biologic compatibility are still not well defined and require further research and longer follow-up examination.

  11. Long Term Corrosion/Degradation Test Six Year Results

    Energy Technology Data Exchange (ETDEWEB)

    M. K. Adler Flitton; C. W. Bishop; M. E. Delwiche; T. S. Yoder


    The Subsurface Disposal Area (SDA) of the Radioactive Waste Management Complex (RWMC) located at the Idaho National Engineering and Environmental Laboratory (INEEL) contains neutron-activated metals from non-fuel, nuclear reactor core components. The Long-Term Corrosion/Degradation (LTCD) Test is designed to obtain site-specific corrosion rates to support efforts to more accurately estimate the transfer of activated elements to the environment. The test is using two proven, industry-standard methods—direct corrosion testing using metal coupons, and monitored corrosion testing using electrical/resistance probes—to determine corrosion rates for various metal alloys generally representing the metals of interest buried at the SDA, including Type 304L stainless steel, Type 316L stainless steel, Inconel 718, Beryllium S200F, Aluminum 6061, Zircaloy-4, low-carbon steel, and Ferralium 255. In the direct testing, metal coupons are retrieved for corrosion evaluation after having been buried in SDA backfill soil and exposed to natural SDA environmental conditions for times ranging from one year to as many as 32 years, depending on research needs and funding availability. In the monitored testing, electrical/resistance probes buried in SDA backfill soil will provide corrosion data for the duration of the test or until the probes fail. This report provides an update describing the current status of the test and documents results to date. Data from the one-year and three-year results are also included, for comparison and evaluation of trends. In the six-year results, most metals being tested showed extremely low measurable rates of general corrosion. For Type 304L stainless steel, Type 316L stainless steel, Inconel 718, and Ferralium 255, corrosion rates fell in the range of “no reportable” to 0.0002 mils per year (MPY). Corrosion rates for Zircaloy-4 ranged from no measurable corrosion to 0.0001 MPY. These rates are two orders of magnitude lower than those specified in

  12. Results of a Survey of Long-Term Archiving Implementations (United States)

    Gurman, Joseph B.; Spencer, Jennifer L.


    NASA’s Heliophysics Data Management Policy calls for discipline-specific “final archives,” which will be responsible for the long-term archiving and service of Heliophysics mission data. Long-term archival functions, such as periodic revalidation of the data and migration to newer storage media when appropriate, have never been part of the Solar Data Analysis Center core capabilities. We also recognize that the largest space solar physics data set, the SDO AIA and HMI data at the Stanford Joint Science and Operations Center (JSOC), will eventually need preservation and long-term access, as will the potentially much larger data archive of DKIST observations. We have carried out a study of data archiving best practices in other disciplines and organizations, including NASA’s Space Physics Data Facility (SPDF), the National Institute of Standards and Technology (NIST), and private industry, and report on the lessons learned and possible cost models. We seek input from the broader solar physics community on the relative value of various levels of preservation effort.

  13. Long Term Results of Radiation Therapy in Early Glottic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Byun, Sang Jun [Dongsan Medical Center, Daegu (Korea, Republic of)


    This study was designed to evaluate long-term results in terms of failure, survival and voice preservation after radiation therapy for early glottic cancer. From February 1988 to December 2003, 70 patients with early glottic cancer were treated with radiation therapy at Keimyung University Dongsan Medical Center. Patient age distribution was from 39 to 79 years, with a median age of 62 years. All patients had squamous cell carcinoma. According to the TNM stage, 58 patients had stage I disease, 12 patients had stage II disease; 67 patients were male. The laryngeal area was irradiated with the use of bilateral opposing fields with/without a wedge filter with 6 MV photons at a total dose of 54{approx}70.2 Gy in 1.8{approx}2.2 Gy fractions over 6{approx}8 weeks. We delivered a median radiation dose of 60 Gy for stage I patients and a median radiation dose of 66 Gy for stage II patients. Salvage surgery was performed in patients with local recurrence. The voice preservation rate was analyzed after all treatments including salvage surgery. Follow-up periods were from 13 to 180 months, with a median follow-up period of 77.5 months. The survival rate was analyzed by the use of the Kaplan Meier method and log rank test. A comparison of two groups was performed with the use of the chi-squared test. The local control rate was 98.5% (69/70). The five-year-overall survival rate was 93.9%. The five-year disease free survival rate (5YDFS) was 84.1% and the 5YDFS after radiation and salvage surgery was 92.8%. According to stage, the 5YDFS was 93.1% and 91.7% for stage I and stage II respectively. Thirteen patients (18.5%) had local failure with 24 months of median time to local failure and nine patients received salvage surgery; however, four patients were lost to follow-up after a diagnosis of recurrence. Only two patients died due to a distant metastasis at 33 months and 71 months after radiation therapy, respectively. Nine patients died due to other diseases with a median time

  14. [Surgical treatment of hepatocellular carcinoma. Long term results]. (United States)

    Figueras, Juan; Ramos, Emilio; Ibáñez, Luis; Valls, Carles; Serrano, Teresa; Rafecas, Antonio; Casanovas, Teresa; Fabregat, Juan; Xiol, Xavier; Torras, Jaume; Baliellas, Carmen; Jaurrieta, Eduardo; Casais, Luis


    Surgical treatment for hepatocellular carcinoma remains controversial due to a lack of prospective randomized studies. Between January 1990 and December 2000, 121 liver transplantations (group 1) and 52 hepatectomies (group 2) were performed for hepatocellular carcinoma. Each surgical treatment was carried out depending on patients' and tumor's characteristics. Patients from group 1 had a more advanced tumoral grade, with higher involvement of two lobes (19 vs 4%; p = 0.015) and higher number of nodules (1.9 DE [2] vs 1.2 [0.6]; p = 0.001); yet the mean tumor size was lower (3 cm [1.5] vs 4.2 [3.2]; p = 0.006). Operative mortality (4% vs 2%; p = 0.66) and 5- and 10-years survival (68% and 42% vs 63% and 45%; p = 0.23) were similar between both groups. Nevertheless, 5- and 10-years recurrence rates (10.6% and 10.6% vs 50% and 65.5%; p < 0.0001) were more favourable in group 1. Prognostic factors of recurrence included microscopic vascular invasion (RR = 12.12; CI, 2.02-75.52) and alpha-fetoprotein levels higher than 300 ng/mL (RR = 7.12; 95% CI, 1.08-47.02) in group 1, and the pT3-4 stage (RR = 3.86; 95% CI, 1.06-14.03) in group 2. Mean time on waiting lists for liver transplantation was 3.06 (2.66) months and it has increased significantly in last years, especially among blood group 0 patients. However, this fact has not been associated with a worsening of survival rates (p = 0.98). After a good patient selection, either liver transplantation or hepatectomy achieve excellent long term survival rates in patients with hepatocellular carcinoma, though the former allows a better control of the tumoral disease. The increase of mean time on waiting lists for liver transplantation during the last years has not led to a worsening of survival results.

  15. Long term results in refractory tennis elbow using autologous blood

    Directory of Open Access Journals (Sweden)

    Naseem ul Gani


    Full Text Available Tennis elbow (TE is one of the commonest myotendinosis. Different treatment options are available and autologous blood injection has emerged as the one of the acceptable modalities of treatment. Long term studies over a larger group of patients are however lacking. The purpose of this study was to evaluate these patients on longer durations. One-hundred and twenty patients of TE, who failed to respond to conventional treatment including local steroid injections were taken up for this prospective study over the period from year 2005 to 2011 and were followed up for the minimum of 3 years (range 3-9 years. Two mL of autologous blood was taken from the ipsilateral limb and injected into the lateral epicondyle. The effectiveness of the procedure was assessed by Pain Rating Sscale and Nirschl Staging, which was monitored before the procedure, at first week, monthly for first three months, at 6 months and then 3 monthly for first year, six monthly for next 2 years and then yearly. Statistical analysis was done and a P value of <0.05 was taken as significant. The patients (76 females and 44 males were evaluated after procedure. The mean age group was 40.67±8.21. The mean follow up was 5.7±1.72 (range 3 to 9 years. The mean pain score and Nirschl stage before the procedure was 3.3±0.9 and 6.2±0.82 respectively. At final follow up the pain score and Nirschl were 1.1±0.9 and 1.5±0.91 respectively. Autologous blood injection was found to be one of the modalities for treatment of TE. Being cheap, available and easy method of treatment, it should be considered as a treatment modality before opting for the surgery. Universal guidelines for the management of tennis elbow should be made as there is lot of controversy regarding the treatment.

  16. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation

    National Research Council Canada - National Science Library

    Becker, Corinne; Assouad, Jalal; Riquet, Marc; Hidden, Geneviève


    Lymphedema complicating breast cancer treatment remains a challenging problem. The purpose of this study was to analyze the long-term results following microsurgical lymph node (LN) transplantation...


    Directory of Open Access Journals (Sweden)

    D. V. Nenashev


    Full Text Available The retrospective analysis of 97 shoulder arthroplasties during 1998 to 2009 was performed. The hemiarthroplasty were fulfilled in 92 patients and total shoulder replacement in 5 patients. Total rate good and satisfactory results consists 32,0%, poor results - 68,0% (66 patients, include 5 patients with total shoulder arthroplasty. The lower level of good results was revealed in patients with chronic fractures and fracture-dislocations of shoulder. It related with changes bones of shoulder and muscles of shoulder (rotator cuff. In the studied group of patients there was no proper pre-operative diagnostics of the rotator cuff, articular surface of the scapula, which shows the need for careful preoperative examination to determine the indications for shoulder arthroplasty and select the type of prosthesis. Unsatisfactory results of total arthroplasty related to screw migration (in case of the transacromion approach and to the development of subacromial impingement. The conclusion about the need to narrow the indications for use of the scapular component «Ortho-P». The authors showed preference to cemented implants without a metal base. It is necessary to introduce in practice the anatomic implants of the third generation allowing the fullest play the anatomy and biomechanics of the shoulder joint.

  18. Brachytherapy in Lip Carcinoma: Long-Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Guibert, Mireille, E-mail: [Department of Head and Neck Surgery, Larrey Hospital, Toulouse (France); David, Isabelle [Department of Radiation Oncology, Claudius Regaud Institut, Toulouse (France); Vergez, Sebastien [Department of Head and Neck Surgery, Larrey Hospital, Toulouse (France); Rives, Michel [Department of Radiation Oncology, Claudius Regaud Institut, Toulouse (France); Filleron, Thomas [Department of Epidemiology, Claudius Regaud Institut, Toulouse (France); Bonnet, Jacques; Delannes, Martine [Department of Radiation Oncology, Claudius Regaud Institut, Toulouse (France)


    Purpose: The aim of this study was to evaluate the effectiveness of low-dose-rate brachytherapy for local control and relapse-free survival in squamous cell and basal cell carcinomas of the lips. We compared two groups: one with tumors on the skin and the other with tumors on the lip. Patients and methods: All patients had been treated at Claudius Regaud Cancer Centre from 1990 to 2008 for squamous cell or basal cell carcinoma. Low-dose-rate brachytherapy was performed with iridium 192 wires according to the Paris system rules. On average, the dose delivered was 65 Gy. Results: 172 consecutive patients were included in our study; 69 had skin carcinoma (squamous cell or basal cell), and 92 had squamous cell mucosal carcinoma. The average follow-up time was 5.4 years. In the skin cancer group, there were five local recurrences and one lymph node recurrence. In the mucosal cancer group, there were ten local recurrences and five lymph node recurrences. The 8-year relapse-free survival for the entire population was 80%. The 8-year relapse-free survival was 85% for skin carcinoma 75% for mucosal carcinoma, with no significant difference between groups. The functional results were satisfactory for 99% of patients, and the cosmetic results were satisfactory for 92%. Maximal toxicity observed was Grade 2. Conclusions: Low-dose-rate brachytherapy can be used to treat lip carcinomas at Stages T1 and T2 as the only treatment with excellent results for local control and relapse-free survival. The benefits of brachytherapy are also cosmetic and functional, with 91% of patients having no side effects.

  19. Rotationplasty in skeletally immature patients. Long-term followup results. (United States)

    Hanlon, M; Krajbich, J I


    Twenty-one skeletally immature patients with a Grade IIB osteosarcoma about the knee were treated with a modified Van Nes rotationplasty. Fourteen patients were followed up for 4 to 10.5 years (mean followup, 8 years). Functional assessment using Enneking's method showed all had good or excellent results. No patient thought that the reconstruction affected their ability to achieve recreational, sporting, or career goals. The reconstruction is durable and is not associated with an increase in late complications.

  20. Long-term results of 56 revision total knee replacements. (United States)

    Gustilo, T; Comadoll, J L; Gustilo, R B


    Fifty-six consecutive revised total knee arthroplasties (TKA) were followed for an average of 8.3 years (range: 3 to 15 years). The purpose of this study was to evaluate the results of revision TKA to determine any trends in either the good outcomes or the failures. We found that the success rate for revision TKA was comparable to that for primary TKA. Eighty-nine percent of the knees rated at least fair, with 73% of these rating good or excellent, and 4% poor result. Moreover, the findings suggest that if prostheses are aligned correctly at implantation, there is only slight deterioration in their performance over time. Outcome was not affected by the type of prosthesis used in either the previous surgery or the revision. There is a correlation between the number of revisions and the functional knee rating; the more revisions, the less chance for success. There was also a direct correlation between varus knee alignment and significant increased incidence of failure. No appreciable difference was found between degenerative arthritis patients and rheumatoid patients, except that the rheumatoid patients had a higher incidence of delayed infections.

  1. Long-term results after proximal thoracic aortic redo surgery.

    Directory of Open Access Journals (Sweden)

    Martin Czerny

    Full Text Available OBJECTIVE: To evaluate early and mid-term results in patients undergoing proximal thoracic aortic redo surgery. METHODS: We analyzed 60 patients (median age 60 years, median logistic EuroSCORE 40 who underwent proximal thoracic aortic redo surgery between January 2005 and April 2012. Outcome and risk factors were analyzed. RESULTS: In hospital mortality was 13%, perioperative neurologic injury was 7%. Fifty percent of patients underwent redo surgery in an urgent or emergency setting. In 65%, partial or total arch replacement with or without conventional or frozen elephant trunk extension was performed. The preoperative logistic EuroSCORE I confirmed to be a reliable predictor of adverse outcome- (ROC 0.786, 95%CI 0.64-0.93 as did the new EuroSCORE II model: ROC 0.882 95%CI 0.78-0.98. Extensive individual logistic EuroSCORE I levels more than 67 showed an OR of 7.01, 95%CI 1.43-34.27. A EuroSCORE II larger than 28 showed an OR of 4.44 (95%CI 1.4-14.06. Multivariate logistic regression analysis identified a critical preoperative state (OR 7.96, 95%CI 1.51-38.79 but not advanced age (OR 2.46, 95%CI 0.48-12.66 as the strongest independent predictor of in-hospital mortality. Median follow-up was 23 months (1-52 months. One year and five year actuarial survival rates were 83% and 69% respectively. Freedom from reoperation during follow-up was 100%. CONCLUSIONS: Despite a substantial early attrition rate in patients presenting with a critical preoperative state, proximal thoracic aortic redo surgery provides excellent early and mid-term results. Higher EuroSCORE I and II levels and a critical preoperative state but not advanced age are independent predictors of in-hospital mortality. As a consequence, age alone should no longer be regarded as a contraindication for surgical treatment in this particular group of patients.

  2. Long-term results of PRRT in advanced bronchopulmonary carcinoid

    Energy Technology Data Exchange (ETDEWEB)

    Mariniello, Annapaola; Bodei, Lisa; Baio, Silvia Melania; Gilardi, Laura; Colandrea, Marzia; Papi, Stefano; Grana, Chiara Maria [European Institute of Oncology, Division of Nuclear Medicine, Milan (Italy); Tinelli, Carmine [IRCCS Foundation Policlinico San Matteo, Epidemiology and Biometric Unit, Pavia (Italy); Valmadre, Giuseppe [Presidio Ospedaliero E. Morelli AOVV, Sondalo (Italy); Fazio, Nicola [European Institute of Oncology, Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, Milan (Italy); Galetta, Domenico [European Institute of Oncology, Thoracic Surgery Division, Milan (Italy); Paganelli, Giovanni [Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Nuclear Medicine and Radiometabolic Units, Meldola (Italy)


    Peptide receptor radionuclide therapy (PRRT) for the treatment of neuroendocrine tumours (NET) has been explored for almost two decades, but there are still few trials that have exclusively investigated well-differentiated and moderately differentiated NET arising from the respiratory tree. Thus, the aim of this study was to explore the outcome in patients affected by bronchopulmonary carcinoid (BPC) following PRRT. We retrospectively analysed 114 patients with advanced stage BPC consecutively treated with PRRT at the European Institute of Oncology, Milan, from 1997 to 2012 and followed until October 2014. The objective responses, overall survival (OS) and progression-free survival (PFS) were rated, and three different PRRT protocols ({sup 90}Y-DOTATOC vs. {sup 177}Lu-DOTATATE vs. {sup 90}Y-DOTATOC + {sup 177}Lu-DOTATATE) were compared with regard to their efficacy and tolerability. The median OS (evaluated in 94 of the 114 patients) was 58.8 months. The median PFS was 28.0 months. The {sup 177}Lu-DOTATATE protocol resulted in the highest 5-year OS (61.4 %). Morphological responses (partial responses + minor responses) were obtained in 26.5 % of the cohort and were associated with longer OS and PFS. The {sup 90}Y-DOTATOC + {sup 177}Lu-DOTATATE protocol provided the highest response rate (38.1 %). Adverse events were mild in the majority of patients. However, haematological toxicity negatively affected survival. No severe (grade 3/4) serum creatinine increase was observed. Patients treated with {sup 90}Y-DOTATOC alone more frequently showed a mild/moderate decrease in renal function. In patients treated with chemotherapy before PRRT had a shorter OS and PFS, and a higher risk of developing nephrotoxicity. In a large cohort of patients with advanced BPC treated in a ''real-world'' scenario and followed up for a median of 45.1 months (range 2 - 191 months), PRRT proved to be promising in prolonging survival and delaying disease progression. Despite

  3. Short and long term measures of anxiety exhibit opposite results.

    Directory of Open Access Journals (Sweden)

    Ehud Fonio

    Full Text Available Animal models of human diseases of the central nervous system, generalized anxiety disorder included, are essential for the study of the brain-behavior interface and obligatory for drug development; yet, these models fail to yield new insights and efficacious drugs. By increasing testing duration hundredfold and arena size tenfold, and comparing the behavior of the common animal model to that of wild mice, we raise concerns that chronic anxiety might have been measured at the wrong time, for the wrong duration, and in the wrong animal. Furthermore, the mice start the experimental session with a short period of transient adaptation to the novel environment (habituation period and a long period reflecting the respective trait of the mice. Using common measures of anxiety reveals that mice exhibit opposite results during these periods suggesting that chronic anxiety should be measured during the post-habituation period. We recommend tools for measuring the transient period, and provide suggestions for characterizing the post habituation period.

  4. Artificial Urinary Sphincter: Long-Term Results and Patient Satisfaction

    Directory of Open Access Journals (Sweden)

    Drogo K. Montague


    Full Text Available The published evidence concerning the safety, efficacy, and patient satisfaction for implantation of the current model of the artificial urinary sphincter (AS 800 in men with post prostatectomy urinary incontinence was the objective of this review. A Pub Med English language literature search from 1995 to 2011 was performed. A majority of men who undergo AUS implantation for post prostatectomy urinary incontinence achieve satisfactory results (0 to 1 pad per day. Infection rates range from 0.46 to 7%, cuff erosion rates range from 3.8 to 10%, and urethral atrophy ranges from 9.6 to 11.4%. Kaplan-Meier 5 year projections for freedom from any reoperation were 50% for a small series and 79.4% for a larger series. Kaplan-Meier projections for freedom from mechanical failure were 79% at 5 years and 72% at 10 years. In another series 10 year projections for freedom from mechanical failure were 64%. Although the artificial urinary sphincter (AUS is the gold standard for the treatment of this disorder, most men will continue to need at least one pad per day for protection, and they are subject to a significant chance of future AUS revision or replacement.

  5. [Long-term Results of Arthrodesis of the Talocrural Joint.]. (United States)

    Richtr, M; Sosna, A; Rysavý, M


    The authors evaluate a group of 19 arthrodeses of the talocrural joint in 16 patients after a mean interval of 6 years and three months following arthrodesis (operation). They demonstrate that the hitherto used method of evaluation of the position of the foot after arthrodesis of the ankle - measurement of the tibiotalar angle, is insufficient and does not record the changes in function and shape distally from Chopart's joint, e. g. pes cavus. Some deformities of the foot can lead to an entirely afunctional arthrodesis even when from the theoretical aspect the tibio-talar angle of arthrodesis is correct. The evaluation from the lateral radiograph only is misleading, as the X-ray picture without the extreme position of dorsiflexion of the forefoot does not express the real position of the foot important from the functional aspect. The X-ray evaluation must be in relation to the position of the planta. The authors recommend therefore their own method of X-ray evaluation of the arthrodesis of the talus. In their opinion the position of the arthrodesis of the ankle is correct when during sustained dorsal flexion of the foot the connecting line of the plantar margin of the head of the 1st metatarsus and the plantar margin of the tuber calcanei and the tibial axis form an angle of 85 - 90 degrees . The authors describe this angle as the "functional angle of arthrodesis of the ankle". It can be measured during sustained dorsiflexion of the foot by means of an elastic longet-te. The functional results of arthrodesis of the talocrural joint were assessed by the authors by a Mazur ankle evaluation grading system. The authors demonstrate the importance of a correct position of the foot after arthrodesis in case-histories of some patients where already in case of desis of the foot in plantiflexion of 10 degrees , the arthrodesis was obviously inadequate from the functional aspect. After arthrodesis of the talocrural joint the range of motion of the forefoot is 10 - 15 degrees

  6. [Cholecystolithotomy: first middle-long term results of our series]. (United States)

    Roqués, J L; Pruneda, R Ruiz; Sánchez, J; Girón, O; Aranda, M J; Trujillo, A; Hernández, J P; Guirao, M J; Zambudio, G; Jiménez, J I Ruiz


    Cholelithiasis in children is an infrequent disease whose incidence has increased over the last few decades. It has its own typical characteristics, different from those present in adults. Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cases, still its connection with right-sided colon cancer and other diseases associated with the procedure has led to recommend it with some reservation. Though several authors adopted cholecystotomy as a therapeutic option in recent years, its use remains controversial. Our indication criteria for this technique are presented herewith, as well as long- and medium-term results (mean follow-up of 10 years) of our series, previously reported in 2003, and a new case added later in 2006. Since 2003, a prospective study of 15 patients from our previous series and a new patient added afterwards is being carried out, including: 1) Medical history checking for symptoms connected with biliary conditions. 2) DIAGNOSTIC TESTS: laboratory tests and ultrasonography. Out of our 16 patients: A girl relapsed a few months later and underwent cholecystectomy, but whether it was a true relapse or a missed gallstone was not established. A patient with a history of recurrent abdominal pain has shown no improvement in his symptoms even though his tests are normal. Two patients have been lost for our study, but showed normal tests for 5 and 7 years respectively. Our 11 remaining patients show no symptoms as well as normal laboratory and imaging tests. A new patient joined our study in 2006, showing normal tests to date and no postsurgical complications. Based on our experience, cholecystotomy has proved to be a complication-free, safe and easy procedure with a virtually nonexistent relapse rate in the long and medium term for patients in the pediatric age group presenting with single or double cholelithiasis, unchanged for 1-2 years with no size increase, no apparent etiology, no complications and a normal bile duct.

  7. Short- and Long-Term Survival in Metastatic Pancreatic Adenocarcinoma, 1993-2013. (United States)

    Golan, Talia; Sella, Tal; Margalit, Ofer; Amit, Uri; Halpern, Naama; Aderka, Dan; Shacham-Shmueli, Einat; Urban, Damien; Lawrence, Yaacov Richard


    Background: During the past 2 decades, numerous clinical trials have focused on improving outcomes in patients with metastatic pancreatic cancer (mPDAC). The efficacy of new treatments has been demonstrated among highly selected patients in randomized phase III trials; hence, it is not clear to what extent these advances are reflected within the broader mPDAC population. Materials and Methods: Survival statistics were extracted from the SEER database for patients diagnosed with mPDAC between 1993 and 2013. Survival was analyzed using the Kaplan-Meier method and proportional hazard models. Results: The study population consisted of 57,263 patients diagnosed with mPDAC between 1993 and 2013; 52% were male, with a median age of 69 years (range, 15-104). Superior prognosis correlated with younger age, being married, tumor located within the head of the pancreas, lower grade disease, and more recent year of diagnosis. Median overall survival (OS) remained stable at 2 months between 1993 and 2013. Improvements in OS were seen for younger patients (age <50 years) and those with a more recent year of diagnosis (2009-2013). The percentage of patients who died within 2 months of initial diagnosis decreased between 1993 and 2013 (from 63.5% to 50.6%; P<.0001). The percentage of patients surviving ≥12 months improved from 4.9% in 1993 to 12.7% in 2013 (P<.0001). Conclusions: In recent years a modest improvement in OS has been seen among younger patients with mPDAC. The percentage of patients living beyond 1 year has significantly increased over time; however, the percentage of those dying within 2 months remains substantial. Copyright © 2017 by the National Comprehensive Cancer Network.

  8. Long-term outcome of sports injuries : results after inpatient treatment

    NARCIS (Netherlands)

    Dekker, R; van der Sluis, CK; Groothoff, JW; Eisma, WH; ten Duis, HJ

    Objective: To investigate whether sports injuries result in long-term disabilities and handicaps and to establish variables with a prognostic value for the occurrence of these long-term consequences. Materials and methods: All patients older than 17 years of age and admitted to the University

  9. Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: a New Tool to Assess Sarcopenia (United States)

    Amini, Neda; Spolverato, Gaya; Gupta, Rohan; Margonis, Georgios A.; Kim, Yuhree; Wagner, Doris; Rezaee, Neda; Weiss, Matthew J.; Wolfgang, Christopher L.; Makary, Martin M.; Kamel, Ihab R.; Pawlik, Timothy M.


    Background While sarcopenia is typically defined using total psoas area (TPA), characterizing sarcopenia using only a single axial cross-sectional image may be inadequate. We sought to evaluate total psoas volume (TPV) as a new tool to define sarcopenia and compare patient outcomes relative to TPA and TPV. Method Sarcopenia was assessed in 763 patients who underwent pancreatectomy for pancreatic adenocarcinoma between 1996 and 2014. It was defined as the TPA and TPV in the lowest sex-specific quartile. The impact of sarcopenia defined by TPA and TPV on overall morbidity and mortality was assessed using multivariable analysis. Result Median TPA and TPV were both lower in women versus men (both Psarcopenia was not associated with higher risk of postoperative complications (OR 1.06; P=0.72), sarcopenia defined by TPV was associated with morbidity (OR 1.79; P=0.002). On multivariable analysis, TPV-sarcopenia remained independently associated with an increased risk of postoperative complications (OR 1.69; P=0.006), as well as long-term survival (HR 1.46; P=0.006). Conclusion The use of TPV to define sarcopenia was associated with both short- and long-term outcomes following resection of pancreatic cancer. Assessment of the entire volume of the psoas muscle (TPV) may be a better means to define sarcopenia rather than a single axial image. PMID:25925237

  10. Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: Does the operative approach have an influence on the long-term prognosis?

    Directory of Open Access Journals (Sweden)

    Kneist Werner


    Full Text Available Abstract Background The goal of the present analysis was to investigate the long-term prognosis for adenocarcinoma of the esophagus treated with either the transhiatal (TH or the transthoracic (TT operative approach. Methods Between September 1985 and March 2004, esophageal resection due to carcinoma was performed on a total of 424 patients. This manuscript takes into account the 150 patients suffering from adenocarcinoma of the esophagus in whom a transhiatal resection of the esophagus was performed. In the event of transmural tumor growth and a justifiable risk of surgery, the transthoracic resection was selected. An extended mediastinal lymph node dissection, however, was only carried out in the course of the transthoracic approach. Results The transthoracic resection of the esophagus demonstrated a higher rate of general complications (p = 0.011 as well as a higher mortality rate (p = 0.011. The mediastinal dissection of the lymph nodes, however, revealed no prognostic influence. Considering all of the 150 patients with adenocarcinoma, as well as only those patients who had undergone curative resections (R0, the transhiatal approach was seen to demonstrate a better five-year survival rate of 32.1% versus 35.1%, with a median survival time of 24 versus 28 months, as compared with those who had undergone a transthoracic approach with a five-year survival rate of 13.6% (all patients versus 17.7% (R0 resection with a median survival time of 16 versus 17 months (p Conclusion The prognosis in patients with adenocarcinoma of the esophagus is influenced by the depth of the tumor (pT and the pM-category, as shown in the multivariate analysis. The present analysis did not demonstrate a relevant difference in survival for patients with N0 and N1 stages undergoing transhiatal or transthoracic esophagectomy. It is questionable, if a more extensive mediastinal lymph node dissection, in addition to the clearance of abdominal lymph nodes, offers prognostic

  11. Results of long-term field tests of protective earthing device for vessel electric systems

    Directory of Open Access Journals (Sweden)

    Blaginin V.A.


    Full Text Available The results of prolonged natural tests of protective neutral earthing device for controlling the fire and electrical safety of vessel electric systems have been shown. The use of such devices provides safe single-phase fault currents and reducing arc overvoltage during the long-term operation of a ship. The results of long-term monitoring of the device operation as part of the existing vessel electric power system have confirmed its effectiveness

  12. Long term azathioprine maintenance therapy in ANCA-associated vasculitis: combined results of long-term follow-up data. (United States)

    de Joode, Anoek A E; Sanders, Jan Stephan F; Puéchal, Xavier; Guillevin, Loic P; Hiemstra, Thomas F; Flossmann, Oliver; Rasmussen, Nils; Westman, Kerstin; Jayne, David R; Stegeman, Coen A


    We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up. Three hundred and eighty newly diagnosed ANCA-associated vasculitis patients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months. During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative). Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.

  13. Vitamin A deprivation results in reversible loss of hippocampal long-term synaptic plasticity. (United States)

    Misner, D L; Jacobs, S; Shimizu, Y; de Urquiza, A M; Solomin, L; Perlmann, T; De Luca, L M; Stevens, C F; Evans, R M


    Despite its long history, the central effects of progressive depletion of vitamin A in adult mice has not been previously described. An examination of vitamin-deprived animals revealed a progressive and ultimately profound impairment of hippocampal CA1 long-term potentiation and a virtual abolishment of long-term depression. Importantly, these losses are fully reversible by dietary vitamin A replenishment in vivo or direct application of all trans-retinoic acid to acute hippocampal slices. We find retinoid responsive transgenes to be highly active in the hippocampus, and by using dissected explants, we show the hippocampus to be a site of robust synthesis of bioactive retinoids. In aggregate, these results demonstrate that vitamin A and its active derivatives function as essential competence factors for long-term synaptic plasticity within the adult brain, and suggest that key genes required for long-term potentiation and long-term depression are retinoid dependent. These data suggest a major mental consequence for the hundreds of millions of adults and children who are vitamin A deficient.

  14. Long-term results, prognostic factors and cataract surgery after diabetic vitrectomy

    DEFF Research Database (Denmark)

    Ostri, Christoffer; Lux, Anja; Lund-Andersen, Henrik


    PURPOSE: To report long-term results, prognostic factors and cataract surgery after diabetic vitrectomy. METHODS: Retrospective review of patient files from a large diabetes centre between 1996 and 2010. Surgical history was obtained from the Danish National Patient Register. Follow-up intervals...... after 5 and 10 years, respectively. Use of silicone oil increased the risk of cataract surgery (p = 0.009, log-rank test). CONCLUSIONS: Most diabetic vitrectomy patients stand to gain visual acuity ≥0.3 after surgery and a stable long-term visual acuity after 1 year. The only consistent long......-term predictor of low vision after surgery is use of silicone oil for endotamponade. About 2/3 of phakic patients will subsequently have cataract surgery the first 10 years after diabetic vitrectomy....

  15. [Long-term survival of metastatic clear cell adenocarcinoma of the female urethra by multidisciplinary treatment: a case report]. (United States)

    Suzuki, Takahisa; Furuse, Hiroshi; Kurita, Yutaka; Imanishi, Takeshi; Tamura, Keita; Otsuka, Atsushi; Mugiya, Soichi; Ozono, Seiichiro


    We report a case of clear cell adenocarcinoma of the female urethra. A 57-year-old woman presented with complaint of gross hematuria. Abdominal ultrasonography, cystourethroscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the urethral tumor was invasive to bladder neck. Clinical stage was determined as cT3N1M0, then anterior pelvic exenteration and ileal conduit formation were performed. The pathological diagnosis was clear cell adenocarcinoma of urethra and the stage was pT3N1. The patient received TS-1 and cisplatin for postoperative recurrence, but she died from multiple lung metastasis 54 months after the operation. Clear cell adenocarcinoma of the female urethra is rare case in the Japanese literatures. Pathogenesis and management of this rare condition are discussed.

  16. Early and long term results of necrosectomy and planned re-exploration for infected pancreatic necrosis

    NARCIS (Netherlands)

    van Goor, Harry; Sluiter, WJ; Bleichrodt, RP

    Objective: To evaluate the early and long term results of necrosectomy, planned re-explorations and open drainage in patients with infected pancreatic necrosis. Design: Retrospective and case control study. Setting: University hospital, The Netherlands. Subjects: 10 patients with documented infected

  17. Long-term Results of the Posteromedial Release in the Treatment of Idiopathic Clubfoot

    NARCIS (Netherlands)

    van Gelder, Janke H.; van Ruiten, Alward G. P.; Visser, Jan D.; Maathuis, Patrick G. M.


    Background: Short-term follow-up studies show good results in foot function, after surgical treatment of idiopathic clubfeet. Long-term follow-up studies are rare and probably represent a mixture of experience of different treating orthopedic surgeons. The purpose of this study is to present the

  18. Fundus rotation gastroplasty vs. Kirschner-Akiyama gastric tube in esophageal resection: comparison of perioperative and long-term results. (United States)

    Hartwig, Werner; Strobel, Oliver; Schneider, Lutz; Hackert, Thilo; Hesse, Christine; Büchler, Markus W; Werner, Jens


    Improved tube length and low anastomotic leakage rates have been demonstrated for fundus rotation gastroplasty (FRG) after esophageal resection. The aim of the present study was to compare the safety of FRG vs. the conventional Kirschner-Akiyama gastric tube in a large prospective clinical series. All patients with primary esophageal cancer who were to undergo esophageal resection at the authors' department were prospectively assessed. The subgroup of patients in whom FRG or the Kirschner-Akiyama reconstruction with either intrathoracic or cervical anastomosis was performed between October 2001 and November 2005 was analyzed for perioperative surgical and nonsurgical complications and for long-term survival. FRG was performed in 57 patients and Akiyama reconstruction was performed in 54 patients with potentially curative resectable carcinoma. The patients had a mean age of 60.3 years. Tumor type was squamous cell carcinoma in 51 patients and adenocarcinoma (AEG types I and II) in 60 patients. There were no differences between the reconstruction groups with respect to age, gender, tumor type, neoadjuvant treatment, and tumor stage. Duration of surgery, blood loss, resection margins, extent of lymphadenectomy, ICU stay, and hospital stay also did not show any significant differences. Overall leakage rate, including tube ischemia, was 9.9% and mortality was 2.7%. Compared with the Akiyama reconstruction, FRG was performed significantly more often in combination with cervical anastomosis (4 vs. 22, respectively, p = 0.0001). Uni- and multivariate analyses excluded the reconstruction type as a possible parameter for insufficiency. Furthermore, neither hospital mortality nor long-term survival was significantly different between the two groups. This clinical series is the first to compare FRG and conventional gastric tube reconstruction after esophagectomy in esophageal cancer. With comparable perioperative and long-term results of either technique, the increased length

  19. Long-term results after repair of ruptured and non-ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Kuzmanović Ilija B.


    Full Text Available INTRODUCTION Abdominal aortic aneurysm can be repaired by elective procedure while asymptomatic, or immediately when it is complicated - mostly due to rupture. Treating abdominal aneurysm electively, before it becomes urgent, has medical and economical reason. Today, the first month mortality after elective operations of the abdominal aorta aneurysm is less than 3%; on the other hand, significant mortality (25%-70% has been recorded in patients operated immediately because of rupture of the abdominal aneurysm. In addition, the costs of elective surgical treatment are significantly lower. OBJECTIVE The objective of this study is to compare long-term survival of patients that underwent elective or immediate repair of abdominal aortic aneurysm (due to rupture, and to find out the factors influencing the long-term survival of these patients. MATERIAL AND METHODS Through retrospective review of prospectively collected data of the Institute for Cardiovascular Diseases of Clinical Center of Serbia, Belgrade, 56 patients that had elective surgery and 35 patients that underwent urgent operation due to rupture of abdominal aneurysm were followed up. Only the patients that survived 30 postoperative days were included in this review, and were followed up (ranging from 2 to 126 months. Electively operated patients were followed during 58.82 months on the average (range 7 to 122, and urgently operated were followed over 52.26 months (range 2 to 126. There was no significant difference of the length of postoperative follow-up between these two groups. RESULTS During this period, out of electively operated and immediately operated patients, 27 and 22 cases died, respectively. There was no significant difference (p>0,05a of long-term survival between these two groups. Obesity and early postoperative complications significantly decreased long-term survival of both electively and immediately operated patients. Graft infection, ventral hernia, aneurysm of

  20. Long-term results of transarticular pinning for surgical stabilisation of coxofemoral luxation in 20 cats. (United States)

    Sissener, T R; Whitelock, R G; Langley-Hobbs, S J


    The objective of this study was to describe initial and long-term results of open reduction and transarticular pinning for treatment of coxofemoral luxations in cats. Cats were treated by open reduction and transarticular pinning for coxofemoral luxation over a five year period at two institutions. Follow-up assessment included orthopaedic examination, radiography and owner questionnaires. Twenty cats were included in the study (14 males and six females). One cat was affected bilaterally. Mean time to follow-up was 21 months. Seventeen joints were stabilised with a 1.6 mm pin, three with 2.0 mm pins and a 1.2 mm pin was used in the remaining joint. An Ehmer sling was not utilised in any case. All transarticular pins except one were removed (mean 3.5 weeks), with all hips still in reduction The overall success rate was 77 per cent, with two reluxations and one resorbed femoral head noted on radiographs of 13 joints followed long term. All 20 owners reported good to excellent long-term functional outcome for their cats. Results from this study indicate that transarticular pinning for stabilisation of coxofemoral luxation in cats can provide a good long-term outcome without sacrificing the integrity of the coxofemoral joint.

  1. Long-term results of young patients with acute coronary syndrome undergoing coronary stent implantation. (United States)

    Yao, Yuan; Zhang, Yao


    Long-term follow-up studies on young patients with acute coronary syndrome (ACS) undergoing coronary stent implantation are relatively scarce. This study was applied to review the long-term results of young ACS patients who had undergone coronary stenting in our hospital. One hundred and two young patients with ACS underwent coronary stent implantation in our hospital. In this study, inpatient records and long-term data of the 102 patients were comprehensively collected for analysis. Major gender of the young patients was men. Most of the patients had smoking, and each patient had at least one risk factor. During hospitalization, no patient died. At last follow-up, all patients were alive and the occurrence rate of major adverse cardio/cerebrovascular accidents was 4.9%. In summary, long-term follow-ups revealed extremely satisfactory outcomes in young ACS patients after coronary stent implantation. Smoking and traditional ACS risk factors are the leading causes of ACS in young population.

  2. Adenocarcinoma arising in multiple hyperplastic polyps in a patient with Helicobacter pylori infection and hypergastrinemia during long-term proton pump inhibitor therapy. (United States)

    Anjiki, Hajime; Mukaisho, Ken-Ichi; Kadomoto, Yu; Doi, Hisakazu; Yoshikawa, Kunio; Nakayama, Takahisa; Vo, Diem Thi-Ngoc; Hattori, Takanori; Sugihara, Hiroyuki


    We report a case of developing multiple adenocarcinoma foci in multiple hyperplastic polyps in a patient with Helicobacter pylori infection and hypergastrinemia during long-term proton pump inhibitor (PPI) therapy. A 57-year-old man, who was undergoing hemodialysis for chronic renal failure, underwent an upper gastrointestinal endoscopy to elucidate the cause of anemia. Atrophic gastritis with H. pylori infection and multiple adenocarcinoma foci in multiple hyperplastic polyps were found in the endoscopic and histological examinations. Enterochromaffin-like micronests and parietal cell protrusion in the background of the polyps suggested the existence of hypergastrinemia. The serum gastrin level was markedly high-10,206 pg/ml (normal range 37-172 pg/ml). The cause of this marked hypergastrinemia was not autoimmune gastritis and gastrinoma. After discontinuing PPI therapy and successful eradication of H. pylori, the serum gastrin level decreased to normal range. These findings indicate that hypergastrinemia may be caused by long-term PPI therapy in patients with H. pylori infection. This case suggests that hypergastrinemia may mediate gastric carcinogenesis in patients with H. pylori infection.

  3. Radiologic Predictors for Clinical Stage IA Lung Adenocarcinoma with Ground Glass Components: A Multi-Center Study of Long-Term Outcomes. (United States)

    Li, Zhao; Ye, Bo; Bao, Minwei; Xu, Binbin; Chen, Qinyi; Liu, Sida; Han, Yudong; Peng, Mingzhen; Lin, Zhifeng; Li, Jingpei; Zhu, Wenzhuo; Lin, Qiang; Xiong, Liwen


    This study was to define preoperative predictors from radiologic findings for the pathologic risk groups based on long-term surgical outcomes, in the aim to help guide individualized patient management. We retrospectively reviewed 321 consecutive patients with clinical stage IA lung adenocarcinoma with ground glass component on computed tomography (CT) scanning. Pathologic diagnosis for resection specimens was based on the 2011 IASLC/ATS/ERS classification of lung adenocarcinoma. Patients were classified into different pathologic risk grading groups based on their lymph node status, local regional recurrence and overall survival. Radiologic characteristics of the pulmonary nodules were re-evaluated by reconstructed three-dimension CT (3D-CT). Univariate and multivariate analysis identifies independent radiologic predictors from tumor diameter, total volume (TV), average CT value (AVG), and solid-to-tumor (S/T) ratio. Receiver operating characteristic curves (ROC) studies were carried out to determine the cutoff value(s) for the predictor(s). Univariate cox regression model was used to determine the clinical significance of the above findings. A total of 321 patients with clinical stage IA lung adenocarcinoma with ground glass components were included in our study. Patients were classified into two pathologic low- and high- risk groups based on their distinguished surgical outcomes. A total of 134 patients fell into the low-risk group. Univariate and multivariate analyses identified AVG (HR: 32.210, 95% CI: 3.020-79.689, Plung adenocarcinoma. Statistical significance of 5-year OS and RFS was noted among clinical low-, moderate- and high-risk groups (log-rank, p = 0.024 and 0.010). The AVG and the S/T ratio by reconstructed 3D-CT are important preoperative radiologic predictors for pathologic risk grading. The two cutoff values of AVG and S/T ratio are recommended in decision-making for patients with clinical stage IA lung adenocarcinoma with ground glass components.

  4. Nuss procedure for pectus excavatum in adults: long-term results in a prospective observational study. (United States)

    Hoksch, Beatrix; Kocher, Gregor; Vollmar, Philippe; Praz, Fabien; Schmid, Ralph Alexander


    Since the end of the 1990s, the management of pectus excavatum has undergone major changes. The Nuss procedure (pectus bar) has been the method of choice for patients with pectus excavatum at Bern University Hospital for over a decade. The current study will describe our experiences, with a particular focus on long-term results in adults. The prospective observational study began in autumn 2002. The Haller index was used to quantify pectus excavatum severity. Pulmonary function tests and cardiac examinations were performed preoperatively, and a standardized management for surgical techniques and for the pre- and postoperative treatments including long-term follow-up at 3, 12 and 36 months after surgery was developed. Quality of life and satisfaction with the cosmetic result after the Nuss procedure were evaluated. Better or much better quality of life after the Nuss procedure was observed: n = 108 (88.4%) at 3 months, n = 97 (89.0%) at 12 months and n = 87 (92.5%) at 36 months. Pain intensity decreased in the follow-up [pain score visual analogue scale (VAS) at 3 months: median 1 (0-7), 12 months: median 1 (0-4), 36 months: median 0.8 (0-5)]. After long-term observation, over 90% of patients described their quality of life after the operation as being better or much better. Satisfaction with the cosmetic results of the operation was also very high, with >90% of patients being satisfied. Only a very small group of patients suffered from pain in the long-term follow-up. Complications were rare (14.7%) and could be treated in most cases without reoperation. Our results demonstrate that the Nuss procedure is safe and can be performed with excellent results in adults, both in the short term and in the long term. The improved quality of life and patients' satisfaction with cosmetic results remained high in the long-term follow-up, 10 years after the surgical procedure. © The Author 2016. Published by Oxford University Press on behalf of the European Association for

  5. Detailed analysis of epithelial-mesenchymal transition and tumor budding identifies predictors of long-term survival in pancreatic ductal adenocarcinoma. (United States)

    Kohler, Ilona; Bronsert, Peter; Timme, Sylvia; Werner, Martin; Brabletz, Thomas; Hopt, Ulrich Theodor; Schilling, Oliver; Bausch, Dirk; Keck, Tobias; Wellner, Ulrich Friedrich


    Pancreatic ductal adenocarcinoma (PDAC) is characterized by aggressive biology and poor prognosis even after resection. Long-term survival is very rare and cannot be reliably predicted. Experimental data suggest an important role of epithelial-mesenchymal transition (EMT) in invasion and metastasis of PDAC. Tumor budding is regarded as the morphological correlate of local invasion and cancer cell dissemination. The aim of this study was to evaluate the biological and prognostic implications of EMT and tumor budding in PDAC of the pancreatic head. Patients were identified from a prospectively maintained database, and baseline, operative, histopathological, and follow-up data were extracted. Serial tissue slices stained for Pan-Cytokeratin served for analysis of tumor budding, and E-Cadherin, Beta-Catenin, and Vimentin staining for analysis of EMT. Baseline, operative, standard pathology, and immunohistochemical parameters were evaluated for prediction of long-term survival (≥ 30 months) in uni- and multivariate analysis. Intra- and intertumoral patterns of EMT marker expression and tumor budding provide evidence of partial EMT induction at the tumor-host interface. Lymph node ratio and E-Cadherin expression in tumor buds were independent predictors of long-term survival in multivariate analysis. Detailed immunohistochemical assessment confirms a relationship between EMT and tumor budding at the tumor-host interface. A small group of patients with favorable prognosis can be identified by combined assessment of lymph node ratio and EMT in tumor buds. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  6. Requirements for a Stable Long-Term Result in Surgical Reduction of Vertebral Fragility Fractures. (United States)

    Crespo-Sanjuán, Jesús; Ardura, Francisco; Hernández-Ramajo, Rubén; Noriega, David C


    Osteoporotic vertebral fractures are one of the major health problems in the world. Minimally invasive surgical treatment has great advantages compared with conservative treatment in treating these fractures, because it eliminates pain and functional disability. The percutaneous intravertebral expandable titanium device SpineJack (Vexim SA, Balma, France) is beneficial compared with other kyphoplasty devices, showing results that are maintained over time and a reduction in complications. However, controversy exists about the minimum amount of cement that should be used to achieve long-term restoration and which is essential to minimize complications. We reviewed publications studying the maintenance of long-term restoration using this percutaneous expandable titanium device in cadavers. In this study, we show the first long-term work with patients treated with percutaneous expandable titanium device, describing precise indications concerning the minimum amount of cement that should be used. Results were evaluated from a clinical study including 178 patient outcomes with long-term follow-up results performed by our team. The mean total quantity of cement injected was 4.4 mL (25% vertebral body filling). The leakage rate was 12.9%, and all of these occurrences were asymptomatic. The mean follow-up time was 77 months (60-96 months). All clinical scales improved significantly after the procedure. A recollapse of the treated vertebra was observed in 3 cases (1.6%), and the adjacent fracture rate was 2.2%. From the results of our study and review of the literature, cement equivalent to 25% of the vertebral body filling volume, when combined with the titanium expandable device, seems to be sufficient to prevent recollapse in osteoporotic and type A.3 fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. medium- and long-term results of surgical therapy of nasal valve incompetency


    Wendt, Susanne


    Background: A frequent cause for nasal airway obstruction is the incompetence of the internal nasal valve. Many techniques, e. g. Butterfly grafts, Flaring sutures and Spreader grafts, have been described for the management of cases with incompetent cartilage support or with narrowed nasal valve angle. However, all of these techniques show weaknesses in long-term functionality and/ or cosmetic results. A new technique to spread and stabilize the internal nasal valve was developed by àWengen i...

  8. Long-Term Results of Bariatric Restrictive Procedures: A Prospective Study (United States)

    Wiryasaputra, Dorothee C.; van Dielen, Francois M. H.; van Gemert, Wim G.; Greve, Jan Willem M.


    Laparoscopic adjustable gastric banding (LAGB) and vertical-banded gastroplasty (VBG) are surgical treatment modalities for morbid obesity. This prospective study describes the long-term results of LAGB and VBG. One hundred patients were included in the study. Fifty patients underwent LAGB and 50 patients, open VBG. Study parameters were weight loss, changes in obesity-related comorbidities, long-term complications, re-operations including conversions to other bariatric procedures and laboratory parameters including vitamin status. From 91 patients (91%), data were obtained with a mean follow-up duration of 84 months (7 years). Weight loss [percent excess weight loss (EWL)] was significantly more after VBG compared with LAGB, 66% versus 54%, respectively. All comorbidities significantly decreased in both groups. Long-term complications after VBG were mainly staple line disruption (54%) and incisional hernia (27%). After LAGB, the most frequent complications were pouch dilatation (21%) and anterior slippage (17%). Major re-operations after VBG were performed in 60% of patients. All re-operations following were conversions to Roux-en-Y gastric bypass (RYGB). In the LAGB group, 33% of patients had a refixation or replacement of the band, and 11% underwent conversion to another bariatric procedure. There were no significant differences in weight loss between patients with or without re-interventions. No vitamin deficiencies were present after 7 years, although supplement usage was inconsistent. This long-term follow-up study confirms the high occurrence of late complications after restrictive bariatric surgery. The failure rate of 65% after VBG is too high, and this procedure is not performed anymore in our institution. The re-operation rate after LAGB is decreasing as a result of new techniques and materials. Results of the re-operations are good with sustained weight loss and reduction in comorbidities. However, in order to achieve these results, a durable and

  9. Cecal Ligation and Puncture Results in Long-Term Central Nervous System Myeloid Inflammation.

    Directory of Open Access Journals (Sweden)

    Benjamin H Singer

    Full Text Available Survivors of sepsis often experience long-term cognitive and functional decline. Previous studies utilizing lipopolysaccharide injection and cecal ligation and puncture in rodent models of sepsis have demonstrated changes in depressive-like behavior and learning and memory after sepsis, as well as evidence of myeloid inflammation and cytokine expression in the brain, but the long-term course of neuroinflammation after sepsis remains unclear. Here, we utilize cecal ligation and puncture with greater than 80% survival as a model of sepsis. We found that sepsis survivor mice demonstrate deficits in extinction of conditioned fear, but no acquisition of fear conditioning, nearly two months after sepsis. These cognitive changes occur in the absence of neuronal loss or changes in synaptic density in the hippocampus. Sepsis also resulted in infiltration of monocytes and neutrophils into the CNS at least two weeks after sepsis in a CCR2 independent manner. Cellular inflammation is accompanied by long-term expression of pro-inflammatory cytokine and chemokine genes, including TNFα and CCR2 ligands, in whole brain homogenates. Gene expression analysis of microglia revealed that while microglia do express anti-microbial genes and damage-associated molecular pattern molecules of the S100A family of genes at least 2 weeks after sepsis, they do not express the cytokines observed in whole brain homogenates. Our results indicate that in a naturalistic model of infection, sepsis results in long-term neuroinflammation, and that this sustained inflammation is likely due to interactions among multiple cell types, including resident microglia and peripherally derived myeloid cells.

  10. Cecal Ligation and Puncture Results in Long-Term Central Nervous System Myeloid Inflammation. (United States)

    Singer, Benjamin H; Newstead, Michael W; Zeng, Xianying; Cooke, Christopher L; Thompson, Robert C; Singer, Kanakadurga; Ghantasala, Ramya; Parent, Jack M; Murphy, Geoffrey G; Iwashyna, Theodore J; Standiford, Theodore J


    Survivors of sepsis often experience long-term cognitive and functional decline. Previous studies utilizing lipopolysaccharide injection and cecal ligation and puncture in rodent models of sepsis have demonstrated changes in depressive-like behavior and learning and memory after sepsis, as well as evidence of myeloid inflammation and cytokine expression in the brain, but the long-term course of neuroinflammation after sepsis remains unclear. Here, we utilize cecal ligation and puncture with greater than 80% survival as a model of sepsis. We found that sepsis survivor mice demonstrate deficits in extinction of conditioned fear, but no acquisition of fear conditioning, nearly two months after sepsis. These cognitive changes occur in the absence of neuronal loss or changes in synaptic density in the hippocampus. Sepsis also resulted in infiltration of monocytes and neutrophils into the CNS at least two weeks after sepsis in a CCR2 independent manner. Cellular inflammation is accompanied by long-term expression of pro-inflammatory cytokine and chemokine genes, including TNFα and CCR2 ligands, in whole brain homogenates. Gene expression analysis of microglia revealed that while microglia do express anti-microbial genes and damage-associated molecular pattern molecules of the S100A family of genes at least 2 weeks after sepsis, they do not express the cytokines observed in whole brain homogenates. Our results indicate that in a naturalistic model of infection, sepsis results in long-term neuroinflammation, and that this sustained inflammation is likely due to interactions among multiple cell types, including resident microglia and peripherally derived myeloid cells.

  11. Long-term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis in the pediatric population. (United States)

    Merino-Ingelmo, Raquel; Santos-de Soto, José; Coserria-Sánchez, Félix; Descalzo-Señoran, Alfonso; Valverde-Pérez, Israel


    Percutaneous pulmonary valvuloplasty is the preferred interventional procedure for pulmonary valve stenosis. The aim of this study was to evaluate the effectiveness of this technique, assess the factors leading to its success, and determine the long-term results in the pediatric population. The study included 53 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty between December 1985 and December 2000. Right ventricular size and functional echocardiographic parameters, such as pulmonary regurgitation and residual transvalvular gradient, were assessed during long-term follow-up. Peak-to-peak transvalvular gradient decreased from 74 mmHg [interquartile range, 65-100 mmHg] to 20 mmHg [interquartile range, 14-34 mmHg]. The procedure was unsuccessful in 2 patients (3.77%). The immediate success rate was 73.58%. Follow-up ranged from 10 years to 24 years (median, 15 years). During follow-up, all patients developed late pulmonary regurgitation which was assessed as grade II in 58.4% and grade III in 31.2%. There was only 1 case of long-term restenosis (2.1%). Severe right ventricular dilatation was observed in 27.1% of the patients. None of the patients developed significant right ventricular dysfunction. Pulmonary valve replacement was not required in any of the patients. Percutaneous balloon valvuloplasty is an effective technique in the treatment of pulmonary valve stenosis with good long-term results. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  12. Long-term Results of Percutaneous Ethanol Injection for the Treatment of Hepatocellular Carcinoma in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Yon Mi; Choi, Don Gil; Lim, Hyo K. [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)] (and others)


    To evaluate the long-term follow-up results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in Korea. Sixty-eight nodular HCCs initially detected in 64 patients, were subjected to US-guided PEI as a first-line treatment. Long-term survival rates, local tumor progression rates, and complications were evaluated, as were the influences of tumor size and Child-Pugh class on these variables. No major complications occurred. The overall survival rates of the 64 patients at three and five years were 71% and 39%, and their cancer-free survival rates were 22% and 15%, respectively. The overall survival rate of patients with a small HCC ({<=} 2 cm) was significantly higher (p = 0.014) than that of patients with a medium-sized HCC ({<=} 2 cm). The overall survival rate of patients with Child- Pugh class A was significantly higher (p = 0.049) than that of patients with Child- Pugh class B. Of 59 cases with no residual tumor, local tumor progression was observed in ablation zones in 18, and this was not found to be significantly influenced by tumor size or Child-Pugh class. The results of our investigation of the long-term survival rates of PEI in HCC patients in Korea (a hepatitis B virus-endemic area) were consistent with those reported previously in hepatitis C endemic areas. Patients with a smaller tumor or a better liver function exhibited superior survival rates.

  13. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results

    Directory of Open Access Journals (Sweden)

    Weiss Hans-Rudolf


    Full Text Available Abstract Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS, early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years and long-term results (7 years or more, both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures

  14. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results (United States)


    Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated

  15. [Robot-assisted laparoscopic pyeloplasty in adults: Excellent long-term results of primary pyeloplasty]. (United States)

    Traumann, M; Kluth, L A; Schmid, M; Meyer, C; Schwaiger, B; Rosenbaum, C; Schriefer, P; Fisch, M; Dahlem, R; Seiler, D; Ahyai, S; Haese, A; Chun, F K-H


    With the development of the robot-assisted surgical technique, robot-assisted pyeloplasty (RAP) has become established as an alternative to open and laparoscopic surgery. Currently there are only a few single-center studies with larger numbers of cases and long-term results. The aim of this study was to investigate perioperative and long-term postoperative success rates of Anderson-Hynes robot-assisted pyeloplasty (RAP) at a single center. We retrospectively reviewed our RAP experience of 61 patients performed by two surgeons between 2004 and 2013 regarding operating time, length of hospital stay, perioperative complication, and success. Overall success was measured in terms of necessary redo pyeloplasty. We also identified patients with temporary stent placement due to symptomatic hydronephrosis or with further obstruction in diuretic renography. Median age, operating time, and follow-up were 33 years, 195 min, and 64 months, respectively. No conversion to open procedure was necessary. The success rate was 98% (n=60) with 1 patient undergoing open redo pyeloplasty due to a recurrent stenosis. Temporary stent placement was required in 3 patients due to pyelonephritis and dilatation. Satisfying long-term success rates including low complication rates of RAP were obtained in this study. RAP presents a safe and standardized procedure for symptomatic ureteropelvic junction obstruction.

  16. Long-term results of transperitoneal laparoscopic fenestration in the treatment of simple renal cysts. (United States)

    Iannelli, Antonio; Fabiani, Pascal; Niesar, Eric; Gigante, Marc; Benizri, Emmanuel I; Amiel, Jean; Toubol, Jacques; Mouiel, Jean; Gugenheim, Jean


    The aim of this paper was to assess long-term results of transperitoneal laparoscopic fenestration in the treatment of symptomatic simple renal cysts. Fifteen consecutive patients (7 men, 8 women), with a mean age of 51 years (range, 36-79 years), underwent transperitoneal fenestration of simple renal cysts (SRC) at our institution from 1994 to 2001. Data were collected by reviewing patients' clinical files, conducting telephone interviews regarding symptoms, and followup renal ultrasonography (US). There were 15 symptomatic cysts (10 parenchymal, 5 peripelvic) ranging in diameter from 3.5 to 20 cm (mean, 8 cm). All patients had lumbar pain and in four (26.6%) the collecting system was compressed by the cysts. Fenestration was carried out laparoscopically in all patients. There was no mortality and no postoperative complications were recorded. No malignancies were detected at final histopathology. Mean length of stay was 2.5 days. All patients were available for long-term followup. At a mean of 60 months (range, 22-93 months) from surgery, three patients (20%) complained of slight discomfort in the lumbar area not requiring any analgesic. No recurrence of the cysts was seen on US. Two asymptomatic patients (13.3%) developed additional cysts originating from sites different than the one operated on. Laparoscopic fenestration of SRC is safe and effective in the long term to relieve patients from symptoms.

  17. [Endovascular treatment of symptomatic intracranial stenoses: short- and long-term results in a single center]. (United States)

    Aparici Robles, F; Mainar Tello, E; Vázquez-Añón, V; Lago Martín, A; Parkhutik, V; Tembl Ferrairo, J


    We present the short- and long-term results of a series of patients with symptomatic intracranial arterial stenoses treated with angioplasty and stenting. We reviewed patients with symptomatic intracranial stenoses greater than 50% who were treated with angioplasty, stenting, or both. We recorded demographic data and risk factors (hypertension, diabetes, dyslipemia, ischemic heart disease). We classified all lesions treated according to their location, degree of stenosis, and length. The degree of stenosis was classified as moderate (50%-70%) or severe (>70%). In the follow-up, we assessed cerebrovascular accidents, episodes of ischemic heart disease, and deaths in the first 30 days and in later follow-up. Between 2006 and 2010, we treated 26 patients (21 men and 5 women; age range, 44-79 years; mean age, 63 years) with 29 intracranial lesions. The endovascular procedure (angioplasty+stenting) was successfully performed in 23 cases (92.0%). In the first 30 days after the procedure, 3 (11.5%) patients had adverse effects of vascular origin: 1 stroke, 1 hemorrhage, and 1 death due to thrombosis of the stent. Long-term follow-up (5-46 months) in the 25 patients who survived more than 30 days detected no recurrence of symptoms. Endovascular treatment of intracranial stenosis is technically feasible. Short-term complications are highly prevalent. No recurrence of symptoms was detected during long-term follow-up. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  18. Minimally invasive mitral valve repair in Barlow's disease: early and long-term results. (United States)

    Borger, Michael A; Kaeding, Anna F; Seeburger, Joerg; Melnitchouk, Serguei; Hoebartner, Michael; Winkfein, Michael; Misfeld, Martin; Mohr, Friedrich W


    Barlow's disease remains a challenging surgical pathology in patients presenting with mitral regurgitation. We reviewed our early and long-term results for patients with Barlow's disease who underwent minimally invasive mitral valve surgery. Between 1999 and 2010, 145 patients with Barlow's disease underwent minimally invasive mitral valve repair at Leipzig Heart Center. Preoperative echocardiography and intraoperative valve analysis confirmed annular dilatation, bileaflet prolapse, and excessive leaflet tissue in all cases. We retrospectively reviewed mitral valve repair techniques, early and late postoperative clinical outcomes, and follow-up echocardiographic data. Successful mitral valve repair was performed in 94.5% of patients (n=137), initial mitral valve replacement was performed in 2.8% of patients (n=4), and mitral valve replacement after unsuccessful mitral valve repair was performed in 2.8% of patients (n=4). Mean aortic crossclamp time was 99±33 minutes, cardiopulmonary bypass time was 153±47 minutes, and total duration of surgery was 200±44 minutes. Mitral valve repair techniques consisted of ring annuloplasty and a variety of other methods (not mutually exclusive): "loop" neochordae (72% of patients), posterior mitral leaflet resection (28%), Alfieri stitch (17%), commissural plication (9%), chordal transfer (9%), and anterior mitral leaflet resection (7%). Concomitant procedures consisted of cryoablation for atrial fibrillation (28%), tricuspid valve repair (6%), and closure of an atrial septal defect/patent foramen ovale (12%). Thirty-day mortality was 1.4% (n=2), rethoracotomy for bleeding was required in 4.1% of patients (n=6), and conversion to sternotomy was required in 1 patient (0.7%). Long-term clinical follow-up was obtained in 100% of patients, and long-term echocardiographic data were obtained in 93.3% of surviving patients. Long-term survival was 94.7%±2.2% at 5 years and 88.3%±4.9% at 10 years. Freedom from mitral valve reoperation

  19. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. (United States)

    Pachon, Jose Carlos M; Pachon, Enrique Indalecio M; Cunha Pachon, Maria Zelia; Lobo, Tasso Julio; Pachon, Juan Carlos M; Santillana, Tomas Guilhermo P


    Neurally meditated reflex or neurocardiogenic or vasovagal syncope (NMS) is usually mediated by a massive vagal reflex. This study reports the long-term outcome of NMS therapy based on endocardial radiofrequency (RF) catheter ablation of the cardiac vagal nervous system aiming permanent attenuation or elimination of the cardioinhibitory reflex (cardioneuroablation). A total of 43 patients (18F/25M, 32.9 ± 15 years) without apparent cardiopathy (left ventricular ejection fraction=68.6 ± 5%) were included. All had recurrent NMS (4.7 ± 2 syncope/patient) with important cardioinhibition (pauses=13.5 ± 13 s) at head-up tilt test (HUT), normal electrocardiogram (ECG), and normal atropine test (AT). The patients underwent atrial endocardial RF ablation using spectral mapping to track the neurocardiac interface (AF Nest Mapping). The follow-up (FU) consisted of clinical evaluation, ECG (1 month/every 6 months/or symptoms), Holter (every 6 months/or symptoms), HUT (≥ 4 months/or symptoms), and AT (end of ablation and ≥ 6 months). A total of 44 ablations (48 ± 9 points/patient) were performed. Merely three cases of spontaneous syncope occurred in 45.1 ± 22 months (two vasodepressor, one undefined). Only four partial cardioinhibitory responses occurred in post-ablation HUT without pauses or asystole (sinus bradycardia). Long-term AT (21.7 ± 11 months post) was negative in 33 (76.7%, P < 0.01), partially positive in 7(16.3%), and normal in three patients only (6.9%) reflecting long-term vagal denervation (AT-Δ%HR pre 79.4% × 23.2% post). The post-ablation stress test and Holter showed no abnormalities. No major complications occurred. Endocardial RF catheter ablation of severe neurally meditated reflex syncope prevented pacemaker implantation and showed excellent long-term results in well selected patients. Despite no action in vasodepression it seems to cause enough long-term vagal reflex attenuation, eliminating the cardioinhibition, and keeping most patients

  20. Comparison of long-term results of laparoscopic and endoscopic exploration of common bile duct

    Directory of Open Access Journals (Sweden)

    Rai Sarabjit


    Full Text Available Background: To compare long term results of laparoscopic and endoscopic exploration of common bile duct, to assess post-procedure quality of life. Materials and Methods: From September 1992 to August 2003, we performed 4058 cholecystectomies, out of which 479 (11.80% patients had choledocholithiasis. There were 163 males and 316 females. Mean age was 63.65 ± 5.5 years. These patients were put in two groups. In the first group of 240 patients, a majority of patients underwent two-stage procedures. ERCP/ES was performed in 210 (87.50% cases. In the second group of 239 patients, a majority of patients underwent single-stage procedures. ERCP/ES was done in 32 (13.38% cases. Results: Mortality was zero in both groups. Morbidity was 15.1% in first group and 7.5% in second group. Mean hospital stay was 11.7 ± 3.2 days in first group and 6.2 ± 2.1 days in second group. Average operative time was 95.6 ± 20 minutes in first group and 128.4 ± 32 minutes in second group. Completed questionnaires received from 400 (83.50% patients revealed better long-term results in the second group. Clinical features of low-grade cholangitis were seen in 20% of patients who underwent ES. Hence the post-procedure quality of life in patients who underwent single-stage procedures was definitely much better, because of minimal damage of sphincter of Oddi. Conclusions: Single-stage laparoscopic operations provide better results and shorter hospital stay. Damage to sphincter of Oddi should be minimal, to avoid long-term low-grade cholangitis. In young patients, the operation of choice should be single-stage laparoscopic procedure with absolutely no damage to sphincter of Oddi.

  1. Long-term Results of Endovascular Stent Graft Placement of Ureteroarterial Fistula

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Takuya, E-mail:; Yamaguchi, Masato, E-mail: [Kobe University Hospital, Department of Radiology (Japan); Muradi, Akhmadu, E-mail:; Nomura, Yoshikatsu, E-mail: [Kobe University Hospital, Center for Endovascular Therapy (Japan); Uotani, Kensuke, E-mail: [Tenri Hospital, Department of Radiology (Japan); Idoguchi, Koji, E-mail: [Kobe University Hospital, Center for Endovascular Therapy (Japan); Miyamoto, Naokazu, E-mail:; Kawasaki, Ryota, E-mail: [Hyogo Brain and Heart Center at Himeji, Department of Radiology (Japan); Taniguchi, Takanori, E-mail: [Tenri Hospital, Department of Radiology (Japan); Okita, Yutaka, E-mail: [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimoto, Koji, E-mail: [Kobe University Hospital, Department of Radiology (Japan)


    PurposeTo evaluate the safety, efficacy, and long-term results of endovascular stent graft placement for ureteroarterial fistula (UAF).MethodsWe retrospectively analyzed stent graft placement for UAF performed at our institution from 2004 to 2012. Fistula location was assessed by contrast-enhanced computed tomography (CT) and angiography, and freedom from hematuria recurrence and mortality rates were estimated.ResultsStent graft placement for 11 UAFs was performed (4 men, mean age 72.8 {+-} 11.6 years). Some risk factors were present, including long-term ureteral stenting in 10 (91 %), pelvic surgery in 8 (73 %), and pelvic radiation in 5 (45 %). Contrast-enhanced CT and/or angiography revealed fistula or encasement of the artery in 6 cases (55 %). In the remaining 5 (45 %), angiography revealed no abnormality, and the suspected fistula site was at the crossing area between urinary tract and artery. All procedures were successful. However, one patient died of urosepsis 37 days after the procedure. At a mean follow-up of 548 (range 35-1,386) days, 4 patients (36 %) had recurrent hematuria, and two of them underwent additional treatment with secondary stent graft placement and surgical reconstruction. The hematuria recurrence-free rates at 1 and 2 years were 76.2 and 40.6 %, respectively. The freedom from UAF-related and overall mortality rates at 2 years were 85.7 and 54.9 %, respectively.ConclusionEndovascular stent graft placement for UAF is a safe and effective method to manage acute events. However, the hematuria recurrence rate remains high. A further study of long-term results in larger number of patients is necessary.

  2. Long-term results of viscocanalostomy and phacoviscocanalostomy: a twelve-year follow-up study

    Directory of Open Access Journals (Sweden)

    Uzeyir Gunenc


    Full Text Available AIM: To evaluate the long-term efficacy and safety results of viscocanalostomy and phacoviscocanalostomy. METHODS: The charts of 49 glaucoma patients who underwent viscocanalostomy or phacoviscocanalostomy surgery between February 1999 and August 2004 were reviewed retrospectively. Thirty-one eyes of 21 glaucoma patients who underwent filtering procedure with a postoperative follow-up of at least 5y were included in the study. Results of complete ophthalmologic examinations were recorded and statistically analyzed. Long-term surgical outcome was defined as an overall success when intraocular pressure (IOP was found as ≤20 mm Hg with or without antiglaucomatous medication at the last follow-up visit, while it was defined as a complete success when IOP was measured ≤20 mm Hg without antiglaucomatous medication. RESULTS: Mean age was 68.1±9.6y (range: 32-81y. Mean follow-up time was 101.5±27.3mo (range: 60-144mo. Viscocanalostomy was performed in 8 eyes (25.8% and phacoviscocanalostomy was performed in 23 eyes (74.2%. The mean preoperative IOP was 23.1±7.6 mm Hg with 2.1±1.0 medications, while mean IOP was 16.8±3.8 mm Hg with 0.9±1.1 medication at the last follow-up visit. Both the IOP decrease and the reduction in the antiglaucomatous medication were statistically significant (P<0.001 and P<0.001. No case required further glaucoma surgery. Overall success and complete success were found as 87.1% and 51.6%, respectively. Complete success rate was statistically higher in phacoviscocanalostomy group compared with the viscocanalostomy group (P=0.031, however there was no significant difference in overall success rate between two groups (P=0.072. CONCLUSION: Both viscocanalostomy and phacoviscocanalostomy provide good IOP reduction in the long-term period.

  3. Nerve root decompression without fusion in spondylolytic spondylolisthesis: long-term results of Gill's procedure. (United States)

    Arts, Mark; Pondaag, Willem; Peul, Wilco; Thomeer, Raph


    Nerve root decompression with instrumented fusion is currently most commonly performed in the treatment of patients with spondylolytic spondylolisthesis. The relationship between successful fusion and clinical outcome remains controversial, thereby questioning the necessity of fusion. Nerve root decompression without fusion, i.e. Gill's procedure, might be a less invasive surgical alternative with comparable clinical outcome. The objective of this study is to compare the long-term results of Gills's procedure with data from literature on decompression with fusion, and, moreover, to determine if a future randomised trial is legitimate. We retrospectively reviewed the long-term results of Gill's procedure in patients with grade I or II spondylolytic spondylolisthesis. All patients suffered from leg pain with or without low back pain. No patient had low back pain alone. In 17 patients a bilateral and in 25 patients a unilateral Gill's procedures were performed. The patients were evaluated at three follow-up moments. On moment 1, 38 patients were clinically examined on their last out-patient control (mean follow-up 11 months). On moment 2, 34 patients were interviewed by telephone (mean follow-up 4.4 years). The final long-term follow-up moment 3 (mean follow-up 10.5 years) included a mailed patient-satisfaction questionnaire of 31 patients (response rate 74%). No surgical complication occurred. Ten of the 42 patients were reoperated because of persistent or recurrent radicular pain (mean time interval 2.9 years). Kaplan-Meier analysis showed a disease-free survival rate of 79% at 5 years and 72% at 10 years after the index operation. On the three follow-up moments, the improvement of leg pain was 92, 97 and 88%, respectively. The final long-term follow-up showed 71% good result in terms of patient satisfaction. The Gill's procedure is a less invasive surgical technique in the treatment of patients with leg pain due to low-grade spondylolytic spondylolisthesis. This

  4. Transhiatal and transthoracic resection in adenocarcinoma of the esophagus: does the operative approach have an influence on the long-term prognosis? (United States)

    Gockel, Ines; Heckhoff, Sina; Messow, Claudia M; Kneist, Werner; Junginger, Theodor


    The goal of the present analysis was to investigate the long-term prognosis for adenocarcinoma of the esophagus treated with either the transhiatal (TH) or the transthoracic (TT) operative approach. Between September 1985 and March 2004, esophageal resection due to carcinoma was performed on a total of 424 patients. This manuscript takes into account the 150 patients suffering from adenocarcinoma of the esophagus in whom a transhiatal resection of the esophagus was performed. In the event of transmural tumor growth and a justifiable risk of surgery, the transthoracic resection was selected. An extended mediastinal lymph node dissection, however, was only carried out in the course of the transthoracic approach. The transthoracic resection of the esophagus demonstrated a higher rate of general complications (p = 0.011) as well as a higher mortality rate (p = 0.011). The mediastinal dissection of the lymph nodes, however, revealed no prognostic influence. Considering all of the 150 patients with adenocarcinoma, as well as only those patients who had undergone curative resections (R0), the transhiatal approach was seen to demonstrate a better five-year survival rate of 32.1% versus 35.1%, with a median survival time of 24 versus 28 months, as compared with those who had undergone a transthoracic approach with a five-year survival rate of 13.6% (all patients) versus 17.7% (R0 resection) with a median survival time of 16 versus 17 months (p < 0.05). The prognosis in patients with adenocarcinoma of the esophagus is influenced by the depth of the tumor (pT) and the pM-category, as shown in the multivariate analysis. The present analysis did not demonstrate a relevant difference in survival for patients with N0 and N1 stages undergoing transhiatal or transthoracic esophagectomy. It is questionable, if a more extensive mediastinal lymph node dissection, in addition to the clearance of abdominal lymph nodes, offers prognostic advantages in adenocarcinoma of the esophagus

  5. Age-Related Long-Term Functional Results after Riboflavin UV A Corneal Cross-Linking

    Directory of Open Access Journals (Sweden)

    Aldo Caporossi


    Full Text Available Purpose. To report a comparative prospective long-term functional analysis after Riboflavin UV A corneal cross-linking (CXL in three different age groups of patients affected by progressive keratoconus (KC. Methods. Functional analysis comprised paediatric patients (≤18 years included 152 eyes (29.5%; intermediate group (19–26 years 286 eyes (55.4%, and adults (≥27 years 78 eyes (15.1%. CXL was performed according to the Siena protocol by using the Vega CBM (Caporossi-Baiocchi-Mazzotta X linker (CSO, Florence, Italy at Siena University by the same authors. Pre- and post-op examinations included UCVA, BSCVA, corneal topography, and surface aberrometry (CSO Eye Top, Florence, Italy, at 48 months followup. Results. At 48 months followup paediatrics, intermediate, and adult patients showed a mean gain in UCVA of +0.2, +0.14 and +0.12 Snellen lines. BSCVA gained by a mean of +0.21, +0.2, and +0.1 Snellen lines. Kmax was reduced by a mean value of −0.9 D, −0.6 D, and −0.5 D, respectively. Coma values improved by a mean of −0.45 μm, −0.91 μm, and −0.19 μm, respectively. Treatment ensured a long-term keratoconus stabilization in over 90% of treated patients. Conclusion. According to our long-term comparative results, epithelium-off Riboflavin UV A cross-linking should be the first choice therapy of progressive KC, particularly in paediatric age and patients under 26 years.

  6. [Short- and long-term results of a systematic benzodiazepine discontinuation programme for psychiatric patients]. (United States)

    Kan, C C; Mickers, F C; Barnhoorn, D


    Although guidelines for the use of benzodiazepines emphasise that these drugs should only be prescribedfor short periods of time, in practice long-term usage persists and can be a serious problem. There is afear among patients and among doctors prescribing the drugs that symptoms will become more acute if attempts are made to terminate the regimen. To determine the short- and long-term results of a standardized method for discontinuing the use of benzodiazepines (BZD) and to test whether these results were related to the age and gender of the patients, the BZD dosage level and the treatment modality. A retrospective cohort study was performed at the Department of Psychiatry of the Radboud University Nijmegen Medical Centre. A systematic BZD discontinuation programme was offered by the Department of Psychiatry to patients who had been using BZD for at least three months. By studying the medical records, by conducting telephone interviews and by examining the prescription data of the GP or the pharmacy it was ascertained how many patients managed to become abstinent in the short- and long-term. Upon termination of the discontinuation programme 65% of the patients had managed to stop taking BZD and at follow-up approximately 2 years later 37% of the patients interviewed had not used BZD for the last 3 months. Neither age, nor gender, nor treatment modality predicted BZD usage immediately after the end of the discontinuation programme or at the 2-year follow-up. A high dose of BZD was the only significant predictor of post-programme usage 2 years later. A systematic discontinuation programme seems to be just as effective for psychiatric patients as it isfor general practice patients and deserves to be included in the regular treatment programmes provided by psychiatric practices.

  7. Use of Contact Lenses in Eyes with Severe Keratoconus: Long-term Results

    Directory of Open Access Journals (Sweden)

    Zerrin Tuncer


    Full Text Available Pur po se: To evaluate the long-term results of rigid gas permeable (RGP contact lenses in severe keratoconic eyes. Ma te ri al and Met hod: Severe keratoconic eyes with RGP contact lenses were evaluated retrospectively. Re sults: Long-term follow-up results of RGP contact lenses applied to 59 eyes of 42 patients (25 women, 17 men with a diagnosis of severe keratoconus were analyzed. Follow-up period was 3 to 12 years (mean: 6.57±3.60. The mean age at first exam was 25.88±9.10 years, the mean corneal curve K1 was 6.49±0.40 mm and K2 was 5.91±0.40 mm. Mean visual acuities with spectacles and contact lenses were 0.26±0.10 lines (0.63±0.20 logMAR and 0.66±0.20 lines (0.20±0.10 logMAR, respectively. The difference between both visual acuities was statistically significant (p=0.0001. At the last visit, the mean visual acuity with RGP contact lenses was 0.68±0.20 lines (0.19±0.10 logMAR. There was no statistically significant difference in visual acuity between first and last examinations with contact lenses (p=0.32. During the long-term follow-up period, apical scarring developed in 17 eyes. Only the 2 eyes of one patient needed penetrating keratoplasty after 6 years of RGP contact lens use. Dis cus si on: Use of RGP contact lenses should be considered before penetrating keratoplasty in cases of severe keratoconus. (Turk J Ophthalmol 2012; 42: 202-6

  8. Long-term results after Boston brace treatment in adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Steen Harald


    Full Text Available Abstract Background Few studies have evaluated long-term outcome after bracing using validated health related quality of life outcome measures. The aim of the present study was to evaluate the long-term outcome in adolescent idiopathic scoliosis (AIS 12 years or more after treatment with the Boston brace. Methods 109 (80% of 135 patients (7 men with AIS treated with the Boston brace at a mean of 19.2 (range 12–28 years previously responded to long-term follow-up examination. All patients (n = 109 answered a standardised questionnaire including demographics, work status, treatment, Global Back Disability Question, Oswestry Disability Index (ODI (100-worst possible, General Function Score (GFS (100 – worst possible, EuroQol (EQ-5D (1 – best possible, EQ-VAS (100 – best possible and Scoliosis Research Society -22 (SRS – 22 (5 – best possible. Clinical and radiological examination was obtained in 86 patients. Results The magnitude of the primary prebrace major curve was in average 33.4° (range 20 – 52. At weaning and at the last follow-up the corresponding values were 28.3° (9–56 and 34.2° (8 – 87, respectively. The mean age at follow-up was 35 (27 – 46 years. Work status was: full time (80%, on sick-leave (3%, on rehabilitation (4%, disability pension (4%, homemaker (7%, students (2%, 7% had changed their job because of back pain. 88% had had delivered a baby, 55% of them had pain in pregnancy. Global back status was excellent or good in 81%. The mean (standard deviation ODI was 6.4 (9.8, GFS 5.4 (10.5, EQ-5D 0.84 (0.2, SRS-22: pain 4.2 (0.8, mental health 4.2 (0.7, self-image 3.9 (0.7, function 4.1 (0.6, satisfaction with treatment 3.7 (1.0. 28% had taken physiotherapy for back pain the last year and 12% had visited a doctor. Conclusion Long-term results were satisfactory in most patients with AIS treated with the Boston brace.

  9. Long-term results of LINAC-based stereotactic radiosurgery for acoustic neuroma: The Greek experience

    Directory of Open Access Journals (Sweden)

    Kalogeridi Maria-Aggeliki


    Full Text Available Purpose: To estimate the value of LINAC-based stereotactic radiosurgery (SRS for the long-term local control of unilateral acoustic neuromas. Materials and Methods: Twenty patients (median age 66; range 57-80 years with unilateral acoustic neuroma underwent LINAC-based SRS from May 2000 through June 2004 with a dose of 11-12 Gy. The follow-up period ranged from 36 to 84 months (median follow-up period: 55 months. Before SRS none of the patients had useful hearing. The follow-up consisted of repeat imaging studies and clinical examination for assessment of facial and trigeminal nerve function at 6-month intervals for the first year and yearly thereafter. Results: Eleven tumors (58% decreased in size and eight (42% remained stable. One tumor showed a minor increase in size on the MRI done 6 months after SRS in comparison with the pretreatment MRI; however, a subsequent decrease was noticed on the next radiographic assessment and the tumor remained stable from then on. None of the tumors increased in size in the long-term follow-up, thus giving an overall growth control of 100% for the patients in this study. None of the patients had useful hearing before SRS, so hearing level was not assessed during follow-up. No patient developed new, permanent facial or trigeminal neuropathy. Conclusion: LINAC-based SRS with 11-12 Gy provides excellent tumor control in acoustic neuroma and has low toxicity even after long-term follow-up.

  10. Long-term results after laparoscopic sleeve gastrectomy in a large monocentric series. (United States)

    Casella, Giovanni; Soricelli, Emanuele; Giannotti, Domenico; Collalti, Marco; Maselli, Roberta; Genco, Alfredo; Redler, Adriano; Basso, Nicola


    Laparoscopic sleeve gastrectomy (SG) has gained great popularity as a stand-alone bariatric procedure because short- and mid-term outcomes in terms of weight loss and resolution of co-morbidities have been very positive. However, long-term results from large series still are sparse. To evaluate the long-term clinical outcomes of SG in a large series of patients undergoing SG as a stand-alone procedure. University hospital in Italy. A retrospective analysis of prospectively collected data from 182 patients undergoing SG between 2006 and 2008 in the authors' institution. Long-term outcomes at 6 and 7 years were analyzed in terms of weight loss and co-morbidities resolution. Mean initial body mass index (BMI) was 45.9±7.3 kg/m(2). Major postoperative complications occurred in 8 patients (5.4%): 4 leaks, 2 bleeding, 1 abdominal collection, and 1 dysphagia. All complications were managed conservatively. One hundred forty-eight patients (81.4%) completed the 72-month (6-year) follow-up. Thirty-seven patients (25%) reached a follow-up of 84 months. At year 6 follow-up the mean BMI and the mean percentage of excess weight loss (%EWL) were 30.2 kg/m(2) and 67.3%, respectively. Mean total body weight loss was 44.9 kg, while a %EWL >50 was registered in 123 patients (83.1%). Preoperative BMI did not significantly influence postoperative %EWL. Remission of type 2 diabetes mellitus, arterial hypertension, obstructive sleep apnea syndrome, and gastroesophageal reflux disease symptoms occurred in 83.8%, 59.7%, 75.6%, and 64.7% of patients, respectively. %EWL and resolution of co-morbidities appear to be sustained 6 and 7 years after SG. Preoperative BMI is not predictive for weight loss outcomes. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  11. Long term results of sentinel lymph node biopsy in early oral squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Dequanter D


    Full Text Available Didier Dequanter, Mohammad Shahla, Pascal Paulus, Philippe Lothaire Civil Hospital of Charleroi (site Vésale, Montigny le Tilleul, Belgium Abstract: The objective of the study was to evaluate the long term results of the sentinel node (SN biopsy technique in the management of the clinically negative (N0 neck in patients with early oral squamous cell carcinoma (T1–T2. Patients with positive SN underwent neck dissection. A sentinel lymph node (SLN biopsy was performed on 31 consecutive patients. Six of the 31 patients were upstaged by the results of the SLN biopsy. The SLN biopsy allowed the identification of node metastasis in 100% of the cases with a sensitivity of 100%, specificity of 100%, and negative predictive value of 100%. There was a mean follow-up of 59 months. The neck control rate was 100% in the SLN negative group and two SLN positive patients developed subsequent neck disease (neck control rate of 88%. One SLN patient presented at the follow-up with a second primary tumor, 18 months later treated successfully by chemoradiotherapy. The overall survival rate was 100% in both groups. The promising reported short-term results have been sustained by long term follow-up. Patients with negative SLN achieved an excellent neck control rate. The neck control rate in SN negative patients was superior to that in SLN positive patients, but not statistically different. Keywords: sentinel lymph node, characteristics of patients, head and neck cancer

  12. Renal Angiomyolipoma: Mid- to Long-Term Results Following Embolization with Onyx

    Energy Technology Data Exchange (ETDEWEB)

    Thulasidasan, Narayanan, E-mail:; Sriskandakumar, Srividhiya; Ilyas, Shahzad; Sabharwal, Tarun [Guy’s & St Thomas’ NHS Foundation Trust, Department of Interventional Radiology (United Kingdom)


    PurposePercutaneous transcatheter embolization is currently the preferred treatment for ruptured or enlarging renal angiomyolipoma (AML), although the optimum choice of embolic material has not yet been established. We present mid- to long-term outcomes following embolization of AMLs with Onyx.Materials and MethodsTen AMLs in seven patients (including two with tuberous sclerosis) were embolized with Onyx. Patients were followed-up clinically, with tumour size and renal function measured pre- and post-procedure.ResultsMean pre-treatment AML size was 63.4 mm (range 42–100). Mean clinical follow-up was 431.4 days (range 153–986) and imaging follow-up 284.2 days (range 30–741). There was no haemorrhage from treated lesions within the follow-up period. Of patients who had cross-sectional imaging pre- and post-procedure, mean decrease in AML size of 22 mm was seen after Onyx embolization (p = 0.0058, 95 % CI 9.13–34.87). No significant difference between serum creatinine was seen pre- and post-procedure (p = 0.54, 95 % CI 8.63–4.85).ConclusionsOnyx embolization of renal AMLs is effective in the medium to long term, with theoretical benefits in safety and durability of result.

  13. Homeopathic therapy in pediatric atopic diseases: short- and long-term results. (United States)

    Rossi, Elio; Picchi, Marco; Bartoli, Paola; Panozzo, Marialessandra; Cervino, Chiara; Nurra, Linda


    To study the outcomes of atopic diseases in children treated with homeopathy at the Homeopathic Clinic of Lucca (Italy) and related long-term results after approximately an 8-year period. Our data derive from an observational longitudinal study carried out on 857 pediatric patients who consecutive visited from 1998 to 2014. Children with atopic diseases were 325 (37.9%), 126 (39%) suffered from atopic dermatitis, 72 (22%) from allergic rhinitis, and 127 (39%) from asthma. Moreover, a long-term study was conducted on a subset of 107/165 patients, consecutively visited from 1998 to 2006, and with ≥5 years follow-up. The study also investigated the evolution of overall symptoms in those patients with a complex atopic symptomatology. 75.8% of atopic children had moderate or major improvement (67.1% with asthma as the primary disease; 84.2% rhinitis; 84.2% dermatitis). At re-evaluation after 5-10 years, complete remission of atopic symptoms was obtained in 70.1% of the children: 84.2% in dermatitis; 48.1% in allergic rhinitis; 71.4% in asthma. Children with two or three atopic diseases at the first visit were completely cured in 40% of cases. The results seem to confirm that homeopathic medicine produces positive therapeutic response in atopic children. Copyright © 2016 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  14. Long-term results after revisions of failed primary vertical banded gastroplasty (United States)

    van Wezenbeek, Martin R; Smulders, Frans J F; de Zoete, Jean-Paul J G M; Luyer, Misha D; van Montfort, Gust; Nienhuijs, Simon W


    AIM: To compare the results after revision of primary vertical banded gastroplasty (Re-VBG) and conversion to sleeve gastrectomy (cSG) or gastric bypass (cRYGB). METHODS: In this retrospective single-center study, all patients with a failed VBG who underwent revisional surgery were included. Medical charts were reviewed and additional postal questionnaires were sent to update follow-up. Weight loss, postoperative complications and long-term outcome were assessed. RESULTS: A total 152 patients were included in this study, of which 21 underwent Re-VBG, 16 underwent cSG and 115 patients underwent cRYGB. Sixteen patients necessitated a second revisional procedure. No patients were lost-to-follow-up. Two patients deceased during the follow-up period, 23 patients did not return the questionnaire. Main reasons for revision were dysphagia/vomiting, weight regain and insufficient weight loss. Excess weight loss (%EWL) after Re-VBG, cSG and cRYGB was, respectively, 45%, 57% and 72%. Eighteen patients (11.8%) reported postoperative complications and 27% reported long-term complaints. CONCLUSION: In terms of additional weight loss, postoperative complaints and reintervention rate, Roux-en-Y gastric bypass seems feasible as a revision for a failed VBG. PMID:27022451

  15. Homeopathic medical practice: Long-term results of a cohort study with 3981 patients

    Directory of Open Access Journals (Sweden)

    Baur Roland


    Full Text Available Abstract Background On the range of diagnoses, course of treatment, and long-term outcome in patients who chose to receive homeopathic medical treatment very little is known. We investigated homeopathic practice in an industrialized country under everyday conditions. Methods In a prospective, multicentre cohort study with 103 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data from all patients (age >1 year consulting the physician for the first time were observed. The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10 and quality of life at baseline, and after 3, 12, and 24 months. Results A total of 3,981 patients were studied including 2,851 adults (29% men, mean age 42.5 ± 13.1 years; 71% women, 39.9 ± 12.4 years and 1,130 children (52% boys, 6.5 ± 3.9 years; 48% girls, 7.0 ± 4.3 years. Ninety-seven percent of all diagnoses were chronic with an average duration of 8.8 ± 8 years. The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children. Disease severity decreased significantly (p Conclusion Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period. Our findings indicate that homeopathic medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.

  16. Long-term results of golimumab therapy for rheumatoid arthritis. Therapy compliance issues

    Directory of Open Access Journals (Sweden)

    N. V. Chichasova


    Full Text Available The goal of therapy for rheumatoid arthritis (RA is to suppress inflammation, to prevent or delay destructive changes in the joints, and to normalize functions during the longest monitoring of the course of RA. The data of randomized controlled trials and national registries are of great importance to a clinician. The paper reviews the literature data characterizing the long-term results of RA therapy with the tumor necrosis factor-α inhibitor golimumab (GLM and patient compliance with the therapy. Treatment with GLM at the registered subcutaneous dose of 50 mg once every 4 weeks gives rise to an effect in the vast majority of patients regardless of the type of previous ineffective therapy, the dose of concurrently administered methotrexate, the number of previous ineffective disease-modifying antirheumatic drugs, and the use and nonuse of glucocorticoids. GLM is characterized by a long-term (as long as 5 years effect with suppressed progression of destruction, functional recovery, and satisfactory tolerability with no additional risk for adverse events as the therapy is continued.

  17. [The Role of Preferences in the German Long-Term Care Insurance - Results from Expert Interviews]. (United States)

    Heuchert, M; König, H-H; Lehnert, T


    As a result of population aging, the number of persons dependent on long-term care (LTC) is expected to increase considerably in Germany. Information about LTC preferences is important to decision-makers in future reforms. Taking into account the preferences of people can lead to a better congruence between desired and utilized LTC services. The aim of this study was to evaluate LTC preferences, their underlying reasons, and the potential to satisfy individual preferences within the German LTC insurance system. Interviews with 20 LTC (insurance) experts in Germany between July and September 2014 were analyzed using qualitative content analysis methods. Irrespective of the care setting, people prefer flexible LTC (services), which allow for as much autonomy and independence as possible. Ideally, care is provided by close relatives at the dependent's home. Besides informal homecare, professional care at home is also (becoming increasingly) important, whereas inpatient LTC (nursing home) is rarely preferred over homecare arrangements. To most LTC dependents, interpersonal needs are more important than bodily and professional aspects of care. While the flexible choices and manifold options to combine services (high degree of person-centeredness) within the German LTC insurance constitute an important basis for the satisfaction of individual preferences, the widespread lack of information about entitlements, costs of services, and corresponding LTC options in the general population (future dependents) substantially hampers long-term care that is in line with preferences. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Structural Fat Grafting to Improve Outcomes of Vocal Folds' Fat Augmentation: Long-term Results. (United States)

    Cantarella, Giovanna; Mazzola, Riccardo F; Gaffuri, Michele; Iofrida, Elisabetta; Biondetti, Pietro; Forzenigo, Laura V; Pignataro, Lorenzo; Torretta, Sara


    Objective Evaluating the long-term outcomes of vocal fold structural fat grafting. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Seventy-nine dysphonic patients (16-82 years; 55 with unilateral laryngeal paralysis and 24 with vocal fold scarring) underwent vocal fold fat injection. Fat was harvested by low-pressure liposuction and then processed by centrifugation. Refined fat aliquots were placed in the vocal fold and paraglottic space in multiple tunnels to enhance graft neovascularization. All patients were followed for 12 months, 15 for 3 years, and 5 for 10 years with videolaryngostroboscopy, maximal phonation time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS (grade, roughness, breathiness, asthenia, strain) perceptual evaluation. Laryngeal computed tomography (CT) and/or magnetic resonance imaging (MRI) studies were performed in 16 patients 3 to 28 months postoperatively; MRI was repeated in 5 cases 12 to 18 months after the first radiological study. Results The voice quality of all patients improved after surgery, and long-term stability was confirmed by MPT, GRBAS, and VHI ( P ranging between .004 and fat resorption. CT and MRI demonstrated survival of the fat grafts in all of the 16 examined cases. Serial MRI scans showed no change in graft size over time. Conclusions The reported clinical and radiological data demonstrate that fat is an effective filler for permanent vocal fold augmentation if the refined micro-aliquots are placed in multiple tunnels.

  19. Long-term results of autologous fascia in unilateral vocal fold paralysis. (United States)

    Reijonen, Petri; Tervonen, Hanna; Harinen, Kirsi; Rihkanen, Heikki; Aaltonen, Leena-Maija


    The objective of this retrospective clinical review was to evaluate the long-term results of injection laryngoplasty with autologous fascia as a single, primary procedure in unilateral vocal fold paralysis. Forty-three patients who had undergone injection laryngoplasty between 1996 and 2003 entered the study. Clinical examination and videostroboscopy were performed and the voice handicap index was analyzed postoperatively. Pre- and post-operative evaluation included computerized acoustic analysis and perceptual evaluation. The results remained stable 3-10 years and were not affected by the length of follow-up, the delay from paralysis to surgery, or the age of the patient. Although most mean values of voice parameters were significantly improved, results in individual patients were difficult to predict. Poor results were especially related to cases caused by intrathoracic lesions. Wide glottal gaps should not be treated with fascia injection. Fascia is a stable graft and most suitable for cases with less severe glottal insufficiency.

  20. Long-term Results After Arthroscopic Repair of Isolated Subscapularis Tears. (United States)

    Seppel, Gernot; Plath, Johannes E; Völk, Christopher; Seiberl, Wolfgang; Buchmann, Stefan; Waldt, Simone; Imhoff, Andreas B; Braun, Sepp


    Although some reports have presented short- to midterm results after arthroscopic repair of isolated subscapularis (SSC) tendon tears, long-term evaluation is still lacking. Long-term results after arthroscopic repair of isolated SSC tears are comparable with the functional and radiological short- to midterm outcomes described in the literature. Case series, Level of evidence, 4. This study assessed 17 patients (5 females and 12 males; mean age, 45.6 years) with isolated SSC tears (Fox and Romeo classification types 2-4) who underwent all-arthroscopic suture anchor repair. The mean interval from symptom onset to the time of surgery was 5.3 months in 16 patients (94.1%). One patient (5.9%) was symptomatic for a prolonged period (104 months) before surgery. All patients were assessed with a clinical examination preoperatively. SSC function was investigated using specific clinical tests and common scoring systems, including Constant, American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), and Simple Shoulder Test (SST) scores. At follow-up, muscular strength was evaluated using an electronic force-measuring plate. Structural integrity of the repair was assessed using magnetic resonance imaging (MRI). At a mean follow-up of 98.4 ± 19.9 months, the mean Constant score improved from 47.8 preoperatively to 74.2 postoperatively ( P = .001). Higher Constant ( P = .010) and ASES ( P = .001) scores were significantly associated with a shorter time from symptom onset to surgery. The size of the SSC lesion did not correlate with any clinical score outcome ( P = .476, .449, .985, and .823 for Constant, ASES, DASH, and SST scores, respectively). Three patients (17.6%) had persistent positive clinical test results (belly-press/lift-off). Compared with the uninjured contralateral side, SSC strength was significantly reduced in the belly-press position ( P = .031), although active internal ( P = .085) and external ( P = .093) rotation was not

  1. Mid- and long-term clinical results of surgical therapy in unicameral bone cysts

    Directory of Open Access Journals (Sweden)

    Hagmann Sébastien


    Full Text Available Abstract Background Unicameral (or simple bone cysts (UBC are benign tumours most often located in long bones of children and adolescents. Pathological fractures are common, and due to high recurrence rates, these lesions remain a challenge to treat. Numerous surgical procedures have been proposed, but there is no general consensus of the ideal treatment. The aim of this investigation therefore was to study the long-term outcome after surgical treatment in UBC. Methods A retrospective analysis of 46 patients surgically treated for UBC was performed for short and mid-term outcome. Clinical and radiological outcome parameters were studied according to a modified Neer classification system. Long-term clinical information was retrieved via a questionnaire at a minimum follow-up of 10 years after surgery. Results Forty-six patients (17 female, 29 male with a mean age of 10.0 ± 4.8 years and with histopathologically confirmed diagnosis of UBC were included. Pathological fractures were observed in 21 cases (46%. All patients underwent surgery for UBC (35 patients underwent curettage and bone grafting as a primary therapy, 4 curettage alone, 3 received corticoid instillation and 4 decompression by cannulated screws. Overall recurrence rate after the first surgical treatment was 39% (18/46, second (17.4% of all patients and third recurrence (4.3% were frequently observed and were addressed by revision surgery. Recurrence was significantly higher in young and in male patients as well as in active cysts. After a mean of 52 months, 40 out of 46 cysts were considered healed. Prognosis was significantly better when recurrence was observed later than 30 months after therapy. After a mean follow-up of 15.5 ± 6.2 years, 40 patients acknowledged clinically excellent results, while five reported mild and casual pain. Only one patient reported a mild limitation of range of motion. Conclusions Our results suggest satisfactory overall long-term outcome for the

  2. Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome

    DEFF Research Database (Denmark)

    Klitfod, Lotte; Just, Sven; Foegh, Pia


    BACKGROUND: Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired...... quality of life in more than 50%. Endovascular treatment for iliac vein obstruction using stents is known to alleviate PTS symptoms in selected patients. PURPOSE: To report the Danish long-term results of endovascular treatment with iliac stenting. MATERIAL AND METHODS: From 2000 to 2013 consecutive...... at 6 weeks, 3 months, and annually thereafter. RESULTS: Nineteen patients, all women, all with left-sided iliac vein obstruction, and all with severe PTS symptoms were included. The median follow-up time was 81 months (range, 1-146 months; mean, 69 months). Primary patency rate of the inserted iliac...

  3. Sleeve Gastrectomy: Correlation of Long-Term Results with Remnant Morphology and Eating Disorders. (United States)

    Tassinari, Daniele; Berta, Rossana D; Nannipieri, Monica; Giusti, Patrizia; Di Paolo, Luca; Guarino, Daniela; Anselmino, Marco


    Remnant dimension is considered one of the crucial elements determining the success of sleeve gastrectomy (SG), and dilation of the gastric fundus is often believed to be the main cause of failure. The main outcome of this study is to find correlations between remnant morphology in the immediate post-operative stage, its dilation in years, and the long-term results. The second purpose aims to correlate preoperative eating disorders, taste alteration, hunger perception, and early satiety with post-SG results. Remnant morphology was evaluated, in the immediate post-operative stage and over the years (≥2 years), through X-ray of the oesophagus-stomach-duodenum calculating the surface in anteroposterior (AP) and right anterior oblique projection (RAO). Presurgery diagnosis of eating disorders and their evaluation through "Eating Disorder Inventory-3" (EDI3) during follow-up were performed. Change in taste perception, sense of appetite, and early satiety were evaluated. Patients were divided into two groups: "failed SGs (EWL50%). There were a total of 50 patients (37 F, 13 M), with mean age 52 years, preoperative weight 131 ± 21.8 kg, and BMI 47.4 ± 6.8 kg/m2. Post-operative remnant mean dimensions overlapped between the two groups. On a long-term basis, an increase of 57.2 and 48.4% was documented in the AP and RAO areas respectively. In "failed" SGs, dilation was significantly superior to "efficient" SGs (AP area 70.2 vs 46.1%; RAO area 59.3 vs 39%; body width 102% vs 41.7%). Preoperative eating disorders were more present in efficient SGs than in failed SGs with the exception of sweet eating. There were no significant changes to taste perception during follow-up. Fifty-two percent of efficient SGs vs 26% of failed SGs reported a persistent lack of sense of hunger; similarly, 92.5 vs 78% declared the persistence of a sense of early satiety. The two groups did not statistically differ as far as all the variables of the EDI3 are concerned. On a long-term

  4. Technique and long-term results of intersphincteric resection for low rectal cancer. (United States)

    Schiessel, Rudolf; Novi, Gabriele; Holzer, Brigitte; Rosen, Harald R; Renner, Karl; Hölbling, Nikolaus; Feil, Wolfgang; Urban, Michael


    Intersphincteric resection of low rectal tumors is a surgical technique extending rectal resection into the intersphincteric space. This procedure is performed by a synchronous abdominoperineal approach with mesorectal excision and excision of the entire or part of the internal sphincter. This study was designed to evaluate the long-term results of this method focused on continence function and oncologic results. From 1984 to 2000, a total of 121 patients were operated on. The patients were evaluated prospectively according to a detailed preoperative and postoperative program. One hundred seventeen patients had rectal cancers, two had dysplastic villous adenomas, and two had carcinoid tumors. Cancers were staged according to the Dukes classification (Stage A in 41 percent, Stage B in 28 percent, and Stage C in 31 percent; median distance from the anal margin, 3 (range, 1-5) cm). Postoperative complications were: one death because of pulmonary embolism, 5.1 percent developed an anastomotic fistula, one patient had a fistula to the bladder requiring reoperation, one patient with ileus needed relaparotomy as well as one for intra-abdominal hemorrhage and a small-bowel fistula. One patient developed a fistula after closing the protective colostomy. Five patients developed late strictures of the coloanal anastomosis. After a median follow-up of 72.86 months, 5.3 percent of patients developed local recurrence. The continence status was satisfactory with 16 patients (13.7 percent) showing continence for solid stool only, and 1 patient (0.8 percent) showing episodes of incontinence. A transient problem was a high stool frequency after closure of the protective stoma. Intersphincteric resection is a valuable procedure for sphincter-saving rectal surgery. We showed that this technique has satisfactory long-term results in functional and oncologic respects. An important prerequisite is a careful preoperative evaluation of local tumor spread with rectal magnetic resonance

  5. Long-Term Results of Punctal Plug Applied to Dry Eye Patients

    Directory of Open Access Journals (Sweden)

    ismet Doğru


    Full Text Available Purpose: The evaluation of long-term results of punctal plugs applied to dry eye patients and the potential problems they may bring about. Material and Method: In this study, we retrospectively assessed 30 eyes of 15 patients with moderate to advanced dry eyes who were applied punctal plug (5 mm for treatment purpose and were observed for 12 months. The patients’ Ocular Surface Disease Index (OSDI scoring, Schimer-1 test (without topical anesthesia, tear film break-up time (TBUT and ocular surface staining with fluorescein results were evaluated and compared before and after 6- and 12-month use of punctal plug. The patients were started on topical antiinflammatory treatment and artificial tears two months before the application of the punctum plug. Results: The patients’ average age was 56.4±2.3 (range: 36-70 years, and the average follow-up period was 15 (12-30 months. The average OSDI score was statistically significantly decreased at 6 and 12 months when compared to the initial value (p<0.05. The average Schirmer-1 test values measured at 6 and 12 months were also statistically significantly increased compared with the initial value (p<0.05. The average Schirmer-1 test value at 12 months was considerably increased when compared with the 6th month’s value (p<0.05. The average TBUT was statistically significantly increased when compared to the values at 6 and 12 months (p<0.05. When the outcomes of ocular surface staining with fluorescein were evaluated, a significant decrease was seen at 6 and 12 months when compared to the initial value (p<0.05. Discussion: The punctal plug treatment associated with topical anti-inflammatory treatment for moderate and advanced dry eye patients is a reliable method. It decreases the dry eye symptoms and findings in the long term. (Turk J Ophthalmol 2011; 41: 225-9

  6. Percutaneous Transluminal Angioplasty for Complete Membranous Obstruction of Suprahepatic Inferior Vena Cava: Long-Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Kucukay, Fahrettin, E-mail: [Turkiye Yuksek Ihtisas Hospital, Department of Interventional Radiology (Turkey); Akdogan, Meral, E-mail: [Turkiye Yuksek Ihtisas Hospital, Department of Gastroenterology (Turkey); Bostanci, Erdal Birol, E-mail: [Turkiye Yuksek Ihtisas Hospital, Department of Gastrointestinal Surgery (Turkey); Ulus, Ahmet Tulga, E-mail: [Hacettepe University, Department of Cardiovascular Surgery (Turkey); Kucukay, Murat Bulent, E-mail: [Lokman Hekim Hospital, Department of Internal Medicine (Turkey)


    PurposeTo determine the long-term results of percutaneous transluminal angioplasty (PTA) for a complete membranous obstruction of the suprahepatic inferior vena cava.MethodsPatients (n = 65) who were referred to the interventional unit for PTA for a complete membranous obstruction of the suprahepatic inferior vena cava between January 2006 and October 2014 were included in the study. Thirty-two patients (18 males, 14 females, mean age 35 ± 10.7, range 20–42 years) were treated. The patients presented with symptoms of ascites (88 %), pleural effusion (53 %), varicose veins (94 %), hepatomegaly (97 %), abdominal pain (84 %), and splenomegaly (40 %). Transjugular liver access set and re-entry catheter were used to puncture and traverse the obstruction from the jugular side. PTA balloon dilations were performed. The mean follow-up period was 65.6 ± 24.5 months. The objective was to evaluate technical success, complications, primary patency, and clinical improvement in the symptoms of the patients.ResultsThe technical success rate was 94 %. In two patients, obstruction could not be traversed. These patients underwent cavoatrial graft bypass surgery. There were no procedure-related complications. Clinical improvements were achieved in all patients within 3 months. The primary patency rate at 4 years was 90 %. There was no primary assisted patency. There was no need for metallic stent deployment in the cohort. The secondary patency rate at 4 years was 100 %.ConclusionsPercutaneous transluminal angioplasty for a complete membranous obstruction of the suprahepatic inferior vena cava is safe and effective, and the long-term results are excellent.

  7. Electroconvulsive stimulation results in long-term survival of newly generated hippocampal neurons in rats

    DEFF Research Database (Denmark)

    Olesen, Mikkel Vestergaard; Wörtwein, Gitta; Folke, Jonas


    of the previous work aiming to test the hypothesis that rats subjected to ECS in combination with chronic restraint stress (CRS) display increased formation of new hippocampal neurons, which have a potential for long-term survival. Furthermore, using mediation analysis, we tested if an ECS-induced increase......U-positive neurons showed time-dependent attrition of ∼40% from day 1 to 3 months, with no further decline between 3 and 12 months. ECS did not affect the number of pre-existing dentate granule neurons or the volume of the dentate granule cell layer, suggesting no damaging effect of the treatment. Finally, we found...... that, while ECS increases neurogenesis, this formation of new neurons was not associated to ameliorated immobility in the FST. This implies that other ECS-induced effects than neurogenesis must be part of mediating the antidepressant action of ECS. Taken together, the results of the present study...

  8. Final results of a long-term, clinical follow-up in fatty liver patients

    DEFF Research Database (Denmark)

    Dam-Larsen, Sanne; Becker, Ulrik; Franzmann, Maria-Benedicte


    OBJECTIVE: There is increasing focus on non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to conduct a long-term clinical follow-up of patients with biopsy-confirmed fatty liver without inflammation or significant fibrosis (pure fatty liver), to analyse for potential risk...... factors at the time of index liver biopsy important for survival and the development of cirrhosis and to describe the causes of death. MATERIAL AND METHODS: Patients were linked through their personal identification number to the Danish National Registry of Patients and the Register of Causes of Death....... All admissions, discharge diagnoses and causes of death during follow-up were collected. All surviving patients were invited to a clinical follow-up. RESULTS: The follow-up period was 20.4 and 21.0 years, respectively, for the NAFLD and alcoholic fatty liver disease (AFLD) groups. Two NAFLD patients...

  9. Cystic Dilation of Extrahepatic Bile Ducts in Adulthood: Diagnosis, Surgical Treatment and Long. Term Results

    Directory of Open Access Journals (Sweden)

    G. Belli


    Full Text Available To evaluate the long-term results of surgery for choledohal cyst in adulthood, a series of 13 patients over the age of 16 operated on for choledochal cyst during a period of six years and followed-up for a minimum of 3 years was analyzed. Patients with type I and IVa cysts underwent extrahepatic cyst resection and Roux-en-Y hepatico-jejunostomy. Choledochoceles (type III were managed endoscopically. No operative mortality or morbidity occurred. Type I and III cysts showed almost ideal follow-up with no sign of stricture on HIDA scan. One type IVa cyst patients developed recurrent cholangitis due to anastomotic stricture, managed percutaneously. Whenever possible, complete cyst resection and Roux-en-Y reconstruction is the treatment of choice for all extrahepatic biliary cysts. Intra- and extrahepatic dilatations are adequately treated by extrahepatic resection and careful endoscopic or radiologic surveillance. Small choledochoceles can be safely managed by endoscopic sphincterotomy.

  10. Laparoscopic central pancreatectomy: Our technique and long-term results in 14 patients

    Directory of Open Access Journals (Sweden)

    Palanisamy Senthilnathan


    Full Text Available Introduction: Conventional pancreatic resections may be unnecessary for benign tumours or for tumours of low malignant potential located in the neck and body of pancreas. Such extensive resections can place the patient at increased risk of developing postoperative exocrine and endocrine insufficiency. Central pancreatectomy is a plausible surgical option for the management of tumours located in these locations. Laparoscopic approach seems appropriate for such small tumours situated deep in the retroperitoneum. Aims: To assess the technical feasibility, safety and long-term results of laparoscopic central pancreatectomy in patients with benign and low malignant potential tumours involving the neck and body of pancreas. Settings and Design: This study was an observational study which reports a single-centre experience with laparoscopic central pancreatectomy over a 9-year period. Materials and Methods: 14 patients underwent laparoscopic central pancreatectomy from October 2004 to September 2013. These included patients with tumours located in the neck and body of pancreas that were radiologically benign-looking tumours of less than 3 cm in size. Statistical Analysis Used: The statistical analysis was done using GraphPad Prism software. Results: The mean age of patients was 48.93 years. The mean operative time was 239.7 min. Mean blood loss was 153.2 ml. Mean postoperative ICU stay was 1.2 days and overall mean hospital stay was 8.07 days. There were no mortalities and no major postoperative complications. Margins were negative in all cases and with a median follow-up of 44 months, there was no recurrence. Conclusions: Laparoscopic central pancreatectomy is a feasible procedure with acceptable morbidity. In the long term, there were no recurrences and pancreatic function was well preserved.

  11. Long-term performance of landfill covers - results of lysimeter test fields in Bavaria (Germany). (United States)

    Henken-Mellies, Wolf-Ulrich; Schweizer, Andreas


    A comprehensive study was conducted to examine the performance and possible changes in the effectiveness of landfill surface covers. Three different profiles of mineral landfill caps were examined. The results of precipitation and flow measurements show distinct seasonal differences which are typical for middle-European climatic conditions. In the case of the simple landfill cap design consisting of a thick layer of loamy sand, approximately 100-200 L m(-2) of annual seepage into the landfill body occurs during winter season. The three-layer systems of the two other test fields performed much better. Most of the water which percolated through the top soil profile drained sideways in the drainage layer. Only 1-3% of precipitation percolated through the sealing layer. The long-term effectiveness of the mineral sealing layer depended on the ability of the top soil layer to protect it from critical loss of soil water/critical increase of suction. In dry summers there was even a loss in soil water content at the base of the 2.0 m thick soil cover. The results of this study demonstrate the importance of the long-term aspect when assessing the effectiveness of landfill covers: The hydraulic conductivity at the time of construction gives only an initial (minimum) value. The hydraulic conductivity of the compacted clay layer or of the geosynthetic clay liner may increase substantially, if there is no long-lasting protection against desiccation (by a thick soil cover or by a geomembrane). This has to be taken into account in landfill cover design.

  12. Post-operative morbidity results in decreased long-term survival after resection for hilar cholangiocarcinoma (United States)

    Chauhan, Aakash; House, Michael G; Pitt, Henry A; Nakeeb, Attila; Howard, Thomas J; Zyromski, Nicholas J; Schmidt, C Max; Ball, Chad G; Lillemoe, Keith D


    Background The purpose of the present study was to demonstrate that post-operative morbidity (PM) associated with resections of hilar cholangiocarcinoma (HCCA) is associated with short- and long-term patient survival. Methods Between 1998 and 2008, 51 patients with a median age of 64 years underwent resection for HCCA at a single institution. Associations between survival and clinicopathologic factors, including peri- and post-operative variables, were studied using univariate and multivariate models. Results Seventy-six per cent of patients underwent major hepatectomy with resection of the extrahepatic bile ducts. The 30- and 90-day operative mortality was 10% and 12%. The overall incidence of PM was 69%, with 68% of all PM as major (Clavien grades III–V). No difference in operative blood loss or peri-operative transfusion rates was observed for patients with major vs. minor or no PM. Patients with major PM received adjuvant chemotherapy less frequently than patients with minor or no complications 29% vs. 52%, P= 0.15. The 1-, 3- and 5-year overall (OS) and disease-specific survival (DSS) rates for all patients were 65%, 36%, 29% and 77%, 46%, 35%, respectively. Using univariate and multivariate analysis, margin status (27% R1), nodal metastasis (35% N1) and major PM were associated with OS and DSS, P operations for HCCA can produce substantial post-operative morbidity. In addition to causing early mortality, major post-operative complications are associated with decreased long-term cancer-specific survival after resection of HCCA. PMID:21241432

  13. Long-term results after Ilizarov treatment for severe high-energy injuries of the elbow. (United States)

    Fodor, Lucian; Ullmann, Yehuda; Soudry, Michael; Lerner, Alexander


    Clinical aspects, such as the long-term results after circular external fixation and functional rehabilitation after high-energy injuries of the elbow joint, have not received sufficient attention in the literature. Fourteen patients with high-energy elbow injuries were treated in our hospital over the last 15 years with a circular external fixation frame. The mechanism of injury was blast in eight patients, gunshot wounds in two, motor vehicle crash in two, and fall from height in two. Twelve patients had high-energy open periarticular fractures, nine had Gustillo-Anderson 3B fractures, and three had Gustillo-Anderson 3C fractures. Two patients suffered from closed high-energy periarticular elbow injuries. Seven patients had associated peripheral neurologic injuries and three had vascular injuries. Average Ilizarov fixation time was 20 weeks (range, 6-47 weeks). The follow-up period varied from 1.5 years to 11 years. The average arc of elbow flexion was 110.4 degrees and extension was 19.6 degrees. The average arc of forearm rotation was of 63.5 degrees for pronation (range, 5-90 degrees) and 63.2 degrees for supination (range, 5-90 degrees). The average Mayo Elbow Performance Index score was 84 points (range, 60-100) and the average Khalfayan functional score was 83.4 (range, 68.7-100). Long-term follow-up proved that the hinged Ilizarov/hybrid frame represents a useful instrument to provide stabilization of the elbow joint while facilitating early movements and physiotherapy. The main indication is patients who suffered from open high-energy contaminated fractures with extensive soft-tissue damage (e.g., blast, war injuries) and combined bone and ligaments injuries.

  14. Long term results of Epi-LASIK and LASEK for myopia. (United States)

    Yuksel, Nilay; Bilgihan, Kamil; Hondur, Ahmet M; Yildiz, Burcin; Yuksel, Erdem


    To evaluate the long term clinical and confocal results of mechanical (Epi-LASIK) versus alcohol-assisted laser epithelial keratomileusis (LASEK) for correction of myopia. Gazi University Medical School, Department of Ophthalmology, Ankara, Turkey. Retrospective study. Twenty-two eyes treated with LASEK and twenty eyes treated with Epi-LASIK were evaluated with a mean follow-up duration of 45 months. Mechanical separation of the epithelium was performed with Lasitome epithelial separator, and alcohol-assisted separation with 25s application of 18% alcohol. Laser ablation was performed with the ESIRIS laser. All patients were examined daily until epithelial closure; at 1, 3, 6, and 12 months; and every year subsequently. Main outcome measures were uncorrected visual acuity (UCVA), manifest refraction, haze, and gray scale value in confocal microscopy, efficacy and safety indexes. Preoperative myopic spherical equivalent refraction was -4.65 ± 1.74 D in the LASEK and -3.87 ± 1.30 D in the Epi-LASIK-treated eyes (p=0.36). Of both LASEK and Epi-LASIK-treated eyes, 95% achieved 20/25 or better final UCVA. The grade of haze and mean gray scale value in confocal microscopy were similar in LASEK and Epi-LASIK-treated eyes at all postoperative periods. The efficacy index was 0.94 in LASEK group and 0.96 in Epi-LASIK group (p=0.44). The safety index was 1.01 in LASEK group and 1.02 in Epi-LASIK group (p=0.42). Both LASEK and Epi-LASIK offer safe and effective correction of myopia in the long term. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  15. [Laparoscopic approach of achalasia. Long-term clinical and functional results and quality of life]. (United States)

    Marinello, Franco G; Targarona, Eduardo M; Balague, Carmen; Poca, María; Mones, Joan; Trias, Manuel


    Laparoscopic Heller myotomy has become the gold standard procedure for patients with achalasia. This study evaluates the clinical status, quality of life, and functional outcomes after laparoscopic Heller myotomy. We analyzed patients who underwent laparoscopic Heller myotomy with an associated anti-reflux procedure from October 1998 to December 2010. Before surgery, we administered a clinical questionnaire and as of 2002, we also evaluated quality of life using a specific questionnaire (GIQLI). In 2011, we performed a follow up for all available patients. We administered the same clinical questionnaire and quality of life test as before surgery and performed manometry and 24-hour pH monitoring. According to the length of follow up, patients were divided into 3 groups. Group 1 with a follow-up between 6 and 47 months; group 2 follow-up between 48 and 119 months, and group 3 with a follow-up of more than 120 months). Moreover, 27 patients had already been evaluated with this same protocol in 2003. Pre- and postoperative data were compared for the 3 groups and for patients who completed follow up in 2003 and 2011. Ninety-five patients underwent laparoscopic Heller myotomy. Seventy-six (80%) were available for follow-up. Mean follow-up was 56 months (range 6-143). Global improvement in dysphagia was 89%. Total DeMeester score decreased in the 3 groups. GIQLI scores improved after surgery, reaching normal values. Manometric determinations showed normal LES pressures after myotomy in the 3 groups. Ten percent of overall 24-hour pH monitoring was abnormal. The group of patients followed up in 2003 and in 2011 showed no impairment in the variables studied in the long term. Long-term follow up of the laparoscopic approach to achalasia showed good results concerning clinical status and quality of life, with normal sphincteric pressures and a low incidence of gastroesophageal reflux. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  16. LINAC-radiosurgery for nonsecreting pituitary adenomas. Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Runge, M.J.R.; Maarouf, M.; Hunsche, S.; Ruge, M.I.; El Majdoub, F.; Treuer, H.; Sturm, V. [Koeln Univ. (Germany). Dept. of Stereotaxy and Functional Neurosurgery; Kocher, M.; Mueller, R.P. [Koeln Univ. (Germany). Dept. of Radiation Oncology; Voges, J. [Magdeburg Univ. (Germany). Dept. of Stereotactic Neurosurgery


    Stereotactic linear accelerator-based radiosurgery (LINAC-RS) is increasingly used for microsurgically inaccessible or recurrent pituitary adenomas. This single-center study evaluates the long-term follow-up after LINAC-RS of nonsecreting pituitary adenomas (NSA). Patients and methods: Between 1992 and August 2008, 65 patients with NSA were treated. Patient treatment and follow-up were conducted according to a prospective protocol. Indications for LINAC-RS were (1) tumor recurrence or (2) residual tumor. Three patients were treated primarily. For analysis of prognostic factors, patients were grouped according to epidemiological or treatment-associated characteristics. Results: A total of 61 patients with a follow-up {>=} 12 months (median 83 months, range 15-186 months, longest follow-up of published radiosurgery series) were evaluated with regard to their clinical, radiological, and endocrinological course. The median tumor volume was 3.5 ml ({+-} 4.3 ml, range 0.3-17.3 ml) treated with a median surface and maximum dose of 13.0 Gy and 29.7 Gy, respectively. Local tumor control was achieved in 98%. One patient died of unrelated cause after 36 months and 1 patient developed a radiation-induced seizure disorder. Visual complications did not occur. In 37 of 41 patients (90.2%), pituitary function remained stable. Maximum dose to the pituitary {<=} 16 Gy and female gender were positive prognostic factors for the preservation of pituitary function. Conclusion: LINAC-RS is a minimally invasive, safe, and effective treatment for recurrent NSA or microsurgically inaccessible residual tumor. LINAC-RS yielded a high rate of local long-term tumor control with a small number of radiation-induced side effects. (orig.)

  17. Efficacy of Pelvisoft® Biomesh for cystocele repair: assessment of long-term results

    Directory of Open Access Journals (Sweden)

    Erwann Le Long


    Full Text Available Introduction and Hypothesis To our knowledge a study regarding the efficacy of Pelvisoft® Biomesh for cystocele repair has not previously been reported in the literature. The aim of our study was to assess the long-term efficacy, subjective outcomes and complications in the use of a non-synthetic porcine skin mesh graft (Pelvisoft® Biomesh associated with transvaginal anterior colporrhaphy in the treatment of cystocele prolapse. Materials and Methods A retrospective study was performed at a single centre. Thirty-three women aged 35-77 years underwent cystocele repair using Pelvisoft® graft between December 2005 and June 2009. Twenty-nine women who underwent transvaginal cystocele repair with Pelvisoft® Biomesh for over a 2 years period were assessed. Four patients were lost to follow-up. Cystocele repair was performed via the vaginal route using Pelvisoft®Biomesh implant by inserting it in the anterior vaginal wall. The median follow-up time was 54.0 months. The rate of recurrence was 17.3%. A total of 6.9% of patients presented early mesh exposure treated by conservative treatment. The mean PFDI-20 score was 72.2. Among sexually active women, the mean PISQ 12 was 33.9 but 56.2% had dyspareunia. After surgery, 6 patients had de novo intercourse. Our results show that the use of Pelvisoft® biomaterial associated with anterior colporrhaphy for cystocele repair appears to be safe with acceptable failure and complication rates at long term. Nevertheless, an adverse impact on sexual function was reported by the majority of patients.

  18. Long-term anatomical and functional results of laparoscopic promontofixation for pelvic organ prolapse

    National Research Council Canada - National Science Library

    Sabbagh, Robert; Mandron, Eric; Piussan, Jean; Brychaert, Pierre E; Tu, Le Mai


    ...) for pelvic organ prolapse (POP), and the long-term safety of LP, as POP is a common problem in women of all ages, with treatment including vaginal, abdominal, laparoscopic or robot-assisted surgical approaches...

  19. Radiologic Predictors for Clinical Stage IA Lung Adenocarcinoma with Ground Glass Components: A Multi-Center Study of Long-Term Outcomes.

    Directory of Open Access Journals (Sweden)

    Zhao Li

    Full Text Available This study was to define preoperative predictors from radiologic findings for the pathologic risk groups based on long-term surgical outcomes, in the aim to help guide individualized patient management.We retrospectively reviewed 321 consecutive patients with clinical stage IA lung adenocarcinoma with ground glass component on computed tomography (CT scanning. Pathologic diagnosis for resection specimens was based on the 2011 IASLC/ATS/ERS classification of lung adenocarcinoma. Patients were classified into different pathologic risk grading groups based on their lymph node status, local regional recurrence and overall survival. Radiologic characteristics of the pulmonary nodules were re-evaluated by reconstructed three-dimension CT (3D-CT. Univariate and multivariate analysis identifies independent radiologic predictors from tumor diameter, total volume (TV, average CT value (AVG, and solid-to-tumor (S/T ratio. Receiver operating characteristic curves (ROC studies were carried out to determine the cutoff value(s for the predictor(s. Univariate cox regression model was used to determine the clinical significance of the above findings.A total of 321 patients with clinical stage IA lung adenocarcinoma with ground glass components were included in our study. Patients were classified into two pathologic low- and high- risk groups based on their distinguished surgical outcomes. A total of 134 patients fell into the low-risk group. Univariate and multivariate analyses identified AVG (HR: 32.210, 95% CI: 3.020-79.689, P<0.001 and S/T ratio (HR: 12.212, 95% CI: 5.441-27.408, P<0.001 as independent predictors for pathologic risk grading. ROC curves studies suggested the optimal cut-off values for AVG and S/T ratio were-198 (area under the curve [AUC] 0.921, 2.9 (AUC 0.996 and 54% (AUC 0.907, respectively. The tumor diameter and TV were excluded for the low AUCs (0.778 and 0.767. Both the cutoff values of AVG and S/T ratio were correlated with pathologic

  20. Aphakia correction with retropupillary fixated iris-claw lens (Artisan – long-term results

    Directory of Open Access Journals (Sweden)

    Schallenberg M


    Full Text Available Maurice Schallenberg,1,2 Dirk Dekowski,1 Angela Hahn,1 Thomas Laube,1,3 Klaus-Peter Steuhl,1 Daniel Meller11Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; 2HELIOS Klinikum Wuppertal, Wuppertal, Germany; 3Zentrum für Augenheilkunde PD Dr Laube, Düsseldorf, GermanyPurpose: To evaluate the technique, safety, and efficacy of the retropupillary implantation of iris-claw intraocular lenses in a long-term follow-up study.Patients and methods: This retrospective study included 31 eyes of 31 patients who underwent an Artisan aphakic intraocular lens implantation between January 2006 and February 2011 at the University Hospital Essen, Essen, Germany and at the Zentrum für Augenheilkunde PD Dr Laube, Düsseldorf, Germany. Preoperative data collected included demographics, etiology of aphakia, previous surgeries, preoperative eye pathology, intraocular pressure, clinical signs of endothelial cell loss, and best corrected visual acuity. Operative data and postoperative outcomes included the best corrected visual acuity, lens position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, development of macular edema, and other complications.Results: Thirty-one patients were included. The mean follow-up was 25.2 months (range: 4–48 months. The mean best corrected visual acuity postoperatively was 0.64 logarithm of the minimum angle of resolution (logMAR and varied from 0 logMAR to 3 logMAR. Some patients had a low visual acuity preoperatively because of preoperative eye pathologies. In 22 patients the visual acuity improved, in two patients the visual acuity remained unchanged, and seven patients showed a decreased visual acuity. Complications were peaked pupils (n=10 and retinal detachment in one case. Four patients showed an iris atrophy and high intraocular pressure was observed only in one patient. Subluxation of the intraocular lens, endothelial cell loss, and

  1. What are the long-term results 8 years after sleeve gastrectomy? (United States)

    Noel, Patrick; Nedelcu, Marius; Eddbali, Imane; Manos, Thierry; Gagner, Michel


    Laparoscopic sleeve gastrectomy (LSG) became the most frequent bariatric procedure performed in France (2011) and in the United States (2013), but studies reporting long-term results are still rare. Private hospital, France. This is a retrospective analysis of a prospective cohort of 168 patients who underwent LSG between 2005 and 2008. The objective of this study was to present the 8-year outcome concerning weight loss, modification of co-morbidities, and to report the revisional surgery after sleeve. The preoperative mean body mass index was 42.8 kg/m2 (31.1-77.9), 35 patients were super obese, and 64 patients had a previous gastric band. For LSG as a definitive bariatric procedure, 8 years of follow-up data were available for 116 patients (follow-up: 69%). Of the remainder, 23 patients underwent revisional surgery and 29 were lost to follow-up. For the entire cohort, the mean excess weight loss (EWL) was 76% (0-149) at 5 years and 67% (4-135) at 8 years, respectively. Of the 116 patients with 8 years of follow-up, 82 patients had>50% EWL at 8 years (70.7%). Percentages of co-morbidities resolved were hypertension, 59.4%; type 2 diabetes, 43.4%; and obstructive sleep apnea, 72.4%. Twenty-three patients had revisional surgery for weight regain (n = 14) or for severe reflux (n = 9) at a mean period of 50 months (9-96). Twelve patients underwent resleeve gastrectomy, 6 patients underwent conversion to a bypass, and 5 patients to duodenal switch (1 single anastomosis duodeno-ileostomy). A total of 31% of patients reported gastroesophageal reflux symptoms at 8 years. At 8 years postoperatively, the LSG as a definitive bariatric procedure remained effective for 59% of cases. The results appear to be more favorable especially for the non-super-obese patients and primary procedures. LSG is a well-tolerated bariatric procedure with low long-term complication rates. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. Long-term results after primary infrapopliteal angioplasty for limb ischemia; Langzeitergebnisse nach Ballonangioplastie kruraler Arterien

    Energy Technology Data Exchange (ETDEWEB)

    Alfke, H. [Klinikum Luedenscheid (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Vannucchi, A. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Froelich, J.J. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Klinikum Bad Hersfeld (Germany). Klinik fuer Radiologie und Nuklearmedizin; El-Sheik, M.; Wagner, H.J. [Marburg Univ. (Germany). Klinik fuer Strahlendiagnostik; Vivantes-Klinikum im Friedrichshain (Germany). Inst. fuer Radiologie und Interventionelle Therapie


    Purpose: To evaluate the technical success rate, procedure-related complications, and clinical long-term results for patients who underwent infrapopliteal angioplasty. Materials and Methods: We retrospectively evaluated all patients who underwent infrapopliteal angioplasty to treat critical chronic limb ischemia or severe claudication from 1/1997 to 12/1999. We excluded patients with acute (< 2 weeks) limb ischemia. Procedure-related data were prospectively documented in a database and analyzed with a focus on the technical success rate and procedure-related complications. In addition all clinical documents were analyzed, and a follow-up examination was performed or telephone interviews were conducted with patients, relatives and referring doctors for follow-up. The primary end points were the limb salvage rate and patient survival rate. The secondary end points included the complication rate, technical success rate, and walking distance. Results: 112 patients with a mean age of 72 years (41 women, 71 men) underwent crural angioplasty on 121 limbs. Four patients suffered from severe claudication (Rutherford category 3) and all others had critical chronic limb ischemia (category 4 to 6). The complication rate was 2.7 %. The technical success rate was 92 %. The ankle brachial index increased from 0.59 to 0.88. The mean walking distance increased significantly from 52 {+-} 66 to 284 {+-} 346 meters at the time of follow-up. The limb salvage rate was 83.6 % after one year and 81.1 % after three years. The mean survival rate according to Kaplan-Meier was 79.4 %, 69.2 %, and 54.2 % at 1, 2, and 3 years, respectively. Patients with at least one patent run-off vessel after angioplasty had a significantly better limb salvage rate. Diabetes was not a risk factor for limb salvage. Conclusion: Infrapopliteal angioplasty shows a high technical success rate with an acceptable complication rate. The clinical long-term success seems favorable if a least one open run-off vessel was

  3. Safety of long-term use of linezolid: results of an open-label study

    Directory of Open Access Journals (Sweden)

    Vazquez JA


    Full Text Available Jose A Vazquez,1 Anthony C Arnold,2 Robert N Swanson,3 Pinaki Biswas,3 Matteo Bassetti4 1Section of Infectious Diseases, Medical College of Georgia, Georgia Regents University, Augusta, GA, USA; 2UCLA Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, CA, USA; 3Clinical Research, Global Innovative Pharmaceutical, Pfizer Inc., New York, NY, USA; 4Infectious Diseases Division, Santa Maria della Misericordia University Hospital, Udine, Italy Objective: The objective of this study was to assess the long-term safety of linezolid in patients with chronic infections requiring treatment for ≥6 weeks. Enhanced monitoring for optic neuropathy was included to characterize the early development of this side effect and to identify ophthalmologic tests that might be valuable in early detection of this event. Methods: This was a multicenter, open-label, pilot study of patients aged ≥18 years on long-term linezolid therapy. Matched control patients were included for baseline assessment comparison. Patients were assessed at study entry, monthly while on treatment, at the end of treatment, and 30 days following the last dose. Aggregate ocular safety data were reviewed. Response to treatment was reported. Results: The study was terminated owing to slow enrollment. Twenty-four patients received linezolid; nine patients were included as matched controls. Linezolid was prescribed for a median of 80.5 days (range, 50–254 days. In patients with a reported clinical outcome, the majority were considered improved or cured. Common treatment-related adverse events (AEs included anemia, peripheral neuropathy, polyneuropathy, vomiting, and asthenia, and were consistent with the known safety profile. Most AEs resolved or stabilized with discontinuation of treatment. Results of ophthalmologic tests in the one case adjudicated as probable linezolid-associated optic neuropathy revealed abnormal color vision, characteristic changes in the optic disk

  4. Long-term followup of men born with hypospadias: urological and cosmetic results. (United States)

    Örtqvist, Lisa; Fossum, Magdalena; Andersson, Marie; Nordenström, Anna; Frisén, Louise; Holmdahl, Gundela; Nordenskjöld, Agneta


    We present data on long-term functional and cosmetic results after hypospadias surgery. Males older than 18 years with hypospadias treated in Sweden were asked to participate in the study, as well as age matched controls and circumcised men. All participants answered questionnaires, and a subgroup was examined during an outpatient visit. Relationships with outcome were analyzed using analysis of variance and regression analysis. A total of 167 patients with a mean age of 34 years and 169 controls with a mean age of 33 years answered the questionnaire. Of the patients 63% had distal, 24% mid and 13% proximal hypospadias. A total of 46 patients and 49 controls presented for physical examination. Patients were significantly less satisfied with the penile cosmetic outcome regarding all parameters of the Penile Perception Score. There was a difference in penile length between patients and controls (mean 9.7 vs 11.6 cm, p hypospadias and controls. Men operated on for hypospadias were less satisfied with the cosmetic result than controls, and had a shorter penile length. Patients presented with more symptoms of voiding dysfunction and displayed a lower maximum urinary flow rate. Patients with proximal hypospadias were more affected than those with milder hypospadias. Our results indicate that patients with hypospadias can be subgrouped and that those with severe phenotypes should be followed more closely during childhood as well as later in adulthood. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. The Thrust Plate Prosthesis: long-term clinical and radiological results. (United States)

    Diederix, Leon W; Van Winterswijk, Peter J T S; Schouten, Sander B; Bakx, Pieter A G M; Huij, Jaap


    The Thrust Plate Prosthesis is a femoral implant designed for total hip arthroplasty, based on the principles of physiologic loading of the metaphysis of the proximal femur, and preserving the bone stock. This study presents the long-term clinical and radiological results of 34 patients with 36 Thrust Plate Prostheses. In a retrospective analysis, we investigated the reoperation-free survival as well as the clinical and radiological results. Mean age at operation was 51 +/- 6.4 years. Mean follow-up length was 11.9 +/- 1.6 years. Reoperation-free survival was 88.9%. Four (11.1%) reoperations were performed, in three patients due to aseptic loosening and in one patient because of a fracture distal to the lateral plate. Three of the reoperations were performed between 12 and 32 months postoperatively. The major complaint was pain at the lateral side of the hip (44%). Radiolucencies did not exceed 1 mm, but 35% of the hips showed resorption of the cortex directly under the thrust plate, together with cancellous bone hypertrophy at the calcar, noted in 97%. Because of the relatively high reoperation-free survival and favourable radiological results, the Thrust Plate Prosthesis appears as a possible alternative to stemmed total hip arthroplasty, especially in relatively young patients.

  6. Long-term results with the uncemented thrust plate prosthesis (TPP). (United States)

    Huggler, A H; Jacob, H A; Bereiter, H; Haferkorn, M; Ryf, C; Schenk, R


    The long-term clinical results of a novel concept for total joint replacement called the Thrust Plate Prosthesis (TPP) are presented. Only a restricted number of patients were provided with this new prosthesis (115 at the Orthopedic Department, Canton Hospital, Chur, and 47 at the Department of Orthopedic Surgery, University of Zurich). All patients have undergone clinical and radiological follow-up covering a period from 1980 to 1991. The basic feature of the Thrust Plate Prosthesis is the direct load transfer to the medial cortical bone of the femoral neck, and this has been unchanged since 1978. Titanium alloy has been used since 1986. The good clinical and radiological results are confirmed by a histological examination of an 8-year-old implant: In the crucial area of load transfer newly formed bone can be seen in direct contact with the thrust plate without fibrous tissue in between. The clinical results and histological findings have confirmed the validity of the biomechanical principle of the TPP. The TPP is therefore to be considered a true alternative to the conventional hip prosthesis. In contrast to the conventional intramedullary anchored stem prosthesis the TPP requires the removal of a minimum amount of bone stock, which is certainly important in young patients.

  7. Long-term results of the Ross procedure in a population-based follow-up. (United States)

    Kallio, Merja; Pihkala, Jaana; Sairanen, Heikki; Mattila, Ilkka


    centre, the Ross procedure has provided good long-term results in this challenging group of paediatric patients. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery Stenosis. (United States)

    Brott, Thomas G; Howard, George; Roubin, Gary S; Meschia, James F; Mackey, Ariane; Brooks, William; Moore, Wesley S; Hill, Michael D; Mantese, Vito A; Clark, Wayne M; Timaran, Carlos H; Heck, Donald; Leimgruber, Pierre P; Sheffet, Alice J; Howard, Virginia J; Chaturvedi, Seemant; Lal, Brajesh K; Voeks, Jenifer H; Hobson, Robert W


    In the Carotid Revascularization Endarterectomy versus Stenting Trial, we found no significant difference between the stenting group and the endarterectomy group with respect to the primary composite end point of stroke, myocardial infarction, or death during the periprocedural period or any subsequent ipsilateral stroke during 4 years of follow-up. We now extend the results to 10 years. Among patients with carotid-artery stenosis who had been randomly assigned to stenting or endarterectomy, we evaluated outcomes every 6 months for up to 10 years at 117 centers. In addition to assessing the primary composite end point, we assessed the primary end point for the long-term extension study, which was ipsilateral stroke after the periprocedural period. Among 2502 patients, there was no significant difference in the rate of the primary composite end point between the stenting group (11.8%; 95% confidence interval [CI], 9.1 to 14.8) and the endarterectomy group (9.9%; 95% CI, 7.9 to 12.2) over 10 years of follow-up (hazard ratio, 1.10; 95% CI, 0.83 to 1.44). With respect to the primary long-term end point, postprocedural ipsilateral stroke over the 10-year follow-up occurred in 6.9% (95% CI, 4.4 to 9.7) of the patients in the stenting group and in 5.6% (95% CI, 3.7 to 7.6) of those in the endarterectomy group; the rates did not differ significantly between the groups (hazard ratio, 0.99; 95% CI, 0.64 to 1.52). No significant between-group differences with respect to either end point were detected when symptomatic patients and asymptomatic patients were analyzed separately. Over 10 years of follow-up, we did not find a significant difference between patients who underwent stenting and those who underwent endarterectomy with respect to the risk of periprocedural stroke, myocardial infarction, or death and subsequent ipsilateral stroke. The rate of postprocedural ipsilateral stroke also did not differ between groups. (Funded by the National Institutes of Health and Abbott

  9. Long-term Results of ABI in Children With Severe Inner Ear Malformations. (United States)

    Sennaroğlu, Levent; Sennaroğlu, Gonca; Yücel, Esra; Bilginer, Burçak; Atay, Gamze; Bajin, M Demir; Mocan, Burçe Özgen; Yaral, Mehmet; Aslan, Filiz; Çnar, Betül Çiçek; Özkan, Burcu; Batuk, Merve Özbal; Kirazl, Çiğdem Ekin; Karakaya, Jale; Ataş, Ahmet; Saraç, Sarp; Ziyal, İbrahim


    To report the long-term outcomes of children who received auditory brainstem implant (ABI) because of severe inner ear malformations. Retrospective chart review. Tertiary referral otolaryngology clinic. Between July 2006 and October 2014, 60 children received ABI at Hacettepe University. Preoperative work up included otolaryngologic examination, audiological assessment, radiological evaluation together with assessment of language development and psychological status. The surgeries were performed via retrosigmoid approach with a pediatric neurosurgeon. Intraoperatively, electrical auditory brainstem response was utilized. Initial stimulation was done 4 to 5 weeks postoperatively. Outcomes were evaluated with Categories of Auditory Performance (CAP), speech intelligibility rate (SIR), functional auditory performance of cochlear implant (FAPCI) and Manchester Spoken Language Development Scale scores; receptive and expressive language ages were determined. Sixty children who received ABI were between ages of 12 and 64 months. Thirty-five patients with follow up period of at least 1 year, were reported in means of long-term audiological and language results. The most prevelant inner ear malformation was cochlear hypoplasia (n = 19). No major complication was encountered. Majority of the patients were in CAP 5 category, which implies that they can understand common phrases without lip reading. SIR was found out to be better with improving hearing thresholds. Children with ABI were performing worse than average cochlear implantation (CI) users when FAPCI scores were compared. Patients with the best hearing thresholds have expressive vocabulary of 50 to 200 words when evaluated with Manchester Spoken Language Development Scale. There was no relationship between the number of active electrodes and hearing thresholds. The type of inner ear anomaly with the best and the worst hearing thresholds were common cavity and cochlear aperture aplasia, respectively. Patients with

  10. Fyodorov-Zuev keratoprosthesis implantation: long-term results in patients with multiple failed corneal grafts. (United States)

    Ghaffariyeh, Alireza; Honarpisheh, Nazafarin; Karkhaneh, Akbar; Abudi, Reza; Moroz, Zinaida Ivanovna; Peyman, Alireza; Faramarzi, Abolhasan; Abasov, Fuad


    The long term results of the Fyodorov-Zuev keratoprosthesis are presented for ten patients with repeated graft failures. The study took place at Dr Khodadoust Eye Hospital. The Fyodorov-Zuev keratoprosthesis was implanted in ten patients with repeated graft failures, including seven patients with old trachoma, two patients with chemical injury, and a patient with thermal injury. The outcome measures were visual acuity, retention, and complications of the keratoprosthesis. Preoperative best-uncorrected visual acuity (BUVA) ranged from counting fingers to light perception (median: light perception). The keratoprosthesis dramatically improved vision in most patients. Patients retained BUVA of 20/200-20/50 in 50%, 20/60-20/100 in 30%, 20/200 in 10% and 20/400 in 10%. Overall, 90% had 1 year postoperative vision of 20/200 or better. 70% of cases had BUVA of 20/200 or better at the last follow-up (average 52 months). Of ten keratoprosthesis implanted, three have been removed, and as a result, retention rate was 70% during average follow-up of 52 months .The most common postoperative complications were retroprosthetic membrane formation (40%), uveitis (20%), glaucoma (20%), tissue overgrowth (20%), early leakage (20%), late leakage (20%), aseptic necrosis (20%), retinal detachment (10%), endophthalmitis (10%), and granulation tissue growth (10%). Fyodorov-Zuev keratoprosthesis is an effective means of managing repeated corneal graft failure.

  11. Cyclosporine A in Ullrich Congenital Muscular Dystrophy: Long-Term Results

    Directory of Open Access Journals (Sweden)

    Luciano Merlini


    Full Text Available Six individuals with Ullrich congenital muscular dystrophy (UCMD and mutations in the genes-encoding collagen VI, aging 5–9, received 3–5 mg/kg of cyclosporine A (CsA daily for 1 to 3.2 years. The primary outcome measure was the muscle strength evaluated with a myometer and expressed as megalimbs. The megalimbs score showed significant improvement (P=0.01 in 5 of the 6 patients. Motor function did not change. Respiratory function deteriorated in all. CsA treatment corrected mitochondrial dysfunction, increased muscle regeneration, and decreased the number of apoptotic nuclei. Results from this study demonstrate that long-term treatment with CsA ameliorates performance in the limbs, but not in the respiratory muscles of UCMD patients, and that it is well tolerated. These results suggest considering a trial of CsA or nonimmunosuppressive cyclosporins, that retains the PTP-desensitizing properties of CsA, as early as possible in UCMD patients when diaphragm is less compromised.

  12. Esophageal variceal ligation in the secondary prevention of variceal bleeding: Result of long term follow-up


    Lahbabi, Mounia; Mellouki, Ihssane; Aqodad, Nouredine; Elabkari, Mohammed; Elyousfi, Mounia; Ibrahimi, Sidi Adil; Benajah, Dafr Allah


    Introduction Long-term outcome of patients after band ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation in patients with portal hypertension in the Hassan II university hospital, Fes, Morocco. Methods Over 118 months patients treated by endoscopic variceal ligation were received regular follow- up and detailed clinical assessment of at least 24 months. Results One hundred twenty five patients were followed up for a mean...

  13. More Results from a Long-Term Infrared Survey of M-Class Asteroids (United States)

    Clark, Beth E.; Shepard, M. K.; Rivkin, A. S.


    In collaboration with Shepard et al. (abstract this volume), we are continuing a long-term infrared spectroscopic survey of main-belt M-class (and other X-complex) asteroids. When an asteroid is observed to have rotational variability in radar cross-section, one possible explanation is compositional variability, which should be reflected in a correlated infrared spectral rotational variability. One third of the 12 M-types observed to date show radar albedos unambiguously consistent with metallic compositions. How is this reflected in infrared-derived composition? Our goal is to parallel the tripling in the number of radar observed M-class targets with rotationally-resolved infrared and 3-micron observations within the next five years. This year, we will present results focusing on asteroid 129 Antigone. Acknowledgements. This work was supported by grants from the Research Corporation and the National Science Foundation (AST-0605903). BEC, MKS, and ASR are guest astronomers at the NASA Infrared Telescope Facility on Mauna Kea, Hawaii.

  14. Patient-Based Long-Term Results of the Surgical Treatment of Congenital Talipes Equinovarus. (United States)

    Symeonidis, Panagiotis; Christodoulou, Andreas; Mareti, Evaggelia; Eleftherochorinou, Areti; Gkourani, Syrmatenia; Mbeslikas, Theodoros; Kyrkos, John


    Long-term results of surgical treatment for congenital talipes equinovarus are documented in the literature but mainly in correlation with clinical and radiographic objective criteria. We present a retrospective study of 48 patients who underwent surgical correction (extended Cincinnati type "a la carte" approach) in our department with an average of 17 years' follow-up. Patients were interviewed and completed a validated disease specific instrument, which evaluates foot function as well as patients' satisfaction, the use of orthotics, shoe size, and the impact of this operation in their adult life. Parameters such as gender, age at first surgery, side affected, and the number of procedures were also studied. According to our findings, the greater the age at last surgery, the worse the outcome. Quality-of-life issues were expressed at a higher rate among women and by patients that underwent multiple surgeries. Unilateral correction has a correlation with the shoe size. Even if a "successful" surgical correction is achieved, residual symptoms may alter walking ability, self-image, and shoe wearing in adult life. It would be valuable to continue to follow these patients up over time. Therapeutic, Level IV: Case series. © 2015 The Author(s).

  15. Long term results of no-alcohol laser epithelial keratomileusis and photorefractive keratectomy for myopia

    Directory of Open Access Journals (Sweden)

    Leopoldo Spadea


    Full Text Available RESULTS: Twenty-one eyes and 22 eyes completed follow-up of 60mo in LASEK and PRK group respectively. Manifest refraction at 60mo follow-up was -0.01 and 0.26 in LASEK and PRK group respectively. In the LASEK group mean UDVA and mean CDVA after 60mo were 20/22 and 20/20 respectively (P>0.01. In the PRK group mean UDVA and mean CDVA at 60mo follow-up were 20/20 and 20/20 after 60mo (P>0.01. The efficacy indexes were 0.87 and 0.95, and the safety indexes were 1.25 and 1.4 respectively for LASEK group and PRK group.CONCLUSION:Both standard PRK and no-alcohol LASEK offer safe and effective correction of low-moderate myopia in the long term without any statistically significant difference between the two groups.

  16. Long term results of polytetrafluoroethylene in above knee femoropopliteal bypass for critical ischaemia.

    LENUS (Irish Health Repository)

    Kavanagh, E G


    Ninety-six consecutive above-knee femoropopliteal bypasses, using polytetrafluoroethylene (PTFE) preferentially, were performed for limb-threatening ischaemia. Cumulative primary graft patency was 68 per cent, 49 per cent and 36 per cent and limb salvage 93 per cent, 85 per cent and 75 per cent at 1, 3 and 5 yr respectively. As a result of poor long term survival (51 per cent at 5 yr), and the healing of remedial lesions before graft occlusion, 68 patients (72 per cent) required no further intervention. Eighteen secondary bypasses were undertaken, 12 using ipsilateral saphenous vein. In this group of elderly patients with poor life expectancy, where a limited operation is desirable, the use of PTFE provided excellent limb salvage with low morbidity. Although we can no longer justify our continued use of PTFE in every case of critical ischaemia because of its inferior patency to autogenous vein, we continue to use it preferentially in patients whose lifespan is likely to be short and in cases where a remedial lesion is present.

  17. 2015 Long-Term Hydrologic Monitoring Program Sampling and Analysis Results at Rio Blanco, Colorado

    Energy Technology Data Exchange (ETDEWEB)

    Findlay, Rick [Nararro Research and Engineering, Oak Ridge, TN (United States); Kautsky, Mark [US Department of Energy, Washington, DC (United States). Office of Legacy Management


    The U.S. Department of Energy (DOE) Office of Legacy Management conducted annual sampling at the Rio Blanco, Colorado, Site for the Long-Term Hydrologic Monitoring Program (LTHMP) on May 20–21, 2015. This report documents the analytical results of the Rio Blanco annual monitoring event, the trip report, and the data validation package. The groundwater and surface water monitoring samples were shipped to the GEL Group Inc. laboratories for conventional analysis of tritium and analysis of gamma-emitting radionuclides by high-resolution gamma spectrometry. A subset of water samples collected from wells near the Rio Blanco site was also sent to GEL Group Inc. for enriched tritium analysis. All requested analyses were successfully completed. Samples were collected from a total of four onsite wells, including two that are privately owned. Samples were also collected from two additional private wells at nearby locations and from nine surface water locations. Samples were analyzed for gamma-emitting radionuclides by high-resolution gamma spectrometry, and they were analyzed for tritium using the conventional method with a detection limit on the order of 400 picocuries per liter (pCi/L). Four locations (one well and three surface locations) were analyzed using the enriched tritium method, which has a detection limit on the order of 3 pCi/L. The enriched locations included the well at the Brennan Windmill and surface locations at CER-1, CER-4, and Fawn Creek 500 feet upstream.

  18. 2015 Long-Term Hydrologic Monitoring Program Sampling and Analysis Results Report for Project Rulison, Co

    Energy Technology Data Exchange (ETDEWEB)

    Findlay, Rick [Navarro Research and Engineering, Oak Ridge, TN (United States); Kautsky, Mark [US Department of Energy, Washington, DC (United States). Office of Legacy Management


    The U.S. Department of Energy (DOE) Office of Legacy Management conducted annual sampling at the Rulison, Colorado, Site for the Long-Term Hydrologic Monitoring Program (LTHMP) on May 20–22 and 27, 2015. Several of the land owners were not available to allow access to their respective properties, which created the need for several sample collection trips. This report documents the analytical results of the Rulison monitoring event and includes the trip report and the data validation package (Appendix A). The groundwater and surface water monitoring were shipped to the GEL Group Inc. laboratories for analysis. All requested analyses were successfully completed. Samples were analyzed for gamma-emitting radionuclides by high- resolution gamma spectrometry. Tritium was analyzed using two methods, the conventional tritium method, which has a detection limit on the order of 400 picocuries per liter (pCi/L), and the enriched method (for selected samples), which has a detection limit on the order of 3 pCi/L.

  19. Long-term citrus organic farming strategy results in soil organic matter recovery (United States)

    Novara, Agata; Pereira, Paulo; Barone, Ettore; Giménez Morera, Antonio; Keesstra, Saskia; Gristina, Luciano; Jordán, Antonio; Parras-Alcantara, Luis; Cerdà, Artemi


    ABSTRACT Soils play a key role in the Earth System (Keesstra et al., 2012; Brevick et al., 2015). Soils are a key resource for the human societies (Mol and Keesstra, 2012) and they are relevant to achieve the sustainability such as the United Nations Goals highlight (Keesstra et al., 2016). Agriculture soils, especially those under conventional tillage, are prone to organic matter mineralization, soil erosion, compaction and increase of greenhouse gases emission (Novara et al., 2011; Bruun et al., 2015; de Moraes et al., 2015; Choudhury et al., 2016; del Mar et al., 2016). The adoption of organic farming and sustainable management practices may provide a sustainable crop productivity, and in the meanwhile mitigate the negative impact of agriculture on ecosystem services benefits (Laudicina et al., 2015; Parras-Alcantara et al., 2015; 2016). The aim of this study was to examine, under field conditions, the long-term changes of soil organic matter under organic farming management in citrus orchards in Mediterranean environment and evaluate the ecosystem service on C sequestration in terms of economic benefits. The research was carried out at the Alcoleja Experimental Station located in the Cànyoles river watershed in the Eastern Spain on 45year old citrus plantation. Soil Organic Matter (SOM) content was monitored for 20 years at 6 different soil depth. The profitability of citrus plantation was estimated under conventional and organic management. Results showed that SOM in the 0-30 cm soil depth was the double after 20 years of organic farming management, ranging from 0.8 g kg-1 in 1995 to 1.5 g kg-1 in 2006. The highest SOM increase was in the top soil layer (368% of SOM increase in comparison to the initial SOM content) and decreased with soil depth. The effect of organic farming was relevant after 5 years since land management change, indicating that in Mediterranean environment the duration of long term studies should be higher than five years and proper policy

  20. Restorative proctocolectomy with an ileoanal pouch. Postoperative course and long-term functional results

    DEFF Research Database (Denmark)

    Walker, L.R.; Bulow, S.


    INTRODUCTION: Over the last 25 years restorative proctocolectomy with an ileoanal pouch has been the gold standard in the surgical treatment of ulcerative colitis and in selected patients with familial adenomatous polyposis. We present a study of the course, complications and long-term functional...... course and long-term follow-up were managed by few specialists in ileoanal pouch surgery. In our opinion restorative proctocolectomy with an ileoanal pouch is still the gold standard for patients with ulcerative colitis and for selected patients with familial adenomatous polyposis Udgivelsesdato: 2008/5/12...

  1. Long-term results of symptomatic fibroids treated with uterine artery embolization: In conjunction with MR evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Man Deuk [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of)], E-mail:; Lee, Hyun Seok [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Lee, Mee Hwa [Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Kim, Hee Jin [Department of Diagnostic Radiology Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of); Cho, Jin Ho; Cha, Sun Hee [Department of Obstetrics and Gynecology, Bundang CHA General Hospital, Pochon CHA University (Korea, Republic of)


    Objective: The aim of the present study is to determine long-term clinical efficacy of uterine fibroid embolization (UFE) for symptomatic fibroids in conjunction with MR evaluation. Materials and methods: Sixteen patients with a follow-up period of 4 years or longer were analyzed retrospectively. Ages ranged from 27 to 45 (mean 39.5) years. Mean follow-up periods were 5.8 years (range: 4.1-6.9 years). The symptom changes, in terms of menorrhagia and dysmenorrhea and bulk-related symptoms, were assessed. The primary embolic agent was polyvinyl alcohol particle (250-710 {mu}m). All patients underwent preprocedural and long-term follow up MR imaging. Uterine volumes were calculated using MRI. Results: Symptom improvements were reported for menorrhagia (8/9, 88.9%), dysmenorrhea (5/5, 100%), and bulk-related symptoms (7/9, 77.8%) at long-term follow up. Two patients (12.5%) had symptom recurrences at long-term follow-up. Tumor regrowth from incomplete infarction was a cause of recurrence in one patient and newly developed leiomyomas in the other one. One patient underwent hysterectomy because endometriosis developed 4 years after UFE. Of the 14 necrotic myomas on short-term follow up MR after UFE, eight (57.1%) demonstrated maintaining necrosis with further shrinkage and six (42.9%) were no longer visualized on long-term follow up MR images. Overall, the mean volume reduction rates of the predominant fibroid and uterus were 80.5%, 36.7% at long-term follow up, respectively. Conclusion: UFE is an effective treatment for symptomatic fibroids with an acceptable long-term success rate. Long-term MR imaging after UFE revealed persistent necrotic fibroid, non-visualization of fibroids and tumor regrowth when incompletely infarcted.

  2. Long-term results of radiotherapy in patients with chronic palmo-plantar eczema or psoriasis

    Energy Technology Data Exchange (ETDEWEB)

    Sumila, M.; Notter, M.; Bodis, S.; Gruber, G. [State Hospital, Aarau (Switzerland). Inst. of Radiation Oncology; Itin, P. [State Hospital, Aarau (Switzerland). Dept. of Dermatology


    Background and Purpose: Radiotherapy (RT) is well accepted for therapy-refractory palmo-plantar eczema or psoriasis, despite of lacking evidence regarding beneficial long term effects. Furthermore, the optimal irradiation dose is unknown. We evaluated the outcome of RT with two different RT single/total dose (SD/TD) treatment policies. Patients and Methods: 28 consecutive patients with therapy-refractory eczema (n = 22) or psoriasis (n = 6) of palms and/or soles were irradiated twice a week either with a D{sub max} SD of 1 Gy (6/98-5/03; median TD: 12 Gy) or 0.5 Gy (6/03-7/04; median TD: 5 Gy). Median age was 52 years (27-71), median follow-up 20 months (4-76). Totally 88 regions were treated, 49 with 1 Gy, 39 with 0.5 Gy SD. Eight different symptoms were scored from 0 (absent) -3 (severe), giving a possible sum score of 0-24. Patients' rating of RT result was also documented (worse/stable/better/complete remission). Results: The sum score was 15 (6-23) before RT, 2 (0-16) at the end of RT, and 1 (0-21) at last follow-up, respectively. The improvement was highly significant in both treatment regimens. Better or complete remission by the patients were reported in 44 and 39 (= 83 out of 88) localisations, that was often stable during the follow-up. 5 (6%) regions in 3 (11%) patients didn't benefit from RT. Conclusion: RT reveals excellent results in palmo-plantar eczema or psoriasis. We recommend a SD of 0.5 Gy twice a week up to a TD of 4-5 Gy. (orig.)

  3. Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hee; Byun, Sang Jun [Dongsan Medical Center, Daegu (Korea, Republic of)


    To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10{approx}16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13{approx}179 months, with a median of 92.5 months. The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ({<=}6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

  4. Long-term physical health consequences of perceived inequality: Results from a twin comparison design. (United States)

    Schwartz, Joseph A


    Previous research has identified long-term exposure to stress as a risk factor for negative mental and physical health outcomes. This pattern of findings suggests that environmental stimuli that evoke feelings of stress or strain may also result in physiological responses, which may accumulate over the life course and ultimately increase the overall risk of various physical health conditions. This physiological "wear and tear" resulting from sustained levels of stress or strain has been previously operationalized as allostatic load (AL), a comprehensive indicator of stress exposure. The current study examines the association between one potential environmental stressor-perceived inequality-and AL with a research design aimed at addressing both observed and unobserved sources of confounding; it also employs a more comprehensive AL measure (comprised of 24 biomarkers tapping seven physiological systems) than previous studies. The biomarker twin sample from the Midlife Development in the United States (MIDUS) study was used to estimate a series of twin comparison models, which include controls for latent sources of influence that cluster within families. The sibling comparison models also included additional controls for lifestyle choices, overall physical health, and demographics which may confound the examined associations. The results revealed significant associations between greater perceptions of inequality and greater overall levels of AL. The association persisted even after including controls for both observed and unobserved influences that may confound the examined associations but was limited to more recent measures of perceived inequality. Associations involving earlier measures of perceived inequality, along with a lifetime measure, failed to reach conventional levels of significance. Perceived inequality appears to be a robust predictor of AL and potentially contributes to subsequent physical health problems, particularly for more proximate forms of

  5. Long-term results of radiotherapy in primary carcinoma of the vagina

    Energy Technology Data Exchange (ETDEWEB)

    Hegemann, Stefan; Willich, Normann [University Hospital, Muenster (Germany). Dept. of Radiotherapy and Radiation Oncology; Schaefer, Ulrich [University Hospital, Muenster (Germany). Dept. of Radiotherapy and Radiation Oncology; Lippe Hospital, Lemgo (Germany). Dept. of Radiotherapy; Lelle, Ralph [University Hospital, Muenster (Germany). Dept. of Gynecology and Gynecologic Oncology; Micke, Oliver [University Hospital, Muenster (Germany). Dept. of Radiotherapy and Radiation Oncology; Franziskus Hospital, Bielefeld (Germany). Dept. of Radiotherapy and Radiation Oncology


    Background: The long-term results of radiotherapy in primary carcinoma of the vagina are not well defined. Patients and Methods: The treatment results of 41 patients with primary malignancies of the vagina were analyzed. The mean follow-up period was 77.3 months (2.3-404 months). The predominant histology was squamous cell carcinoma, FIGO stages I: n = 7 (17.1%), II: n = 13 (31.7%), III: n = 13 (31.7%), and IVa: n = 8 (19.5%). Radiotherapy was the primary treatment for all patients. None of the patients had undergone prior surgery for vaginal carcinoma. The majority of patients received pelvic irradiation, including treatment of the inguinal lymphatics (median dose: 50 Gy). 26 patients received additional intravaginal brachytherapy. Results: Overall, 21 patients (51.2%) achieved complete remission, 17 patients (41.5%) had partial responses, and three patients (7.3%) had no change or progressive disease. The total median survival of the analyzed patients was 41.3 months. The 1-year survival probability was 85.4%, the 5-year survival probability 40.6%, and the 10-year survival probability 27.2%. Univariate analysis revealed a survival advantage for earlier tumor stages (FIGO I and II) compared to advanced stages (FIGO III and IV), with a median survival of 58.1 months compared to 26.8 months. Treatment side effects were tolerable and easily managed. Conclusion: Definite radiotherapy is the treatment of choice for primary carcinomas of the vagina. Considering that primary malignancies of the vagina are typically diseases of the elderly, it should be noted that radiotherapy is especially well tolerated in this population. (orig.)

  6. Comments on results of a long-term low-level microwave exposure of rats

    NARCIS (Netherlands)

    Rongen, E. van; Rhoon, G.C. van; Aleman, A.; Kelfkens, G.; Kromhout, H.; Leeuwen, F.E. van; Savelkoul, H.F.J.; Wadman, W.J.; Weerdt, R.D.H.J. van de; Zwamborn, A.P.M.


    In a recent publication in this Transactions, Adang concluded that long-term exposure to RF electromagnetic fields may have effects on survival and on blood parameters in rats. The Electromagnetic Fields Committee of the Health Council of The Netherlands disputes this conclusion.

  7. Comments on "Results of a Long-Term Low-Level Microwave Exposure of Rats"

    NARCIS (Netherlands)

    van Rongen, Eric; van Rhoon, Gerard C.; Aleman, Andre; Kelfkens, Gert; Kromhout, Hans; van Leeuwen, Flora E.; Savelkoul, Huub F. J.; Wadman, Wytse J.; van de Weerdt, Rik D. H. J.; Zwamborn, A. Peter M.

    In a recent publication in this TRANSACTIONS, Adang et al. concluded that long-term exposure to RF electromagnetic fields may have effects on survival and on blood parameters in rats. The Electromagnetic Fields Committee of the Health Council of The Netherlands disputes this conclusion.

  8. The classic elephant trunk technique for staged thoracic and thoracoabdominal aortic repair: Long-term results.

    NARCIS (Netherlands)

    Castrovinci, S.; Murana, G.; Maat, G.E. de; Smith, T.; Schepens, M.A.A.M.; Heijmen, R.H.; Morshuis, W.J.


    OBJECTIVE: The classic elephant trunk (ET) technique has become the standard approach for patients with diffuse aortic disease requiring a staged thoracic and thoracoabdominal aortic repair. The aim of this study was to assess long-term outcomes and predictors for survival after surgical repair of

  9. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, Francesco, E-mail: [Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Napoli, Manuela, E-mail: [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Leone, Giuseppe, E-mail: [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Marseglia, Mariano, E-mail: [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Mariniello, Giuseppe, E-mail: [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Caranci, Ferdinando, E-mail: [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Tortora, Fabio, E-mail: [Chair of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples (Italy); Maiuri, Francesco, E-mail: [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy)


    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  10. More Results from a Long-Term Radar Survey of M-Class Asteroids. (United States)

    Shepard, Michael K.; Clark, B. E.; Benner, L. A.; Giorgini, J. D.; Magri, C.; Nolan, M. C.; Ostro, S. J.


    We present more results from our long-term radar survey of main-belt M-class asteroids. Because metals are denser and more radar reflective than silicates, an asteroid's radar cross-section can provide unambiguous information on its composition and near surface porosity [1]. The composition of this enigmatic class has important implications for the structure and evolution of the asteroid belt. As of July 2006 the following twelve main-belt M-class asteroids had been observed with radar: 16 Psyche [2,3,5], 21 Lutetia [3,5], 22 Kalliope [3], 83 Beatrix [4], 97 Klotho [3], 129 Antigone [5], 135 Hertha [5], 224 Oceana [5], 325 Heidelberga [5], and 785 Zwetana [5], 216 Kleopatra [4], and 796 Sarita [3]. Only one-third of this sample -- 16 Psyche, 129 Antigone, 216 Kleopatra and 785 Zwetana -- have radar albedos unambiguously consistent with metallic compositions [1,5]. Our goal is to triple the number of radar observed M-class targets within the next five years. We will present results focusing on the unusual radar variability of 129 Antigone. Acknowledgements. This work was partially supported by a grant from Bloomsburg University to MKS and NSF grant AST-0605903. The Arecibo Observatory is part of the National Astronomy and Ionosphere Center, which is operated by Cornell University under a cooperative agreement with the National Science Foundation. [1] Ostro et al. Science 252, 1399-1404, 1991. [2] Ostro et al. Science 229,442-446, 1985. [3] Magri et al. Icarus 140, 379-407, 1999. [4] Magri et al. submitted to Icarus. [5] Shepard et al in prep.

  11. Management of acute sigmoid volvulus: short- and long-term results. (United States)

    Bruzzi, M; Lefèvre, J H; Desaint, B; Nion-Larmurier, I; Bennis, M; Chafai, N; Tiret, E; Parc, Y


    The best form of prophylactic management of a decompressed sigmoid volvulus (SV) is controversial especially in the elderly. We have studied our experience with this condition to assess the short- and long-term results of SV management. All patients treated for SV in our department between 2003 and 2013 were retrospectively included. Emergency decompression was attempted in all patients in whom there was no sign of peritonitis. Planned surgical resection was the procedure of choice in young patients. Percutaneous endoscopic colopexy (PEC) was used in high surgical risk patients. There were 65 patients (45 males) of median age 71.5 (24-99) years. Non-surgical reduction was performed in 62 with a success rate of 95% (59/62). Recurrence after initial decompression was 67% at a median follow-up of 5 (1-14) years. A prophylactic surgical resection was performed with primary anastomosis in 33 patients. There were no deaths and the major morbidity rate was 6%. At a mean follow-up of 62 months, only 1 (3%) patient had had a recurrence (at 130 months). PEC was performed in six patients of median age 90 (84-99) years and with a median American Society of Anesthesiologists score of 4. Complications included local site infection (n = 2), pain (n = 1) and abdominal wall bleeding (n = 1). After a median follow-up of 2 (1-4) years, three patients died from medical causes and one recurrence occurred 13 months after removal of the PEC tube. Prophylactic treatment after initial decompression of SV results in a low rate of recurrence. Planned sigmoid resection is safe and effective. In frail elderly patients, PEC is satisfactory. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  12. Treatment outcome of mineral trioxide aggregate or calcium hydroxide direct pulp capping: long-term results. (United States)

    Mente, Johannes; Hufnagel, Sarah; Leo, Meltem; Michel, Annemarie; Gehrig, Holger; Panagidis, Dimos; Saure, Daniel; Pfefferle, Thorsten


    This controlled, historic cohort study project continues a previously reported trial aiming to assess treatment outcome of direct pulp capping with mineral trioxide aggregate (MTA) versus calcium hydroxide (CH). Potential prognostic factors were re-evaluated on the basis of a larger sample size and longer follow-up periods. Clinical and radiographic outcomes of 229 teeth treated with direct pulp capping between 2001 and 2011 were investigated 24 up to 123 months post-treatment (median = 42 months). Pre-, intra-, and postoperative information was evaluated and statistically analyzed using a logistic regression model as well as generalized estimating equation logit models. Two hundred five patients (229 teeth) were available for follow-up (74% recall rate). The overall success rates were 80.5% (95% confidence interval [CI], 74.5-86.5) of teeth in the MTA group (137/170) and 59% (95% CI, 46.5-71.5) of teeth in the CH group (35/59). Multivariate analyses (generalized estimating equation logit model) indicated a significantly increased risk of failure for teeth that were directly pulp capped with CH compared with MTA (odds ratio = 2.67; 95% CI, 1.36-5.25; P = .001). Teeth that were permanently restored ≥ 2 days after direct pulp capping had a significantly worse prognosis irrespective of the pulp capping material chosen (odds ratio = 3.18; 95% CI, 1.61-6.3; P = .004). The results of this study indicate that MTA provides better long-term results after direct pulp capping compared with CH. Placing a permanent restoration immediately after direct pulp capping is recommended. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  13. Treatment outcome of mineral trioxide aggregate: repair of root perforations-long-term results. (United States)

    Mente, Johannes; Leo, Meltem; Panagidis, Dimos; Saure, Daniel; Pfefferle, Thorsten


    This historical cohort study follows on a previously reported trial, with the aim of assessing the outcome for teeth with root perforations managed by the orthograde placement of mineral trioxide aggregate (MTA) and identifying potential outcome factors for such treatment with a larger sample size and longer follow-up periods than in the first phase of the project. The treatment outcomes of 64 root perforations repaired between 2000 and 2012 with MTA were investigated. The root perforations were located in different areas of the root. Calibrated examiners assessed clinical and radiographic outcomes by using standardized follow-up protocols 12-107 months after treatment (median, 27.5 months). Preoperative, intraoperative, and postoperative information was evaluated. The outcomes were dichotomized as healed or diseased. Of the 64 teeth examined (85% recall rate), 86% were healed. The univariate analyses (χ(2) tests) identified 2 potential prognostic factors, experience of the treatment providers (odds ratio, 2.14; 95% confidence interval, 0.39-11.74; P < .01) and placement of a post after treatment (odds ratio, 0.06; 95% confidence interval, 0.01-0.27; P < .01). In the multivariate stepwise logistic Cox regression, none of the potential prognostic factors displayed a significant effect on the outcome at the 5% level. MTA appears to have good long-term sealing ability for root perforations regardless of the location. The results of this historical cohort study confirm the results of the first phase of this project. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  14. Homeopathy in paediatric atopic diseases: long-term results in children with atopic dermatitis. (United States)

    Rossi, Elio; Bartoli, Paola; Bianchi, Alba; Da Frè, Monica


    To study the socio-demographic features, the prescribed remedies and the outcome of atopic diseases in children treated with homeopathy at the Homeopathic Clinic of Lucca (Italy), and the long-term outcome of children suffering from atopic dermatitis (AD) after an approximate 8-year period (range 5-10 years). Our data derive from an observational longitudinal study carried out on 213 children (38.6%) with atopic diseases out of 551 children consecutively examined from September 1998 to December 2008. We used the Glasgow Homeopathic Hospital Outcome Score to evaluate the results that were classified on the basis of a Likert scale. Eighty-three (39%) children were affected by asthma, 51 (24%) by allergic rhinoconjunctivitis, 76 (36%) by AD and 3 (1%) by food intolerance. Follow-up patients were 104 (48.8%), and 65 (62.5%) of them reported a major improvement or resolution. The parents of paediatric patients suffering from AD, who had started homeopathic treatment at children (mean age 12.9) were examined; 28/40 (70%) had a complete disappearance of AD, 12/40 children (30.0%) were still affected by AD; 8/40 (20%) had asthma and 8/40 patients had, or developed, allergic rhinitis. These preliminary results seem to confirm a positive therapeutic effect of homeopathy in atopic children. Furthermore, according to the data from the literature paediatric patients treated with homeopathy seem to show a reduced tendency to maintain AD and develop asthma (and allergic rhinitis) in adult age. Copyright © 2011 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

  15. Long-term results of jaw reconstruction with microsurgical fibula grafts and dental implants. (United States)

    Gbara, Ali; Darwich, Khaldoun; Li, Lei; Schmelzle, Rainer; Blake, Felix


    The aim of this retrospective study was to evaluate the long-term utility of the free fibula flap for the reconstruction of the maxilla and mandible and to investigate its suitability for prosthetic rehabilitation with dental implants focusing on implant survival and implant-related morbidity. Thirty patients who underwent microsurgical reconstruction of the upper or lower jaw after resection from 1992 to 1994 and were available for follow-up examination were included in the investigation. The primary afflictions were malignant tumors, alveolar atrophy, or osteomyelitis. Clinical and radiologic findings were gathered and evaluated with emphasis on the radiologic follow-up as well as clinical investigations disclosing implant-related complications. The fibula proved very suitable for the reconstruction of the upper and lower jaw, allowing rehabilitation with dental implants in all cases. Additionally, the peri-implant bone resorption and the overall complication rate proved to be low. In 93 of 128 implants, probing depths ranged from 2 to 3 mm. In 20 implants, probing depths of 4 to 6 mm were observed. In 4 implants, probing depths of greater than 7 mm were observed. These values corresponded with the radiologically assessed values. The reconstruction of the upper and lower jaw with a microsurgically reanastomosed fibula flap, in combination with dental implants, leads to satisfactory functional and esthetic results. The fibula flap seems resistant to peri-implantary resorption processes and is capable of withstanding the masticatory forces that develop during functional loading. In conjunction with the new prosthetic attachments, like the titanium magnetic inserts, the fixation of cover dentures and the oral hygiene is simplified and improved.

  16. Adjustable Perineal Male Sling for the Treatment of Urinary Incontinence: Long-term Results. (United States)

    Altan, Mesut; Asi, Tariq; Bilen, Cenk Yucel; Ergen, Ali


    To present the long-term results in patients with urinary incontinence who were treated with adjustable perineal male sling. An adjustable male sling procedure was performed in 45 patients with a mean age of 67.6 ± 7.8 years who had urinary incontinence. The mean period between primary prostatic surgery and the sling procedure was 36.7 months. The difference between the classical sling and the adjustable one is a 10 cm tissue expander between the 2 layers of polypropylene mesh with an injection port. Adjustment of the sling was performed with saline via this port, in case of recurrence or persistence of incontinence. Mean follow-up was 48 ± 29 months. Average operative time was 101.1 ± 25.5 minutes (45-150). Median daily pad use in these patients decreased from 8(2-12) to 1(0-10) (P pad daily, 28.9% used 1-2 pads daily, making the total success rate 66.7%. Complete dry rate was higher in patients with nonsevere incontinence compared to the others with severe incontinence (57.9% vs 23.1%, P = .029). Nevertheless, there was no significant difference in the case of total success rate (78.9% vs 57.7%, respectively; P = .135). Age was significantly greater in both complete dry group (71.1 ± 4.8 vs 65.4 ± 8.7) and total success group (70.1 ± 5.2 vs 62.4 ± 5.2) (P = .017 and P incontinence. At the same time, this procedure may be offered to patients with previous incontinence surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Long-term results of tracheostomy for severe obstructive sleep apnea syndrome. (United States)

    Haapaniemi, J J; Laurikainen, E A; Halme, P; Antila, J


    Severe obstructive sleep apnea (OSAS) is most often accompanied by metabolic syndrome, obesity, diabetes and coronary disease. In its most severe form, it is a life-threatening condition, requiring active and immediate help. Nasal continuous positive airway pressure (CPAP) is the most efficient nonsurgical treatment for patients with OSAS. However, for anatomical, disease-related and subjective reasons, many patients cannot accept this treatment. A permanent tracheostomy may be one alternative in such patients who, in addition, often suffer from extreme obesity and severe heart disease. In this paper, we describe the long-term follow-up results of 7 patients suffering from OSAS and treated with permanent tracheostomy. All the patients (5 men, 2 women) were diagnosed using the static charge sensitive bed method and night-time oximetry for sleep analysis. The mean body mass index (BMI) of the patients ranged from 34 to 60 and the age from 41 to 64 years. All the patients had severe OSAS and long periods of low oxygen saturation (SaO2) levels. Six patients had a CPAP trial before tracheostomy. Only 2 patients tolerated the trial but, despite the continuous use of CPAP, they were nonresponders. Permanent tracheostomy was done according to normal routine in each patient. After primary healing of 2 days, they used silver cannulae, which also allowed them to speak. The patients were evaluated every year after the tracheostomy. After some practical difficulties including proper maintenance of the cannula, all the patients quickly learned the correct management. In postoperative sleep studies, nadir SaO2 levels had improved significantly, obstructive apneas had disappeared and the subjective quality of life had improved. No marked changes in BMI were found.

  18. High-risk extracranial chondrosarcoma: long-term results of surgery and radiation therapy. (United States)

    Goda, Jayant Sastri; Ferguson, Peter C; O'Sullivan, Brian; Catton, Charles N; Griffin, Anthony M; Wunder, Jay S; Bell, Robert S; Kandel, Rita A; Chung, Peter W


    A study was undertaken to evaluate results of surgery and radiotherapy (RT) for high-risk extracranial chondrosarcomas. Between 1986 and 2006, 60 patients underwent surgery and RT for extracranial high-risk chondrosarcoma. Preoperative RT (median, 50 gray [Gy]) and postoperative RT (median, 60 Gy) were used in 40% and 60% patients, respectively. Sites included pelvis/lower extremity (48%), chest wall (22%), spine/paraspinal (17%), and head and neck (13%). Overall, median tumor size was 7 cm (range, 1-22 cm), and tumor grade was I, II, and III in 22%, 64%, and 14% of cases, respectively. Pathologically clear surgical margins (R0) were present in 50%, microscopic positive margins (R1) in 28%, and gross positive margins (R2) in 13%, half of whom had clinically detectable residual disease; surgical margin was unknown in 8%. Median follow-up was 75 months (range, 5-230 months). The crude local control rate was 90%. Patients with R0, R1, and R2 resections had local control of 100%, 94%, and 42%, respectively. Of the 8 cases that had R2 resection, 3 experienced uncontrolled progression, but 5 patients had stable disease with long-term follow-up. The 10-year overall survival, progression-free survival, and cause-specific survival were 86%, 80.5%, and 89.4%, respectively. Younger age and grade III tumors were associated with worse progression-free survival (P = .03 and .0003, respectively). Although surgery with complete resection is paramount in management of chondrosarcoma, RT is a useful adjuvant treatment and appears to offer excellent and durable local control where wide surgical resection is difficult to accomplish. Copyright © 2011 American Cancer Society.

  19. Long-term results of primary transpupillary thermal therapy for the treatment of choroidal malignant melanoma. (United States)

    Aaberg, T M; Bergstrom, C S; Hickner, Z J; Lynn, M J


    This is a long-term follow-up report investigating primary transpupillary thermal therapy (TTT) for choroidal melanoma. Retrospective case series of 135 patients harbouring choroidal melanoma treated with primary TTT. Patient demographics, tumour characteristics, treatment responses and complications, visual acuity outcomes and mortality data were captured and reported. A statistical analysis was performed for predictors of treatment failure. Successful tumour regression was achieved in 76% of patients. Of the 32 patients who failed, 12 had enucleation, and 20 had irradiation. Metastatic disease has occurred in three patients, and two patients have died (3/135, or 2%). Multivariate analysis determined that tumour diameter, tumour thickness greater than 3 mm and tumours exhibiting high-risk characteristics were significant predictors of failure. Patient age, gender, number of treatments and proximity of the tumour to the disc or fovea were not predictive of failure. Kaplan-Meier cumulative probability predicted a 19% 5-year treatment failure and 33% 10-year treatment failure. Treatment failure occurred as late as 99 months. Final visual acuity was 20/40 or better in 50% of patients; 32% had a final visual acuity of 20/200 or worse. Thirty-two per cent of patients developed one or more complications as a result of the TTT, the most concerning of which was intra- or extrascleral extension of tumour (occurring in 11 patients). Though not as successful as radiation therapy, TTT successfully induced regression in 76% of patients. TTT may still have a role in our treatment paradigm but should probably be reserved for specific cases, such as monocular patients with tumours near critical visual structures, surgically unstable patients or patients with advanced diabetic retinopathy. All patients considering TTT as monotherapy for choroidal melanoma must be selected, counselled and followed appropriately.

  20. Long-term results after external radiotherapy in age-related macular degeneration. A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Prettenhofer, U.; Mayer, R.; Stranzl, H.; Oechs, A.; Hackl, A. [Dept. of Radiotherapy, Univ. Medical School, Graz (Austria); Haas, A. [Dept. of Opthalmology, Univ. Medical School, Graz (Austria)


    Purpose: to prospectively evaluate the short- and long-term efficacy of external radiotherapy (RT) in patients with age-related macular degeneration (AMD) by comparing two different dose schedules. Patients and methods: in this prospective, nonrandomized, comparative study including 80 patients, the efficacy of external RT with a total dose of 14.4 Gy (group A, n = 40) and 25.2 Gy (group B, n = 40) was compared. Patients of group a were irradiated between September 1995 and July 1996, patients of group b between August 1996 and November 1997. 67 patients presented with occult choroidal neovascularization (CNV), 13 with classic subfoveal lesions. Complete ophthalmologic investigation was performed before RT, at intervals of 3 months during the 1st year after RT, and of 6 months thereafter. Results: 12 months after RT, vision deteriorated in 85% (14.4 Gy) and 65% (25.2 Gy) of patients. Central visual field decreased with both dose schedules. There was no morphological benefit in neovascular changes. After 48 months, complete follow-up was possible in 46 patients who showed a significant loss of vision similar to the natural course of AMD. Conclusion: external RT of AMD with 14.4 Gy as well as with the escalated dose of 25.2 Gy showed a poor beneficial outcome after 6 and 12 months, respectively. After a follow-up of 4 years, visual outcome in irradiated patients was similar to the natural course of the disease. A conspicuous efficacy of RT in prevention of blindness could not be demonstrated. (orig.)

  1. Long-term results after transplantation of pediatric liver grafts from donation after circulatory death donors.

    Directory of Open Access Journals (Sweden)

    Rianne van Rijn

    Full Text Available Liver grafts from donation after circulatory death (DCD donors are increasingly accepted as an extension of the organ pool for transplantation. There is little data on the outcome of liver transplantation with DCD grafts from a pediatric donor. The objective of this study was to assess the outcome of liver transplantation with pediatric DCD grafts and to compare this with the outcome after transplantation of livers from pediatric donation after brain death (DBD donors.All transplantations performed with a liver from a pediatric donor (≤16 years in the Netherlands between 2002 and 2015 were included. Patient survival, graft survival, and complication rates were compared between DCD and DBD liver transplantation.In total, 74 liver transplantations with pediatric grafts were performed; twenty (27% DCD and 54 (73% DBD. The median donor warm ischemia time (DWIT was 24 min (range 15-43 min. Patient survival rate at 10 years was 78% for recipients of DCD grafts and 89% for DBD grafts (p = 0.32. Graft survival rate at 10 years was 65% in recipients of DCD versus 76% in DBD grafts (p = 0.20. If donor livers in this study would have been rejected for transplantation when the DWIT ≥30 min (n = 4, the 10-year graft survival rate would have been 81% after DCD transplantation. The rate of non-anastomotic biliary strictures was 5% in DCD and 4% in DBD grafts (p = 1.00. Other complication rates were also similar between both groups.Transplantation of livers from pediatric DCD donors results in good long-term outcome especially when the DWIT is kept ≤30 min. Patient and graft survival rates are not significantly different between recipients of a pediatric DCD or DBD liver. Moreover, the incidence of non-anastomotic biliary strictures after transplantation of pediatric DCD livers is remarkably low.

  2. Long-term results of adjuvant irradiation or surveillance in stage I testicular seminoma

    Energy Technology Data Exchange (ETDEWEB)

    Miki, Tsuneharu; Nonomura, Norio [Osaka Univ., Suita (Japan). Medical School; Saiki, Shigeru; Kotake, Toshihiko


    Excellent treatment results are obtained for stage I testicular seminoma treated with orchiectomy and prophylactic radiotherapy. In patients with stage I nonseminomatous testicular tumors, surveillance alone is successful, however, this treatment option for stage I testicular seminomas is controversial. There have been few reports of long-term follow-up of surveillance alone for patients with stage I testicular seminoma. To assess the appropriateness of this treatment option, a retrospective survey of stage I testicular seminoma was undertaken. Twenty-seven patients who underwent prophylactic radiation therapy (RT group) and 41 patients followed only by surveillance (S group) after high orchiectomy were evaluated. Their follow-up consisted of frequent clinical examinations, abdominal CT scans, chest x-rays and serum tumor markers. In the RT group, with a median follow-up period of 15 years, 1 patient (3.6%) had a recurrence in the lung at 4 months after orchiectomy and died, but the remaining 26 are alive with no evidence of disease (NED). In the S group, with a median follow-up period of 7.3 years, 5 (12.2%) relapsed in the retroperitoneal lymph nodes, but all are alive with NED following chemotherapy. The remaining 36 are all alive without recurrence (follow-up period, 38 to 132 months). Although the relapse rate in the S group was relatively higher than in the RT group, there was no significant difference between the 2 groups. If a frequent follow-up protocol is administered and followed by the patient, surveillance alone may be a recommended management for stage I testicular seminoma. (author)

  3. The Erlangen Dose Optimization Trial for radiotherapy of benign painful shoulder syndrome. Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Ott, O.J.; Hertel, S.; Gaipl, U.S.; Frey, B.; Schmidt, M.; Fietkau, R. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany)


    To evaluate the long-term efficacy of pain reduction by two dose-fractionation schedules for radiotherapy of painful shoulder syndrome. Between February 2006 and February 2010, 312 evaluable patients were recruited for this prospective trial. All patients received low-dose orthovoltage radiotherapy. One course consisted of 6 fractions in 3 weeks. In the case of insufficient pain remission after 6 weeks, a second course was administered. Patients were randomly assigned to one of two groups to receive single doses of either 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before radiotherapy, as well as immediately after (early response), 6 weeks after (delayed response) and approximately 3 years after (long-term response) completion of radiotherapy using a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS). Median follow-up was 35 months (range 11-57). The overall early, delayed and long-term response rates for all patients were 83, 85 and 82%, respectively. The mean VAS scores before treatment and those for early, delayed and long-term response in the 0.5- and 1.0-Gy groups were 56.8±23.7 and 53.2±21.8 (p=0.16); 38.2±36.1 and 34.0±24.5 (p=0.19); 33.0±27.2 and 23.7±22.7 (p=0.04) and 27.9±25.8 and 32.1±26.9 (p=0.25), respectively. The mean CPS values before treatment and those for early, delayed and long-term response were 9.7±3.0 and 9.5±2.7 (p=0.31); 6.1±3.6 and 5.4±3.6 (p=0.10); 5.3±3.7 and 4.1±3.7 (p=0.05) and 4.0±3.9 and 5.3±4.4 (p=0.05), respectively. No significant differences in the quality of the long-term response were found between the 0.5- and 1.0-Gy arms (p=0.28). Radiotherapy is an effective treatment for the management of benign painful shoulder syndrome. For radiation protection reasons, the dose for a radiotherapy series should not exceed 3.0 Gy. (orig.)

  4. Both column fractures of the acetabulum: epidemiology, operative management and long-term-results. (United States)

    Gänsslen, A; Frink, M; Hildebrand, F; Krettek, C


    occued in only 17.5% of these patients. A joint failure was present in 25.4%. In this group, a joint failure was significantly more likely to be present with an additional lesion of the femoral head and severe primary articular fracture displacement. In contrast to other acetabular fracture types, both column fractures show worser results regarding joint reconstruction, and functional and radiological long-term results. The optimal results can be achieved with anatomic joint reconstruction.

  5. Long-term results of «Universal» total knee endoprosthesis

    Directory of Open Access Journals (Sweden)

    J. Pilny


    Full Text Available The objective - to evaluate long-term results and survival rates of «Universal» condylar knee prosthesis. Material and methods. There were a total of 121 total knee joint replacements in the set with 107 patients aged 71.3 years on average (52-86 years. A total of 115 knees diagnosed with osteoarthritis of the 3-4th degree were indicated for the surgery, and there were 6 patients with the diagnosis of rheumatoid arthritis. Functional outcomes were evaluated using the Knee Society Score (KSS, Results. The assessment of the knee state on a scale KSS average clinical section KSS (knee score was 48.2, and functional (function score - 46,8 points. After surgery, the indices increased to 87.4 points and 85.8 points, respectively. One complication was described during the surgery, namely - the fracture of the medial tibia condyle (0.8%. In the early post-surgery period, peroneal nerve paresis was observed in two patients (1.6%. In the postoperative period, disorders of the wound healing were observed in 6 patients (4.9%, which were healed successfully in a conservative way. In the late post-surgery period, there were infectious complications in the knee joint in 4 knee joints (3.3%. Aseptic loosening was observed in 4 cases out of 117 endoprostheses (3.4%. It always concerned the loosening of tibial component. The loosening of the femoral component was not observed. In the period from the implantation until June 2014, which is 16-22 years after the implantation, there are 16 patients in total surviving, who had a total of 21 implanted endoprostheses. Among them there are no signs of a loosening only in 4 patients (19%; there was an apparent radiolucent line up until 2 mm with a sclerotic rim under the tibial component. All the patients were without clinical symptoms for the loosening. Six female patients (28.5% state troubles in the area of the femoro-patellar joint, where there is a lateralization of the patella, apparent on the X-ray images. Two

  6. Long-term results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty. (United States)

    Shousha, Mohamed Abou; Yoo, Sonia H; Kymionis, George D; Ide, Takeshi; Feuer, William; Karp, Carol L; O'Brien, Terrence P; Culbertson, William W; Alfonso, Eduardo


    To evaluate the long-term results of femtosecond laser-assisted anterior lamellar keratoplasty (FALK) for anterior corneal pathologies. Retrospective, noncomparative, interventional case series. Thirteen consecutive patients who underwent FALK for anterior corneal pathologies. Femtosecond laser-assisted sutureless anterior lamellar keratoplasty. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, need for adjunctive surgery, and complications. Follow-up ranged from 12 to 69 months (mean = 31 months). The BSCVA was significantly improved over preoperative values at the 12-, 18-, 24-, and 36-month visits. A BSCVA greater than 20/30 was achieved in 54% of patients at the 12-month visit when all 13 patients were available for follow-up, in 50% and 33% of patients at the 18- and 24-month visits, respectively, when 12 patients were available, and in 60% and 50% of patients at the 36- and 48-month visits when 5 and 2 patients were available, respectively. The BSCVA of the eye that completed the 60- and 70-month visits was 20/50. Patients achieved a mean gain of 5 lines of BSCVA at the 6-, 12-, 18-, and 24-month visits, 4 lines at the 36-month visit, 5 lines at the 48-month visit, and 6 lines at the 60- and 72-month visits. Two patients lost a mean of 1.5 lines of BSCVA because surface haze developed after photorefractive keratectomy (PRK) and granular dystrophy recurred in the graft. At a mean of 5 weeks postoperatively, 83.3% of patients achieved BSCVA within 2 lines of that recorded at the 24-month visit. At the 12-month visit, mean spherical equivalent and refractive astigmatism were -0.4 diopters (D) and 2.2 D, respectively, with no significant shift from preoperative values or values recorded in different follow-up visits. Adjunctive surgeries included phototherapeutic keratectomy, PRK, cataract extraction, and epithelial ingrowth debridement. Complications included residual corneal pathology, mild interface haze, anisometropia, recurrence of

  7. Long-Term Results from an Epiretinal Prosthesis to Restore Sight to the Blind. (United States)

    Ho, Allen C; Humayun, Mark S; Dorn, Jessy D; da Cruz, Lyndon; Dagnelie, Gislin; Handa, James; Barale, Pierre-Olivier; Sahel, José-Alain; Stanga, Paulo E; Hafezi, Farhad; Safran, Avinoam B; Salzmann, Joel; Santos, Arturo; Birch, David; Spencer, Rand; Cideciyan, Artur V; de Juan, Eugene; Duncan, Jacque L; Eliott, Dean; Fawzi, Amani; Olmos de Koo, Lisa C; Brown, Gary C; Haller, Julia A; Regillo, Carl D; Del Priore, Lucian V; Arditi, Aries; Geruschat, Duane R; Greenberg, Robert J


    Retinitis pigmentosa (RP) is a group of inherited retinal degenerations leading to blindness due to photoreceptor loss. Retinitis pigmentosa is a rare disease, affecting only approximately 100 000 people in the United States. There is no cure and no approved medical therapy to slow or reverse RP. The purpose of this clinical trial was to evaluate the safety, reliability, and benefit of the Argus II Retinal Prosthesis System (Second Sight Medical Products, Inc, Sylmar, CA) in restoring some visual function to subjects completely blind from RP. We report clinical trial results at 1 and 3 years after implantation. The study is a multicenter, single-arm, prospective clinical trial. There were 30 subjects in 10 centers in the United States and Europe. Subjects served as their own controls, that is, implanted eye versus fellow eye, and system on versus system off (native residual vision). The Argus II System was implanted on and in a single eye (typically the worse-seeing eye) of blind subjects. Subjects wore glasses mounted with a small camera and a video processor that converted images into stimulation patterns sent to the electrode array on the retina. The primary outcome measures were safety (the number, seriousness, and relatedness of adverse events) and visual function, as measured by 3 computer-based, objective tests. A total of 29 of 30 subjects had functioning Argus II Systems implants 3 years after implantation. Eleven subjects experienced a total of 23 serious device- or surgery-related adverse events. All were treated with standard ophthalmic care. As a group, subjects performed significantly better with the system on than off on all visual function tests and functional vision assessments. The 3-year results of the Argus II trial support the long-term safety profile and benefit of the Argus II System for patients blind from RP. Earlier results from this trial were used to gain approval of the Argus II by the Food and Drug Administration and a CE mark in

  8. Feasibility of Compliant Flooring in Long-Term Care: Results from a Stakeholder Symposium. (United States)

    Lachance, Chantelle C; Mackey, Dawn C


    Compliant flooring aims to prevent fall-related injuries among high-risk older adults in long-term care, but uptake of compliant flooring in this setting is limited. We hosted a one-day stakeholder symposium to identify advantages and disadvantages of implementing compliant flooring in long-term care and the most pressing directions for future research from the perspective of key stakeholders. Twenty-three stakeholders representing health care, industry, and research attended the symposium. Attendees believed the most important advantages of compliant flooring were reducing injuries in residents who have fallen, potential benefits to care staff, and potential increases in quality of life for residents. Attendees perceived the most significant disadvantages of compliant flooring were financial considerations, lack of research evidence, and challenges with installation. Attendees indicated a need for additional research on cost-effectiveness and clinical effectiveness. While stakeholders perceived compliant flooring to add value to long-term care, there are significant informational and financial barriers to uptake.

  9. Long-term results of the Ross operation: an 18-year single institutional experience. (United States)

    da Costa, Francisco Diniz Affonso; Takkenberg, Johanna Josepha Maria; Fornazari, Daniele; Balbi Filho, Eduardo Mendel; Colatusso, Claudinei; Mokhles, Mohammad Mostafa; da Costa, Ana Beatriz Brenner Affonso; Sagrado, Andressa Gervasoni; Ferreira, Andreia Dumsch de Aragon; Fernandes, Tiago; Lopes, Sergio Veiga


    The purpose of the study was to assess the 18-year outcome of the Ross operation (RO), with emphasis on survival, reoperations, and late function of the pulmonary autografts (PAs) and the right-sided pulmonary allografts. Between May 1995 to July 2013, 414 patients with a mean age (mean ± standard deviation) of 30.8 ± 13.1 years were submitted to an RO with the root replacement (n = 356) or the inclusion (n = 58) technique. The most prevalent aetiology was bicuspid valve (n = 206, 49.8%). Patients were divided in four groups depending on the type of allograft used on the right side. The mean follow-up was 8.2 ± 5.2 years and was 97.7% complete. In addition to longitudinal outcomes determined by means of the Kaplan-Meier analysis, log-rank test and Cox regression analysis were used to identify predictors of valve failure. The early mortality rate was 2.7% and the late survival rate was 89.3% at 15 years, similar to an age- and sex-matched population. There were 22 reoperations on the PA (90.7% freedom at 15 years) and 15 on the pulmonary allografts (92.5% freedom at 15 years). The freedom rate from more than mild aortic insufficiency (AI) was 73.1% at 15 years. Thirty-three patients presented with a late root diameter >45 mm, corresponding to a freedom rate of 72.4% at 15 years. Patients with AI and a dilated annulus, especially males, are at greater risk for these complications. Among the right-sided allografts, fresh decellularized allografts showed significantly superior freedom from structural valve dysfunction. The RO was associated with excellent long-term survival and low incidence of reoperations up to 15 years. Male patients with AI and dilated annulus are at increased risk for late insufficiency and root dilatation. Fresh decellularized allografts presented the best results for reconstruction of the right ventricular outflow tract. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery

  10. Long-Term Results of 2-Dimensional Radiation Therapy in Patients with Nasopharyngeal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nam Kwon; Park, Young Je; Yang, Dae Sik; Yoon, Won Sup; Lee, Suk; Kim, Chul Yong [Dept. of Radiation Oncology, Korea University College of Medicine, Seoul (Korea, Republic of)


    To analyze the treatment outcomes, complications, prognostic factors after a long-term follow-up of patients with nasopharyngeal carcinoma treated with radiation therapy (RT) alone or concurrent chemoradiation therapy (CCRT). Between December 1981 and December 2006, 190 eligible patients with non-metastatic nasopharyngeal carcinoma were treated at our department with a curative intent. Of these patients, 103 were treated with RT alone and 87 patients received CCRT. The median age was 49 years (range, 8-78 years). The distributions of clinical stage according to the AJCC 6th edition included I: 7 (3.6%), IIA: 8 (4.2%), IIB: 33 (17.4%), III: 82 (43.2%), IVA: 31 (16.3%), IVB: 29 (15.3%). The accumulated radiation doses to the primary tumor ranged from 66.6-87.0 Gy (median, 72 Gy). Treatment outcomes and prognostic factors were retrospectively analyzed. Acute and late toxicities were assessed using the RTOG criteria. A total of 96.8% (184/190) of patients completed the planned treatment. With a mean follow-up of 73 months (range, 2-278 months; median, 52 months), 93 (48.9%) patients had relapses that were local 44 (23.2%), nodal 13 (6.8%), or distant 49 (25.8%). The 5- and 10-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 55.6% and 44.5%, 54.8% and 51.3%, in addition to 65.3% and 57.4%, respectively. Multivariate analyses revealed that CCRT, age, gender, and stage were significant prognostic factors for OS. The CCRT and gender were independent prognostic factors for both DFS and DSS. There was no grade 4 or 5 acute toxicity, but grade 3 mucositis and hematologic toxicity were present in 42 patients (22.1%) and 18 patients (9.5%), respectively. During follow-up, grade 3 hearing loss in 9 patients and trismus in 6 patients were reported. The results of our study were in accordance with findings of previous studies and we confirmed that CCRT, low stage, female gender, and young age were related to improvement in OS

  11. Pledgeted repair of giant hiatal hernia provides excellent long-term results. (United States)

    Kang, Thomas; Urrego, Hernan; Gridley, Asahel; Richardson, William S


    Use of mesh in hiatal hernia repairs is a topic of debate. We present our experience in laparoscopic primary (nonmesh) repair of giant hiatal hernia. All laparoscopic antireflux procedures done by a single surgeon from November 1997 to October 2006 were retrospectively reviewed. Inclusion criteria were primary crural closure with pledgets and giant hiatal hernia (greater than one-third of the stomach in the chest by esophagram, greater than 5 cm in length endoscopically, or greater than one-third of the stomach in the chest operatively). We attempted to reach all patients who met inclusion criteria and administered the Reflux Symptom Index (RSI) and Quality of Life Scale for Gastroesophageal Reflux Disease (QLSGR) questionnaires. In total, 89 patients met inclusion criteria. The male-to-female ratio was 32:57. Average age was 62.7 years. Average body mass index was 29.3 kg/m(2). Average length of stay was 2 days, and mean clinic follow-up was 161 days. At the most recent follow-up, 62% of patients were asymptomatic. The most common postoperative symptoms were dysphagia (16%), reflux/emesis (5%), bloating (5%), nausea (4%), epigastric pain (4%), and heartburn (3%). There were six (6.7%) recurrences on esophagogastroduodenoscopy or upper gastrointestinal examination. Five patients with recurrence were symptomatic. Of the 89 patients, 29 (33%) completed the questionnaire, with a mean follow-up of 69.7 months. Average RSI score was 12 (maximum possible score, 45). In six of nine categories, the average score was less than 1 (possible score, 0-5). Average QLSGR score was 12 (maximum possible score, 45). For satisfaction with the present condition, the average score was 4.34 (maximum score, 5), and 82.7% of respondents were satisfied or very satisfied with their present condition. Laparoscopic primary repair of giant hiatal hernia provides excellent long-term results. We found that 62% of patients were asymptomatic at the last follow-up and that 82% of respondents were

  12. The Erlangen Dose Optimization Trial for radiotherapy of benign painful shoulder syndrome. Long-term results. (United States)

    Ott, O J; Hertel, S; Gaipl, U S; Frey, B; Schmidt, M; Fietkau, R


    To evaluate the long-term efficacy of pain reduction by two dose-fractionation schedules for radiotherapy of painful shoulder syndrome. Between February 2006 and February 2010, 312 evaluable patients were recruited for this prospective trial. All patients received low-dose orthovoltage radiotherapy. One course consisted of 6 fractions in 3 weeks. In the case of insufficient pain remission after 6 weeks, a second course was administered. Patients were randomly assigned to one of two groups to receive single doses of either 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before radiotherapy, as well as immediately after (early response), 6 weeks after (delayed response) and approximately 3 years after (long-term response) completion of radiotherapy using a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS). Median follow-up was 35 months (range 11-57). The overall early, delayed and long-term response rates for all patients were 83, 85 and 82 %, respectively. The mean VAS scores before treatment and those for early, delayed and long-term response in the 0.5- and 1.0-Gy groups were 56.8 ± 23.7 and 53.2 ± 21.8 (p = 0.16); 38.2 ± 36.1 and 34.0 ± 24.5 (p = 0.19); 33.0 ± 27.2 and 23.7 ± 22.7 (p = 0.04) and 27.9 ± 25.8 and 32.1 ± 26.9 (p = 0.25), respectively. The mean CPS values before treatment and those for early, delayed and long-term response were 9.7 ± 3.0 and 9.5 ± 2.7 (p = 0.31); 6.1 ± 3.6 and 5.4 ± 3.6 (p = 0.10); 5.3 ± 3.7 and 4.1 ± 3.7 (p = 0.05) and 4.0 ± 3.9 and 5.3 ± 4.4 (p = 0.05), respectively. No significant differences in the quality of the long-term response were found between the 0.5- and 1.0-Gy arms (p = 0.28). Radiotherapy is an effective treatment for the management of benign painful shoulder syndrome. For radiation protection reasons, the dose for a radiotherapy series should

  13. Long-term results following switch from abciximab to eptifibatide during percutaneous coronary intervention. (United States)

    Koutouzis, Michael; Lagerqvist, Bo; Oldgren, Jonas; Akerblom, Axel; Wahlin, Magnus; Karlsson, Thomas; Albertsson, Per; Matejka, Göran; Grip, Lars


    The usage of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors improves the outcome during high-risk percutaneous coronary interventions (PCI). The aim of this study was to evaluate the long-term effects after a planned switch from abciximab to eptifibatide during PCI. A switch from the general use of abciximab to eptifibatide as a GP IIb/IIIa in connection with PCI would not have any negative effects on long-term clinical outcomes. To reduce costs, a general switch from abciximab to eptifibatide was instituted in 2004 in 2 university hospitals in Sweden. All patients treated 6 months before and 6 months after the switch were followed for 30 months. During the study period, 1038 patients underwent PCI and received a GP IIb/IIIa receptor inhibitor, 481 (46%) before the switch (Group A) and 557 (54%) after the switch (Group B). The 2 groups had similar baseline characteristics. The primary endpoint was the composite of death, myocardial infarction, stroke, or new coronary revascularization (percutaneous or surgical); secondary endpoints were the individual components of this composite. A separate analysis was performed on patients treated for ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction/unstable angina, and diabetes, respectively. Data were collected from the Swedish Coronary Angiography and Angioplasty Registry. There were no differences between the groups in the primary endpoint (29.7% in Group A vs 29.3% in Group B; P = 0.48) or in any of the secondary endpoints. A switch from the general usage of abciximab to eptifibatide as a GP IIb/IIIa receptor inhibitor in connection with PCI did not seem to have any negative effects on long-term clinical outcomes. Copyright © 2008 Wiley Periodicals, Inc.

  14. Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China. (United States)

    Wang, Xiao-Qing; Jiang, Feng-Ming; Chen, Qi-Hui; Hou, Yu-Chuan; Zhang, Hai-Feng; Hao, Yuan-Yuan; Zhang, Long; Wang, Chun-Xi


    We compared long-term clinical outcomes of upper urinary tract transitional cell carcinoma (TCC) patients treated by retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). Upper urinary tract TCC patients were treated with RNU (n = 86) or ONU (n = 72) and followed-up for more than three years. Demographic and clinical data, including preoperative indexes, intraoperative indexes and long-term clinical outcomes, were retrospectively compared to determine long-term efficacy of the two procedures. The RNU and ONU groups were statistically similar in age, gender, previous bladder cancer history, tumour location, pathologic tumour stage, pathologic node metastasis or tumour pathologic grade. The original surgery time required for both RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 42.4 months, range: 3-57) revealed that the RNU 3-year recurrence-free survival rate was 62.8% and the 3-year cancer specific survival rate was 80.7%. In the ONU group, the 3-year recurrence-free survival and the three-year cancer-specific survival rates were 59.2% and 80.3%, respectively. Neither of the survival rates were statistically different between the two groups. T stage, grade, lymph node metastasis and bladder tumour history were risk factors for tumour recurrence; the operation mode and the bladder cuff incision mode had no correlation with the recurrence-free survival. The open surgery strategy and the retroperitoneoscopic nephroureterectomy strategy are equally effective for treating upper urinary tract TCC. However, the RNU procedure is less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy.

  15. [Proximal femoral varus osteotomy in adults after developmental dysplasia of the hip: long-term results]. (United States)

    Rozkydal, Z; Janíček, P; Otiepka, P


    follow-up. Conversion to THR in 10 patients (11 hips) was done at an average of 12 years after osteotomy. The median values before surgery and at the latest follow-up were: CCD angle, 158° and 118°; Wiberg angle, 13° and 20°; and AHI index, 56 % and 79 %, respectively. The prerequisite for a good result of proximal femoral varus osteotomy is the correct indication, i.e., younger age (18 to 30 years), a lower grade of osteoarthritis, mild dysplasia and a spherical shape of the femoral head. A disadvantage of the procedure is a shortening of the limb. The best indication for femoral varus osteotomy is unilateral coxa valga with a longer leg. This study shows favourable long-term results after isolated proximal femoral varus osteotomy in young adults with developmental dysplasia of the hip. A good function had been preserved in 18 of 28 DDH patients for an average of 22 years.

  16. Long-term results of surgical treatment of vocal fold nodules. (United States)

    Béquignon, Emilie; Bach, Christine; Fugain, Claude; Guilleré, Lia; Blumen, Marc; Chabolle, Frédéric; Wagner, Isabelle


    To evaluate the long-term outcome of patients with vocal fold nodules treated by surgery alone, or by a combination of surgery and voice therapy and to identify factors associated with long-term recurrent dysphonia. Retrospective study. All patients who had undergone surgery for vocal fold nodules in a tertiary care hospital between 1996 and 2006 were contacted. After giving their consent, they were evaluated by videostroboscopic examination of vocal fold nodules and by a subjective questionnaire including the Voice Handicap Index (VHI). Sixty-two out of 90 patients (69%) (60 women, 2 men with a mean age of 33 years) answered the questionnaire at a mean interval of 9.5 years after surgery. Recurrent dysphonia was observed in 19 patients (30%) at a mean interval of 5.2 years after surgery and new benign vocal fold lesions (nodules or Reinke's edema) were observed in 11 patients (18%). Absence of postoperative voice therapy was significantly associated with a higher recurrence rate (P = 0.02) (56% of recurrent dysphonia without voice therapy versus 22% with voice therapy). Postoperative voice therapy decreases the risk of recurrence. Vocal fold nodules can recur over a period of 5 years, consequently requiring follow-up for at least 5 years in clinical practice and in future prospective studies. © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Long-term results with tracheoesophageal voice prosthesis: primary versus secondary TEP. (United States)

    Boscolo-Rizzo, Paolo; Zanetti, Federica; Carpené, Silvia; Da Mosto, Maria Cristina


    The aim of this study was to evaluate the influence of timing of tracheoesophageal puncture (TEP)with indwelling voice prosthesis insertion regarding long-term success rate and postoperative complication. We conducted a Retrospective clinical study at tertiary academic center. There were 75 patients with primary TEP (80.6%) and 18 with secondary TEP (19.3%). Long-term success rate was 81.7%, with 80.0% in primary TEP and 88.9% in secondary TEP. No significant difference in Harrison-Robillard-Schultz Rating Scale success assessment were observed between patients with primary and secondary TEP (P = .596). The use of postoperative radiotherapy did not significantly influence the success rate. The age of patients who were older or younger than 60 years significantly influence the success rate in primary TEP (P = .012). The higher rate of complications in primary TEP was not statistically significant. These findings suggest that primary and secondary TEP are equally safe and effective procedures. Primary TEP should be preferred because of avoiding a second surgical intervention and allowing early voice restoration with a considerable psychological impact.

  18. Cholinergic pairing with visual activation results in long-term enhancement of visual evoked potentials.

    Directory of Open Access Journals (Sweden)

    Jun Il Kang

    Full Text Available Acetylcholine (ACh contributes to learning processes by modulating cortical plasticity in terms of intensity of neuronal activity and selectivity properties of cortical neurons. However, it is not known if ACh induces long term effects within the primary visual cortex (V1 that could sustain visual learning mechanisms. In the present study we analyzed visual evoked potentials (VEPs in V1 of rats during a 4-8 h period after coupling visual stimulation to an intracortical injection of ACh analog carbachol or stimulation of basal forebrain. To clarify the action of ACh on VEP activity in V1, we individually pre-injected muscarinic (scopolamine, nicotinic (mecamylamine, alpha7 (methyllycaconitine, and NMDA (CPP receptor antagonists before carbachol infusion. Stimulation of the cholinergic system paired with visual stimulation significantly increased VEP amplitude (56% during a 6 h period. Pre-treatment with scopolamine, mecamylamine and CPP completely abolished this long-term enhancement, while alpha7 inhibition induced an instant increase of VEP amplitude. This suggests a role of ACh in facilitating visual stimuli responsiveness through mechanisms comparable to LTP which involve nicotinic and muscarinic receptors with an interaction of NMDA transmission in the visual cortex.

  19. Establishing Long-term Observations of Gas Hydrate Systems: Results from Ocean Networks Canada's NEPTUNE Observatory (United States)

    Scherwath, M.; Riedel, M.; Roemer, M.; Heesemann, M.; Chun, J. H.; Moran, K.; Spence, G.; Thomsen, L.


    The key for a scientific understanding of natural environments and the determination of baselines is the long-term monitoring of environmental factors. For seafloor environments including gas hydrate systems, cabled ocean observatories are important platforms for the remote acquisition of a comprehensive suite of datasets. This is particularly critical for those datasets that are difficult to acquire with autonomous, battery-powered systems, such as cameras or high-bandwidth sonar because cable connections provide continuous power and communication from shore to the seafloor. Ocean Networks Canada is operating the NEPTUNE cabled undersea observatory in the Northeast Pacific with two nodes at gas hydrate sites, Barkley Canyon and Clayoquot Slope. With up to seven years of continuous data from these locations we are now beginning to understand the dynamics of the natural systems and are able to classify the variations within the gas hydrate system. For example, the long-term monitoring of gas vent activity has allowed us to classify phases of low, intermittent and high activity that seem to reoccur periodically. Or, by recording the speeds of bacterial mat growth or detecting periods of increased productivity of flora and fauna at hydrates sites we can start to classify benthic activity and relate that to outside environmental parameters. This will eventually allow us to do enhanced environmental monitoring, establish baselines, and potentially detect anthropogenic variations or events for example during gas hydrate production.

  20. Long term operation of nuclear power plants – IAEA SALTO peer review service and its results

    Energy Technology Data Exchange (ETDEWEB)

    Krivanek, Robert, E-mail:


    Highlights: • SALTO peer review service is designed for reviewing of ageing management and NPPs’ preparedness LTO. • It has been established as an effective tool to review the compliance with IAEA safety standards. • The important issues for safe LTO are being identified by SALTO missions. • Analysis of those issues is provided in the paper. • This peer review service is strongly recommended for NPPs prior to entering LTO period. - Abstract: This paper presents main IAEA activities for safe long term operation (LTO) which includes establishment of IAEA Safety Standards and other LTO related documents, fostering information exchange and establishing databases and provision of SALTO (Safety Aspects of Long Term Operation) peer review service. This paper provides insights into IAEA SALTO peer review service objectives, scope and methodology. The SALTO peer review service was designed to assist nuclear power plant (NPP) operators in adopting a proper approach to LTO of their plants and in implementing complete and appropriate activities to ensure that plant safety will be maintained during the LTO period. The SALTO peer review service can also support regulators in establishing or improving regulatory and licensing strategies for LTO of NPPs. Issues derived from 19 SALTO missions and 2 LTO modules of OSART (Operational Safety Review Team) missions conducted during the period of 2005 to March 2014 are also analyzed in this paper.

  1. Long-term results of the Latarjet procedure for anterior instability of the shoulder. (United States)

    Mizuno, Naoko; Denard, Patrick J; Raiss, Patric; Melis, Barbara; Walch, Gilles


    The Latarjet procedure is effective in managing anterior glenohumeral instability in the short term, but there is concern for postoperative arthritis. The purpose of this study was to evaluate the long-term functional outcome after the Latarjet procedure and to assess the prevalence of and risk factors for glenohumeral arthritis after this procedure. A retrospective review was conducted of 68 Latarjet procedures at a mean of 20 years postoperatively. The mean age at surgery was 29.4 years. Functional outcome was determined by the Rowe score, subjective shoulder value, and recurrence of instability. Preoperative arthritis and postoperative radiographs were reviewed to evaluate the development or progression of arthritis. The mean Rowe score increased from 37.9 preoperatively to 89.6 at final follow-up (P Latarjet procedure provides excellent long-term outcomes in the treatment of recurrent anterior glenohumeral instability. Twenty years after the Latarjet procedure, arthritis may develop or progress in 23.5% of cases, but the majority of arthritis is mild. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Long-term results and complications of preoperative radiation in the treatment of rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Reed, W.P.; Garb, J.L.; Park, W.C.; Stark, A.J.; Chabot, J.R.; Friedmann, P.


    A retrospective study of 149 patients with rectal cancer diagnosed between 1972 and 1979 was undertaken to compare survival, disease-free survival, recurrence sites, and long-term complications of 40 patients who received 4000 to 4500 rads of preoperative adjuvant radiotherapy (radiation group) with those of 109 patients treated by resection alone (control group). After a mean follow-up of 84 months and 99 months, respectively, survival of the irradiated patients was significantly better than that of controls (68% versus 52%, p less than 0.05). Disease-free survival of those patients rendered free of disease by treatment was also superior for the irradiated group (84% versus 57%, p less than 0.005). Local recurrence without signs of distant metastases developed only one-third as often in irradiated patients (6% versus 18%). Distant metastases, alone or in combination with local recurrence, were also less common after radiation (12% versus 27%). Second primary tumors developed in 15% and 10% of the respective groups, a difference that was not statistically significant. When we consider the survival benefit of preoperative radiation therapy, long-term complications were relatively mild. Delayed healing of the perineum was noted in two irradiated patients. Persistent diarrhea was severe enough to warrant treatment in only one case, and one patient required a colostomy for intestinal obstruction from pelvic fibrosis.

  3. Long-term results of pediculo-body fixation and posterolateral fusion for lumbar spondylolisthesis. (United States)

    Zagra, Antonino; Giudici, Fabrizio; Minoia, Leone; Corriero, Andrea Saverio; Zagra, Luigi


    in 8 cases (12.9%), and there was persistent lumbar-radicular pain in 2 cases (3.2%). The mean ODI score was 2.6%, the mean VAS back pain was 1.3, the mean VAS leg pain 0.7. Some complications were observed: a nerve root compression by a screw invasion of intervertebral foramen, resolved by screw removal; an iliac artery compression by a lateral exit screw from pediculo, resolved by screw removal; a deep iliac vein phlebitis with thrombosis caused by external compression due to a wrong intraoperative position, treated by medicine. Two cases of synthesis mobilization and two cases of broken screws was detected. No cases of pseudoarthrosis and immediate or late superficial or deep infection were observed. The analysis of the long-term results of the spondylolisthesis surgical treatment with direct pediculo-body screw fixation and postero-lateral fusion gave a very satisfactory response. The technique is reliable in allowing an optimal primary stability, creating the best biomechanical conditions to obtain a solid fusion.

  4. Radiotherapy for benign calcaneodynia: long-term results of the Erlangen Dose Optimization (EDO) trial. (United States)

    Ott, Oliver J; Jeremias, Carolin; Gaipl, Udo S; Frey, Benjamin; Schmidt, Manfred; Fietkau, Rainer


    The goal of this work was to evaluate the long-term efficacy of two dose-fractionation schedules for radiotherapy of calcaneodynia. Between February 2006 and February 2010, 457 evaluable patients were recruited for this prospective trial. All patients received orthovoltage radiotherapy. One course consisted of 6 fractions/3 weeks. In case of insufficient remission of pain after 6 weeks a second series was performed. Patients were randomly assigned to receive either single doses of 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before, right after (early response), 6 weeks (delayed response), and approximately 2.5 years after radiotherapy (long-term response) with a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS). The median follow-up was 32 months (range 9-57 months). The overall early, delayed, and long-term response rates for all patients were 87, 88, and 95%. The mean VAS values before treatment, for early, delayed, and long-term response for the 0.5 and 1.0 Gy groups were 65.5 ± 22.1 and 64.0 ± 20.5 (p = 0.19), 34.8 ± 24.7 and 39.0 ± 26.3 (p = 0.12), 25.1 ± 26.8 and 28.9 ± 26.8 (p = 0.16), and 16.3 ± 24.3 and 14.1 ± 19.7 (p = 0.68). The mean CPS values before treatment, for early, delayed, and log-term response were 10.1 ± 2.7 and 10.0 ± 3.0 (p = 0.78), 5.6 ± 3.7 and 6.0 ± 3.9 (p = 0.34), 4.0 ± 4.1 and 4.3 ± 3.6 (p = 0.26), and 2.1 ± 3.3 and 2.3 ± 3.2 (p = 0.34), respectively. No significant differences in long-term response quality between the two arms were found (p = 0.50). Radiotherapy is a very effective treatment for the management of benign calcaneodynia. For radiation protection reasons, the dose for a RT series should not exceed 3.0 Gy.

  5. Comprehensive Medication Reviews in Long-term Care Facilities: History of Process Implementation and 2015 Results. (United States)

    O'Shea, Terrence E; Zarowitz, Barbara J; Erwin, W Gary


    Since 2013, Part D sponsors have been required to offer comprehensive medication reviews (CMRs) to all beneficiaries enrolled in their medication therapy management (MTM) programs at least annually, including those in long-term care (LTC) settings. Since that time, MTM providers have found that accessing and completing CMRs with beneficiaries is frequently prohibitively complex, since the process often requires a live, face-to-face interactive interview where the beneficiary resides. However, with the migration of the CMR completion rate from a star ratings display measure to an active measure, coupled with the new CMR completion rate cutpoints for 2016, accessing this population for CMR completion has heightened importance. Our proprietary consultant pharmacist (CP) software was programmed in 2012 to produce a cover letter, medication action plan, and personal medication list per CMS standardized format specifications. Using this system, CPs were trained to perform and document CMRs and the interactive interviews. MTM-eligible Part D beneficiaries, identified by several contracted clients as residing in LTC serviced by Omnicare, were provided CMRs and summaries written in CMS standardized format by CPs. Residents with cognitive impairment were identified using 3 data elements in the Minimum Data Set (MDS). In 2015, 7,935 MTM-eligible beneficiaries were identified as receiving medications from an Omnicare pharmacy. After excluding those who were disenrolled by their prescription drug plans, discharged from the LTC facility, or resided in a LTC facility no longer serviced by Omnicare, 5,593 residents were available for CMR completion. Of these, only 3% refused the CMR offer, and 5,392 CMRs (96%) were completed successfully. Thirty-nine percent of residents had cognitive impairment per MDS assessments; in those instances, CMRs were conducted with someone other than the beneficiary. Based on the CMRs and interactive interviews, 7,527 drug therapy problem

  6. Living donor liver transplantation for hepatocellular carcinoma: the impact of neo-adjuvant treatments on the long term results. (United States)

    Di Sandro, Stefano; Giacomoni, Alessandro; Slim, Abdallah; Lauterio, Andrea; Mangoni, Iacopo; Mihaylov, Plamen; Pirotta, Vincenzo; Aseni, Paolo; De Carlis, Luciano


    LDLT may represent a valid therapeutic option allowing several advantages for patients affected by HCC and waiting for liver transplantation (LT). However, some reports show a worse long term survival and disease free survival among patients treated by LDLT for HCC than deceased donor liver transplantation (DDLT) recipients. Among 1145 LT patients, 63 received LDLT. From January 2000 to December 2008, 179 patients underwent LT due to HCC, 30 (16.7%) received LDLT and 154 (86.0%) received DDLT. Patients were selected based on the Milan criteria. TACE, radiofrequency ablation, percutaneous alcoholization, or liver resection were applied as downstaging procedures, while on the waiting list. Overall 3- and 5-year survival rate was 77.3% and 68.7% vs. 82.8% and 76.7%, respectively for LDLT and DDLT recipient with not significant differences. Moreover, 3- and 5- years of recurrence free survival rate was 95.5% (LDLT) vs. 90.5% and 89.4% (DDLT) and resulted not significantly different. LDLT guarantees same long term results than DDLT if the selection criteria of candidates are analogues. Milan criteria remains a valid candidate selection tool to obtain optimal long term results in LDLT. An aggressive downstaging policy seems to improve the long-term results in LDLT, thus LRT may be considered useful to prevent tumor progression waiting for transplantation as well as a neoadjuvant therapy for HCC. A literature detailed meta-analysis could definitely clarify if LDLT is an independent risk factor for HCC recurrence.

  7. Evaluation of long-term results of radical and organ-sparing operations on adrenal gland tumors

    Directory of Open Access Journals (Sweden)

    V. G. Chausova


    Full Text Available Long-term results have been estimated for laparoscopic adrenalectomy and laparoscopic partial adrenalectomy in the treatment of adrenal tumors. If preoperative data and intra-operating evaluation show no sign of malignancy, it is possible to perform organ-sparing surgery.

  8. The impact of health behaviour on long term sickness absence: results from DWECS/DREAM

    DEFF Research Database (Denmark)

    Christensen, Karl B; Lund, Thomas; Labriola, Merete


    Long term sickness absence (LTSA) is a major public health problem. We examined the impact of four, potentially modifiable, health behaviours, such as smoking, alcohol consumption, leisure time physical activity, and the associated variable of body mass index on the risk of subsequent LTSA....... This was done by following a representative population sample of 5,020 Danish employees aged 18-69 for 18 months in a national register on social transfer payments. Risk estimates for onset of LTSA and etiologic fractions were computed. In women, ex-smokers and heavy smokers had an increased risk of LTSA of 1.......61 and 2.05 respectively after adjustment for age, family status, socio economic status, school education, physical and psychosocial work environment exposures and diagnosed disease. In men, effect estimates were smaller and only borderline significant in the fully-adjusted model. The etiologic fraction...

  9. Radiation therapy for wet type age-related macular degeneration. Long term follow-up results

    Energy Technology Data Exchange (ETDEWEB)

    Sasai, Keisuke; Hiraoka, Masahiro; Mandai, Michiyo; Takahashi, Masayo; Honda, Yoshihito [Kyoto Univ. (Japan). Faculty of Medicine


    Between April, 1994 and July, 1995, 33 patients with occult type choroidal neovascularization (CNV) with or without the classical type CNV of the wet type age-related macular degeneration ARMD were treated with radiation therapy (10 Gy/5 fx/1 week or 20 Gy/10 fx/2 weeks). This phase I/II study showed that radiation therapy seems to be useful for CNV during the first 12 months. Some eyes which initially showed good response to irradiation began to lose their visual acuity. However, the dose of 20 Gy in 10 fractions seemed useful to maintain the visual acuity better than 0.1 in this long term follow-up study (24 months). (author)

  10. Long-term results of deep sclerectomy in normal-tension glaucoma. (United States)

    Harju, Mika; Suominen, Sakari; Allinen, Pasi; Vesti, Eija


    To study the long-term outcome of deep sclerectomy with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG). We prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra-ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits. A total of 37 patients were enrolled, 15 in the MMC and 22 in the non-MMC group. The median (range) follow-up was 7.9 (1.0-9.0) years, with a drop-out of three (8%) patients. The preoperative IOP was 15 (11-21) mmHg in the MMC and 15 (10-19) mmHg in the non-MMC group. At the last 6- to 9-year follow-up, IOP was significantly reduced to 9 (2-13) mmHg (p = 0.002) and 10 (5-13) mmHg (p MMC and non-MMC groups (p = 0.14). Needling with MMC injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p = 0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma. In NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications. © 2017 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  11. Long-term results following postoperative radiotherapy for soft tissue sarcomas of the extremity. (United States)

    McGee, Lisa; Indelicato, Daniel J; Dagan, Roi; Morris, Christopher G; Knapik, Jacquelyn A; Reith, John D; Scarborough, Mark T; Gibbs, C Parker; Marcus, Robert B; Zlotecki, Robert A


    To review long-term outcomes following postoperative radiotherapy (RT) for extremity soft tissue sarcoma (STS) and identify variables affecting the therapeutic ratio. Between 1970 and 2008, 173 patients with localized extremity STS were treated with postoperative radiation. No patients received prior irradiation. Sixteen percent of tumors had recurred after initial surgery alone; 89% of tumors were high grade. The median patient age was 57 years (range, 18-86 years). Sixty-one percent underwent >1 surgery before RT in an attempt to achieve wide negative margins. Final margin status was negative in 70% and marginal or microscopically positive in 30%. The median time between final surgery and start of RT was 40 days. The median RT dose was 65 Gy (range, 49-74 Gy). The median follow-up for all patients was 10.4 years and 13.2 years among survivors. At 10 years, local control (LC), cause-specific survival (CSS), and overall survival (OS) rates were 87%, 80%, and 70%, respectively, with 89% of local failures occurring within 3 years after treatment. On multivariate analysis, age >55 years (82% vs 93%, P55 years and local recurrence were associated with inferior CSS and OS on multivariate analysis. Twelve percent of patients experienced grade 3+ toxicity; 12 of these occurred in patients with tumors of the proximal lower extremity, with the most common toxicity of pathologic fracture occurring in 6.3%. This large single-institution series confirms that postoperative RT for STS of the extremities provides good long-term disease control with acceptable toxicity. Our experience supports recurrent presentation and older age as adverse prognostic factors for LC. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Hip-joint congruity after Dega osteotomy in patients with cerebral palsy: long-term results. (United States)

    Braatz, Frank; Staude, Daniel; Klotz, Matthias C; Wolf, Sebastian I; Dreher, Thomas; Lakemeier, Stefan


    Neurogenic hip dislocation is quite common in children with cerebral palsy (CP). The purpose of this study was to evaluate the long-term outcome of single-event multilevel surgery (SEMLS) in combination with hip reconstruction by using a periacetabular osteotomy as described by Dega concerning post-operative remodeling and plasticity of the femoral head post-operatively. A total of 72 patients with CP as the primary disease and in whom a complex surgical hip reconstruction was performed during SEMLS between 1998 and 2004 were included in the study. There were 45 men and 27 women, with a median age of 7.6 (4.7-16.3) years at the time SEMLS was performed. The mean follow-up time was 7.7 years (4.9-11.8). X-rays were taken before and after surgery, and Rippstein 1 and 2 were used for follow-up. As the most reliable value for decentration, migration percentage (MP) as described by Reimers was used. To measure hip-joint cover at follow-up, the centre-edge angle was used. The hip was divided into four different categories according to sphericity and congruity. Using this approach, we could evaluate joint remodeling. Pre-operatively, the mean MP measured by X-ray was 68 %. Directly after surgery, this value decreased on average by 12 % and at the long-term follow-up was 16.0 % on average. A high rate of incongruence was observed on X-rays taken directly after surgery: 66 hip joints were classified as incongruent. The number of aspherical and incongruent joints decreased to 54 at the follow-up examination. Data of our study with high plasticity of the hip joint suggest that even if the femoral head is deformed and a persistent incongruency after surgery is expected, hip reconstruction can be recommended.

  13. Corneal Collagen Cross-Linking for Keratoconus in Pediatric Patients-Long-Term Results. (United States)

    Padmanabhan, Prema; Rachapalle Reddi, Sudhir; Rajagopal, Rama; Natarajan, Radhika; Iyer, Geetha; Srinivasan, Bhaskar; Narayanan, Niveditha; Lakshmipathy, Meena; Agarwal, Shweta


    To report the long-term outcome of corneal collagen cross-linking (CXL) for progressive keratoconus in pediatric patients. "Epithelium-off" CXL was performed in pediatric eyes with progressive keratoconus. Spectacle-corrected distance visual acuity (CDVA), retinoscopy, topography, and tomography were documented preoperatively and postoperatively at 3 months, 6 months, 1 year, and annually thereafter. A total of 377 eyes of 336 pediatric patients aged 8 to 18 years with progressive keratoconus underwent CXL. Of these, 194 eyes had a follow-up beyond 2 years and up to 6.7 years. At last follow-up, there was significant improvement in mean CDVA from 0.33 ± 0.22 to 0.27 ± 0.19 logMAR (P ≤ 0.0001), reduction in mean topographic astigmatism from 7.22 ± 3.55 to 6.13 ± 3.28 D (P = 0.0001), mean flattening of 1.20 ± 3.55 diopters in maximum keratometry (Kmax) (P = 0.0002), and mean corneal thinning of 31.1 ± 36.0 μm (P keratoconus (average keratometry 48-53 diopters). Central cones showed more corneal flattening than peripheral cones. Stabilization or flattening of Kmax was seen in 85% of eyes at 2 years and in 76% after 4 years. Stabilization or improvement of CDVA was seen in 80.1% of eyes at 2 years and in 69.1% after 4 years. CXL remains effective in stabilizing keratoconus for longer than 2 years in a majority of pediatric eyes. Flattening of Kmax was greater in moderately advanced keratoconus and central cones. Long-term follow-up beyond 4 years, however, revealed that a few eyes showed features suggestive of reversal of the effect of CXL.

  14. Long-term regional chemotherapy for patients with epithelial malignant peritoneal mesothelioma results in improved survival. (United States)

    Sugarbaker, P H; Chang, D


    Malignant peritoneal mesothelioma (MPM) is a rare disease with about 300 new cases per year in the USA. Its natural history is described as local progression within the peritoneal space in the absence of liver metastases or systemic disease. Cytoreductive surgery (CRS) is a series of peritonectomy procedures and visceral resections with a goal of complete removal of all visible disease from the abdomen and pelvis. Over 20 years, three protocols investigating increasing efficacy of additional chemotherapy treatments added to CRS have been initiated. Initially, hyperthermic perioperative chemotherapy (HIPEC) with doxorubicin and cisplatin was used in the operating room. Then, early postoperative intraperitoneal chemotherapy (EPIC) with paclitaxel was added for the first 5 days after CRS. The third protocol employed HIPEC, then EPIC, and then long-term intraperitoneal (IP) paclitaxel or IP pemetrexed plus intravenous (IV) cisplatin as a adjuvant normothermic intraperitoneal chemotherapy (NIPEC). The 5-year survival of 42 patients treated with CRS and HIPEC was 44%, for 58 patients treated with EPIC and HIPEC was 52% and 29 patients who received HIPEC, EPIC, and NIPEC was 75% (p = 0.0374). Prognostic variables of age, gender, treatment administered, peritoneal cancer index (PCI) and completeness of cytoreduction were significant by univariate analysis and treatments administered and completeness of cytoreduction significant by multivariate analysis. Long-term regional chemotherapy was associated with improved survival in patients with MPM. In this rare disease, additional phase 2 investigations are suggested. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  15. Physical activity after commitment lotteries: examining long-term results in a cluster randomized trial. (United States)

    van der Swaluw, Koen; Lambooij, Mattijs S; Mathijssen, Jolanda J P; Schipper, Maarten; Zeelenberg, Marcel; Berkhout, Stef; Polder, Johan J; Prast, Henriëtte M


    To overcome self-control difficulties, people can commit to their health goals by voluntarily accepting deadlines with consequences. In a commitment lottery, the winners are drawn from all participants, but can only claim their prize if they also attained their gym-attendance goals. In a 52-week, three-arm trial across six company gyms, we tested if commitment lotteries with behavioral economic underpinnings would promote physical activity among overweight adults. In previous work, we presented an effective 26-week intervention. In the present paper we analyzed maintenance of goal attainment at 52-week follow-up and the development of weight over time. We compared weight and goal attainment (gym attendance ≥ 2 per week) between three arms that-in the intervention period- consisted of (I) weekly short-term lotteries for 13 weeks; (II) the same short-term lotteries in combination with an additional long-term lottery after 26 weeks; and (III) a control arm without lottery-deadlines. After a successful 26-week intervention, goal attainment declined between weeks 27 and 52 in the long-term lottery arm, but remained higher than in the control group. Goal attainment did not differ between the short-term lottery arm and control arm. Weight declined slightly in all arms in the first 13 weeks of the trial and remained stable from there on. Commitment lotteries can support regular gym attendance up to 52 weeks, but more research is needed to achieve higher levels of maintenance and weight loss.

  16. Long-term changes in cognitive bias and coping response as a result of chronic unpredictable stress during adolescence

    Directory of Open Access Journals (Sweden)

    Lauren eChaby


    Full Text Available Animals that experience adverse events in early life often have life-long changes to their physiology and behavior. Long-term effects of stress during early life have been studied extensively, but less attention has been given to the consequences of negative experiences solely during the adolescent phase. Adolescence is a particularly sensitive period of life when regulation of the glucocorticoid stress hormone response matures and specific regions in the brain undergo considerable change. Aversive experiences during this time might, therefore, be expected to generate long-term consequences for the adult phenotype. Here we investigated the long-term effects of exposure to chronic unpredictable stress during adolescence on adult decision making, coping response, cognitive bias, and exploratory behavior in rats. Rats exposed to chronic unpredictable stress (e.g. isolation, crowding, cage tilt were compared to control animals that were maintained in standard, predictable conditions throughout development. Unpredictable stress during adolescence resulted in a suite of long-term behavioral and cognitive changes including a negative cognitive bias (F1,12 = 5.000, P < 0.05, altered coping response (T1,14 = 2.216, P = 0.04, and accelerated decision making (T1,14 = 3.245, P = 0.01. Exposure to chronic stress during adolescence also caused a short-term increase in boldness behaviors; in a novel object test 15 days after the last stressor, animals exposed to chronic unpredictable stress had decreased latencies to leave a familiar shelter and approach a novel object (T1,14 = 2.240, P = 0.04; T1,14 = 2.419, P = 0.03, respectively. The results showed that stress during adolescence has long-term impacts on behavior and cognition that affect the interpretation of ambiguous stimuli, behavioral response to adverse events, and how animals make decisions. Stress during adolescence also induced short-term changes in the way animals moved around a novel environment.


    Araujo, Sergio Eduardo Alonso; Horcel, Lucas de Araujo; Seid, Victor Edmond; Bertoncini, Alexandre Bruno; Klajner, Sidney


    Stapled hemorrhoidopexy is associated with less postoperative pain and faster recovery. However, it may be associated with a greater risk of symptomatic recurrence. We hypothesized that undertaking a limited surgical excision of hemorrhoid disease after stapling may be a valid approach for selected patients. To compare long-term results after stapled hemorrhoidopexy with and without complementation with closed excisional technique. In a retrospective uni-institutional cohort study, sixty-five (29 men) patients underwent stapled hemorrhoidopexy and 21 (13 men) underwent stapled hemorrhoidopexy with excision. The same surgeons operated on all cases. Patients underwent stapled hemorrhoidectomy associated with excisional surgery if symptoms attributable to external hemorrhoid piles were observed preoperatively, or if residual prolapse or bulky external disease was observed after the firing of the stapler. A closed excisional diathermy hemorrhoidectomy without vascular ligation was utilized in all complemented cases. All clinical variables were obtained from a questionnaire evaluation obtained through e-mail, telephone interview, or office follow-up. The median duration of postoperative follow-up was 48.5 (6-40) months. Patients with grades 3 and 4 hemorrhoid disease were operated on more frequently using stapled hemorrhoidopexy complemented with excisional technique (95.2% vs. 55.4%, p=0.001). Regarding respectively stapled hemorrhoidopexy and stapled hemorrhoidopexy complemented with excision, there was no difference between the techniques in relation to symptom recurrence (43% and 33%, p=0.45) and median interval between surgery and symptom recurrence (30 (8-84) and 38.8 (8-65) months, p=0.80). Eight (12.3%) patients were re-operated after stapled hemorrhoidopexy and 2 (9.6%), after hemorrhoidopexy with excision (p=0.78). Patient distribution in both groups according to the degree of postoperative satisfaction was similar (p=0.97). Stapled hemorrhoidopexy combined

  18. Long-term results after subcrestal or crestal placement of delayed loaded implants. (United States)

    Romanos, Georgios E; Aydin, Erhan; Gaertner, Kathrin; Nentwig, Georg-Hubertus


    Prevention of peri-implant bone loss is essential for achieving long-term implant success, but few studies have evaluated the impact of placement depth on long-term bone loss. The aim of this retrospective study was to evaluate outcomes for platform-shifted implants placed at different depths relative to the bone crest. The mesial and distal shoulders of 228 delayed-loaded Ankylos® (Dentsply Implants Manufacturing GmbH, Mannheim, Germany) implants placed in 85 patients were divided retrospectively into two groups based on the implant shoulder position on the day of placement surgery as follows: subcrestal group A (n = 197; 0.5 mm or more below the crestal bone level) or crestal group B (n = 65; within 0.5 mm or less of the crestal bone level). The remaining sites (n = 194; more than 0.5 mm above the crestal bone level) were supracrestal and were excluded from this analysis. Mesial and distal bone loss was evaluated under 5× magnification and analyzed, along with Periotest values. Mean Periotest values were -1.77 (±3.57) for Group A and -1.77 (±3.26) for Group B. For Group A, mean mesial (m) bone loss was 1.84 (±1.49 mm) and mean distal (d) bone loss was 1.73 (±1.31 mm). For Group B, the bone loss values were m: 1.41 (±1.65 mm) and d: 1.34 (±1.60 mm). No statistically significant differences were found for the Periotest values (p = .521) or bone level values for the two groups (m: p = .130; d: p = .153). Within the limitations of this study, subcrestal or crestal implant placement in combination with delayed loading was associated with similar initial implant stability and subsequent crestal bone loss. © 2013 Wiley Periodicals, Inc.

  19. Laparoscopic resection of large gastric GISTs: feasibility and long-term results. (United States)

    Masoni, Luigi; Gentili, Ivan; Maglio, Riccardo; Meucci, Massimo; D'Ambra, Giancarlo; Di Giulio, Emilio; Di Nardo, Giovanni; Corleto, Vito Domenico


    Laparoscopy is the procedure of choice for the resection of gastric Gastrointestinal stromal tumors (GISTs) smaller than 2 cm; there is still debate regarding the most appropriate operative approach for larger GISTs. The aims of this study were to evaluate the safety and long-term efficacy of laparoscopic resection of gastric GISTs larger than 2 cm. Between 2007 and 2011, we prospectively enrolled all patients affected by gastric GIST larger than 2 cm. Exclusion criteria for the laparoscopic approach were the presence of metastases and the absence of any involvement of the esophago-gastric junction, the pyloric canal, or any adjacent organ. Final diagnosis of GIST was confirmed by histological and immunohistochemical analysis. Follow-up assessment included abdominal CT scans every 6 months for the first 2 years and yearly thereafter. Twenty-four consecutive patients were enrolled. Twenty-one patients (87.5%) were symptomatic. The most common symptoms were gastrointestinal bleeding and abdominal pain. The mean tumor size was 5.51 cm (range 2.5-12.0 cm). GISTs were located in the lesser curvature in five cases (20.8%), in the greater curvature in seven cases (29.1%), in the posterior wall in one case (4.1%), in the anterior wall in eight cases (33.3%), and in the fundus in 3 cases (12.5%). Laparoscopic resection was possible in all cases and took on average of 55 min (range 30-105 min). Median blood loss was 24 ml. No major intraoperative complications were observed. Mortality rate was 0%. Median postoperative stay was 3 days. No patients were lost to follow-up. No recurrences occurred after a median follow-up period of 75 months. Although larger randomized controlled trials comparing different surgical strategies for large gastric GISTs are warranted, our study supports the evidence that laparoscopic resection of gastric GISTs is feasible, safe, and effective on long-term clinical outcome even for lesions up to 12 cm.

  20. Long-term results after artificial iris implantation in patients with aniridia. (United States)

    Rickmann, Annekatrin; Szurman, Peter; Januschowski, Kai; Waizel, Maria; Spitzer, Martin S; Boden, Karl T; Szurman, Gesine B


    The custom-made, flexible artificial iris developed by HumanOptics and Koch can reconstruct the anterior segment of patients with aniridia. The aim of this study was to evaluate the long-term clinical outcome and complication spectrum after artificial iris implantation and the role of the embedded fiber mesh in view of specific complications. In this retrospective interventional case series, patients received an artificial iris between 2004 and 2013. Only eyes with a minimum follow-up period of 2 years were included. Indications were congenital, traumatic, or iatrogenic aniridia. The artificial iris was used either with or without embedded fiber mesh for partial or full prostheses. We included 34 patients (mean age 48.8 years; SD ±17.2) with a mean follow-up of 50.0 months (SD ±18.9 months). No repositioning of prostheses was necessary. In cases of keratopathy (17.6 %) visual function increased from baseline mean 1.6 logMAR (SD ±0.7) to 1.2 logMAR (SD ±0.7) after artificial iris implantation. The remaining iris tissue darkened during the follow-up in 23.5 % (83.3 % with and 10.7 % without mesh), 8.8 % developed glaucoma (50 % with and 0 % without mesh) and 14.7 % needed consecutive surgery after prostheses implantation (50 % with and 7.1 % without mesh). In three out of seven trauma cases (42.9 %) silicone oil was spilled into the anterior chamber after 2.5 years on average. The artificial iris prosthesis revealed a good clinical outcome in terms of long-term stability, cosmetic appearance, visual function, and represents a good functional iris diaphragm for compartmentalisation. Complications such as glaucoma, darkening of iris tissue, and need for consecutive anterior segment surgery are clearly associated with implants with integrated fiber mesh, but not to those without. Hence, the use of full iris prostheses without embedded fiber mesh, even in cases with remnant iris, and the use of slightly smaller implants than officially recommended may

  1. Long-term Impact of Ixekizumab on Psoriasis Itch Severity: Results from a Phase III Clinical Trial and Long-term Extension

    Directory of Open Access Journals (Sweden)

    Alexandra B. Kimball


    Full Text Available Itching is a prevalent plaque psoriasis symptom. Ixekizumab, an IL-17A antagonist, has demonstrated rapid, significant improvements in itch severity over 12 weeks in Phase III psoriasis trials (UNCOVER-1, UNCOVER-2. We assessed the long-term (through 60 weeks effect of ixekizumab maintenance therapy (80-mg ixekizumab every 4 weeks [IXEQ4W] on itch severity, using the Itch Numeric Rating Scale, in psoriasis patients who received ixekizumab, placebo, or etanercept for 12 weeks in the Phase III UNCOVER-3 trial. After 12 weeks, patients either continued or switched to IXEQ4W. Mean improvements in itch severity achieved with 12 weeks of ixekizumab (–4.7 to –5.1 were maintained through 60 weeks with IXEQ4W (–4.9 to –5.0. Patients who initially received placebo or etanercept experienced rapid itch severity improvements after switching to ixekizumab at Week 12 (Week 12, placebo: –0.6; etanercept: –3.8; Week 60, placebo/IXEQ4W: –4.9; etanercept/IXEQ4W: –4.7. Ixekizumab maintenance therapy sustained improvements in itch severity through 60 weeks.

  2. Improved Results for Resection of Periampullary Adenocarcinoma

    Directory of Open Access Journals (Sweden)

    H. Obertop


    Full Text Available Background: This study evaluates the indications for and effects of pancreaticoduodenectomy (102 patients or total pancreatectomy (15 patients with extensive lymph node dissection performed upon 117 patients for treatment of periampullary adenocarcinoma.

  3. Long term results (15-30 years) of surgical repair of aortic coarctation. (United States)

    Presbitero, P; Demarie, D; Villani, M; Perinetto, E A; Riva, G; Orzan, F; Bobbio, M; Morea, M; Brusca, A


    The late outcome in 226 patients who survived surgical repair of aortic coarctation was assessed 15-30 years after operation. Twenty six patients died during the follow up mainly from causes related to surgical repair or to associated cardiovascular anomalies. The survival rates of patients operated on between the ages of four and 20 years are 97%, 97%, 92% at 10, 20, and 30 years after operation. For patients operated on after the age of 20 the corresponding rates are 93%, 85%, and 68%. This difference is statistically significant from the fifteenth year of follow up onwards. The survival of patients operated on before the age of 20 is not significantly different from that of a comparable general Italian population. Recoarctation occurred in only 8% of patients who had end to end anastomosis, whereas it occurred in 35% of those who had other types of operation. Two thirds of the patients were hypertensive at the last visit. The actuarial curve shows that blood pressure was normal in most patients 5-10 years after operation, but 30 years after coarctation repair only 32% of patients are expected to be normotensive. Thus early repair of aortic coarctation appears to improve long term survival. Intervention in older patients and when blood pressure is high seem to be the most important predictors of late hypertension. PMID:3593616

  4. Archiving of Particle Physics Data and Results for Long-Term Access and Use (United States)

    Yeomans, J.


    Preprints and published material are not the only output from high energy physics research that should be archived for future generations. Data are frequently not stored long-term and yet examples have arisen where such storage has been proved necessary. There are also lost possibilities for training, and indeed the records of science for future generations are diminished by the absence. Lessons learned from previous attempts and from other fields for which experimental data are successfully stored, can be used to build a storage paradigm for the future. Data from particle physics experiments are highly complex but a collaborative effort from IT staff, librarians, and physicists can perhaps have success. Issues requiring consideration include: who will have the right to access the data; how will access rights be managed; what level of data should be stored; for what length of time should the data be stored, and what additional information associated with the data must be collected. Technical problems associated with the storage and future use of analysis software must also be tackled.

  5. Granulomatous polyangitis (Wegener granulomatosis): Clinical findings and results of long-term follow-up. (United States)

    Şen, Nazan; Aydın Tufan, Müge; Yıldız, Reyhan; Ersözlü Bozkırlı, Emine Duygu; Yücel, Eftal


    To evaluate long-term outcome of patients with granulomatous polyangitis (GPA) followed up in a tertiary university hospital. We reviewed medical records of 22 patients with GPA diagnosis confirmed by tissue biopsies between 2004 and 2014. The mean time from the onset of symptoms to diagnosis was 7.8 ± 12.3 months [interquartile range (IR)= 4.0]. The most commonly involved organs were the upper respiratory tract (URT) (72.7%), lower respiratory tract (81.8%) and kidneys (72.7%). URT involvement indicated good prognosis (p= 0.046). Survival in the patients with and without URT involvement was 124.6 ± 6.9 months and 59.7 ± 22.9 months, respectively. End-stage renal failure (ESRF) requiring dilaysis and cardiac involvement were associated with mortality (p= 0.022 and p= 0.026, respectively). Of the 12 dialysis-dependent patients at diagnosis, 11 survived > 3 months and seven regained renal function permanently. Dialysis dependency was significantly lower in patients who received plasmapheresis (p= 0.047). Overall mortality rate was 18% (4/22). Mean survival was 55.9 ± 42.8 months (IR= 84.0). Diagnosis of GPA may be delayed by the nonspecific nature of its symptoms. URT involvement was associated with good prognosis, whereas cardiac involvement and ESRF requiring dialysis were associated with poor outcome. Plasmapheresis may increase the rate of renal recovery in the patients with ESRF requiring dialysis.

  6. Long-term results of splenectomy in adult chronic immune thrombocytopenia. (United States)

    Guan, Yue; Wang, Shixuan; Xue, Feng; Liu, Xiaofan; Zhang, Lei; Li, Huiyuan; Yang, Renchi


    We performed this study in adult patients with chronic primary immune thrombocytopenia to explore the long-term efficacy and safety of splenectomy. Data of 174 patients who underwent splenectomy in our hospital from 1994 to 2014 were analyzed. After splenectomy, 126 (72.4%) patients achieved a complete response (CR) and 28 (16.1%) achieved a response (R). Thirty-two (20.8%) responders relapsed with a median time of 24 months. Compared with non-responders and recurrent patients, the stable responders were younger and had higher preoperation and postoperation peak platelet count, later peak platelet count emergence time, and more megakaryocytes. Corticosteroid-dependent patients were more likely to response to splenectomy than those refractory to corticosteroid. We performed a relapse-free survival analysis among the 154 responders. In univariate analyses, corticosteroid dependent and time from diagnosis to splenectomy ≤24 months showed predictive value to persistent response. But only corticosteroid dependent was a significant predictor in multivariate analysis. The 30-d complication rate after the surgery was 25.9%. There were five (2.9%) patients experienced thrombosis and three (1.7%) refractory patients died during follow-up. Splenectomy was a safe treatment with a cure rate of 58.0%. Corticosteroid dependent showed predictive value to persistent response. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Results with cyclosporine monotherapy in long-term cardiac transplant recipients. (United States)

    Sansone, F; Boffini, M; Comoglio, C; Checco, L; Saviolo, R; Centofanti, P; La Torre, M; Rinaldi, M


    Triple therapy is the gold standard after heart transplantation while few reports have described experiences with cyclosporine monotherapy (CM). We have analyzed our experience with CM in long-term heart transplant recipients, surviving >5 years. Of the 219 patients transplanted between January 1990 and December 1998, 143 survived >5 years (mean age, 49.6 +/- 10.4). There were 124 (86.7%) male subjects. Matching patients respect to follow-up length, we obtained 2 groups: group A of 41 patients on double therapy (DT; cyclosporine plus Azathioprine) and group B of 41 patients on CM. After a mean follow-up of 119.8 +/- 32.2 months, we did not observe a significant difference in terms of survival and major events: heart failure, malignancy, dialysis, infections, and CAV. We strongly support the use of triple therapy in cardiac transplant recipients because of its known safety and efficacy. However, our experience with CM suggests the utility of this approach. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  8. Safety, efficacy, and long-term follow-up evaluation of perioperative epirubicin, Cisplatin, and capecitabine chemotherapy in esophageal resection for adenocarcinoma

    NARCIS (Netherlands)

    Sluis, P.C. van der; Ubink, I.; Horst, S. van der; Boonstra, J.J.; Voest, E.E.; Ruurda, J.P.; Rinkes, I.H.; Wiezer, M.J.; Schipper, M.E.; Siersema, P.D.; Los, M.; Lolkema, M.P.; Hillegersberg, R. van


    BACKGROUND: Perioperative epirubicin, cisplatin, and capecitabine (ECC) chemotherapy was evaluated in patients who underwent esophageal resection for adenocarcinoma of the esophagus or gastroesophageal junction (GEJ). METHODS: A cohort of 93 consecutive patients was analyzed. The median follow-up

  9. Safety, Efficacy, and Long-Term Follow-Up Evaluation of Perioperative Epirubicin, Cisplatin, and Capecitabine Chemotherapy in Esophageal Resection for Adenocarcinoma

    NARCIS (Netherlands)

    van der Sluis, P. C.; Ubink, I.; van der Horst, S.; Boonstra, J. J.; Voest, E. E.; Ruurda, J. P.; Borel Rinkes, I. H M; Wiezer, M. J.; Schipper, M. E I; Siersema, P. D.; Los, M.; Lolkema, M. P.; van Hillegersberg, R.


    Background: Perioperative epirubicin, cisplatin, and capecitabine (ECC) chemotherapy was evaluated in patients who underwent esophageal resection for adenocarcinoma of the esophagus or gastroesophageal junction (GEJ). Methods: A cohort of 93 consecutive patients was analyzed. The median follow-up

  10. Long-term results of an unloader brace in patients with unicompartmental knee osteoarthritis. (United States)

    Wilson, Becky; Rankin, Heather; Barnes, C Lowry


    Previously, we reported a prospective study of 30 patients with unicompartmental osteoarthritis of the knee treated nonoperatively with an unloader brace and average follow-up of 2.7 years. Although the initial study suggested short-term benefit according to pain and function measures, the objective of the current study was to evaluate these same patients via telephone questionnaire to determine the status of their brace use and any surgical procedures on the affected limb. Because we noted that even at 2.7 years, some patients opted for surgical management despite good response to bracing, our hypothesis was that these patients would not opt for long-term brace wear. Twenty-four of 30 patients were available for reporting based on telephone interview; in addition, we talked with family members of 5 patients who had died. When evaluated at 2.7 years, 41% of the 30 patients were still using the brace, 35% had discontinued brace use, and 24% had undergone arthroplasty. When contacted for the follow-up survey at an average of 11.2 years, 17 (58.6%) of the 29 patients had undergone arthroplasty. The mean interval between initial evaluation and arthroplasty was 3.9 years. In addition, 7 patients had undergone arthroscopic surgery. Importantly, none of the patients were still wearing the brace. The use of an unloader brace is effective in providing short-term pain relief and improved function; however, most patients subsequently opt for total knee replacement on the symptomatic knee. Copyright 2011, SLACK Incorporated.

  11. The treatment of giant cell tumors by curettage and filling with acrylic cement. Long-term functional results. (United States)

    Segura, J; Albareda, J; Bueno, A L; Nuez, A; Palanca, D; Seral, F


    Curettage and filling with acrylic cement in the treatment of para-articular giant cell tumor (GCT) has multiple advantages as compared to other methods; nonetheless, the possibility of progression in arthrosis is still a drawback. The literature does not report long-term functional results when this method was used. Four cases are presented with a mean long-term follow-up of 13.5 years (minimum 11, maximum 18). Clinical results, evaluated by the Enneking system (18), were excellent, and there were no radiological modifications, so that we believe that this is the method to choose for Campanacci stage I and II GCT (1), and in some stage III cases, as joint function is not compromised in time.


    Directory of Open Access Journals (Sweden)

    V. M. Shapovalov


    Full Text Available The authors analyzed the long-term results of surgical treatment 47 patients with true spondylolisthesis. The follow up period ranged from 14 to 25 years. All patients underwent an isolated anterior interbody riving allograft fusion. The scales of VAS and ODI were used for subjective assessment of treatment outcomes; objective assessment was based on clinical and radiographic, CT and MRI outcomes. There were 42.6% (20 cases patients with good, 31.9% (15 cases with satisfactory and 25.5% (12 cases unsatisfactory results in the long-term follow-up. The main reasons of poor outcome were: the continued high degree of displacement of the vertebral body (17.6%, instability (38.3% and the disbalance of the lumbosacral spine (63.8%, persistent compression of neural structures (42.6%. Most patients had the combination of these factors that were existed against backdrop of progressive degenerative changes of the spine.

  13. Which parameters affect medium- to long-term results after angular stable plate fixation for proximal humeral fractures? (United States)

    Bahrs, Christian; Kühle, Luise; Blumenstock, Gunnar; Stöckle, Ulrich; Rolauffs, Bernd; Freude, Thomas


    Very little information on medium- to long-term results is available for surgically treated proximal humeral fractures. The aim of this prospective treatment study was to present long-term results after angular stable plate fixation of displaced proximal humeral fractures and to detect which specific patient- and fracture-related parameters affect the clinical outcome. We performed a prospective clinical and radiologic evaluation of 77 patients with a displaced proximal humeral fracture (28 Neer 2-part, 38 3-part, and 11 4-part fractures; 28 AO A fractures, 30 AO B fractures, and 19 AO C fractures) treated with angular stable plate fixation after a mean follow-up period of 96 months (range, 74-133 months). We assessed outcomes with the Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and evaluated specific patient- and fracture-related parameters including complications. The mean Constant, University of California-Los Angeles (UCLA), and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were 79, 31, and 12 points. Reasons for revisions were implant-related impingement (n = 13), screw perforation (n = 10), infection (n = 4), and secondary fracture displacement (n = 1). There was a significant association between worse score results and occurrence of secondary fracture displacement, screw perforation, residual bone deformities, and a rotator cuff defect at follow-up. Good medium- to long-term results after angular stable plate fixation of displaced proximal humeral fracture can be expected. A reconstruction within a range of 15° in both anteroposterior and axillary views and fracture displacement and screw perforation, and a less favorable long-term result. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Long-Term Results of Cataract Surgery in Patients with Unilateral Childhood Cataract

    Directory of Open Access Journals (Sweden)

    Suzan Güven Yılmaz


    Full Text Available Pur po se: To evaluate the long-term visual outcome and to determine the surgical complications after cataract surgery in patients with unilateral childhood cataract. Ma te ri al and Met hod: We retrospectively reviewed the records of 18 cases with unilateral childhood cataract who had undergone cataract surgery before the age of seven. Primary intraocular lens (IOL implantation was made in children who were older than 1 year of age. Secondary IOL implantation was made after 18 months in children who were operated before the age of 1 year and were left aphakic. Occlusion therapy was performed to all children for amblyopia postoperatively. Visual acuity and complications were evaluated in a mean follow-up period of 4.8 years. Re sults: The mean age of the 18 patients (9 female/9 male at the time of surgery was 43.6±33.7(1-84 months. Eleven (61% patients had cataract surgery after 1 year of age. Secondary IOL implantation was performed at mean 28th month in 4 of 7 aphakic patients (57% who had cataract surgery before one year of age. In 3 (43% aphakic patients, secondary IOL implantation could not be performed because of ocular pathologies such as microophthalmia. Final visual acuity was 0.5 or better in 7 eyes (39%, between 0.1 and 0.5 in 6 eyes (33%, and worse than 0.1 - in 5 eyes (28%. Of 5 eyes that had visual acuity worse than 0.1, 4 (80% had at least one additional ocular pathology such as microphthalmia, strabismus and nystagmus. Nd:YAG laser posterior capsulotomy was performed at mean 8th month in 7 of 8 (87% children whose posterior capsules were left intact at surgery. Dis cus si on: Favorable visual outcomes can be achieved with surgical intervention and complementary amblyopia treatment in children with unilateral cataract. Preoperative microphthalmia, nystagmus and strabismus are not entirely an obstacle to visual development, but they are important factors leading to low visual acuity. (Turk J Ophthalmol 2012; 42: 103-10

  15. Brachiocephalic reconstruction I: operative and long-term results for complex disease. (United States)

    Takach, Thomas J; Reul, George J; Cooley, Denton A; Duncan, J Michael; Livesay, James J; Gregoric, Igor D; Krajcer, Zvonimir; Cervera, Roberto D; Ott, David A; Frazier, O H


    better long-term freedom from graft failure, possibly because it preserves aortic inflow to the great vessels. Nonetheless, the high frequency of late events in this relatively young patient population reflects the presence of multisystem atherosclerosis and suggests the need for close follow-up and lifestyle modification.

  16. Advanced gastric adenocarcinoma. Influence of preoperative radiation therapy on toxicity and long-term survival rates; Adenocarcinoma gastrico avancado. Analise da toxicidade e da influencia da radioterapia pre-operatoria nos indices de sobrevivencia a longo prazo

    Energy Technology Data Exchange (ETDEWEB)

    Malzoni, Carlos Eduardo


    The surgical treatment of gastric cancer has better long-term survival rates when performed in patients with early gastric cancer. Worse results are obtained in treatment of advanced gastric cancer. Most patients in west centers are treated in advanced stages. A great number of them go through a surgical treatment unable by itself to cure them. the frequent local recurrence caused by failure of the surgical treatment has been keeping poor survival rates in patients with advanced gastric cancer for decades. The desire of improving survival is the reason of the use of adjuvant therapies. This paper achieved the retrospective study of the influence of preoperative radiation therapy (2000 cGy) in long-term survival rates (120 months) of patients with advanced gastric cancer on stages IIIa, IIIb and IV. The possible injuries caused in the liver and kidney were observed also as well as first group was treated by surgical and radiation therapies and the second received surgical treatment only. There was no statistical difference between the two groups when sex, age, race, occurrence of other diseases, nutritional assessment, TNM stage, occurrence of obstruction or bleeding caused by tumor, surgical procedure and hepatic and renal function were considered. Survival rates and changes on hepatic and renal function were statistically compared. The results showed a statistic improvement on the long-term survival rates of stage IIIa patients treated by preoperative radiation therapy. No statistic difference was observed on hepatic or renal function between the groups. No adverse influence of radiation therapy method was detected by the used parameters. There was no statistical difference between the two groups when immediate surgical complications were considered. (author) 112 refs., 34 tabs.

  17. [Long-term results of surgical treatment of patients with aortic valve disease and functional mitral insufficiency]. (United States)

    Salagaev, G I; Belov, Yu V; Charchyan, E R; Katkov, A I; Vinokurov, I A


    To analyze long-term surgical results in patients with aortic valve disease and concomitant mitral regurgitation (MR) depending on volume of valve surgery. It was studied 5-year results in 71 patients with aortic valve disease and different degree of mitral regurgitation. Patients were divided into 3 groups. Control group included 40 patients after aortic valve replacement (AVR) and no mitral insufficiency. The 2nd group consisted of 16 patients after AVR and concomitant mitral regurgitation degree 2-3. The 3rd group - 15 patients after aortic and mitral valve replacement. Mortality in long-term postoperative period, quality of life, incidence of complications and echocardiography data were analyzed. There was no significant improvement of mitral regurgitation after AVR. It was showed that persistent MR decreases remote survival and quality of life as well as deteriorates echocardiography data. Herewith these data in the 3rd group did not differ from the control group. Double-valve replacement may be advisable in patients with aortic valve disease and concomitant moderate MR because persistent MR deteriorates long-term However prolonged time of cardiopulmonary bypass, aortic cross-clamping, greater blood loss require comprehensive approach to advanced cardiac surgery.

  18. Long-term results after CT-guided percutaneous ethanol ablation for the treatment of hyper functioning adrenal disorders

    Energy Technology Data Exchange (ETDEWEB)

    Frenk, Nathan Elie; Sebastianes, Fernando; Lerario, Antonio Marcondes; Fragoso, Maria Candida Barisson Villares; Mendonca, Berenice Bilharinho [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Medicina; Menezes, Marcos Roberto de, E-mail: [Instituto do Cancer do Estado de Sao Paulo, SP (Brazil)


    Objectives: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyper functioning adrenal disorders. Method: We retrospectively evaluated the long-term results of nine patients treated with computed tomography guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macro nodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. Results: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macro nodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. Conclusion: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyper functioning adrenal disorders and is not without risks. (author)

  19. Short- and long-term eating habit modification predicts weight change in overweight, postmenopausal women: results from the WOMAN study. (United States)

    Barone Gibbs, Bethany; Kinzel, Laura S; Pettee Gabriel, Kelley; Chang, Yue-Fang; Kuller, Lewis H


    Standard behavioral obesity treatment produces poor long-term results. Focusing on healthy eating behaviors rather than energy intake may be an alternative strategy. In addition, important behaviors might differ for short- vs long-term weight control. Our aim was to describe and compare associations between changes in eating behaviors and weight after 6 and 48 months. We performed secondary analysis of data collected during a randomized weight-loss intervention trial with 48-month follow-up. We studied 481 overweight and obese postmenopausal women enrolled in the Women on the Move through Activity and Nutrition (WOMAN) Study. We measured changes in weight from baseline to 6 and 48 months. Linear regression models were used to examine the associations between 6- and 48-month changes in eating habits assessed by the Conner Diet Habit Survey and changes in weight. Analyses were conducted in the combined study population and stratified by randomization group. At 6 months in the combined population, weight loss was independently associated with decreased desserts (Pdesserts and fried foods associated with weight loss in controls. At 48 months in the combined population, weight loss was again associated with decreased desserts (P=0.003) and sugar-sweetened beverages (P=0.011), but also decreased meats/cheeses (P=0.024) and increased fruits/vegetables (Pdesserts, sugar-sweetened beverages, and fruits/vegetables were independently associated in controls. Changes in eating behaviors were associated with weight change, although important behaviors differed for short- and long-term weight change and by randomization group. Future studies should determine whether interventions targeting these behaviors could improve long-term obesity treatment outcomes. Copyright © 2012 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

  20. Long-term results of total body irradiation in adults with acute lymphoblastic leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Marnitz, Simone; Zich, Alexander; Budach, Volker; Jahn, Ulrich; Neumann, Oliver [Charite University Medicine, Department of Radiation Oncology, Berlin (Germany); Martus, Peter [University Tuebingen, Institute of Clinical Epidemiology and Applied Biostatistics, Tuebingen (Germany); Arnold, Renate [Charite University Medicine, Campus CVK, Department of Hematology and Oncology, Bone Marrow Transplant Unit, Berlin (Germany)


    The aim of this chart review of adult patients treated for acute lymphoblastic leukemia (ALL) with total body irradiation (TBI) was to evaluate early and late toxicity and long-term outcome. A total of 110 adult patients (34 ± 12 years) with ALL underwent TBI (6 fractions of 2 Gy for a total of 12 Gy) as a part of the treatment regimen before transplantation. Treatment-related toxicity, mortality, and hematologic outcome are reported. Mean follow-up was 70 months. The 2- and 5-year leukemia-free survival rates were 78 and 72 %, respectively. In all, 29 % (32/110) patients suffered from medullary recurrence after a median time of 7 months. Gender was the only statistically significant prognostic factor in terms of overall survival in favor of female patients. Treatment-related mortality and overall survival after 2 and 5 years were 16 and 22 %, and 60 and 52.7 %, respectively. The most frequent late reaction wascGVHD of the skin (n = 33, 30 %). In addition, 15.5 % (17/110 patients) suffered pulmonary symptoms, and 6 patients developed lung fibrosis. Eyes were frequently affected by the radiation (31/110 = 28 %); 12 of 110 patients (11 %) presented with symptoms from osteoporosis, 5 of 110 patients (4.5 %) developed hypothyreosis and 2 patients diabetes mellitus. Of the male patients, 11 % reported erectile dysfunction or loss of libido, while 2 of 36 women reported menopausal syndrome at the mean time of 28 months after treatment with requirement for substitution. No women became pregnant after treatment. No acute or late cardiac toxicities were documented in our patients. No secondary malignancies were documented. Although hematologic outcome was in the upper range of that reported in the literature, treatment-related mortality (TRM) and medullary recurrences remain a challenge. Sophisticated radiation techniques allow for decreasing toxicity to certain organs and/or dose escalation to the bone marrow in highly selected patients in order to improve therapeutic

  1. Long-term results of percutaneous balloon valvuloplasty of congenital aortic stenosis in adolescents and young adults

    Directory of Open Access Journals (Sweden)

    Neeraj Awasthy


    Conclusion: There is no statistical difference in the long-term outcome in the adults and adolescents as compared to the children; thus BAV remains an obvious treatment of choice with good long-term outcome.

  2. Clopidogrel plus long-term aspirin after femoro-popliteal stenting. The CLAFS project: 1- and 2-year results

    Energy Technology Data Exchange (ETDEWEB)

    Strecker, Ernst-Peter K.; Boos, Irene B.L.; Goettmann, Dieter; Vetter, Sylvia [Department of Imaging, Interventional Radiology, and Nuclear Medicine, Diakonissen Hospital, Diakonissenstrasse 28, 76199, Karlsruhe (Germany)


    The aim of this study was to determine the patency rate after femoro-popliteal stenting followed by oral clopidogrel plus long-term aspirin. In a prospective trial, 31 patients with a total of 33 femoro-popliteal artery lesions (21 stenoses, 12 occlusions; 24 femoral, 9 popliteal) were treated with flexible tantalum stents after unsuccessful percutaneous transluminal angioplasty (PTA) preceded by local fibrinolysis in 5 of 12 patients with total occlusion. Post-interventionally, oral aspirin 100 mg was started simultaneously for the long term and was combined with an oral loading dose of 300 mg clopidogrel, followed by 75 mg clopidogrel daily for 28 days. Patients were followed for at least 12 months (maximum 34 months) by clinical examination, Doppler pressure measurement, color and duplex sonography, and angiography in case of suspicion of restenosis. In a retrospective analysis, the results were compared with those of historical groups of patients having received aspirin only (41 patients) or a long-term high-dose low molecular weight heparin (LMWH)+aspirin treatment (42 patients). Three small puncture aneurysms were treated successfully by conservative means and were categorized as minor bleeding complication. Cumulative primary patency rate (PPR) was 76{+-}7.5% (1 year), and 70{+-}9.6% (2 years) in the clopidogrel+aspirin group, thus being tendentiously better than in the aspirin-only group showing 75{+-}4.6% (1 year), and 50{+-}8.1% (2 years). Long-term high-dose LMWH+aspirin treatment showed 87{+-}5.8% (1 year), and 72{+-}9.1% (2 years), thus being superior to the other treatment regimes, with a statistically significant difference (p<0.05) between the LMWH+aspirin and the aspirin group. Clopidogrel plus aspirin is a safe medication regimen and may be effective in the prevention of early stent thrombosis. Mid- and long-term patency rate seems to be intermediate as compared with other therapeutic regimens. The LMWH+aspirin seems to be superior compared with

  3. How long does it take to initiate a child on long-term invasive ventilation? Results from a Canadian pediatric home ventilation program


    Reshma Amin; Aarti Sayal; Faiza Syed; Cathy Daniels; Andrea Hoffman; Moraes, Theo J; Peter Cox


    OBJECTIVE: To assess the length of stay required to initiate long-term invasive ventilation at the authors’ institution, which would inform future interventional strategies to streamline the in-hospital stay for these families.METHODS: A retrospective chart review of children initiated on invasive long-term ventilation via tracheostomy at the authors’ acute care centre between January 2005 and December 2013 was performed.RESULTS: Thirty-five children were initiated on long-term invasive venti...

  4. Long-term frozen storage of urine samples: a trouble to get PCR results in Schistosoma spp. DNA detection? (United States)

    Fernández-Soto, Pedro; Velasco Tirado, Virginia; Carranza Rodríguez, Cristina; Pérez-Arellano, José Luis; Muro, Antonio


    Human schistosomiasis remains a serious worldwide public health problem. At present, a sensitive and specific assay for routine diagnosis of schistosome infection is not yet available. The potential for detecting schistosome-derived DNA by PCR-based methods in human clinical samples is currently being investigated as a diagnostic tool with potential application in routine schistosomiasis diagnosis. Collection of diagnostic samples such as stool or blood is usually difficult in some populations. However, urine is a biological sample that can be collected in a non-invasive method, easy to get from people of all ages and easy in management, but as a sample for PCR diagnosis is still not widely used. This could be due to the high variability in the reported efficiency of detection as a result of the high variation in urine samples' storage or conditions for handling and DNA preservation and extraction methods. We evaluate different commercial DNA extraction methods from a series of long-term frozen storage human urine samples from patients with parasitological confirmed schistosomiasis in order to assess the PCR effectiveness for Schistosoma spp. detection. Patients urine samples were frozen for 18 months up to 7 years until use. Results were compared with those obtained in PCR assays using fresh healthy human urine artificially contaminated with Schistosoma mansoni DNA and urine samples from mice experimentally infected with S. mansoni cercariae stored frozen for at least 12 months before use. PCR results in fresh human artificial urine samples using different DNA based extraction methods were much more effective than those obtained when long-term frozen human urine samples were used as the source of DNA template. Long-term frozen human urine samples are probably not a good source for DNA extraction for use as a template in PCR detection of Schistosoma spp., regardless of the DNA method of extraction used.

  5. Long-term frozen storage of urine samples: a trouble to get PCR results in Schistosoma spp. DNA detection?

    Directory of Open Access Journals (Sweden)

    Pedro Fernández-Soto

    Full Text Available BACKGROUND: Human schistosomiasis remains a serious worldwide public health problem. At present, a sensitive and specific assay for routine diagnosis of schistosome infection is not yet available. The potential for detecting schistosome-derived DNA by PCR-based methods in human clinical samples is currently being investigated as a diagnostic tool with potential application in routine schistosomiasis diagnosis. Collection of diagnostic samples such as stool or blood is usually difficult in some populations. However, urine is a biological sample that can be collected in a non-invasive method, easy to get from people of all ages and easy in management, but as a sample for PCR diagnosis is still not widely used. This could be due to the high variability in the reported efficiency of detection as a result of the high variation in urine samples' storage or conditions for handling and DNA preservation and extraction methods. METHODOLOGY/PRINCIPAL FINDINGS: We evaluate different commercial DNA extraction methods from a series of long-term frozen storage human urine samples from patients with parasitological confirmed schistosomiasis in order to assess the PCR effectiveness for Schistosoma spp. detection. Patients urine samples were frozen for 18 months up to 7 years until use. Results were compared with those obtained in PCR assays using fresh healthy human urine artificially contaminated with Schistosoma mansoni DNA and urine samples from mice experimentally infected with S. mansoni cercariae stored frozen for at least 12 months before use. PCR results in fresh human artificial urine samples using different DNA based extraction methods were much more effective than those obtained when long-term frozen human urine samples were used as the source of DNA template. CONCLUSIONS/SIGNIFICANCE: Long-term frozen human urine samples are probably not a good source for DNA extraction for use as a template in PCR detection of Schistosoma spp., regardless of the DNA

  6. Long-term results of vaginal repairs with and without xenograft reinforcement

    DEFF Research Database (Denmark)

    Mouritsen, Lone; Kronschnabl, M.; Lose, G.


    The aim of this paper is to study if xenograft reinforcement of vaginal repair reduces recurrence of prolapse. Results 1-5 years after vaginal repair were studied in 41 cases with xenograft and in 82 matched controls without. Symptoms were evaluated by a validated questionnaire and anatomy...... to literature. Xenograft reinforcement might improve results...

  7. High-dose rate brachytherapy of prostatic adenocarcinoma in combination with external beam radiotherapy. A long-term follow-up of the first 50 patients at one center

    Energy Technology Data Exchange (ETDEWEB)

    Lennernaes, B. [Dept. of Oncology, Sahlgrenska Univ. Hospital (Sweden); Holmaeng, S. [Dept. of Urology, Sahlgrenska Univ. Hospital (Sweden); Hedelin, H. [Kaernsjukhuset, Skoevde (Sweden)


    Aim: To report the long-term follow-up of 50 patients with prostatic adenocarcinoma (PAC) by high-dose rate brachytherapy in combination with external beam radiotherapy. Patients and methods: Between 1988 and 1995, 50 patients were treated with external beam radiotherapy delivered in 2 Gy fractions to a total dose of 50 Gy. Brachytherapy was delivered in two 10 Gy fractions. The mean follow-up time was 7.2 years. Results: 42 patients are alive and four patients have deceased of prostatic adenocarcinoma. Of the remaining patients, 40 have a PSA<1 ng/l. 41 patients were interviewed during the year 2000 and 91% of these were satisfied with the treatment. Four (8%) patients reported grade III/IV side effects. Ten of the 41 patients reported that they still had an erection allowing intercourse. Half of those who developed an erectile dysfunction did so in direct connection with the treatment. In the others erectile dysfunction developed gradually during the first 48 months after the treatment. Conclusion: The combined treatment gave an exceptionally good local control (86%). The method represents a promising curative treatment, but the effect can be double edged. The small number of patients in this study restricts a more conclusive statement concerning this treatment modality. (orig.) [German] Ziel: Monoinstitutioneller Erfahrungsbericht zur Behandlung des Prostatakarzinoms mit kombinierter externer und HDR-Brachytherapie. Patienten und Methoden: Von 1988 bis 1995 wurden 50 Patienten mit einem Prostataadenokarzinom kombiniert extern und interstitiell behandelt. Die perkutane Radiotherapie erfolgte bei einer Einzeldosis von 2 Gy bis zu einer Gesamtreferenzdosis von 50 Gy. Die Brachtherapie folgte mittels zweier HDR-Fraktionen von je 10 Gy. Die mediane Nachbeobachtungszeit betrug 7,2 Jahre. Ergebnisse: 42 Patienten sind am Leben, vier starben am Prostataadenokarzinom. Von den ueberlebenden Patienten haben 40 einen PSA-Wert <1 ng/l. 41 Patienten wurden waehrend des Jahres

  8. Long-term results using LigaSure™ 5 mm instrument for treatment of Zenker's diverticulum

    DEFF Research Database (Denmark)

    Andersen, Michelle Fog; Trolle, Waldemar; Anthonsen, Kristian


    to all patients. The questions dealt with complaints according to a visual analog scale (VAS) and were sent a minimum of one year after the surgery (mean time 22 months, range 12-32 month). The overall response rate was 91%. The mean age of the patients was 69 years (range 37-89 years). The patients......%) reported no symptoms at all. Our results suggest that endoscopic management of ZD with the LigaSure™ 5 mm instrument is a minimally invasive, fast and safe method with solid long-term outcome with relief of symptoms and patient satisfaction. This new operative instrument was not found inferior...

  9. Long-Term Results of Urgent Revascularization for Hepatic Artery Thrombosis After Pediatric Liver Transplantation

    NARCIS (Netherlands)

    Warnaar, Nienke; Polak, Wojciech G.; de Jong, Koert P.; de Boer, Marieke T.; Verkade, Henkjan J.; Sieders, Egbert; Peeters, Paul M. J. G.; Porte, Robert J.

    Hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) is a serious complication resulting in bile duct necrosis and often requiring retransplantation. Immediate surgical thrombectomy/thrombolysis has been reported to be a potentially successful treatment for

  10. Long-term results after lung transplantation using organs from circulatory death donors: a propensity score-matched analysis†. (United States)

    Sabashnikov, Anton; Patil, Nikhil P; Popov, Aron-Frederik; Soresi, Simona; Zych, Bartlomiej; Weymann, Alexander; Mohite, Prashant N; García Sáez, Diana; Zeriouh, Mohamed; Wahlers, Thorsten; Choi, Yeong-Hoon; Wippermann, Jens; Wittwer, Thorsten; De Robertis, Fabio; Bahrami, Toufan; Amrani, Mohamed; Simon, André R


    Due to organ shortage in lung transplantation (LTx), donation after circulatory death (DCD) has been implemented in several countries, contributing to an increasing number of organs transplanted. We sought to assess long-term outcomes after LTx with organs procured following circulatory death in comparison with those obtained from donors after brain death (DBD). Between January 2007 and November 2013, 302 LTxs were performed in our institution, whereby 60 (19.9%) organs were retrieved from DCD donors. We performed propensity score matching (DCD:DBD = 1:2) based on preoperative donor and recipient factors that were significantly different in univariate analysis. After propensity matching, there were no statistically significant differences between the groups in terms of demographics and preoperative donor and recipient characteristics. There were no significant differences regarding intraoperative variables and total ischaemic time. Patients from the DCD group had significantly higher incidence of primary graft dysfunction grade 3 at the end of the procedure (P = 0.014), and significantly lower pO2/FiO2 ratio during the first 24 h after the procedure (P = 0.018). There was a trend towards higher incidence of the need for postoperative extracorporeal life support in the DCD group. Other postoperative characteristics were comparable. While the overall cumulative survival was not significantly different, the DCD group had significantly poorer results in terms of bronchiolitis obliterans syndrome (BOS)-free survival in the long-term follow-up. Long-term results after LTx with organs procured following DCD are in general comparable with those obtained after DBD LTx. However, patients transplanted using organs from DCD donors have a predisposition for development of BOS in the longer follow-up. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.


    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov


    Full Text Available The authors analyse the results of the performance of arthroscopy stitch on the injured capsule with the use of anchor on 46 patients with anterior recurring instability of the shoulder joint within a period of time from 6 months to 4 years. When assessing the results of the given treatment, functional scales, clinical examination methods and radiological methods have been used. The article presents the results of arthroscopy diagnosis of the interior joint damage accompanying the recurring instability of the shoulder joint. The effectiveness of the conducted operations was 93,5%. The occurrence of postoperative relapses of joint instability (reoccurring dislocations in 3 patients (6,5% was caused by the presence of significant damage of bone formations in the shoulder joint – the shoulder-blade joint socket and the shoulder-bone head as well as the reduction of the strength and elasticity of the soft-tissue structures.

  12. Long-term results of vaginal repairs with and without xenograft reinforcement

    DEFF Research Database (Denmark)

    Mouritsen, Lone; Kronschnabl, M.; Lose, G.


    by a validated questionnaire and anatomy by pelvic organ prolapse quantification (POPQ). RESULTS: Significant more cases, 97% versus 81% controls, felt cured or much improved (p = 0.02); 11% of cases and 19% of controls had POP symptoms, POPQ > -1 was found in 31% cases and 24% controls. Defining recurrence...

  13. Long-Term Results of the Diagnostic Tests for Subacromial Impingement Syndrome

    Directory of Open Access Journals (Sweden)

    Bayram Kelle


    Results: There were no significant differences for demographic data between groups. The all tests in both group were found mostly positive. It was seen significant change at the third months after treatment. Conclusions: The specific tests were important fort he diagnosis of SIS, furthermore they can demonstrate the efficacy of treatments. The combinad application of these tests are more important for the diagnosis and follow-up of SIS. [Cukurova Med J 2015; 40(4.000: 794-799

  14. Cholesteatoma surgery in children: long-term results of the inside-out technique. (United States)

    Roth, Thomas N; Ziglinas, Panagiotis; Haeusler, Rudolf; Caversaccio, Marco D


    To present the anatomical and functional results of the inside-out technique applied in pediatric cholestetaoma surgery and to evaluate functionality with good hearing results against radicality with lower recurrence rate. Retrospective analysis and evaluation of the postoperative outcome in a consecutive series of 126 children or 130 ears operated between 1992 and 2008. With the inside-out technique, cholesteatoma is eradicated from the epitympanum toward the mastoid and, as a single stage procedure, functional reconstruction of the middle ear is achieved by tympanoossiculoplasty. In 89.2% of all cases, the ear was dry postoperatively. 80.9% of the ears reached a postoperative air-bone gap of 30 dB or less and the median air conduction hearing threshold was 29 dB; in 60.9% of all cases, hearing was postoperatively improved. The recurrence rate was 16.2% in a mean postoperative follow-up 8.5 years. Altogether, 48 ears (36.9%) underwent revision surgery. The complication rate was 3.1% and involved only minor complications. The inside-out technique allows a safe removal of cholesteatoma from the epitympanum toward the mastoid with a single-stage reconstruction of the ossicular chain. For this reason we support our individual approach, which allows creation of the smallest possible cavity for the size of the cholesteatoma. Our results confirm that the inside-out technique is effective in the treatment of pediatric cholesteatoma. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Rain Attenuation at 58 GHz: Prediction versus Long-Term Trial Results

    Directory of Open Access Journals (Sweden)

    Kvicera Vaclav


    Full Text Available Electromagnetic wave propagation research in frequency band 58 GHz was started at TESTCOM in Praha due to lack of experimentally obtained results needed for a realistic calculation of quality and availability of point-to-point fixed systems. Rain attenuation data obtained from a path at 58 GHz with V polarization located in Praha was processed over a 5-year period. Rainfall intensities have been measured by means of a heated siphon rain gauge. In parallel, rainfall intensity data from rain gauge records was statistically processed over the same year periods as the rain attenuation data. Cumulative distributions of rainfall intensities obtained as well as cumulative distributions of rain attenuation obtained are compared with the calculated ones in accordance with relevant ITU-R recommendations. The results obtained can be used as the primary basis for the possible extension of the ITU-R recommendation for calculating rain attenuation distributions up to 60 GHz. The obtained dependence of percentages of time of the average year on the percentages of time of the average worst month is also compared with the relevant ITU-R recommendation. The results obtained are discussed.

  16. Salvage of failed resection arthroplasties of the distal radioulnar joint using an ulnar head prosthesis: long-term results. (United States)

    van Schoonhoven, Jörg; Mühldorfer-Fodor, Marion; Fernandez, Diego L; Herbert, Timothy J


    The aim of this prospective multicenter study was to evaluate the long-term outcome of the Herbert ulnar head prosthesis for painful instability of the distal radioulnar joint (DRUJ) following resection of the ulnar head. Twenty-three patients were treated with a Herbert ulnar head prosthesis in 3 international hand centers. One patient was excluded from the study because a septic prosthesis had to be removed after 3 months. Sixteen of the remaining 22 patients could be assessed at 2 follow-up times, 28 months (range, 10-43 mo) and 11 years and 2 months (range, 97-158 mo) after surgery, for DRUJ stability, forearm rotation, grip strength, pain level (0-10), and satisfaction (0-10). Standardized radiographs of the wrist were evaluated for displacement of the ulnar head and loosening or bony reactions at the sigmoid notch or the ulna shaft. All patients demonstrated a clinically stable DRUJ at the latest examination, and no patient required further surgery at the DRUJ since the short-term evaluation in 1999. Average pain measured 3.7 before surgery, 1.7 at the short-term follow-up, and 1.7 at the long-term follow-up; patients' satisfaction, 2.2, 8.2, and 8.9; pronation, 73°, 86°, and 83°; supination, 52°, 77°, and 81°; and grip strength, 42%, 72%, and 81% of the unaffected side. All clinical parameters improved significantly from before surgery to the short-term follow-up, with no further statistically significant change between the short-term and long-term follow-up. Radiographs demonstrated no signs of stem loosening or incongruity of the DRUJ. The previously reported short-term results with the Herbert prosthesis did not deteriorate in the long term. Reconstruction of the DRUJ with this prosthesis in painful radioulnar impingement following ulnar head resection is a reliable and reproducible procedure with lasting results. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. Trace element concentration in wheat grain: results from the Swedish long-term soil fertility experiments and national monitoring program. (United States)

    Kirchmann, Holger; Mattsson, Lennart; Eriksson, Jan


    Concentrations of trace elements in wheat grain sampled between 1967 and 2003 from the Swedish long-term soil fertility experiments were analyzed using ICP-MS. The long-term effect of inorganic and organic fertilization on trace metal concentrations was investigated including the impact of atmospheric deposition and myccorhiza, whereas other factors such as soil conditions, crop cultivar, etc. are not discussed in this paper. Mean values derived from 10 experimental sites were reported. Significantly declining Pb and Cd concentrations in wheat grain could be explained by lower atmospheric deposition. Mean Se contents in all samples were 0.031 mg kg(-1) grain dry weight. No samples had sufficiently high Se concentrations for human (0.05 mg Se kg(-1)) or animal demand (0.1 mg Se kg(-1)). Concentrations of Co in wheat grain were extremely low, 0.002-0.005 mg Co kg(-1) grain dry weight, and far below the minimum levels required by animals, which applied to all fertilizer treatments. A doubling of Mo concentrations in grain since 1975 resulted in Cu/Mo ratios often below one, which may cause molybdenosis in ruminants. The increase in Mo concentrations in crops correlated with the decline in sulfur deposition. Concentrations of Cu and Fe declined in NPK-fertilized wheat as compared to unfertilized or manure-treated wheat. Very low concentrations of Se and Co and low concentrations of Fe and Cu require attention to counteract risks for deficiencies. The main characteristic of the study is that there are few significant changes over time between different fertilizer treatments, but throughout there are low concentrations of most trace elements in all treatments. In general, good agreement between concentrations in wheat from the long-term fertility experiments and the national monitoring program indicate that values are representative.

  18. Long-term results of coronary artery bypass grafting in patients with dialysis-dependent renal failure. (United States)

    Hsu, H L; Hsu, H P; Yu, B F; Lu, T M; Huang, C Y; Shih, C C; Cheng, B C; Hsu, C P


    Coronary artery disease is the main cause of mortality and morbidity in dialysis-dependent renal failure patients. Both the prevalence and incidence of renal failure are high in Taiwan. However, there were few reports exploring the outcome of coronary aortic bypass grafting (CABG) in these patients. The aim of this study was to determine the survival outcome and risk factors for mortality from CABG in this population. The operative, early postoperative and late results of 170 dialysis patients undergoing isolated coronary artery bypass grafting from January, 2000 to January, 2012 were retrospectively reviewed. Operative mortality, long-term survival, and risk factors were analyzed. One hundred and seventeen patients (68.8%) were male, and the mean age was 61.5±10.3 years (range, 34-86 years). Follow-up was 40.3±32.1 months. Operative mortality was 8.2%. Actuarial survival, including operative mortality, was 81±3% at 1 year, 68±4% at 3 years, 58±5% at 5 years and 49±6% at 10 years, better than the natural course of dialysis-dependent renal failure patients. Age, emergent operation, postoperative ventricular tachycardia or fibrillation, postoperative intra-aortic balloon pump insertion, gastrointestinal bleeding, and left internal mammary artery graft were significant predictors of operative or long term mortality. Most causes of late death were due to infection or cardiac events. CABG in dialysis patients is associated with a higher incidence of complications, but has acceptable mortality. CABG is beneficial in this population. Internal mammary artery grafting may provide more favorable long term outcomes.


    Directory of Open Access Journals (Sweden)

    A. M. Shestopalov


    Full Text Available The aim is to analyze the long-term results of the avian influenza virus surveillance monitoring of influenza virus in birds of one of the key Northern Eurasia points Lake. Uvs Nuur, the Republic of Tyva. Methods. The analysis of the available sources and our own research results is conducted. We used MEGA 5.2 software to construct a phylogenetic dendrogram. Tree topology is constructed by the method of maximum likelihood. Genetic distance matrix is calculated using the Kimura two-parameter metric method. Results. We conducted a biogeographical analysis of the Great Lakes basin, and an overview of the literature and the original results of highly pathogenic H5N1 influenza circulation and molecular epidemiology at Uvs Nuur Lake. Conclusion. Long-term observations at Lake Uvs Nuur revealed the important role of the biogeocoenose for the preservation and evolution of influenza A virus in wild bird populations. Planned ecological and virological monitoring is the basis for correct conclusions about the dynamics of epizootic process, infection control, as well as for the evaluation of the epidemic and pandemic potential of novel viral strains.

  20. Long-term Results of 185 Consecutive Osseointegrated Hearing Device Implantations

    DEFF Research Database (Denmark)

    Calvo Bodnia, Nadia; Foghsgaard, Søren; Nue Møller, Martin


    OBJECTIVE: To determine the occurrence and type of perioperative and postoperative complications in patients implanted with an osseointegrated hearing device (OHD) (also known as BAHA/BAHS) and compare results in children, adults, and elderly and for different surgical techniques. STUDY DESIGN...... reactions occurred in 14% of observations overall; in 10% in children compared with 16% in adults and 9% in elderly. Partial or total skin overgrowth was seen in 4% and 6% of the observations in children and adults, respectively, whereas none of the elderly experienced this problem. The abutment was removed...


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION: Rupture of tendon calcaneum is a common problem.There are proponents of both conservative and operative methods.Inadequate strength and re ruptures are frequent. To address both the problems we have chosen Lindholm technique and doing it for last 20 yrs with very good results. MATERIALS AND METHODS: From January 1994 to August 2013, 112 consecutive patients were treated by this method, 85 cases were fresh ruptures, 23 were neglected ruptures and four cases were re rupture after operation done elsewhere. Torn tendo calcaneum was repaired by Kessler suture, it was then augmented with two 8cm by 1cm turn down flap of gastrosoleus apponeurosis. Skin suture was done with utmost care. BK pop cast was done in equinus position of ankle for four weeks, followed by gradual weight bearing with heel raised shoe for six months. RESULTS: All patients went back to their pre injury activity level. In four patients there were superficial skin infection which healed without skin necrosis. One patient needed rotation flap. Evaluation was done by modified Rupp score. It was found to be excellent in 47% cases good in 43% cases and fair in 8% cases. CONCLUSION: Lindholm technique was originally described for neglected cases, we used it in all cases to avoid any complication in fresh cases and found it universally successful.

  2. Long-term results of external valvuloplasty in adult patients with isolated great saphenous vein insufficiency

    Directory of Open Access Journals (Sweden)

    Sarac A


    Full Text Available Atilla Sarac,1 Artan Jahollari,1 Sureyya Talay,1 Sevket Ozkaya,2 Ertugrul Ozal1 1Department of Cardiovascular Medicine, Samsun Medical Park Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahcesehir University, Istanbul, Turkey Objective: The aim of this study is to present our 7-year results of external valvuloplasty for isolated great saphenous vein (GSV insufficiency. Methods: External valvuloplasty was applied in 83 patients with isolated GSV insufficiency. Follow-up consisted of venous color duplex scanning performed on the first postoperative day, the first postoperative month, and then annually. Valvular insufficiency, venous reflux, and venous thrombosis formation in the saphenofemoral junction were the main outcomes. Results: A complete clinical and radiological healing was observed in 50 patients (60%. In 13 cases (15.6%, a secondary surgical treatment was performed consisting of vena saphena magna high ligation/stripping and varicose vein excisions, mainly due to severe and progressive vena saphena magna valvular insufficiency and clinical persistence of symptoms. Eight patients (9.6% developed superficial vein thrombosis, and only one patient (1.2% developed deep vein thrombosis. Contact was lost from 32 patients (38.5% for different reasons. Conclusion: External valvuloplasty is an effective surgical technique for selected cases of isolated GSV insufficiency without extensive varicose dilatations. This alternative method can be safely administered as an alternative to high ligation and conventional GSV stripping. Keyword: vein, saphenous, insufficiency, external valv, valvuloplasty, varicosis

  3. Long term results of arthroscopic bankart repair for traumatic anterior shoulder instability

    Directory of Open Access Journals (Sweden)

    Tan Andrew HC


    Full Text Available Abstract Background The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2 year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2004 - 2008. Each patient was followed-up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA shoulder rating scale and the Simple Shoulder Test (SST score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.

  4. The effect of rotationplasty on the ankle joint: long-term results. (United States)

    Gebert, C; Hardes, J; Vieth, V; Hillmann, A; Winkelmann, W; Gosheger, G


    In patients with rotationplasty the biomechanical conditions in the ankle joint are altered dramatically. By displacement and reduction of the weight-bearing area of the joint, the stress affecting its cartilage is increased. The use of an exoprothesis results in skin and soft tissue irritation. Due to these biomechanical changes, a prearthrotic deformity or skin problems could be expected. The current study examines changes in 21 patients treated with rotationplasty (mean follow-up 13.5 years) because of a malignant bone tumour or a femoral segmental defect. Local tenderness, skin and soft tissue changes, problems with exoprostheses, and pain was assessed by clinical examination and documented. Osseous changes were evaluated by plain X-ray. A MRI-scan was also obtained in five patients. Hardened skin and blisters were located at the main loading areas of the rotated foot. These changes could be reduced by optimizing the exoprosthetic fit. Radiographically, a slight asymptomatic attenuation of the articular space was observed in four patients and a slight coexistent subchondral sclerosis with small osteophytes in one patient. No degenerative changes were observed on X-ray and no cartilaginous changes were observed on MRI. The results suggest that the foot is able to adapt to the load changes after this procedure and that rotationplasty does not cause an inevitable arthrosis in the ankle joint.

  5. The long-term results of benign bile duct strictures reconstruction

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.


    infarction and 1 due to stroke. Out of 151 alive fully followed pts, good result (pts symptom-free as after standard cholecystectomy was achieved in 121 (80,13%, satisfactory (mild occasional symptoms but not cholangitis in 27 (17,88% and unsatisfactory result in 3 pts (2%, 2 of which were successfully reoperated (1 passed into group with good and 1 into group with satisfactory results.

  6. Transverse + posterior wall fractures of the acetabulum: epidemiology, operative management and long-term results. (United States)

    Gänsslen, A; Hildebrand, F; Kretek, C


    PURPOUSE OF THE STUDY: Associated transverse and posterior wall fractures account for approximately 20% of all acetabular fractures. To asses the risk of these concommitant bone injuries on early joint failure despite a high rate of postoperative congruency. The analysis of 104 surgically treated patients with associated transverse and posterior wall fractures showed that more than half of these patients had associated injuries. The mean age was 35 years, and > 75% of these patients were male. A high energy trauma was the trauma mechanism in 94.2%. The mean ISS was 26.3 points. The majority of patients showed a juxta- or transtectal fracture line. The mean articular fracture displacement was 13.5 mm. 87.5% of the patients showed a femoral head dislocation. An acetabular roof comminution was present in 16.3%. 20.2% of patients received a fracture related preoperative nerve injury to the sciatic nerve. Osteosynthesis was performed 9.9 days after trauma. The Kocher-Langenbeck approach was used in > 90% for stabilization with a combination of plate and screw fixation in 71.1%. The mean operative time was 190 minutes with a blood loss of 855 ml. Postoperatively the hip joint was congruent in 90.3% with anatomical or near-anatomical joint reconstruction in > 90%. Iatrogenic nerve injury occurred in 12 patients (8.9%). 67 patients (67.7%) could be followed after a mean of 42.7 months. The average subjective Visual Analog Scale pain score was 42.7. Mild or no pain was seen in 58.2%. The mean Merle d'Aubigné score was 15.4 with 56.7% of patients having a functionally perfect or good result. 52.2% had no post-traumatic osteoarthritic changes of their hip joint. A joint failure was diagnosed in 32.8% of the patients. Analyzing only patients with anatomically reconstructed hip joints, patients showed comparable results with 61.3% having no or mild pain and 59.2% a good or excellent functional result. Posttraumatic arthrotic changes occur in only 26.5% of these patients. A

  7. Medium to long-term results of the UNIX uncemented unicompartmental knee replacement. (United States)

    Hall, Matthew J; Connell, David A; Morris, Hayden G


    We report the first non-designer study of the Unix uncemented unicompartmental knee prosthesis. Eighty-five consecutive UKRs were carried out with sixty-five available for follow-up. Oxford Knee Scores, WOMAC questionnaire and radiological assessment were completed. The mean Oxford Knee Score was thirty-eight and WOMAC Score was twenty. Overall Kaplan Meier survival estimate is 76% (95% confidence interval 60%-97%) at 12years and 88% (95% confidence interval 76-100%) with aseptic loosening as the endpoint. Radiographic assessment showed lysis in the tibia in 6% of patients with no lysis evident around the central fin. Survivorship is comparable to other published series of UKRs. We suggest the central fin design is key to dissipating large forces throughout the proximal tibia, resulting in low levels of tibial loosening. Level of evidence IV. Copyright © 2012 Elsevier B.V. All rights reserved.

  8. Long-term results of concurrent radiotherapy and UFT in patients with locally advanced pancreatic cancer

    DEFF Research Database (Denmark)

    Bjerregaard, Jon K; Mortensen, Michael B; Jensen, Helle A


    BACKGROUND: Definition and treatment options for locally advanced non-resectable pancreatic cancer (LAPC) vary. Treatment options range from palliative chemotherapy to chemoradiotherapy (CRT). Several studies have shown that a number of patients become resectable after complementary treatment prior...... to surgery. METHODS: From 2001 to 2005, 63 consecutive patients with unresectable LAPC received CRT. CRT was given at a dose of 50 Gy/27 fractions, combined with UFT (300 mg/m(2)/day) and folinic acid. Re-evaluation of resectability was planned 4-6 weeks after completion of CRT. RESULTS: Fifty-eight patients...... completed all 27 treatment fractions. Toxicity was generally mild, with 18 patients experiencing CTCAE grade 3 or worse acute reactions. One patient died following a treatment-related infection. Two patients developed grade 4 upper GI bleeding. Median survival was 10.6 (8-13) months. Eleven patients...

  9. Dataset Preservation for the Long Term: Results of the DareLux Project

    Directory of Open Access Journals (Sweden)

    Eugène Dürr


    Full Text Available The purpose of the DareLux (Data Archiving River Environment Luxembourg Project was the preservation of unique and irreplaceable datasets, for which we chose hydrology data that will be required to be used in future climatic models. The results are: an operational archive built with XML containers, the OAI-PMH protocol and an architecture based upon web services. Major conclusions are: quality control on ingest is important; digital rights management demands attention; and cost aspects of ingest and retrieval cannot be underestimated. We propose a new paradigm for information retrieval of this type of dataset. We recommend research into visualisation tools for the search and retrieval of this type of dataset.

  10. The weed composition in an orchard as a result of long-term foliar herbicide application

    Directory of Open Access Journals (Sweden)

    Maria Licznar-Małańczuk


    Full Text Available The weed composition and the dominance of individual species occurring in an orchard were assessed at the Research Station of the Wrocław University of Environmental and Life Sciences, Poland, during the first 10 years after orchard establishment. ‘Ligol’ apple trees were planted in the spring of 2004 (3.5 × 1.2 m. Foliar herbicides were applied in 1 m wide tree rows twice or three times per each vegetation period. In the inter-row spaces, perennial grass was maintained. Ten years of maintenance of herbicide fallow contributed to a change in the weed composition in the orchard. It changed as a result of different responses of the most important weed species to the foliar herbicides. Total suppression of Elymus repens was observed in the first year after planting the trees. Convolvulus arvensis, Cirsium arvense, and other perennial weeds, completely disappeared in the succeeding periods. The maintenance of herbicide fallow did not affect the abundance of Taraxacum officinale. The percentage of the soil surface covered by Trifolium repens and Epilobium adenocaulon, perennial weeds with considerable tolerance to post-emergence herbicides, increased during the fruit-bearing period of the trees. The abundance of these weeds was significantly reduced only in the rows with the stronger growing trees on the semi-dwarf P 2 rootstock. Stellaria media was the dominant annual weed. Senecio vulgaris, Poa annua, Capsella bursa-pastoris, and Lamium spp. were also frequently observed. A significant increase in the abundance of annual and perennial weeds was found in the tree rows as a result of improved water availability after a period of high precipitation.

  11. Ocean acidification effects on mesozooplankton community development: Results from a long-term mesocosm experiment (United States)

    Algueró-Muñiz, María; Alvarez-Fernandez, Santiago; Thor, Peter; Bach, Lennart T.; Esposito, Mario; Horn, Henriette G.; Ecker, Ursula; Langer, Julia A. F.; Taucher, Jan; Malzahn, Arne M.; Riebesell, Ulf; Boersma, Maarten


    Ocean acidification may affect zooplankton directly by decreasing in pH, as well as indirectly via trophic pathways, where changes in carbon availability or pH effects on primary producers may cascade up the food web thereby altering ecosystem functioning and community composition. Here, we present results from a mesocosm experiment carried out during 113 days in the Gullmar Fjord, Skagerrak coast of Sweden, studying plankton responses to predicted end-of-century pCO2 levels. We did not observe any pCO2 effect on the diversity of the mesozooplankton community, but a positive pCO2 effect on the total mesozooplankton abundance. Furthermore, we observed species-specific sensitivities to pCO2 in the two major groups in this experiment, copepods and hydromedusae. Also stage-specific pCO2 sensitivities were detected in copepods, with copepodites being the most responsive stage. Focusing on the most abundant species, Pseudocalanus acuspes, we observed that copepodites were significantly more abundant in the high-pCO2 treatment during most of the experiment, probably fuelled by phytoplankton community responses to high-pCO2 conditions. Physiological and reproductive output was analysed on P. acuspes females through two additional laboratory experiments, showing no pCO2 effect on females’ condition nor on egg hatching. Overall, our results suggest that the Gullmar Fjord mesozooplankton community structure is not expected to change much under realistic end-of-century OA scenarios as used here. However, the positive pCO2 effect detected on mesozooplankton abundance could potentially affect biomass transfer to higher trophic levels in the future. PMID:28410436

  12. Calf Augmentation and Restoration: Long-Term Results and the Review of the Reported Complications. (United States)

    Niechajev, Igor; Krag, Christen


    Augmentation or reconstruction of the calves is indicated in patients with thin legs, for bodybuilders, or when there is a defect after an injury or illness. The principle of placing implants under the investing crural fascia was worked out in the 1980s. The senior author (I.N.) introduced many technical modifications and improvements for this operation, among them the new instrument, an inserter for the calf implants. Presented patient material is unique in that the more challenging reconstructive cases almost equal the numbers of the aesthetic cases. During the years 1991 through 2016, 50 patients underwent 60 calf contour corrections. Indications were aesthetic in 23 patients, six were bodybuilders, and 21 underwent lower leg reconstruction because of deformity caused by illness. According to evaluation by the surgeon, excellent-to-good results were obtained in 30 out of 37 followed patients. Patients rated their results as very good (18), good (10), acceptable (7) and bad (2). One 28-year-old professional bodybuilder sustained acute anterior compartment syndrome in one leg. Implants were removed 16 h after surgery, but he developed ischaemia in the anterior compartment leading to the necrosis of muscles. After several surgical operations, including microsurgical transfer of the innervated central caput of the quadriceps femoris muscle, he could resume his bodybuilding activities. Other complications were minor and manageable. Calf augmentation, performed properly, has evolved to be a safe, efficient and aesthetically pleasing operation. The possibility of acute compartment syndrome should be kept in mind. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors .

  13. Results of a Long-Term Demonstration of an Optical Multi-Gas Monitor on ISS (United States)

    Mudgett, Paul; Pilgrim, Jeffrey S.


    Previously at SAMAP we reported on the development of tunable diode laser spectroscopy (TDLS) based instruments for measuring small gas molecules in real time. TDLS technology has matured rapidly over the last 5 years as a result of advances in low power diode lasers as well as better detection schemes. In collaboration with two small businesses Vista Photonics, Inc. and Nanoracks LLC, NASA developed a 4 gas TDLS based monitor for an experimental demonstration of the technology on the International Space Station (ISS). Vista invented and constructed the core TDLS sensor. Nanoracks designed and built the enclosure, and certified the integrated monitor as a payload. The device, which measures oxygen, carbon dioxide, ammonia and water vapor, is called the Multi-Gas Monitor (MGM). MGM measures the 4 gases every few seconds and records a 30 second moving average of the concentrations. The relatively small unit draws only 2.5W. MGM was calibrated at NASA-Johnson Space Center in July 2013 and launched to ISS on a Soyuz vehicle in November 2013. Installation and activation of MGM occurred in February 2014, and the unit has been operating nearly continuously ever since in the Japanese Experiment Module. Data is downlinked from ISS about once per week. Oxygen and carbon dioxide data is compared with that from the central Major Constituents Analyzer. Water vapor data is compared with dew point measurements made by sensors in the Columbus module. The ammonia channel was tested by the crew using a commercial ammonia inhalant. MGM is remarkably stable to date. Results of 18 months of operation are presented and future applications including combustion product monitoring are discussed.

  14. Long-term results of treatment of traumatic coxofemoral joint dislocation in dogs: 64 cases (1973-1992). (United States)

    Evers, P; Johnston, G R; Wallace, L J; Lipowitz, A J; King, V L


    To determine long-term results of various treatments for traumatic coxofemoral joint dislocation in dogs. Retrospective case series. 64 dogs that underwent closed reduction and bandage stabilization, extracapsular suture stabilization, transacetabular pinning, toggle pinning, DeVita pinning, or femoral head and neck excision. Follow-up evaluations included owner evaluation (64 dogs), physical evaluation (23), and radiography (19). Follow-up time ranged from 8 to 156 months. Owner evaluation scores after closed reduction were significantly better than scores after DeVita pinning, extracapsular suture stabilization, and femoral head and neck excision. On physical examination, 6 of 23 dogs were lame on the side of the previous dislocation. Signs of pain and crepitation were evident during palpation of 12 and 8 of 25 joints, respectively. Thirteen of 21 joints had radiographic evidence of degenerative joint disease. There was a greater progression of degenerative joint disease in previously dislocated joints than in unaffected joints. There were not any significant differences between treatments in regard to results of physical and radiographic evaluation. Time between trauma and treatment and existence of concomitant injuries did not influence follow-up results, but there was a significant association between body weight and radiographic evaluation score. Concomitant injuries do not appear to justify a worse prognosis in dogs with traumatic coxofemoral joint dislocation, nor does a delay in treatment of > 3 days. Gait abnormalities and degenerative joint disease might develop in the long term. Proper body weight should be maintained regardless of treatment.

  15. [Effect of quality of root canal obturation on the long-term results of root canal therapy]. (United States)

    Zhu, Ya-ping; Zhu, Ya-qin; Fan, Lin-feng; DU, Rong; Gu, Ying-xin; Qin, Feng


    The purpose of this study was to analyze the quality of obturation affecting the long-term results of root canal therapy (RCT) by radiographic evaluation. Teeth of RCT for 2 or more than 2 years were chosen, and periapical radiographs were taken with paralleling technique. The patients' age, gender, etiology, the time of therapy were recorded. The current apical periodontal status of these endodontically treated teeth were examined and recorded. The data were subjected to univariate and multivariate analysis with SPSS13.0 software package. This study investigated 215 cases with 376 endodontically treated teeth. The success rate was 54.79%. If counted by root canal, there were 513 root canals, the success rate was 61.4%. The quality of obturation including obturation position and obturation density affected significantly the results of root canal therapy (Pobturation position for successful treated canals was 0.5-2mm from the radiographic apex. The success rate was higher for a good obturation density, especially in the apical third. No statistically significant differences were found based on gender, age and obturation time. The quality of root canal obturation significantly affected the long-term results of root canal therapy.


    Directory of Open Access Journals (Sweden)

    I. V. Babkina


    Full Text Available Background: Bone sarcomas are extremely malignant prone to rapid hematogenic metastasing. Evaluation of biological marker expression by the tumor is important not only for the search of new potential chemotherapy targets, but for the assessment of the disease prognosis.Aim: A comparative evaluation of matrix metalloproteinases (MMP-2, -7, -9 and tissue inhibitor of metalloproteinase-1 (TIMP-1 in the serum of patients with primary bone tumors and in healthy people to identify their potential association with the histological characteristics of the tumor and the disease prognosis.Materials and methods: A comparative study of serum MMP-2, -7, -9, and TIMP-1 levels was performed in 54 patients with primary bone tumors (malignant, 45 patients, including central osteosarcoma in 21, periosteal osteosarcoma in 4, Ewing's sarcoma in 11, primary chondrosarcoma in 6, undifferentiated pleomorphic sarcoma in 3, and borderline giant cell tumors in 9 and in 26 healthy individuals with the use of the immunoenzyme technique (Biosource, USA, for TIMP-1 and R&D, USA, for MMP-2, -7, and -9. Results: The TIMP-1 levels in the serum of patients with central and periosteal osteosarcomas were significantly higher than in the serum of healthy controls (р = 0.038 and p = 0.007, respectively. The MMP-9 levels in patients with bone malignancies were significantly lower than that in the normal controls (p < 0.05. There was a positive correlation between serum TIMP-1 and MMP-9 levels in patients with central, periosteal and Ewing's sarcomas (r = 0.37, p = 0.024. No significant differences in the 5-year survival rates related to serum TIMP-1, MMP-2, -7, -9 levels were found in patients with bone sarcomas. However, in those with osteosarcoma and serum MMP-2 > 160 ng/ml, the overall 5-year survival rate was 1.6-fold higher than in those with lower MMP-2 levels, and in those with ММP-9 levels < 377 ng/ml, the 5-year survival rate was 1.4-fold higher than in patients with

  17. Long-term outcomes of intrastromal femtosecond laser presbyopia correction: 3-year results. (United States)

    Thomas, Bettina C; Fitting, Anna; Khoramnia, Ramin; Rabsilber, Tanja M; Auffarth, Gerd U; Holzer, Mike P


    To analyse visual outcomes and corneal changes 3 years after intrastromal femtosecond laser presbyopia treatment. In a prospective, unicentric clinical trial, 25 presbyopic patients received INTRACOR treatment (Technolas femtosecond laser) on their non-dominant eye. Examinations were performed preoperatively as well as 1, 24 and 36 months postoperatively and included refraction, near, intermediate and distance visual acuity tests, reading speed, corneal topography, stray light measurement, endothelial cell count and slit-lamp examination. Comparison of preoperative versus 36 months postoperative values showed in median an improvement of uncorrected near visual acuity (UNVA) from 0.70 logMAR to 0.10 logMAR (p<0.001). Corrected distance visual acuity (CDVA) was reduced from -0.10 logMAR to 0.00 logMAR (p<0.001). The spherical equivalent preoperatively was 0.625 D and after an initial myopic shift after 1 month (0.125 D) and 24 months (0.25 D), the 36 months value (0.50 D) returned to resemble the preoperative value in statistical terms (p=0.123). A significant corneal steepening of 1.50 D in the treated area was measured. Pachymetry (thinnest point) revealed a statistically significant, but clinically insignificant corneal thickening from 535 to 549 µm (p=0.033). Endothelial cell count did not change. 92.86% of patients felt comfortable with the surgery result. INTRACOR treatment after 36 months improved UNVA to varying degrees. The effect can be explained by a corneal steepening. An initial myopic shift was reversible. Reductions especially in CDVA have to be taken into account and therefore careful patient selection and information is obligatory. NCT01164358 and NCT01025050, Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  18. Video-assisted minimally invasive parathyroidectomy: benefits and long-term results. (United States)

    Lombardi, Celestino P; Raffaelli, Marco; Traini, Emanuela; De Crea, Carmela; Corsello, Salvatore M; Bellantone, Rocco


    In recent years several endoscopic and video-assisted techniques for parathyroidectomy have been described. The role of these techniques, with respect to time-honored conventional surgery, has been largely debated. This paper was designed to review the evidence, and make the recommendations, for the video-assisted/endoscopic approach to parathyroidectomy. A database search was conducted in PubMed from which abstracts were screened matching our definition. Publications were further assessed and assigned their respective level of evidence. Additional data were obtained on the basis of our personal experience. Thirty-eight mainly retrospective studies have been published. Only four small, prospective, randomized trials, providing level II evidence, and one retrospective case-control comparative study, providing level IV evidence, have been found. Minimally invasive video-assisted parathyroidectomy (MIVAP) has emerged as one of the leading techniques. To date several randomized studies have shown that MIVAP is an efficacious and feasible procedure with the same complications rate as conventional surgery. Moreover, MIVAP seems to have significant advantages in terms of cosmetic result, postoperative pain and recovery, and patient satisfaction. From an evidence-based point of view, MIVAP should be considered a valid and validated option for the treatment of sporadic primary hyperparathyroidism sustained by a well-localized, single adenoma. Its role for the treatment of multiglandular diseases (familial hyperparathyroidism, secondary hyperparathyroidism) needs to be better clarified.

  19. Long-term results after repair and augmentation ligamentoplasty of rotatory subluxation of the scaphoid. (United States)

    Schweizer, Andreas; Steiger, Regula


    Twenty-two patients had scapholunate ligament repairs combined with a new augmentation ligamentoplasty for chronic scapholunate dissociation. All were evaluated by physical and radiologic examination after a mean postoperative follow-up period of 63 months (range, 12-134 mo). According to Green and O'Brien and Johnson and Carrera scores 5/8 had excellent, 13/12 good, and 4/2 fair results. Thirteen were free of pain; 6 had mild pain and 3 had moderate pain. Nineteen returned to their original occupation. There was an average loss of 10 degrees of flexion, 9 degrees of extension, and 11% of grip force compared with the opposite wrist. Radiologic examination showed an average decrease of 12 degrees of the scapholunate and 10 degrees of the radiolunate angles compared with the levels before surgery. No signs of degenerative osteoarthritis were found in 16 (73%) cases. Five wrists showed a distinct pattern of midcarpal degeneration correlating with notable dorsal intercalated segment instability after surgery, and 2 cases had signs of radioscaphoid degeneration.

  20. Metabolomics for organic food authentication: Results from a long-term field study in carrots. (United States)

    Cubero-Leon, Elena; De Rudder, Olivier; Maquet, Alain


    Increasing demand for organic products and their premium prices make them an attractive target for fraudulent malpractices. In this study, a large-scale comparative metabolomics approach was applied to investigate the effect of the agronomic production system on the metabolite composition of carrots and to build statistical models for prediction purposes. Orthogonal projections to latent structures-discriminant analysis (OPLS-DA) was applied successfully to predict the origin of the agricultural system of the harvested carrots on the basis of features determined by liquid chromatography-mass spectrometry. When the training set used to build the OPLS-DA models contained samples representative of each harvest year, the models were able to classify unknown samples correctly (100% correct classification). If a harvest year was left out of the training sets and used for predictions, the correct classification rates achieved ranged from 76% to 100%. The results therefore highlight the potential of metabolomic fingerprinting for organic food authentication purposes. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  1. Morphology and urodynamics after longitudinal urethral plate incision in proximal hypospadias repairs: long-term results. (United States)

    Orkiszewski, M; Leszniewski, J


    To determine whether longitudinal neourethra incision disturbs the healing and growth of the neourethra, and to see how it affects the urine flow after proximal hypospadias repairs. Nine patients were examined, in whom longitudinal incision had been performed 9 - 15 years earlier, after previous penis lengthening operations. Calibration, urethrography, endoscopy, and urodynamics were carried out in all patients. In all but 1 patient the external meatus had steadily been growing in width, and in 8 out of 9 it was within the normal size range. Urethroscopy showed single hairs growing into the lumen in 3 patients. No scarring was demonstrated in any patient. Saccular dilatation of the neourethra was found in 6 out of 9, urethral stricture was shown in only 1 patient. Peak flow rate was within 2 SD in 5 patients, and below 2 SD in 3. Average flow rate was below 2 SD in 6 patients and in all patients it was markedly low. In the patient with urethral stricture both peak flow rate and average flow rate were well below normal. Although longitudinal neourethra incision allows for easy and safe closure, longitudinal incision may result in functional meatal stenosis with formation of a wide neourethra. This may be due to disproportional low resistance of the urethral wall, compared with external meatus, to urine flow.

  2. Long-Term Results of Reconstruction with Pelvic Allografts after Wide Resection of Pelvic Sarcomas

    Directory of Open Access Journals (Sweden)

    Mehmet Ayvaz


    Full Text Available Reconstruction after the resection of a pelvic tumor is a challenging procedure in orthopedic oncology. The main advantage of allograft reconstruction is restoration of the bony architecture of the complex pelvic region. However, high complication rates such as infection and allograft resorption had been reported in the literature. In this study, we aimed to retrospectively review nine patients treated with pelvic resection and structural pelvic allograft reconstruction. Functional results, complications, and survival of the patients and the allografts were evaluated. At a mean follow-up of 79 months, three patients were dead. Major complications were detected in eight of the nine patients. Infection (four of the nine patients and allograft resorption (three of the nine patients were the most common causes of failure. The cumulative survival of the patients was 66.7 percent at 70 months. However, allograft survival was only 26.7 percent at 60 months. Mean MSTS score was 69. In conclusion, we suggest that other reconstruction options should be preferred after pelvic resections because of the high complication rates associated with massive allograft reconstruction.

  3. Long-term results of intertrochanteric varus osteotomy for the dysplastic hip. (United States)

    Nishiyama, Takayuki; Saegusa, Yasuhiro; Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Kurosaka, Masahiro


    Total hip arthroplasty (THA) is a well established treatment for arthrosis of the hip, however many problems remain which have not yet been resolved, including component loosening and infection. Therefore, surgeons hesitate to perform THA in younger patients showing early signs of the disease. Intertrochanteric varus osteotomy was developed for osteoarthrosis with coxa valga. This procedure has been commonly used in patients with dysplastic hips. However, femoral head coverage is not sufficiently improved by this procedure. In order to overcome the disadvantages of this procedure, since 1972 we performed intertrochanteric varus osteotomy simultaneously combined with acetabuloplasty for the treatment of osteoarthrosis secondary to dysplasia. Between 1969 and 1994, we performed 104 intertrochanteric varus osteotomies for prearthrosis and early stage arthrosis of the hip due to acetabular dysplasia in 84 patients. In this study, we reviewed these patients clinically and radiographically, over 15 years. The intertrochanteric varus osteotomy alone was employed in 38 hips (varus group). Combined intertrochanteric varus osteotomy and acetabuloplasty was employed in 63 hips (combined group). The average Harris hip score at the latest follow-up in the combined group significantly higher than that in the 'varus' group. Postoperative centre-edge angle and age at operation were correlated with the Harris hip score at the most recent follow-up. The results of the present study indicate that this combined intertrochanteric varus osteotomy and acetabuloplasty for dysplastic hip should be considered in young patients when the disease is at an early stage.

  4. Long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo : effect of disease activity

    NARCIS (Netherlands)

    Fongers, A.; Wolkerstorfer, A.; Nieuweboer-Krobotova, L.; Krawczyk, P.; Toth, G. G.; van der Veen, J. P. W.


    Background Punch grafting is a simple and frequently used technique for the treatment of stable vitiligo, resistant to medical therapy. However, studies reporting long-term results are exceptional. Objectives To evaluate the long-term results of 2-mm punch grafting in patients with vitiligo vulgaris

  5. Transitioning MODIS to VIIRS observations for Land: Surface Reflectance results, Status and Long-term Prospective (United States)

    Vermote, E.


    Surface reflectance is one of the key products from VIIRS and as with MODIS, is used in developing several higher-order land products. The VIIRS Surface Reflectance (SR) IP is based on the heritage MODIS Collection 5 product (Vermote et al. 2002). The quality and character of surface reflectance depends on the accuracy of the VIIRS Cloud Mask (VCM) and aerosol algorithms and of course on the adequate calibration of the sensor. Early evaluation of the VIIRS SR product in the context of the maturity of the operational processing system known as the Interface Data Processing System (IDPS), has been a major focus of work to-date, but is now evolving into the development of a VIIRS suite of Climate Data Records produced by the NASA Land Science Investigator Processing System (SIPS). We will present the calibration performance and the role of the surface reflectance in calibration monitoring, the performance of the cloud mask with a focus on vegetation monitoring (no snow conditions), the performance of the aerosol input used in the atmospheric correction with quantitative results of the performance of the SR product over AERONET sites. Based on those elements and further assessment, we will address the readiness of the SR product for the production of higher-order land products such as Vegetation Indices, Albedo and LAI/FPAR, the its application to agricultural monitoring and in particular the integration of VIIRS data into the global agricultural monitoring (GLAM) system developed at UMd. Finally from the lessons learned, we will articulate a set of critical recommendations to ensure consistency and continuity of the JPSS mission with the MODIS data record.

  6. Elder-Clowning in Long-Term Dementia Care: Results of a Pilot Study. (United States)

    Kontos, Pia; Miller, Karen-Lee; Colobong, Romeo; Palma Lazgare, Luis I; Binns, Malcolm; Low, Lee-Fay; Surr, Claire; Naglie, Gary


    To assess the effects of elder-clowning on moderate to severe behavioral and psychological symptoms of dementia (BPSD) in nursing home residents with dementia, primarily of the Alzheimer's type. Before-and-after study. Nursing home. Nursing home residents with moderate to severe BPSD, as defined according to a Neuropsychiatric Inventory-Nursing Home version (NPI-NH) score of 10 or greater (N = 23), and their care aides. A pair of elder-clowns visited all residents twice weekly (~10 minutes per visit) for 12 weeks. They used improvisation, humor, empathy, and expressive modalities such as song, musical instruments, and dance to individualize resident engagement. Primary outcomes were BPSD measured using the the NPI-NH, quality of life measured using Dementia Care Mapping (DCM), and nursing burden of care measured using the Modified Nursing Care Assessment Scale (M-NCAS). Secondary outcomes were occupational disruptiveness measured using the NPI-NH, agitation measured using the Cohen Mansfield Agitation Inventory (CMAI), and psychiatric medication use. Over 12 weeks, NPI-NH scores declined significantly (t22 = -2.68, P = .01), and DCM quality-of-life scores improved significantly (F1,50 = 23.09, P < .001). CMAI agitation scores decreased nominally, but the difference was not statistically significant (t22 = -1.86, P = .07). Occupational disruptiveness score significantly improved (t22 = -2.58, P = .02), but there was no appreciable change in M-NCAS scores of staff burden of care. Results suggest that elder-clowning reduced moderate to severe BPSD of nursing home residents with dementia, primarily of the Alzheimer's type. Elder-clowning is a promising intervention that may improve Alzheimer's disease care for nursing home residents. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  7. Short- and long-term results following standing fracture repair in 34 horses. (United States)

    Payne, R J; Compston, P C


    Standing fracture repair in the horse is a recently described surgical procedure and currently there are few follow-up data. This case series contains 2 novel aspects in the standing horse: repair of incomplete sagittal fractures of the proximal phalanx and medial condylar repair from a lateral aspect. To describe outcome in a case series of horses that had lower limb fractures repaired under standing sedation at Rossdales Equine Hospital. Case records for all horses that had a fracture surgically repaired, by one surgeon at Rossdales Equine Hospital, under standing sedation and local anaesthesia up until June 2011, were retrieved. Hospital records, owner/trainer telephone questionnaire and the Racing Post website were used to evaluate follow-up. Thirty-four horses satisfied the inclusion criteria. Fracture sites included the proximal phalanx (incomplete sagittal fracture, n = 14); the third metacarpal bone (lateral condyle, n = 12, and medial condyle, n = 7); and the third metatarsal bone (lateral condyle, n = 1). One horse required euthanasia due to caecal rupture 10 days post operatively. Twenty horses (66.7% of those with available follow-up) have returned to racing. Where available, mean time from operation to return to racing was 226 days (range 143-433 days). Standing fracture repair produced similar results to fracture repair under general anaesthesia in terms of both the number of horses that returned to racing and the time between surgery and race. Repair of lower limb fracture in the horse under standing sedation is a procedure that has the potential for tangible benefits, including avoidance of the inherent risks of general anaesthesia. The preliminary findings in this series of horses are encouraging and informative when discussing options available prior to fracture repair. © 2012 EVJ Ltd.

  8. Long-term results in obstructive sleep apnea syndrome (OSAS after laser-assisted uvulopalatoplasty (LAUP.

    Directory of Open Access Journals (Sweden)

    Önder Göktas

    Full Text Available Obstructive sleep apnea syndrome (OSAS is a serious disease. The etiology of and optimum therapy options for this disorder have been much discussed and have been the subject of many publications. One much discussed therapy option is laser-assisted uvulopalatoplasty (LAUP. Despite conflicting opinions and guidelines which recommend that it should not be used, it remains in use. Patients who had previously undergone this procedure were invited for follow-up appointments, at which they were asked to complete a questionnaire, underwent an ENT examination and underwent sleep laboratory analysis using a portable sleep lab device. The average time since LAUP treatment was 11 years. The cohort comprised 25 patients. The average preoperative apnea-hypopnea-index (AHI score was 25.25/h; the average postoperative AHI score 23.62/h. Closer examination of our data enabled us to identify 10 responders (40% and 15 non-responders (60%. 12% (3/25 of non-responders experienced either no reduction in their AHI score or an increase compared to their preoperative AHI score of less than 5/h. In the remaining 48% (12/25, AHI increased by more than 5/h compared to the preoperative figure. Our questionnaire showed that 40% (10/25 of patients suffered from dry mouth and 20% (5/25 from foreign body sensation. The data led us to conclude that laser-assisted uvulopalatoplasty can indeed result in a reduction in AHI score comparable to other mucosal resection methods. Also in common with these methods, the efficacy of the therapy reduces with time and the procedure carries a high risk of bringing about an increase in the patient's AHI score.

  9. Long-Term Creep Behavior of the Intervertebral Disc: Comparison between Bioreactor Data and Numerical Results

    Directory of Open Access Journals (Sweden)

    APG eCastro


    Full Text Available The Loaded Disc Culture System (LDCS is an Intervertebral Disc (IVD-oriented bioreactor developed by the VU Medical Center (VUmc, Amsterdam, The Netherlands, which has the capacity of maintaining up to 12 IVDs in culture, for approximately 3 weeks after extraction. Using this system, 8 goat IVDs were provided with the essential nutrients and submitted to compression tests without losing their biomechanical and physiological properties, for 22 days. Based on previous reports (Detiger et al., 2013; Paul et al., 2013, 2012, 4 of these IVDs were kept in physiological condition (control and the other 4 were previously injected with chondroitinase ABC (CABC, in order to promote Degenerative Disc Disease (DDD. The loading profile intercalated 16h of activity loading with 8h of loading recovery to express the standard circadian variations.The displacement behavior of these 8 IVDs along the first 2 days of the experiment was numerically reproduced, using an IVD osmo-poro-hyper-viscoelastic and fiber-reinforced Finite Element (FE model. The simulations were run on a custom FE solver (Castro et al., 2014.The analysis of the experimental results allowed concluding that the effect of the CABC injection was only significant in 2 of the 4 IVDs. The 4 control IVDs showed no signs of degeneration, as expected. In what concerns to the numerical simulations, the IVD FE model was able to reproduce the generic behavior of the two groups of goat IVDs (control and injected. However, some discrepancies were still noticed on the comparison between the injected IVDs and the numerical simulations, namely on the recovery periods. This may be justified by the complexity of the pathways for DDD, associated with the multiplicity of physiological responses to each direct or indirect stimulus. Nevertheless, one could conclude that ligaments, muscles and IVD covering membranes could be added to the FE model, in order to improve its accuracy and properly describe the recovery

  10. Soil carbon sequestration resulting from long-term application of biosolids for land reclamation. (United States)

    Tian, G; Granato, T C; Cox, A E; Pietz, R I; Carlson, C R; Abedin, Z


    Investigations on the impact of application of biosolids for land reclamation on C sequestration in soil were conducted at Fulton County, Illinois, where 41 fields (3.6-66 ha) received biosolids at a cumulative loading rate from 455 to 1654 dry Mg ha(-1) for 8 to 23 yr in rotation from 1972 to 2004. The fields were cropped with corn, wheat, and sorghum and also with soybean and grass or fallowed. Soil organic carbon (SOC) increased rapidly with the application of biosolids, whereas it fluctuated slightly in fertilizer controls. The peak SOC in the 0- to 15-cm depth of biosolids-amended fields ranged from 4 to 7% and was greater at higher rates of biosolids. In fields where biosolids application ceased for 22 yr, SOC was still much higher than the initial levels. Over the 34-yr reclamation, the mean net soil C sequestration was 1.73 (0.54-3.05) Mg C ha(-1) yr(-1) in biosolids-amended fields as compared with -0.07 to 0.17 Mg C ha(-1) yr(-1) in fertilizer controls, demonstrating a high potential of soil C sequestration by the land application of biosolids. Soil C sequestration was significantly correlated with the biosolids application rate, and the equation can be expressed as y = 0.064x - 0.11, in which y is the annual net soil C sequestration (Mg C ha(-1) yr(-1)), and x is annual biosolids application in dry weight (Mg ha(-1) yr(-1)). Our results indicate that biosolids applications can turn Midwest Corn Belt soils from current C-neutral to C-sink. A method for calculating SOC stock under conditions in which surface soil layer depth and mass changes is also described.

  11. The Use of Cryotherapy for Papilloma and Early Laryngeal Cancers: Long-term Results. (United States)

    Benninger, Michael S; Derakhshan, Adeeb; Milstein, Claudio F


    Retrospective chart review. To determine the efficacy of adjuvant cryotherapy in the treatment of early glottic cancer and laryngeal papillomatosis. The use of cryotherapy in conjunction with traditional modalities has recently been proposed to improve voice outcomes in patients with early laryngeal cancer as compared to pretreatment conditions. This study investigates its utility in improving oncological outcomes and decreasing recurrences of laryngeal papillomatosis. Patients with either early glottic cancer or laryngeal papillomatosis that received cryotherapy as part of their surgical regimen were investigated. All patients were seen at a large tertiary care center within a 10-year window. Demographic data were collected and all postoperative notes were reviewed. Recurrences of the laryngeal cancer were noted, as was the duration of time between successive papillomatosis operations. The charts of 54 glottic cancer and 29 papillomatosis patients that received cryotherapy were reviewed. One patient from the papillomatosis cohort was excluded from statistical analysis due to lack of follow-up. Overall, 16 (30%) of the laryngeal cancer patient experienced a malignant recurrence. The overall 5-year survival of these patients was 98% and the 5-year disease-free survival was 74%. The use of adjuvant cryotherapy in the treatment of laryngeal papillomatosis extended the duration of time between surgeries by an average of 79 days (P=.23). The use of adjuvant cryotherapy in the treatment of early glottic cancer does not improve the rate of carcinoma recurrences. Additionally, cryotherapy does not result in a statistically significant increase in the duration of disease-free period for laryngeal papillomatosis patients, although the observed increase may be clinically important. © The Author(s) 2015.

  12. Direct Stenting in Patients with Acute Lower Limb Arterial Occlusions: Immediate and Long-Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Galanakis, Nikolaos [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece); Kontopodis, Nikolaos [University of Crete Medical School, Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion (Greece); Peteinarakis, Ioannis; Kehagias, Elias [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece); Ioannou, Christos V. [University of Crete Medical School, Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion (Greece); Tsetis, Dimitrios, E-mail: [University of Crete Medical School, Interventional Radiology Unit, Department of Medical Imaging, University Hospital Heraklion (Greece)


    PurposeThe purpose of this study is to accentuate the efficacy of direct stenting (stent placement without predilatation of the lesion) in patients with acute lower limb arterial ischemia (ALLI).Materials and MethodsBetween January 2010 and September 2015, 16 patients (11 men and 5 women) underwent direct stenting of acute arterial occlusions. All patients had contraindication for surgical revascularization or catheter-directed thrombolysis. According to SVS/ISCVS Classification, six patients had IIa and ten patients IIb ALLI. The occlusions were located in CIA, EIA, SFA, or popliteal artery. Mean follow-up time with clinical examination and color Duplex ultrasonography was 37.6 months (range 1–72). We analyzed the technical and clinical outcomes of the procedures, as well the complications and patency rates.ResultsTechnical success was achieved in all patients (16/16) and there was significant clinical improvement in 15 patients. There was neither distal embolization nor procedure-related complications. During the 6 years of follow-up, four patients died due to non-procedure-related causes and there were two minor and one major amputations. The primary patency rates and the amputation-free survival rates were 93.7 and 87% at 1 year, 75.2 and 71.2% at 3 years, and 75.2 and 62.3%, respectively, at 6 years.ConclusionsDirect stenting may be a valuable alternative procedure for acute arterial occlusions in selected cases with high technical success and significant clinical improvement.Level of EvidenceLevel 4, Case Series.

  13. CT-guided radiofrequency ablation of osteoid osteoma: long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Cioni, Roberto; Armillotta, Nicola; Bargellini, Irene; Zampa, Virna; Cappelli, Carla; Vagli, Paola; Bartolozzi, Carlo [Department of Oncology, Transplants and Advanced Technologies in Medicine, Division of Diagnostic and Interventional Radiology, University of Pisa, Via Roma 67, 56126, Pisa (Italy); Boni, Giuseppe [Division of Nuclear Medicine, University of Pisa, Via Roma 67, 56126, Pisa (Italy); Marchetti, Stefano; Consoli, Vincenzo [Department of Orthopedics, University of Pisa, Via Roma 67, 56126, Pisa (Italy)


    The aim of the study was to assess the safety and efficacy of CT-guided percutaneous radiofrequency (RF) ablation of osteoid osteoma (OO). From 1997 to 2001, RF ablation was performed on 38 patients with OO, diagnosed clinically and by radiography, scintigraphy, contrast-enhanced MRI, and CT. Treatment was performed via percutaneous (n=29) or surgical (n=9) access, under CT guidance in all cases, with an 18-gauge straight electrode. Patients were discharged within 24 h and followed up clinically (at 1 week and every 6-12 months) and with MRI (at 6 months) and scintigraphy (after 1 year). The technical success rate was 100%. Complications occurred in two patients, consisting in local skin burns. The follow-up range was 12-66 months (mean {+-} SD, 35.5{+-}7.5 months). Prompt pain relief and return to normal activities were observed in 30 of 38 patients. Persistent pain occurred in eight patients; two patients refused further RF ablation and were treated surgically; RF ablation was repeated in six cases achieving successful results in five. One patient reported residual pain and is being evaluated for surgical excision. Primary and secondary clinical success rates were 78.9 (30/38 patients) and 97% (35/36 patients), respectively. CT-guided RF ablation of OO is safe and effective. Persistent lesions can be effectively re-treated. Several imaging modalities are needed for the diagnosis of OO and for the follow-up after treatment, particularly in patients with persistent symptoms. (orig.)

  14. Efficacy and safety results of long-term growth hormone treatment of idiopathic short stature. (United States)

    Kemp, Stephen F; Kuntze, Joyce; Attie, Kenneth M; Maneatis, Thomas; Butler, S; Frane, James; Lippe, Barbara


    Small clinical trials of GH treatment of idiopathic short stature (ISS) show variable efficacy. The study was an analysis of a large GH registry for efficacy and safety of GH treatment of ISS. There was also a comparison with a specific clinical trial. Up to 7 yr of GH treatment of ISS was evaluated for efficacy and safety in the National Cooperative Growth Study (NCGS). The NCGS study was conducted at Genentech, Inc. and included 47,226 patients. The ISS group included maximum stimulated GH 10 ng/ml or more and/or a report of ISS by investigator (n = 8018; all included for safety). Cohort 1 (n = 2520) was similar to the clinical trial, cohort 2 (n = 283) included subjects younger than 5 yr of age, and cohort 3 (n = 940) was pubertal at GH start. GH, approximately 0.30 mg/kg.wk, was given. These included growth velocities and height sd (HtSDS). Mean first-year growth velocities in cohorts 1, 2, and 3 increased 4.6, 3.9, and 4.4 cm/yr over pretreatment, respectively. Measures included: baseline mean HtSDS, -2.9, -3.2, and -2.8; mean HtSDS at 1 yr, -2.4, -2.3, and -2.3, respectively. Mean HtSDS after 7 yr in cohorts 1 (n = 303) and 2 (n = 85) and 5 yr in cohort 3 (n = 58) were: -1.2, -1.0, and -1.5, respectively. Cohort 3 shorter treatment time was due to advanced baseline age (mean 13.8 yr) and puberty. Mean HtSDS gain in cohort 1 was comparable with the clinical trial. No new safety signals specific to the NCGS ISS population were observed. ISS patients in the GH registry demonstrate a significant increase in HtSDS with the safety profile similar to GH-deficient patients. RESULTS were similar to the clinical trial.

  15. Long-Term Outcomes of Cultivated Limbal Epithelial Transplantation: Evaluation and Comparison of Results in Children and Adults (United States)

    Ganger, Anita; Vanathi, M.; Mohanty, Sujata; Tandon, Radhika


    Purpose. To compare the long-term clinical outcomes of cultivated limbal epithelial transplantation (CLET) in children and adults with limbal stem cell deficiency. Design. Retrospective case series. Methods. Case records of patients with limbal stem cell deficiency (LSCD) who underwent CLET from April 2004 to December 2014 were studied. Outcome measures were compared in terms of anatomical success and visual improvement. Parameters for total anatomical success were avascular, epithelized, and clinically stable corneal surface without conjunctivalization, whereas partial anatomical success was considered when mild vascularization (sparing centre of cornea) and mild conjunctivalization were noted along with complete epithelization. Results. A total of 62 cases underwent the CLET procedure: 38 (61.3%) were children and 24 (38.7%) were adults. Patients with unilateral LSCD (33 children and 21 adults) had autografts and those with bilateral LSCD (5 children and 3 adults) had allografts. Amongst the 54 autografts partial and total anatomical success were noted in 21.2% and 66.6% children, respectively, and 19.0% and 80.9% in adults, respectively (p value 0.23). Visual improvement of 1 line and ≥2 lines was seen in 57.5% and 21.2% children, respectively, and 38% and 38% in adults, respectively (p value 0.31). Conclusion. Cultivated limbal epithelial transplantation gives good long-term results in patients with LSCD and the outcomes are comparable in children and adults. PMID:26770973

  16. Pulmonary Arteriovenous Malformation in the Korean Population: Clinical Manifestations and the Long-Term Results of Transarterial Embolotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae A; Kwak, Hyo Sung; Jin, Gong Young; Han, Young Min [Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of); Roh, Byung Suk [Wonkwang University School of Medicine, Wonkwang University Hospital, Iksan (Korea, Republic of)


    This study was designed to evaluate the general features and the long-term results of transarterial embolotherapy (TAE) for the treatment of pulmonary arteriovenous malformations (PAVMs). Thirteen (n=13) patients who underwent TAE for PAVMs were identified. These patients were comprised of 4 men and 9 women, aged between 19 and 67 years (mean age, 44 years). The authors evaluated the general features of PAVMs, including, type, location, size, and symptoms. In addition, results following TAE were analyzed to evaluate its efficacy, and to investigate arterial oxygen pressure changes. In total, 13 patients presented with 21 angiographically confirmed PAVMs. Nine (69.2%) patients had single PAVM. Of the 21 PAVMs, 19 were simple, 16 were located in lower lobes, and 17 were located in the subpleural region. Furthermore, 2 of the 13 patients experienced coughing, 2 experienced dyspnea, and 1 experienced massive hemoptysis. All PAVMs were subjected to superselective TAE using a detachable balloon or coils. Six PAVMs (28.6%) in three patients (23.1%) were subsequently recanalized as determined by contrast-enhanced CT scan. All 3 patients were identified during long-term follow up (mean: 61.9 months). One of the 3 patients experienced an acute stroke due to thrombi migration in the middle cerebral artery following PAVM recanalization. TAE with coils is effective for the treatment of PAVMs, and it should be noted that patients who undergo embolotherapy require careful surveillance, due to the need for recanalization during follow-up

  17. Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer: long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Prada, Pedro J.; Anchuelo, Javier; Blanco, Ana Garcia; Paya, Gema; Cardenal, Juan; Acuña, Enrique; Ferri, Maria [Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria (Spain); Vazquez, Andres; Pacheco, Maite; Sanchez, Jesica [Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria (Spain)


    Objectives: We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy. Methods and Materials: From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the 'Phoenix consensus'. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition. Results: The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function. Conclusions: The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer. (author)

  18. Speech and language development after cochlear implantation in children with bony labyrinth malformations: long-term results. (United States)

    Catli, Tolgahan; Uckan, Burcu; Olgun, Levent


    The aim of this study was to investigate speech and language development after long-term cochlear implantation in children with bony labyrinth malformations (BLMs) and to present the surgical findings in this group of patients. The auditory and linguistic skills of 21 children who had BLM were assessed in this study. They were implanted between 1998 and 2009. Twenty-two sex-matched and age-matched implantees without BLM were evaluated as the control group. To compare speech perception and speech intelligibility between the groups, the categories of auditory performance (CAP) test and speech intelligibility rating (SIR) test, respectively, were administered. The Turkish version of the Test of Early Language Development (TELD-3-T) was administered to evaluate and compare the linguistic skills of the groups. Surgical findings and complications were also analyzed. Implanted anomalies were common cavity in five patients, incomplete partition type 1 in 5 patients, and incomplete partition type 2 in 11 patients. The CAP and SIR scores were significantly higher in the control group (p 0.05). Based on the specific type of malformation, the CAP and SIR scores were comparable between the subgroups (p > 0.05). No perioperative complications occurred in the control group. However, various perioperative complications (gusher, etc.) and surgical difficulty occurred in the anomaly group. The malformation group had unsatisfactory results with regard to speech perception skills; however, this group and the non-anomalous group exhibited comparable long-term results on linguistic development.

  19. Anti-vascular endothelial growth factors for choroidal neovascularization secondary to choroidal osteoma: Long-term results

    Directory of Open Access Journals (Sweden)

    T Lekha


    Full Text Available Choroidal osteoma is an uncommon benign osseous intraocular tumor typically seen unilaterally in young women. Visual loss can occur due to choroidal neovascularization (CNV complicating osteoma. We report a rare case of bilateral choroidal osteoma with secondary CNV in a young male and the long-term results following anti-vascular endothelial growth factor (VEGF therapy. A 30-year-old male with history of defective vision in both eyes since several years and recent worsening in the right eye (RE since 2 months was found to have bilateral macular osteoma with CNV in the RE based on clinical evaluation, fluorescein angiography, optical coherence tomography, and ultrasonography. Intravitreal injection of ranibizumab at monthly intervals for three doses resulted in resolution of CNV and remained stable for 5 years. Recurrent CNV detected 6 years later responded to an injection of intravitreal bevacizumab and has remained stable till date. Anti-VEGF therapy stabilized the secondary CNV in our patient for 7 years with satisfactory structural and functional outcome, demonstrating the long-term efficacy of this modality of treatment.

  20. Dynamic self-regulating prosthesis (protesi autoregolantesi dinamica): the long-term results in the treatment of primary inguinal hernias. (United States)

    Valenti, Gabriele; Baldassarre, Emanuele; Testa, Alessandro; Arturi, Alessandro; Torino, Giovanni; Campisi, Costantino; Capuano, Giorgio


    The dynamic self-regulating prosthesis (protesi autoregolantesi dinamica, PAD) is a double-layered prosthesi, in use since 1992 in inguinal hernia repair. In 1999, we published the short-term results on 500 patients and herein we report the long-term follow-up. Five hundred eighty-five PAD procedures were performed on 500 adult male, unselected patients. Hernias were unilateral in 415 patients, were bilateral in 85 patients, were direct in 197 patients (33.7%), were indirect in 269 patients (46.0%), and were combined in 119 patients (20.3%). Four hundred sixty-four patients were alive at the follow-up period of minimum 5 years, whereas 36 died (7.2%) of causes unrelated to the hernia. No information was available on 73 patients (14.6%). Therefore, the follow-up was consisted of 391 patients (78.2%) with 469 hernias. The recurrence and testicular atrophy rates were nil. Three patients (0.77%) presented chronic pain and 18 (4.6%) suffered persistent discomfort or paresthesia. A hydrocoele was observed in one patient (0.2%). The long-term data confirm the efficacy of the dynamic self-regulating posthesis hernioplasty. We propose it as a standard of care in all cases of primary inguinal hernia in adult males, retaining it as a definitive and comfortable solution.

  1. Excess Body Mass Index Loss at 3 Months: A Predictive Factor of Long-Term Result after Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Guillaume Philouze


    Full Text Available Introduction. Laparoscopic Sleeve Gastrectomy (SG is considered as successful if the percentage of Excess Body Mass Index Loss (% EBMIL remains constant over 50% with long-term follow-up. The aim of this study was to evaluate whether early % EBMIL was predictive of success after SG. Methods. This retrospective study included patients who had SG with two years of follow-up. Patients had follow-up appointments at 3 (M3, 6, 12, and 24 months (M24. Data as weight and Body Mass Index (BMI were collected systematically. We estimated the % EBMIL necessary to establish a correlation between M3 and M24 compared to % EBMIL speeds and calculated a limit value of % EBMIL predictive of success. Results. Data at operative time, M3, and M24 were available for 128 patients. Pearson test showed a correlation between % EBMIL at M3 and that at M24 (r=0.74;  p<0.0001. % EBMIL speed between surgery and M3 (p=0.0011 was significant but not between M3 and M24. A linear regression analysis proved that % EBMIL over 20.1% at M3 (p<0.0001 predicted a final % EBMIL over 50%. Conclusions. % EBMIL at M3 after SG is correlated with % EBMIL in the long term. % EBMIL speed was significant in the first 3 months. % EBMIL over 20.1% at M3 leads to the success of SG.

  2. Long-Term Results of Peri-implant Conditions in Periodontally Compromised Patients Following Lateral Bone Augmentation. (United States)

    Keeve, Philip L; Khoury, Fouad

    The aim of this retrospective study was to compare long-term (≥ 5 years) outcomes of implants placed in patients treated for chronic periodontitis versus those placed in periodontally healthy patients. In both groups, the implants were placed in alveolar ridges that were laterally augmented with autogenous bone block grafts using a split bone block technique. Two hundred ninety-two patients were screened in the course of supportive periodontal treatment examinations. Nonsmoking patients without any severe systemic diseases who had adhered to regular supportive periodontal treatment for a minimum of 5 years after undergoing autogenous lateral grafting (using the split bone block technique), implant placement, and prosthetic reconstructions were classified into two groups based on their presurgical status: periodontally healthy patients (PHP) and periodontally compromised patients (PCP). Clinical outcomes for 77 patients, 38 PHP and 39 PCP, were examined. All had been successfully treated for severe lateral atrophy and received a total of 241 endosseous implants between 2002 and 2008. At the final examination, mean bleeding on probing was 7.08% ± 7.27% in PHP and 14.49% ± 18.14% in PCP, a statistically significant difference. Significantly higher Plaque Index and more recession were associated with a narrow (bone block technique revealed similar clinical peri-implant conditions in both PHP and PCP. Using autogenous bone block grafts without biomaterials resulted in long-term peri-implant tissue stability.

  3. Percutaneous endoscopic gastrostomy to set up a long-term enteral feeding route in children: an encouraging result. (United States)

    Chang, Pi-Feng; Ni, Yen-Hsuan; Chang, Mei-Hwei


    Percutaneous endoscopic gastrostomy (PEG) is now accepted as the preferred technique to establish long-term enteral feeding. A total of 30 pediatric patients (21 males and 9 females, aged from 5 months to 14 years) underwent PEG in the National Taiwan University Hospital from December 1994 to February 2001. The underlying diseases of the patients receiving PEG were neurological dysfunction ( n=26), gastrointestinal disease ( n=2) and metabolic disorders ( n=2). All patients received intravenous sedation and PEG was performed successfully. Prophylactic antibiotic treatment was given for 1 day. Tube feeding began 48 h after the placement. The Z-score of weight before and 6 months after PEG was -1.54+/-1.74 and -0.98+/-1.46, respectively, which is significant (paired t-test, pPEG. Complications of PEG in our patients included local wound infection ( n=15), gastrocolic fistula ( n=1), pneumoperitoneum ( n=1), dislodgement of tube ( n=6) and tube occlusion ( n=2). Of these patients 12 received button replacement after PEG and the gastrostomy tube was discontinued in 2 patients when they resumed adequate oral intake. Removal of PEG was performed in 2 patients due to complications of gastrocolic fistula and severe dislodgement. Our results encourage the use of PEG as a long-term route for nutritional supply.

  4. Long-term results of hearing preservation cochlear implant surgery in patients with residual low frequency hearing. (United States)

    Moteki, Hideaki; Nishio, Shin-Ya; Miyagawa, Maiko; Tsukada, Keita; Iwasaki, Satoshi; Usami, Shin-Ichi


    Differences were found between patients with stable hearing and those with progressive hearing loss in the lower frequencies with respect to the rate of progression in the contralateral ear. It is suggested that the electric acoustic stimulation (EAS) can provide improvement in hearing ability over the long-term if residual hearing might be lost to some extent. To evaluate the long-term threshold changes in the low frequency hearing of the implanted ear as compared with the non-implanted ear, and the hearing abilities with EAS along with the extent of residual hearing. Seventeen individuals were enrolled and received the EAS implant with a 24-mm FLEXeas electrode array. Hearing thresholds and speech perception were measured pre- and post-operatively for 1-5 years. Post-operative hearing preservation (HP) rates were calculated using the preservation numerical scale. The average linear regression coefficient for the decline in hearing preservation score was -6.9 for the implanted ear and the patients were subsequently categorized into two groups: those with better than average, stable hearing; and those with worse than average, progressive hearing loss. EAS showed better results than electric stimulation alone, in spite of an absence of speech perception with acoustic stimulation.

  5. Long-term results of percutaneous ethanol injection therapy for hepatocellular carcinoma in cirrhosis: a European experience

    Energy Technology Data Exchange (ETDEWEB)

    Lencioni, R. [Pisa Univ. (Italy). Dept. of Radiology; Pinto, F. [Pisa Univ. (Italy). Dept. of Radiology; Armillotta, N. [Pisa Univ. (Italy). Dept. of Radiology; Bassi, A.M. [Pisa Univ. (Italy). Dept. of Radiology; Moretti, M. [Pisa Univ. (Italy). Dept. of Radiology; Di Giulio, M. [Pisa Univ. (Italy). Dept. of Radiology; Marchi, S. [Pisa Univ. (Italy). Dept. of Internal Medicine 1 and Gastroenterology; Uliana, M. [Pisa Univ. (Italy). Dept. of Internal Medicine 2; Della Capanna, S. [Pisa Univ. (Italy). Dept. of Internal Medicine 2; Lencioni, M. [Pisa Univ. (Italy). Dept. of Oncology; Bartolozzi, C. [Pisa Univ. (Italy). Dept. of Radiology


    The objective of our work was to evaluate the long-term results of percutaneous ethanol injection (PEI) for the treatment of hepatocellular carcinoma (HCC) in patients with liver cirrhosis. A total of 184 cirrhotic patients with HCC underwent PEI as the only anticancer treatment over an 8-year period. Patients were followed after therapy by means of clinical examinations, laboratory tests, and US and CT studies performed at regular time intervals. Survival rates were determined according to the Kaplan-Meier method. The overall survival was 67% at 3 years, 41% at 5 years, and 19% at 7 years. The 3-, 5-, and 7-year survival rates of patients with single HCC{<=}3 cm (78, 54, and 28%, respectively) were significantly higher (p<0.01) than those of patients with single HCC of 3.1-5 cm (61, 32, and 16, respectively) or multiple HCCs (51, 21, and 0%, respectively). Survival of Child-Pugh A patients (79% at 3 years, 53% at 5 years, and 32% at 7 years) was significantly longer (p<0.01) than that of Child-Pugh B patients (50% at 3 years, 28% at 5 years, and 8% at 7 years). A selected group of 70 patients with Child-Pugh A cirrhosis and single HCC{<=}3 cm had a 7-year survival of 42%. Long-term survival of cirrhotic patients with HCC treated with PEI is comparable to that reported in published series of matched patients submitted to surgical resection. (orig.)

  6. Microbial borehole observatories deployed within the oceanic crust: Design considerations and initial results from long-term colonization experiments (Invited) (United States)

    Orcutt, B. N.; Bach, W.; Becker, K.; Fisher, A. T.; Hulme, S.; Toner, B. M.; Wheat, C. G.; Edwards, K. J.; Iodp Expedition 327 Shipboard Party


    Borehole observatories developed for long-term sampling and monitoring in the subseafloor of the deep ocean must satisfy design and operation requirements that are similar to systems deployed on land. Many of these systems are used to achieve simultaneous hydrologic, geochemical and microbiological goals, requiring innovative design, installation, and operation. There are major logistical challenges for subseafloor observatories, the foremost being having to remotely access sites kilometers underwater using multiple oceanographic platforms (drill ship, surface ship, submersible, remotely-operated vehicle) and reliance on autonomous devices that are serviced only after several years. Contamination of the analytical environment is probable during installation operations, requiring vigilance during analysis for interpretation. Subseafloor observatories also require self-contained and robust instrumentation that can withstand long-term exposure to seawater at high pressures, elevated temperatures, a variety of redox conditions, and little to no access to external power. Although subseafloor borehole observatories have been in development for hydrologic monitoring for two decades, the inclusion of experimentation to examine the deep biosphere in the marine subsurface has only recently been developed. Results from some of the first microbial colonization experiments in young basaltic rocks on the eastern flank of the Juan de Fuca Ridge demonstrate in situ microbial-mineral interactions that can be identified using complementary geochemical and microbiological techniques. Mineral surfaces were first colonized by iron oxidizing bacteria, and as fluid composition changed, the microbial community became dominated by Firmicutes bacteria, some of which are phylogenetically similar to microbial communities observed in the terrestrial deep biosphere.

  7. Goede lange-termijn resultaten van droog-bedtraining bij kinderen met enuresis nocturna [Good long-term results of dry bed training of children with nocturnal enuresis

    NARCIS (Netherlands)

    Hirasing, R.A.; Reus, H.


    Good long-term results of dry bed training of children with nocturnal enuresis. Objective. To determine the long-term effect of dry bed training in a youth health care setting. Setting. Haarlemmermeer, the Netherlands.Design. Descriptive. Method. Parents of 36 children (mean age 9 year) subjected to

  8. Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients. (United States)

    Carbajo, Miguel A; Luque-de-León, Enrique; Jiménez, José M; Ortiz-de-Solórzano, Javier; Pérez-Miranda, Manuel; Castro-Alija, María J


    Excellent results have been reported with mini-gastric bypass. We adopted and modified the one-anastomosis gastric bypass (OAGB) concept. Herein is our approach, results, and long-term follow-up (FU). Initial 1200 patients submitted to laparoscopic OAGB between 2002 and 2008 were analyzed after a 6-12-year FU. Mean age was 43 years (12-74) and body mass index (BMI) 46 kg/m2 (33-86). There were 697 (58 %) without previous or simultaneous abdominal operations, 273 (23 %) with previous, 203 (17 %) with simultaneous, and 27 (2 %) performed as revisions. Mean operating time (min) was as follows: (a) primary procedure, 86 (45-180); (b) with other operations, 112 (95-230); and (c) revisions, 180 (130-240). Intraoperative complications led to 4 (0.3 %) conversions. Complications prompted operations in 16 (1.3 %) and were solved conservatively in 12 (1 %). Long-term complications occurred in 12 (1 %). There were 2 (0.16 %) deaths. Thirty-day and late readmission rates were 0.8 and 1 %. Cumulative FU was 87 and 70 % at 6 and 12 years. The highest mean percent excess weight loss was 88 % (at 2 years), then 77 and 70 %, 6 and 12 years postoperatively. Mean BMI (kg/m2) decreased from 46 to 26.6 and was 28.5 and 29.9 at those time frames. Remission or improvement of comorbidities was achieved in most patients. The quality of life index was satisfactory in all parameters from 6 months onwards. Laparoscopic OAGB is safe and effective. It reduces difficulty, operating time, and early and late complications of Roux-en-Y gastric bypass. Long-term weight loss, resolution of comorbidities, and degree of satisfaction are similar to results obtained with more aggressive and complex techniques. It is currently a robust and powerful alternative in bariatric surgery.

  9. Determinants of long-term fatigue in breast cancer survivors: results of a prospective patient cohort study

    NARCIS (Netherlands)

    Schmidt, M.E.; Chang-Claude, J.; Seibold, P.; Vrieling, A.; Heinz, J.; Flesch-Janys, D.; Steindorf, K.


    OBJECTIVE: Fatigue is among the most distressing symptoms across the breast cancer continuum. However, little is known about the factors contributing to long-term persisting fatigue. Therefore, we explored determinants of long-term physical, affective, and cognitive fatigue in a prospective cohort

  10. Long-term Testing Results for the 2008 Installation of LED Luminaires at the I-35 West Bridge in Minneapolis

    Energy Technology Data Exchange (ETDEWEB)

    Kinzey, Bruce R.; Davis, Robert G.


    This document reports the long-term testing results from an extended GATEWAY project that was first reported in “Demonstration Assessment of Light-Emitting Diode (LED) Roadway Lighting at the I-35W Bridge, in Minneapolis, MN,” August 2009. That original report presented the results of lighting the newly reconstructed I 35W Bridge using LEDs in place of conventional high-pressure sodium (HPS) roadway luminaires, comparing energy use and illuminance levels with a simulated baseline condition. That installation was an early stage implementation of LED lighting and remains one of the oldest installations in continued operation today. This document provides an update of the LED system’s performance since its installation in September 2008.

  11. Contemporary and long-term erosion in the Kruger National Park, Lowveld Savanna, South Africa. First results. (United States)

    Baade, Jussi; Rheinwarth, Bastian; Glotzbach, Christoph


    periods of a few 100,000 years. This presentation provides first results based on more than 10 investigated reservoirs and compares contemporary and long-term erosion rates.

  12. Long-term results of percutaneous balloon valvuloplasty of congenital aortic stenosis in adolescents and young adults. (United States)

    Awasthy, Neeraj; Garg, Ria; Radhakrishnan, S; Shrivastava, Savitri

    Balloon aortic valvuloplasty (BAV) is a well accepted modality of treatment in congenital aortic stenosis in all age groups. Although in infants and children it is the modality of choice, in adolescents and young adults, it is of debatable efficacy. To evaluate long-term results of aortic valvuloplasty particularly in adolescent and adults (>12 years) and compare the outcome in other age groups that are 12 years) n=68. The characteristics of each subgroup were mutually compared. Percutaneous balloon valvuloplasty with mean (SD) balloon to annulus ratio of 0.93. Main outcome measures were repeat BAV, significant aortic regurgitation (AR), and aortic valve replacement/repair. The incidence of significant AR from the whole cohort was 9.9% (8% moderate, 1.9% severe); n=16. Group A=significant AR 9.5% (7.1% moderate, 2.4% severe), Group B=significant AR 11.3% (9.4% moderate, 1.9% severe), and Group C=significant AR 9% (7.5% moderate, 1.5% severe); p value=0.99 (Group C vs Group A) and 0.92 (Group C vs Group B). Repeat BAV rate was 13.3% (n=22 out of 165 patients). Group A - n=5 (11.9%), Group B - n=10 (18.2%), and Group C - n=7 (10.3%). p Value=0.78 (C vs A) and 0.19 (C vs B). Surgery in follow-up was needed in n=4 (2.4%), none in Group A, 2 patients in Group B (3.6%), and 2 patients in group C (2.9%). Patients were followed up for a period of 14 years; Group A=up to 8 years, Group B=up to 13 years, and Group C=up to 14 years. Mean survival probability after the procedure was 8 years (Group A=6.5 years, Group B=8.1 years, and Group C=9.9 years), and p value=0.49 (A vs B), 0.23 (B vs C), and 0.4 (A vs C). There is no statistical difference in the long-term outcome in the adults and adolescents as compared to the children; thus BAV remains an obvious treatment of choice with good long-term outcome. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  13. Radiotherapy in early-stage Dupuytren's contracture. Long-term results after 13 years

    Energy Technology Data Exchange (ETDEWEB)

    Betz, Nicolas; Ott, Oliver J.; Sauer, Rolf; Fietkau, Rainer [Dept. of Radiation Oncology, Univ. Hospital Erlangen (Germany); Adamietz, Boris [Radiologic Inst., Univ. Hospital Erlangen (Germany); Keilholz, Ludwig [Dept. of Radiation Oncology, Univ. Hospital Erlangen (Germany); Dept. of Radiotherapy, Klinikum Bayreuth GmbH (Germany)


    Background and Purpose: In early-stage Dupuytren's contracture, radiotherapy is applied to prevent disease progression. Long-term outcome and late toxicity of the treatment were evaluated in a retrospective analysis. Patients and Methods: Between 12/1982 and 02/2006, 135 patients (208 hands) were irradiated with orthovoltage (120 kV; 20 mA; 4-mm Al filter), in two courses with five daily fractions of 3.0 Gy to a total dose of 30 Gy; separated by a 6- to 8-week interval. The extent of disease was described according to a modified classification of Tubiana et al. Long-term outcome was analyzed at last follow-up between 02/2008 and 05/2008 with a median follow-up of 13 years (range, 2-25 years). Late treatment toxicity and objective reduction of symptoms as change in stage and numbers of nodules and cords were evaluated and used as evidence to assess treatment response. Results: According to the individual stages, 123 cases (59%) remained stable, 20 (10%) improved, and 65 (31%) progressed. In stage N 87% and in stage N/I 70% remained stable or even regressed. In more advanced stages, the rate of disease progression increased to 62% (stage I) or 86% (stage II). 66% of the patients showed a long-term relief of symptoms (i.e., burning sensations, itching and scratching, pressure and tension). Radiotherapy did not increase the complication rate after surgery in case of disease progression and only minor late toxicity (skin atrophy, dry desquamation) could be observed in 32% of the patients. There was no evidence for a second malignancy induced by radiotherapy. Conclusion: After a mean follow-up of 13 years radiotherapy is effective in prevention of disease progression and improves patients' symptoms in early-stage Dupuytren's contracture (stage N, N/I). In case of disease progression after radiotherapy, a ''salvage'' operation is still feasible. (orig.)

  14. [Long-term results of active-passive ligament repair of the external lateral ligament of the ankle]. (United States)

    Farizon, F; Paris, D; Azoulai, J J; Bousquet, G


    We reviewed 95 ankles at an average of 9 years after an "activo-passive" operation performed for chronic lateral instability. All the patients had suffered recurrent ankle sprain or instability, with pain in 67 patients. Ten ankles showed a subtalar injury at operation. Degenerative changes were noted in 11 ankle joints. On review, 81 ankles (85%) were stable. The 14 cases with persistent instability had developed the problem one to five years after operation. Two cases presented with limitation in mobility. Osteoarthritis, found in 15 ankles, was severe in only two, and had been present on preoperative films. We found no correlation between functional results (talar tilt, anterior-drawer test) and radiological evaluation. The "activo-passive" operation provides long-term stabilization with preservation of the ankle and of subtalar mobility without severe osteoarthritis.

  15. Replacement of chordae tendineae with polytetrafluoroethylene (PTFE) sutures in mitral valve repair: early and long-term results. (United States)

    Chiappini, Bruno; Sanchez, Alvaro; Noirhomme, Philippe; Verhelst, Robert; Rubay, Jean; Poncelet, Alain; Funken, Jean Christophe; El Khoury, Gebrine


    A variety of reliable techniques are now available for chordal disease management and repair of the anterior mitral valve leaflet prolapse. The study aim was to review the authors' experience with polytetrafluoroethylene (PTFE), using a standardized technique for length adjustment, and to analyze the long-term results in patients who underwent mitral valve repair. A total of 111 patients (mean age 56.2 +/- 16.1 years) underwent mitral valve repair with PTFE neochordae, in addition to a variety of other surgical procedures. Etiologies were degenerative in 82 patients (73.9%), Barlow disease in 13 (11.7%), rheumatic in 10 (9%), and infection in six (5.4%). Prolapse of the anterior leaflet was present in 78 patients (70.3%), of the posterior leaflet in 15 (13.5%), a bileaflet prolapse was present in 12 (10.8%), and a commissural prolapse in six (5.4%). In all cases the anterior annulus was used as the reference level in order to assess the appropriate length of the PTFE neochordae. The mean number of PTFE neochordae used was 6 +/- 4 per patient. In-hospital mortality was 1.8% (n = 2); mean follow up was 36.8 +/- 25.6 months (range: 12-94 months). There were no late deaths. At five years postoperatively the patient overall survival was 98.2 +/- 1.8%, freedom from reoperation rate 100%, and freedom from grade 1+ mitral regurgitation rate 97.2 +/- 2.8%. There were no documented thromboembolism or hemorrhagic events. In degenerative and myxomatous mitral valve disease, leaflet prolapse can be successfully repaired by implantation of PTFE neochordae. Both immediate and long-term results proved the versatility, efficiency and durability of this technique.

  16. Results of long-term carcinogenicity bioassays on Coca-Cola administered to Sprague-Dawley rats. (United States)

    Belpoggi, Fiorella; Soffritti, Morando; Tibaldi, Eva; Falcioni, Laura; Bua, Luciano; Trabucco, Francesca


    Coca-Cola was invented in May 1886 in Atlanta, Georgia by a pharmacist who, by accident or design, mixed carbonated water with the syrup of sugar, phosphoric acid, caffeine, and other natural flavors to create what is known as "the world's favorite soft drink." Coca-Cola is currently sold in more than 200 countries and in early 2000, the company sold its 10 billionth unit case of Coca-Cola branded products. Given the worldwide consumption of Coca-Cola, a project of experimental bioassays to study its long-term effects when administered as substitute for drinking water on male and female Sprague-Dawley rats was planned and executed. The objective of the project was to study whether and how long-term consumption of Coca-Cola affects the basic tumorigram of test animals. The bioassays were performed on rats beginning at different ages, namely: (a) on males and females exposed since embryonic life or from 7 weeks of age; and (b) on males and females exposed from 30, 39, or 55 weeks of age. Overall, the project included 1999 rats. During the biophase, data were collected on fluid and feed consumption, body weight, and survival. Animals were kept under observation until spontaneous death and underwent complete necropsy. The results indicate: (a) an increase in body weight in all treated animals; (b) a statistically significant increase of the incidence in females, both breeders and offspring, bearing malignant mammary tumors; (c) a statistically significant increase in the incidence of exocrine ademonas of the pancreas in both male and female breeders and offspring; and (d) an increased incidence, albeit not statistically significant, of pancreatic islet cell carcinomas in females, a malignant tumor which occurs very rarely in our historical controls. On the basis of the results of this study, excessive consumption of regular soft-drinks should be generally discouraged, in particular for children and adolescents.

  17. Long-Term Protection against Diphtheria in the Netherlands after 50 Years of Vaccination: Results from a Seroepidemiological Study. (United States)

    Swart, E M; van Gageldonk, P G M; de Melker, H E; van der Klis, F R; Berbers, G A M; Mollema, L


    To evaluate the National Immunisation Programme (NIP) a population-based cross-sectional seroepidemiological study was performed in the Netherlands. We assessed diphtheria antitoxin levels in the general Dutch population and in low vaccination coverage (LVC) areas where a relatively high proportion of orthodox Protestants live who decline vaccination based on religious grounds. Results were compared with a nationwide seroepidemiological study performed 11 years earlier. In 2006/2007 a national serum bank was established. Blood samples were tested for diphtheria antitoxin IgG concentrations using a multiplex immunoassay for 6383 participants from the national sample (NS) and 1518 participants from LVC municipalities. A cut-off above 0.01 international units per ml (IU/ml) was used as minimum protective level. In the NS 91% of the population had antibody levels above 0.01 IU/ml compared to 88% in the 1995/1996 serosurvey (pdiphtheria vaccination in the NIP and 46% (vs. 37% in the 1995/1996 serosurvey, p = 0.11) of orthodox Protestants living in LVC areas had antibody levels above 0.01 IU/ml. Linear regression analysis among fully immunized individuals (six vaccinations) without evidence of revaccination indicated a continuous decline in antibodies in both serosurveys, but geometric mean antibodies remained well above 0.01 IU/ml in all age groups. The NIP provides long-term protection against diphtheria, although antibody levels decline after vaccination. As a result of natural waning immunity, a substantial proportion of individuals born before introduction of diphtheria vaccination in the NIP lack adequate levels of diphtheria antibodies. Susceptibility due to lack of vaccination is highest among strictly orthodox Protestants. The potential risk of spread of diphtheria within the geographically clustered orthodox Protestant community after introduction in the Netherlands has not disappeared, despite national long-term high vaccination coverage.

  18. Acute and Long-term Results After Contemporary Subcutaneous Implantable Cardioverter-defibrillator Implantation: A Single-center Experience. (United States)

    Arias, Miguel A; Pachón, Marta; Akerström, Finn; Puchol, Alberto; Martín-Sierra, Cristina; Rodríguez-Padial, Luis


    The subcutaneous implantable cardioverter-defibrillator (S-ICD) has emerged as an alternative to the transvenous defibrillator. The incidence of complications is similar, with inappropriate shocks (IS) being more frequent than those occurring with contemporary programming of transvenous defibrillators. Several improvements have been implemented after the S-ICD was approved for use in Europe in 2009. This study reports the results of S-ICD use in a single center, whose experience began late, at the end of 2013. Prospective observational study including consecutive patients with defibrillator indication and no indication for either permanent pacing or cardiac resynchronization who underwent S-ICD implantation. Implant data and long-term follow-up were analyzed. An S-ICD was implanted in 50 patients who were deemed suitable after electrocardiographic screening. The mean age was 46.9±15 (range, 15-78) years and 72% were male. Thirty eight percent had left ventricular ejection fraction ≤ 35%. The most frequent heart disease was ischemic heart disease (34%), followed by hypertrophic cardiomyopathy (18%). The intermuscular technique was used, with 3 incisions in 10% and 2 incisions in the remaining 90%. Ventricular fibrillation was induced in 49 patients, with 100% effectiveness in their conversion. After a mean follow-up of 18.1 (range, 2.3-44.8) months, there were no late complications requiring surgical revision, the rate of IS was 0%, and 1 patient (2%) experienced appropriate shocks. Improvements in technology, implant technique and device programming, along with appropriate patient selection, have led to outstanding acute and long-term results, especially regarding the absence of both IS and complications requiring surgical revision. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  19. Long-term results of cabergoline therapy for macroprolactinomas and analyses of factors associated with remission after withdrawal. (United States)

    Watanabe, Shinya; Akutsu, Hiroyoshi; Takano, Shingo; Yamamoto, Tetsuya; Ishikawa, Eiichi; Suzuki, Hiroaki; Matsumura, Akira


    Withdrawal of cabergoline is generally challenging, especially in patients with large or invasive macroprolactinomas. Therefore, we aimed to assess long-term results of cabergoline therapy for macroprolactinomas and remission achievement results after withdrawal in patients with macroprolactinomas. We also investigated clinical characteristics and factors related to remission after withdrawal. This was an institutional review board-approved retrospective analysis. We studied 46 macroprolactinoma patients who had taken cabergoline during the period from 2003 through 2013. Administration of cabergoline was maintained for 5 years before withdrawal. Median follow-up after the initiation of cabergoline therapy was 54·3 (range 5·3 to 137·2) months. Recurrences of hyperprolactinaemia were observed in 3 of 11 (27%) postwithdrawal patients at a median time of 3·0 (range; 2·9-11·2) months, indicating that a high percentage (73%) maintained remission for at least 12 months after cabergoline cessation. Factors significantly associated with remission were analysed in 21 patients receiving long-term cabergoline administration. On multivariate analysis, the absence of cavernous sinus invasion on pretreatment MRI (≥3/4 tumour encasement of the intracavernous internal carotid artery) (HR; 21·94, 95% CI; 2·06-1071·0, P = 0·006), initial PRL cabergoline therapy (HR; 5·14, 95% CI; 1·10-39·02, P = 0·04) showed statistically significant correlations with remission after withdrawal. Cabergoline therapy can achieve a high percentage (73% in this series) of remission maintenance for at least 12 months after cessation of a 5-year course of therapy, even in patients with macroprolactinomas. The absence of cavernous sinus invasion, serum PRL level lower than 132·7 ng/ml before cabergoline therapy or nadir serum PRL below 1·9 ng/ml were related to more frequent remission after withdrawal of cabergoline in patients receiving this medication for 5 years. © 2016 John Wiley

  20. Evaluation of long-term cosmetic results and complications following breast conserving surgery and radiation therapy for breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Fujishiro, Satsuki; Mitsumori, Michihide; Kokubo, Masaki; Nagata, Yasushi; Sasai, Keisuke; Hiraoka, Masahiro [Kyoto Univ. (Japan). Hospital; Kodama, Hiroshi


    Long-term cosmetic outcomes and complications were evaluated in 109 patients with breast cancer who had been treated by breast conservation therapy. Patients received radiation therapy at Kyoto University Hospital following quadrantectomy and level II or III axillary node dissection. Factors that might influence long-term cosmetic results were also analyzed. Irradiation to the breast was administered in 2 Gy fractions, 5 times a week for a total of 50 Gy in all patients. Cobalt-60 {gamma}-rays were used in 108 patients with the exception of 1 patient who received 6 Mev X-ray. Some patients with positive or close margins received boost irradiation of 10 Gy using electron beams to the primary tumor bed. Cosmetic outcome was assessed by both a scoring method and breast retraction assessment (BRA). Forty-seven percent of patients were assessed as excellent to good before radiation therapy. The percent of excellent to good decreased shortly after termination of radiation therapy, but gradually improved and stabilized by 3 years. Seventy percent of patients showed a score of excellent to good 5 years after treatment. The average BRA of the 109 patients was 3.0 cm. This did not change between 3 and 5 years after treatment. A significant correlation between cosmetic score and BRA was shown at all follow-up times. Factors such as age over 50 years (p=0.008), tumor location in the outer quadrant (p=0.02) and boost irradiation (p=0.03) significantly affected the cosmetic score. Arm edema and restriction of shoulder movement were observed in 22% and 49% at the start of radiation therapy, these improved within approximately 3 years and 1 year after treatment, respectively. Mild skin change was observed in 60% of patients even 5 years after treatment. The results indicate that cosmetic outcome after breast conservation therapy is clinically acceptable, and the complication rate is low. (author)

  1. Bladder Function Preservation With Brachytherapy, External Beam Radiation Therapy, and Limited Surger in Bladder Cancer Patients: Long-Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Aluwini, Shafak, E-mail: [Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam (Netherlands); Rooij, Peter H.E. van [Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam (Netherlands); Kirkels, Wim J.; Boormans, Joost L. [Department of Urology, Erasmus MC Cancer Institution, Rotterdam (Netherlands); Kolkman-Deurloo, Inger-Karina K.; Wijnmaalen, Arendjan [Department of Radiation Oncology, Erasmus MC Cancer Institution, Rotterdam (Netherlands)


    Purpose: To report long-term results of a bladder preservation strategy for muscle-invasive bladder cancer (MIBC) using external beam radiation therapy and brachytherapy/interstitial radiation therapy (IRT). Methods and Materials: Between May 1989 and October 2011, 192 selected patients with MIBC were treated with a combined regimen of preoperative external beam radiation therapy and subsequent surgical exploration with or without partial cystectomy and insertion of source carrier tubes for afterloading IRT using low dose rate and pulsed dose rate. Data for oncologic and functional outcomes were prospectively collected. The primary endpoints were local recurrence-free survival (LRFS), bladder function preservation survival, and salvage cystectomy-free survival. The endpoints were constructed according to the Kaplan-Meier method. Results: The mean follow-up period was 105.5 months. The LRFS rate was 80% and 73% at 5 and 10 years, respectively. Salvage cystectomy-free survival at 5 and 10 years was 93% and 85%. The 5- and 10-year overall survival rates were 65% and 46%, whereas cancer-specific survival at 5 and 10 years was 75% and 67%. The distant metastases-free survival rate was 76% and 69% at 5 and 10 years. Multivariate analysis revealed no independent predictors of LRFS. Radiation Therapy Oncology Group grade ≥3 late bladder and rectum toxicity were recorded in 11 patients (5.7%) and 2 patients (1%), respectively. Conclusions: A multimodality bladder-sparing regimen using IRT offers excellent long-term oncologic outcome in selected patients with MIBC. The late toxicity rate is low, and the majority of patients preserve their functional bladder.

  2. Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up. (United States)

    Seker, Ali; Kara, Adnan; Armagan, Raffi; Oc, Yunus; Varol, Ali; Sezer, Hasan Basri


    Repair of the neglected achilles tendon ruptures can be challenging due to retraction of tendon stumps. Different repair and augmentation techniques were described. This study aims to investigate long-term results of neglected achilles tendon rupture repair with gastrocnemius flaps. Between 1995 and 2005, 21 neglected achilles tendon rupture reconstructions were performed with using gastrocnemius fascial flaps. Mean age was 32.1 years. Mean period between rupture and operation was 8.4 weeks. Ankle range of motion, calf circumference, heel raise test, Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) hindfoot and Foot and Ankle Disability Index (FADI) scores were checked. The average gap length was 6.4 cm. Mean follow-up was 145.3 months. Median dorsiflexion/plantar flexion values for operated and uneffected sides were 18°/30° and 19°/30°, respectively. The mean values for AOFAS and FADI scores were 98.5 points and 98.9 %, respectively. VAS score was 0 point for all patients. With the numbers available, no significant difference could be detected in terms of ankle range of motion, calf circumference measures and dynamometric analysis. Mean time for return to daily activities was 11.1 (8-16) weeks after surgery. Prerupture activity level was achieved 14.1 months postoperatively. All patients were able to perform heel raise test. Repair of neglected achilles tendon ruptures with gastrocnemius flaps has satisfactory long-term results.

  3. Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy; Results from a United States Cohort (United States)

    Jabs, Douglas A.; Ahuja, Alka; Van Natta, Mark L.; Lyon, Alice T.; Yeh, Steven; Danis, Ronald


    Objectives To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and the acquired immunodeficiency syndrome (AIDS)in the modern era of combination antiretroviral therapy. Design Prospective, observational, cohort study Participants Patients with AIDS and CMV retinitis Testing Immune recovery, defined as a CD4+ T cell count>100 cells/μL for ≥ 3 months. Main outcome measures Mortality, visual impairment (visual acuity worse than 20/40) and blindness (visual acuity 20/200 or worse) on logarithmic visual acuity charts, loss of visual field on quantitative Goldmann perimetry. Results Patients without immune recovery had a mortality of 44.4/100 person years (PY), and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PY (Pvisual impairment and blindness were 0.9/100 PY and 0.4/100 PY, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was ~1% of the normal field/year, whereas among those without immune recovery it was ~7% of the normal field/year. Conclusions Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates seen in the non-HIV-infected population, the rates of bilateral visual impairment and blindness are low, especially when compared to rates seen in the era before modern antiretroviral therapy. PMID:25892019

  4. Long-term results in three-dimensional conformal radiotherapy of localized prostate cancer at moderate dose (66 Gy)

    Energy Technology Data Exchange (ETDEWEB)

    Goldner, G.; Wachter, S.; Wachter-Gerstner, N.; Dieckmann, K.; Poetter, R. [Dept. of Radiotherapy and Radiobiology, Univ. of Vienna, Medical School, Vienna (Austria)


    Purpose: biochemical control (bNED), disease-specific survival (DSS), overall survival (OS), and late gastrointestinal (GI) and urogenital (UG) side effects (EORTC/RTOG) of patients with long-term follow-up were evaluated. Patients and methods: three-dimensional radiotherapy up to 66 Gy with/without additional hormonal therapy was performed in 154 prostate cancer (T1-3 NO MO) patients. According to T-stage, pretreatment prostate-specific antigen (PSA) and grading, patients were divided into a low-, intermediate-, and high-risk group. The 5-, 8-, and 10-year actuarial rates of bNED, DSS and OS and late side effects were calculated. Results: median follow-up was 80 months. Additional hormonal therapy was given in 57% of patients. Distribution concerning risk groups (low, intermediate, high) showed 15%, 49%, and 36% of patients, respectively. bNED 5-, 8-, and 10-year actuarial rates were 46%, 44%, and 44%. DSS 5-, 8- and 10-year rates amounted to 96%, 90%, and 82%. OS 5-, 8- and 10-year rates were 81%, 64%, and 56%. In uni- and multivariate analysis, only pretreatment PSA (< 10 vs. {>=} 10 ng/ml; p < 0.05) and PSA nadir (< 0.5 vs. {>=} 0.5 ng/ml; p < 0.0001) affected bNED significantly. Age, risk group, T-stage, grading, and hormonal therapy had no significant influence on bNED, DSS, and OS. Rates of late GI and UG side effects grade {>=} 2 at 5 years were 17% and 15%. Conclusion: current dose escalation studies with better bNED rates may be able to further increase long-term clinical outcome. (orig.)

  5. Long-term results from a randomized phase II trial of neoadjuvant combined-modality therapy for locally advanced rectal cancer

    Directory of Open Access Journals (Sweden)

    Oblak Irena


    Full Text Available Abstract Background This study evaluated the effectiveness and safety of preoperative chemoradiotherapy with capecitabine in patients with locally advanced resectable rectal cancer. This report summarizes the results of the phase II study together with long-term (5-year follow-up. Methods Between June 2004 and January 2005, 57 patients with operable, clinical stage II-III adenocarcinoma of the rectum entered the study. Radiation dose was 45 Gy delivered as 25 fractions of 1.8 Gy. Concurrent chemotherapy with oral capecitabine 825 mg/m2 twice daily was administered during radiotherapy and at weekends. Surgery was scheduled 6 weeks after the completion of the chemoradiotherapy. Patients received four cycles of postoperative chemotherapy comprising either capecitabine 1250 mg/m2 bid days 1-14 every 3 weeks or bolus i.v. 5-fluorouracil 425 mg/m2/day and leucovorin 20 mg/m2/day days 1-5 every 4 weeks (choice was at the oncologist's discretion. Study endpoints included complete pathological remission, proportion of R0 resections and sphincter-sparing procedures, toxicity, survival parameters and long-term (5-year rectal and urogenital morbidity assessment. Results One patient died after receiving 27 Gy because of a pulmonary embolism. Fifty-six patients completed radiochemotherapy and had surgery. Median follow-up time was 62 months. No patients were lost to follow-up. R0 resection was achieved in 55 patients. A complete pathological response was observed in 5 patients (9.1%; T-, N- and overall downstaging rates were 40%, 52.9% and 49.1%, respectively. The 5-year overall survival rate, recurrence-free survival, and local control was 61.4% (95% CI: 48.9-73.9%, 52.4% (95% CI: 39.3-65.5%, and 87.4% (95% CI: 75.0-99.8%, respectively. In 5 patients local relapse has occurred; dissemination was observed in 19 patients and secondary malignancies have occurred in 2 patients. The most frequent side-effect of the preoperative combined therapy was dermatitis

  6. Are the good functional results from arthroscopic repair of massive rotator cuff injuries maintained over the long term?

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki


    Full Text Available ABSTRACT OBJECTIVE: To evaluate whether the good and excellent functional results from arthroscopic repair of massive rotator cuff tears are maintained over the long term. METHODS: From the sample of the study conducted by our group in 2006, in which we evaluated the functional results from arthroscopic repair of massive rotator cuff tears, 35 patients were reassessed, 8 years after the first evaluation. The inclusion criteria were that these patients with massive rotator cuff tears operated by means of an arthroscopic technique, who participated in the previous study and achieved good or excellent outcomes according to the UCLA criteria. Patients whose results were not good or excellent in the first evaluation according to the UCLA criteria were excluded. RESULTS: Among the 35 patients reassessed, 91% of them continued to present good and excellent results (40% excellent and 51% good, while 3% presented fair results and 6% poor results. The time interval between the first and second evaluations was 8 years and the minimum length of follow-up since the immediate postoperative period was 9 years (range: 9-17 years, with an average of 11.4 years. CONCLUSION: The good and excellent results from arthroscopic repair of massive rotator cuff tears were mostly maintained (91%, with the same level of function and satisfaction, even though 8 years had passed since the first assessment, with a follow-up period averaging 11.4 years.

  7. Combined management of retroperitoneal sarcoma with dose intensification radiotherapy and resection: Long-term results of a prospective trial.

    LENUS (Irish Health Repository)

    Smith, Myles J F


    Late failure is a challenging problem following resection of retroperitoneal sarcoma (RPS). We investigated the effects of preoperative XRT plus dose escalation with early postoperative brachytherapy (BT) on long-term survival and recurrence in RPS.

  8. Short-term and Long-term Clinical Results of the Surgical Correction of Thumb-in-Palm Deformity in Patients With Cerebral Palsy. (United States)

    Alewijnse, Juul V; Smeulders, Mark J C; Kreulen, Mick


    Thumb-in-palm deformity disturbs a functional grip of the hand in patients with cerebral palsy. Reported recurrence rates after surgical correction are contradicting and earlier studies are limited to short-term follow-up. Therefore, the aim of this retrospective clinical outcome study is to evaluate the success rate of surgical correction of thumb-in-palm deformity around 1 year and at a minimum of 5 years follow-up. In addition, long-term patient satisfaction of the treatment is evaluated. Patients with cerebral palsy who underwent a surgical correction for their thumb-in-palm deformity between April 2003 and April 2008 at the Academic Medical Center in Amsterdam were included. All patients were classified into 4 categories according to the assessment system of the Committee on Spastic Hand Evaluation. The result of surgery was considered "short-term successful" and "long-term successful" when, respectively, short-term and long-term classification was better compared with preoperative. The association between the patient satisfaction outcomes and the long-term clinical outcomes were statistically analyzed. Data were collected from 39 patients and their charts. The success rate was 87% at short-term follow-up, which in the long term decreased to 80%. Interestingly, thumb position deteriorated in 29% of the patients between short-term and long-term follow-up. In the long term, 74% of the patients were satisfied with the position of their thumb and 87% would undergo the surgery again. Both these outcomes were statistically significant associated with the long-term success rate (Pthumb-in-palm deformity has a high clinical success rate and patient satisfaction in the long term. However, it should be taken into account that the clinical result around 1 year postoperative cannot be considered final.

  9. Hydrogeological characterization based on the results of long term monitoring in the Mizunami Underground Research Laboratory Project (United States)

    Takeuchi, R.; Ohyama, T.; Matsuoka, T.; Saegusa, H.; Takeuchi, S.


    The Mizunami Underground Research Laboratory (MIU) is now under construction by the Japan Atomic Energy Agency in the Cretaceous Toki granite in the Tono area of central Japan. Conceptual design of the MIU consists of two 1,000 m shafts (the Main Shaft and the Ventilation Shaft) and horizontal research galleries. The MIU project is a broad scientific study of the deep geological environment as a base for the research and development for geological disposal of nuclear wastes. One of the main goals is to establish comprehensive techniques for investigation, analysis and assessment of the deep geological environment in fractured crystalline rock. The project is being implemented in three overlapping phases: Surface-based Investigation (Phase I), Construction (Phase II) and Operation (Phase III), with a total duration of 20 years. In Phase I, surface investigations were carried out in a stepwise manner in order to obtain information of the geological environment at the site scale (about 2km square). Geological modeling and simulations of various kinds had been carried out in order to synthesize these investigation results. Two NNW-trending faults, which are important for hydrogeological characterization, are included in the model. One of the faults (fault A) strikes through the site in the immediate vicinity of the Main Shaft and another fault (fault B) strikes through the southern part of the MIU construction site. In Phase II, field investigations have been carried out in and around the MIU construction site. For hydrogeological characterization, long term monitoring of hydraulic pressure, surface tilt and self-potential have been carried out on surface and in the research galleries to obtain information on changes of groundwater flow due to shaft excavation. The results of the long term monitoring focused on fault A are as follows: - The hydraulic pressure responses are observed in surface boreholes in and around the MIU construction site and the galleries. The

  10. Results of the "Komplast" experiment on the long-term exposure of materials specimens on the ISS surface (United States)

    Shumov, Andrey; Novikov, Lev

    The "Komplast" materials experiment was designed by the Khrunichev State Research and Production Space Center together with Skobeltsyn Institute of Nuclear Physics, Lomonosov Moscow State University and other Russian scientific institutes, and has been carried out since 1998. The aim of the experiment is to study the complex effects of space factors on specimens of various materials. Eight “Komplast” panels fitted with material specimens equipped UV-sensors and temperature sensors were located on the International Space Station (ISS) Functional Cargo Block (FGB) module exterior surface. The panels were sent into orbit with the FGB when it launched on November 20, 1998. Two of these panels were subsequently returned to Earth by Space Shuttle Discovery after 12 years of LEO exposure. The uniqueness of the "Komplast" experiment determined by long duration of open space exposure, which is much longer than in other similar experiments. For example LDEF: 1984-1990, МЕЕР (Space Station «Mir»): 1996-1997, MISSE-1, -2 (ISS): 1,5-2 years. In this work reveals laboratory research results of some materials specimens, which had been exposed on “Komplast” panels. A distinctive feature of this research was additional irradiation of specimens by atomic oxygen and electrons with energies of ~ 1-8 MeV in laboratory. In the interpretation of the experiment results was taken into account the specimens exposure temperature conditions on the ISS exterior surface and the conditions of their sunlit, defined by the above-mentioned sensors readings. Lot of attention was paid to the investigation of rubber materials specimens. The deformation, mechanical and relaxation characteristics were defined for the specimens. Also were investigations the seals-ability of model rubber seals after the long-term outer exposure. It was determined conservation volumetric deformation and relaxation characteristics of the exposed specimens and the localization of structural changes in the thin

  11. Long-term results after non-operative and operative treatment of radial neck fractures in adults. (United States)

    Keil, Holger; Schnetzke, Marc; Kocharyan, Arpine; Vetter, Sven Yves; Beisemann, Nils; Swartman, Benedict; Grützner, Paul-Alfred; Franke, Jochen


    The aim of this study is to determine the functional long-term outcome after non-operative and operative treatment of radial neck fractures in adults. Thirty-four consecutive patients with a mean age of 46.4 (18.0 to 63.0) years with a fracture of the radial neck who were treated between 2000 and 2014 were examined regarding the clinical and radiological outcome. Twenty patients were treated non-operatively, and 14 patients underwent surgery. After a mean follow-up of 5.7 (2.0 to 15.7) years, the clinical scores showed good results in both groups. The Disabilities of Arm, Shoulder and Hand score was 16.1 (0 to 71.6) in the non-operative group and 8.8 (0 to 50.8) in the operative group, respectively. The Mayo Elbow Performance Score was 80.0 (30 to 95) in the non-operative group and 82.5 (35 to 95) in the non-operative group, respectively. The initial angle of the radial head towards the shaft (RHSA) was significantly higher in the operative group in the anterior-posterior plane (12.8° [2 to 23] vs. 26.3° [1 to 90], p = 0.015). In the follow-up radiographs, the RHSA was significantly lower in the operative group (15.1° [3 to 30] vs. 10.9° [3 to 18], p = 0.043). Five patients developed 7 complications in the non-operative group, and 7 patients developed 12 complications in the operative group. Revision rates were higher in the operative groups as 1 patient received radial head resection in the non-operative (5%) group while 7 patients in the operative group (50%) needed revision surgery. A good functional long-term outcome can be expected after operative and non-operative treatment of radial neck fractures in adults. If needed due to major displacement, open reduction is associated with a higher risk of complications and the need for revision surgery but can achieve similar clinical results. DRKS DRKS00012836 (retrospectively registered).

  12. Changes in water and beverage intake and long-term weight changes: results from three prospective cohort studies. (United States)

    Pan, A; Malik, V S; Hao, T; Willett, W C; Mozaffarian, D; Hu, F B


    To examine the long-term relationship between changes in water and beverage intake and weight change. Prospective cohort studies of 50013 women aged 40-64 years in the Nurses' Health Study (NHS, 1986-2006), 52987 women aged 27-44 years in the NHS II (1991-2007) and 21988 men aged 40-64 years in the Health Professionals Follow-up Study (1986-2006) without obesity and chronic diseases at baseline. We assessed the association of weight change within each 4-year interval, with changes in beverage intakes and other lifestyle behaviors during the same period. Multivariate linear regression with robust variance and accounting for within-person repeated measures were used to evaluate the association. Results across the three cohorts were pooled by an inverse-variance-weighted meta-analysis. Participants gained an average of 1.45 kg (5th to 95th percentile: -1.87 to 5.46) within each 4-year period. After controlling for age, baseline body mass index and changes in other lifestyle behaviors (diet, smoking habits, exercise, alcohol, sleep duration, TV watching), each 1 cup per day increment of water intake was inversely associated with weight gain within each 4-year period (-0.13 kg; 95% confidence interval (CI): -0.17 to -0.08). The associations for other beverages were: sugar-sweetened beverages (SSBs) (0.36 kg; 95% CI: 0.24-0.48), fruit juice (0.22 kg; 95% CI: 0.15-0.28), coffee (-0.14 kg; 95% CI: -0.19 to -0.09), tea (-0.03 kg; 95% CI: -0.05 to -0.01), diet beverages (-0.10 kg; 95% CI: -0.14 to -0.06), low-fat milk (0.02 kg; 95% CI: -0.04 to 0.09) and whole milk (0.02 kg; 95% CI: -0.06 to 0.10). We estimated that replacement of 1 serving per day of SSBs by 1 cup per day of water was associated with 0.49 kg (95% CI: 0.32-0.65) less weight gain over each 4-year period, and the replacement estimate of fruit juices by water was 0.35 kg (95% CI: 0.23-0.46). Substitution of SSBs or fruit juices by other beverages (coffee, tea, diet beverages, low-fat and whole milk) were all

  13. Long term effectiveness on prescribing of two multifaceted educational interventions: results of two large scale randomized cluster trials.

    Directory of Open Access Journals (Sweden)

    Nicola Magrini

    Full Text Available INTRODUCTION: Information on benefits and risks of drugs is a key element affecting doctors' prescribing decisions. Outreach visits promoting independent information have proved moderately effective in changing prescribing behaviours. OBJECTIVES: Testing the short and long-term effectiveness on general practitioners' prescribing of small groups meetings led by pharmacists. METHODS: Two cluster open randomised controlled trials (RCTs were carried out in a large scale NHS setting. Ad hoc prepared evidence based material were used considering a therapeutic area approach--TEA, with information materials on osteoporosis or prostatic hyperplasia--and a single drug oriented approach--SIDRO, with information materials on me-too drugs of 2 different classes: barnidipine or prulifloxacin. In each study, all 115 Primary Care Groups in a Northern Italy area (2.2 million inhabitants, 1737 general practitioners were randomised to educational small groups meetings, in which available evidence was provided together with drug utilization data and clinical scenarios. Main outcomes were changes in the six-months prescription of targeted drugs. Longer term results (24 and 48 months were also evaluated. RESULTS: In the TEA trial, one of the four primary outcomes showed a reduction (prescription of alfuzosin compared to tamsulosin and terazosin in benign prostatic hyperplasia: prescribing ratio -8.5%, p = 0.03. Another primary outcome (prescription of risedronate showed a reduction at 24 and 48 months (-7.6%, p = 0.02; and -9,8%, p = 0.03, but not at six months (-5.1%, p = 0.36. In the SIDRO trial both primary outcomes showed a statistically significant reduction (prescription of barnidipine -9.8%, p = 0.02; prescription of prulifloxacin -11.1%, p = 0.04, which persisted or increased over time. INTERPRETATION: These two cluster RCTs showed the large scale feasibility of a complex educational program in a NHS setting, and its potentially

  14. Induced damage in Carrara Marble as a result of long-term low-magnitude environmental stresses (United States)

    Voigtlaender, Anne; Leith, Kerry; Krautblatter, Michael; Walter, Jens M.


    Damage of intact rock is commonly driven by the interaction of long-term low-magnitude external environmental stresses in combination with surface chemistry, rather than short-term loading in excess of intact rock strength. In order to determine the contribution of environmental stresses to the propagation of micro- and macroscopic fractures under natural environmental conditions we undertook long-term three-point bending tests on large size Carrara Marble specimens. The interaction of mechanical stresses induced by external loading and corrosive conditions (e.g. the presence of water) at the tip of a pre-existing crack is termed stress corrosion. We investigate stress corrosion below saw cut notches in wet and dry samples of Carrara Marble (M1-5, each 10cm x 10cm x 110cm). These were pre-loaded to about 66% of their assumed ultimate strength (determined by the fracture toughness (Kic) calculated for the crack tip). Two marble beams (M1, M3) were initially loaded to 22% and three (M2, M4, M5) to 55% of Kic. CaC03 saturated water was continuously dripped in the notch of samples --M1-4 to create corrosive conditions, while M5 was kept dry. After a three-week bedding period, loading on sample M1 was increased to 55%, M2 and M5 to 77% and M3 and M4 to 85% of Kic respectively. The tests were interrupted prior to failure of the specimens in order to allow the assessment of the crack-tip structure. During the testing period we used classical strain gages and acoustic emission sensors to measure strain and elastic stress changes through coda wave interferometry. Temperature and humidity were monitored and the outflowing fluid was collected for future analysis, throughout. The effect of induced damage on residual intrinsic stresses was evaluated using neutron diffraction on the SALSA instrument at the Institute Laue-Langevin (ILL, Grenoble, France), while texture measurements were undertaken using the X-ray goniometer at the Geoscience Center, University Göttingen, and

  15. Off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm: long-term results. (United States)

    Huang, Xin-sheng; Gu, Cheng-xiong; Yang, Jun-feng; Wei, Hua; Li, Jing-xing; Yu, Yang; Fang, Ying; Liu, Rui; Li, Hai-tao; Zhou, Qi-wen


    The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair. From March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed. Early mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90 ± 0.59 to 1.65 ± 0.54 among the mid-term survivors (P 80 ml/m(2) (OR = 3.7, 95%CI 1.0 - 14.0); and advanced age > 70 years (OR = 2.4, 95%CI 1.0 - 12.0). The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.

  16. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis

    Energy Technology Data Exchange (ETDEWEB)

    Gaerdin, Anna; Shalabi, Adel [Karolinska University Hospital/Huddinge, Departments of Radiology, Karolinska Institutet, Clintec, Stockholm (Sweden); Movin, Tomas [Karolinska University Hospital/Huddinge, Karolinska Institutet, Departments of Orthopedics, Stockholm (Sweden); Svensson, Leif [Karolinska Institutet, Karolinska University Hospital/Huddinge, Departments of Medical Physics, Stockholm (Sweden)


    To evaluate the long-term results following eccentric calf-muscle training in patients with chronic Achilles tendinopathy. A total of 24 patients with chronic Achilles tendinopathy were included in a study evaluating MRI findings and clinical symptoms before and after 3 months of daily eccentric calf-muscle strength training. Median duration of symptoms was 18 months (range 6-120). Four of the patients did not perform the prescribed treatment for different reasons and were followed for 14 months. The resulting 20 treated patients completed 4.2-year (range 29-58 months) follow up. Tendon volume was evaluated by using 3D seed growing technique and signal abnormalities were visually semi-quantitatively graded. Level of pain and performance was categorized using a questionnaire completed by the patient. In the symptomatic treated patients, median intensity level of pain decreased from moderate/severe at time of inclusion to mild at follow up (p < 0.05). Median level of performance increased from severe impairment at time of inclusion to normal at follow up (p < 0.05). 12 out of 20 patients had raised intratendinous signal at time of inclusion compared to 2 out of 20 patients at follow up (p < 0.001). Mean tendon-volume measured 6.7 cm{sup 3} (SD 2.0) at time of inclusion and 6.4 cm{sup 3} (SD 2.0) at follow up (p = 0.18). The four symptomatic non-treated tendons did not improve regarding pain, performance, intratendinous signal or tendon volume. We found decreased pain, improved performance and decreased intratendinous signal both compared to index examination and immediately after the 3 months training regimen in a 4.2-year clinical and MRI follow up, in a group of patients treated with heavy loaded eccentric calf-muscle training for chronic Achilles tendinopathy. The improvements were greater at 4.2-year follow up, despite no further active treatment, than immediately after the treatment. This may indicate a good long-term prognosis for Achilles tendinosis patients

  17. Long Term Results of PHILOS Plating and Percutaneous K-Wire Fixation in Proximal Humerus Fractures in The Elderly

    Directory of Open Access Journals (Sweden)

    GS Jaura


    Full Text Available This is a report of a study on the long term results of PHILOS plating and percutaneous K-wire fixation in a prospective series of proximal humerus fractures in elderly patients. We reviewed a total of 60 patients with proximal humerus fractures in 30 patients (Group 1, who were treated by open reduction and internal fixation with Proximal Humeral Internal Locking System (PHILOS plate and 30 patients (Group 2 who were treated with percutaneous K-wire fixation. Functional outcome was assessed using Visual Analogue Scale(VAS and Constant-Murley Score. Mean Constant-Murley score was 84.6 points (range: 61-100 in Group 1 and - 76.4 points(range:56-100 in Group 2 at final follow up. Values varied depending upon the fracture type with worst in 4-part fractures. Mean VAS Score was 2.6(range:0-10 in Group 1 and 3.8(range:0-10 in Group 2. We obtained satisfactory results in both the groups, with each procedure having its advantages and shortcomings. We found that PHILOS plate fixation provided stable fixation with minimal implant problems and enabled early range-of motion exercises to achieve acceptable functional results. Fixation with percutaneous K-wires presented an efficient treatment option with the advantages of minimal invasiveness and soft tissue dissection.

  18. [Long-term results of thrust plate prostheses: comparison of patients younger than and older than 50 years]. (United States)

    Wienbeck, S; Osada, N; Basad, E; Stürz, H; Ishaque, B A


    Hip replacement in patients younger than 50 years old is no longer an exception in view of the increasing necessity for care. The aim of the present study was to analyze whether the results after implantation of thrust plate prosthesis (TPP) with metaphyseal anchorage are equal for patients below 50 years compared to older patients. The investigation comprised 465 TPP implantations. In 149 TPP the patient age was below 50 years (group A) und in 316 TPP cases above 50 years (group B). Clinical and radiological evaluation of the results for both groups was carried out as well as a differentiated survival analysis with defined endpoints. Survival analysis of group A (96%/13.2 years) showed a significantly improved survival rate compared to group B (86%/12.5 years). Additionally, the risk of prosthesis and/or radiological signs loosening of was significantly lower in group A than in group B (p <0.05). Comparison of long-term results of prostheses with intramedullary fixation shows that the anchorage principle of TPP with bone-saving implantation to the proximal femur is justified especially for patients below 50 years of age.

  19. Microbiological quality of ready-to-eat foods: results from a long-term surveillance program (1995 through 2003). (United States)

    Meldrum, R J; Ribeiro, C D; Smith, R M M; Walker, A M; Simmons, M; Worthington, D; Edwards, C


    The coordination of food sampling activities across Wales, a part of the United Kingdom with a population of approximately 3 million, led to the establishment in 1995 of a coordinated food-sampling program designed to monitor on a long-term basis the microbiological quality and safety of specific ready-to-eat products. This surveillance system has been ongoing for 9 years and has generated a database of microbiological and associated demographic results for 15,228 ready-to-eat food samples. The food types that had the poorest overall results were sliced meats, unsliced poultry, sandwiches made without salad, and cakes made without dairy cream. For all food types, the overall unsatisfactory rate was 17% for aerobic colony counts, 1.6% for Escherichia coli, and 0.5% for Listeria spp. Overall unsatisfactory or unacceptable rates for pathogens such as Clostridium perfringens, Listeria monocytogenes, Bacillus cereus, and Staphylococcus aureus were all below 0.5%. No Campylobacter-positive samples and only one Salmonella-positive sample were found. The analysis of the results show that the ready-to-eat food types sampled over the 9 years of the program were generally of good microbiological quality when compared with current United Kingdom guidelines. The information contained in the database provides a baseline measurement of the microbial quality of a variety of ready-to-eat foods and allows environmental health officers and food microbiologists to generate hypotheses for targeted surveys or research work.

  20. Long-term applicability of the new ILAE definition of epilepsy. Results from the PRO-LONG study. (United States)

    Beretta, Simone; Carone, Davide; Zanchi, Clara; Bianchi, Elisa; Pirovano, Marta; Trentini, Claudia; Padovano, Giada; Colombo, Matteo; Cereda, Diletta; Scanziani, Sofia; Giussani, Giorgia; Gasparini, Sara; Bogliun, Graziella; Ferrarese, Carlo; Beghi, Ettore


    The new epilepsy definition adopted by the International League Against Epilepsy (ILAE) includes patients with one unprovoked seizure with a probability of further seizures, similar to the general recurrence risk after two unprovoked seizures, occurring in a 10-year period. Long-term follow-up of patients diagnosed after a single seizure is needed to assess the applicability of the new epilepsy definition in clinical practice. Patients with newly diagnosed epilepsy were recruited retrospectively with a minimum follow-up of 10 years. Patients were stratified in two groups depending on the occurrence of one (new definition, ND) or two or more unprovoked seizures (traditional definition, TD) at the time of epilepsy diagnosis and compared for disease characteristics and factors predicting seizure recurrence. The primary outcome was the occurrence of a new unprovoked seizure during follow-up in the ND group. The secondary outcome was the achievement of an early remission in both groups. Among 1,006 patients with newly diagnosed epilepsy, 152 (15.1%) were diagnosed after a single seizure. Compared to patients diagnosed using the TD, patients diagnosed according to the ND showed a higher proportion of subjects with an abnormal neurologic examination (19.9% vs. 13.7%, p = 0.0504) and with focal seizures (69.3% vs. 60.4%, p = 0.0021). The two samples differed in the presence of at least one of the factors predicting seizure recurrence (focal seizures or abnormal findings in at least one among the following: neurologic examination, electroencephalography [EEG], and neuroimaging) (94.6% vs. 89.1%, p = 0.0376). Long-term recurrence in patients diagnosed with the new definition was 83.6% at 10 years and 89.1% at 15 years. The probability of early remission did not differ between the two groups. Our results support the applicability of the new epilepsy definition in clinical practice. Individual patient characteristics and a personalized diagnostic approach can justify

  1. Long-Term Results of a Highly Performing Conformal Electron Therapy Technique for Chest Wall Irradiation After Mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Grellier Adedjouma, Noemie, E-mail: [Department of Radiation Oncology, Institut Curie, Paris (France); Chevrier, Marion [Department of Biostatistics, Institut Curie, Paris (France); Fourquet, Alain; Costa, Emilie; Xu, Haoping [Department of Radiation Oncology, Institut Curie, Paris (France); Berger, Frederique [Department of Biostatistics, Institut Curie, Paris (France); Campana, Francois [Department of Radiation Oncology, Institut Curie, Paris (France); Laki, Fatima [Department of Surgical Oncology, Institut Curie, Paris (France); Beuzeboc, Philippe [Department of Medical Oncology, Institut Curie, Paris (France); Lefeuvre, Delphine [Department of Biostatistics, Institut Curie, Paris (France); Fournier-Bidoz, Nathalie; Kirova, Youlia M. [Department of Radiation Oncology, Institut Curie, Paris (France)


    Purpose: To evaluate locoregional control and survival after mastectomy, as well as toxicity, in patients irradiated by a previously described postmastectomy highly conformal electron beam radiation therapy technique (PMERT). Methods and Materials: We included all women irradiated by postmastectomy electron beam radiation therapy for nonmetastatic breast cancer between 2007 and 2011 in our department. Acute and late toxicities were retrospectively assessed using Common Terminology Criteria for Adverse Events version 3.0 criteria. Results: Among the 796 women included, 10.1% were triple-negative, 18.8% HER2-positive, and 24.6% received neoadjuvant chemotherapy (CT). Multifocal lesions were observed in 51.3% of women, and 64.6% had at least 1 involved lymph node (LN). Internal mammary chain, supraclavicular, infraclavicular, and axillary LNs were treated in 85.6%, 88.3%, 77.9%, and 14.9% of cases, respectively. With a median follow-up of 64 months (range, 6-102 months), 5-year locoregional recurrence–free survival and overall survival were 90% (95% confidence interval 88.1%-92.4%) and 90.9% (95% confidence interval 88.9%-93%), respectively. Early skin toxicity was scored as grade 1 in 58.5% of patients, grade 2 in 35.9%, and grade 3 in 4.5%. Concomitant CT was associated with increased grade 3 toxicity (P<.001). At long-term follow-up, 29.8% of patients presented temporary or permanent hyperpigmentation or telangiectasia or fibrosis (grade 1: 23.6%; grade 2: 5.2%; grade 3: 1%), with higher rates among smokers (P=.06); 274 patients (34.4%) underwent breast reconstruction. Only 24 patients (3%) had early esophagitis of grade 1. Only 3 patients developed ischemic heart disease: all had been treated by anthracycline-based CT with or without trastuzumab, all had been irradiated to the left chest wall and LN, and all presented numerous cardiovascular risk factors (2-4 factors). Conclusions: This study demonstrated the good efficacy of this technique in terms of

  2. Long-term exposure to benzalkonium chloride disinfectants results in change of microbial community structure and increased antimicrobial resistance. (United States)

    Tandukar, Madan; Oh, Seungdae; Tezel, Ulas; Konstantinidis, Konstantinos T; Pavlostathis, Spyros G


    The effect of benzalkonium chlorides (BACs), a widely used class of quaternary ammonium disinfectants, on microbial community structure and antimicrobial resistance was investigated using three aerobic microbial communities: BACs-unexposed (DP, fed a mixture of dextrin/peptone), BACs-exposed (DPB, fed a mixture of dextrin/peptone and BACs), and BACs-enriched (B, fed only BACs). Long-term exposure to BACs reduced community diversity and resulted in the enrichment of BAC-resistant species, predominantly Pseudomonas species. Exposure of the two microbial communities to BACs significantly decreased their susceptibility to BACs as well as three clinically relevant antibiotics (penicillin G, tetracycline, ciprofloxacin). Increased resistance to BACs and penicillin G of the two BACs-exposed communities is predominantly attributed to degradation or transformation of these compounds, whereas resistance to tetracycline and ciprofloxacin is largely due to the activity of efflux pumps. Quantification of several key multidrug resistance genes showed a much higher number of copies of these genes in the DPB and B microbial communities compared to the DP community. Collectively, our findings indicate that exposure of a microbial community to BACs results in increased antibiotic resistance, which has important implications for both human and environmental health.

  3. Long-Term Results from Evaluation of Advanced New Construction Packages in Test Homes: Lake Elsinore, California

    Energy Technology Data Exchange (ETDEWEB)

    Stecher, D.; Brozyna, K.


    This report presents the long-term evaluation results from a hot-dry climate project that examines the room-to-room temperature conditions that exist in a high performance envelope, the performance of a simplified air distribution system, and a comparison of modeled energy performance with measured energy use. The project, a prototype house built by K. Hovnanian Homes' Ontario Group, is located in Lake Elsinore, Riverside County, California, and achieves a 50% level of whole house source energy savings with respect to the Building America (BA) Benchmark Definition 2009 (Hendron and Engebrecht 2010). Temperature measurements in three rooms indicate that the temperature difference between the measured locations and the thermostat were within recommendations 90.3% of the time in heating mode and 99.3% of the time in cooling mode. The air distribution system is operating efficiently with average delivered temperatures adequate to facilitate proper heating and cooling and only minor average temperature differences observed between the system's plenum and farthest register. Monitored energy use results for the house indicate that it is using less energy than predicted from modeling. A breakdown of energy use according to end use determined little agreement between comparable values.

  4. Impact of burnout and psychosocial work characteristics on future long-term sickness absence. Prospective results of the Danish PUMA-study among human service workers

    DEFF Research Database (Denmark)

    Borritz, Marianne; Christensen, KB; Bültmann, Ute


    Objectives: The objective of this study was to examine if burnout and psychosocial factors predicted long-term sickness absence (>2 weeks) at work unit level. Methods: Data were collected prospectively at 82-work units in human services (PUMA cohort, PUMA: Danish acronym for Burnout, Motivation...... and Job satisfaction) followed up during the proceeding 18 months regarding onset of long-term sickness absence. Questionnaire data regarding burnout and psychosocial factors were aggregated at work unit level. We used Poisson regression models with psychosocial factors and burnout as predictors of long......-term sickness absence for more than 18 months based on data from a national absence register. Results: Long-term sickness absence was predicted by psychosocial factors and by burnout at work unit level. Conclusion: To reduce sickness absence, organizations within human services should improve the psychosocial...

  5. 5-fluorouracil and weekly oxaliplatin combined with radiotherapy for locally advanced rectal cancer: surgical complications and long-term results. (United States)

    Pucciarelli, Salvatore; Urso, Emanuele; DeSalvo, Gian Luca; Aschele, Carlo; Friso, Maria Luisa; Rugge, Massimo; Toppan, Paola; Bruttocao, Andrea; Fabris, Giuliano; Ferraro, Benito; Lonardi, Sara; Frego, Mauro; Finco, Cristiano; Lise, Mario; Nitti, Donato


    We undertook this study to evaluate early surgical complications and long-term results after preoperative radiotherapy and chemotherapy (RCT) using 5-fluorouracil (5-FU) and oxaliplatin (OXA) for rectal cancer. Forty six TNM stage II-III rectal cancer patients were studied, who were given preoperative RT (50.4 Gy/28 fractions) combined with 5-FU (200-225 mg/m(2)/day by continuous venous infusion) and weekly OXA (25-60 mg/m(2)). Major complications and reoperations were recorded overall, whereas outcome analyses were performed only for patients who received the recommended regimen dosage. Forty three patients (M:F, 25:18; median age 59 years) were available for analysis. All patients received the planned RT dose. There were no postoperative deaths; seven patients had early major surgical complications, four requiring re-operation. One additional patient had a second surgical procedure due to a duodenal fistula complicating the resection of an aortic aneurysm performed concomitantly with rectal cancer surgery. At a median follow-up of 49 months, two of the 23 patients treated at the recommended doses developed recurrence (one local, and one local and distant), and two died of cancer progression. Following the Kaplan-Meier method, the estimated 5-year overall and disease-free survival rates were 92 and 89%, respectively. The preoperative RCT regimen used in the present study incurs a low rate of recurrence with an acceptable surgical morbidity.

  6. Long-Term Results of Surgical Treatment for Herniated Discs Using the Technique of Autologous Chondrocyte Transplantation

    Directory of Open Access Journals (Sweden)

    E.G. Pedachenko


    Full Text Available Objective: to evaluate the effectiveness of autologous chondrocyte (AC transplantation in patients after lumbar microdiscectomy in the long-term period. Materials and methods. Transplantation of cryopreserved AC has been carried out in 6 patients 3 months after lumbar microdiscectomy. Evaluation of clinical status was performed using VAS and NASS scales, before and 3 months after microdiscectomy, 1 and 2 years after AC transplantation. In the same period, there were also evaluated magnetic resonance characteristics of hydration of intervertebral disc. Results. According to magnetic resonance imaging, recovery of nucleus pulposus hydrophilicity was found in 4 of 6 patients (66.7 %, who underwent AC transplantation. Pain severity decreased significantly in the early period after microdiscectomy, and 3 months after (by the time of AC transplantation it has reduced by almost 6 times. One and 2 years after this procedure, pain continued to decline steadily. Functional status and quality of life after microdiscectomy significantly improved during first 3 months, and after transplantation they have not changed. Conclusions. Autologous chondrocyte transplantation after lumbar microdiscectomy is a safe method of surgical treatment for degenerative diseases of the spine, it helps to recover the biomechanical properties of the operated intervertebral disc.

  7. A thin tracheal silicone washer to solve periprosthetic leakage in laryngectomies: direct results and long-term clinical effects. (United States)

    Hilgers, Frans J M; Soolsma, Jessica; Ackerstaff, Annemieke H; Balm, Fons J M; Tan, I Bing; van den Brekel, Michiel W M


    Assessment of the immediate results and long-term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage. Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom-made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later. There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8-330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38-240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient. In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage.

  8. Long-Term Reduction in 137Cs Concentration in Food Crops on Coral Atolls Resulting from Potassium Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Robison, W L; Stone, E L; Hamilton, T F; Conrado, C L


    Bikini Island was contaminated March 1, 1954 by the Bravo detonation (U.S nuclear test series, Castle) at Bikini Atoll. About 90% of the estimated dose from nuclear fallout to potential island residents is from cesium-137 ({sup 137}Cs) transferred from soil to plants that are consumed by residents. Thus, radioecology research efforts have been focused on removing {sup 137}Cs from soil and/or reducing its uptake into vegetation. Most effective was addition of potassium (K) to soil that reduces {sup 137}Cs concentration in fruits to 3-5% of pretreatment concentrations. Initial observations indicated this low concentration continued for some time after K was last applied. Long-term studies were designed to evaluate this persistence in more detail because it is very important to provide assurance to returning populations that {sup 137}Cs concentrations in food (and, therefore, radiation dose) will remain low for extended periods, even if K is not applied annually or biennially. Potassium applied at 300, 660, 1260, and 2070 kg ha{sup -1} lead to a {sup 137}Cs concentration in drinking coconut meat that is 34, 22, 10, and about 4% of original concentration, respectively. Concentration of {sup 137}Cs remains low 8 to 10 y after K is last applied. An explanation for this unexpected result is discussed.

  9. Long-Term Reduction in 137Cs Concentration in Food Crops on Coral Atolls Resulting from Potassium Treatment

    Energy Technology Data Exchange (ETDEWEB)

    Robison, W; Stone, E; Hamilton, T; Conrado, C


    Bikini Island was contaminated March 1, 1954 by the Bravo detonation (U.S nuclear test series, Castle) at Bikini Atoll. About 90% of the estimated dose from nuclear fallout to potential island residents is from cesium-137 ({sup 137}Cs) transferred from soil to plants that are consumed by residents. Thus, radioecology research efforts have been focused on removing {sup 137}Cs from soil and/or reducing its uptake into vegetation. Most effective was addition of potassium (K) to soil that reduces {sup 137}Cs concentration in fruits to 3-5% of pretreatment concentrations. Initial observations indicated this low concentration continued for some time after K was last applied. Long-term studies were designed to evaluate this persistence in more detail because it is very important to provide assurance to returning populations that {sup 137}Cs concentrations in food (and, therefore, radiation dose) will remain low for extended periods, even if K is not applied annually or biennially. Potassium applied at 300, 660, 1260, and 1970 kg ha{sup -1} lead to a {sup 137}Cs concentration in drinking coconut meat that is 34, 22, 10, and about 4 % of original concentration, respectively. Concentration of {sup 137}Cs remains low 8 to 10 y after K is last applied. An explanation for this unexpected result is discussed.

  10. [Ahmed glaucoma valve via pars plana access. Long-term results of implantation for therapy refractive glaucoma]. (United States)

    Mazinani, B; Schwarzer, H; Willkomm, A; Weinberger, A; Plange, N; Walter, P; Rössler, G


    Aim of this study is the presentation of long-term results regarding the effectiveness and safety of the implantation of Ahmed glaucoma valve (AGV) devices using a pars plana approach after vitrectomy in the treatment of therapy refractive glaucoma. The implantation of AGV devices using a pars plana approach after vitrectomy was performed in 27 eyes of 22 patients with neovascular glaucoma (n = 7 patients), uveitis (n = 6), complex juvenile secondary glaucoma (n = 4), primary open angle glaucoma (n = 3), pseudoexfoliation glaucoma (n = 1) and nanophthalmus (n = 1). Intraocular pressure, visual acuity and subsequent complications were documented. The mean follow-up period was 23.6 months. Intraocular pressure was significantly reduced from 30.2 mmHg preoperatively to 13 mmHg after a follow-up of 36 months. The mean visual acuity did not change significantly, five eyes required a subsequent explantation of which three were due to AGV-related complications. The implantation of AGV devices using a pars plana approach permits an effective and permanent reduction of intraocular pressure (IOP) even in severe therapy refractive secondary glaucoma; however, the risk of serious sight-threatening complications has to be taken into account.

  11. Motivation and results of a long-term research on pool boiling heat transfer in low gravity

    Energy Technology Data Exchange (ETDEWEB)

    Di Marco, P.; Grassi, W. Lothar [Low gravity and Thermal Advanced Research Laboratory, Dipartimento di Energetica ' ' L. Poggi' ' , Universita di Pisa (Italy)


    This paper summarises the main results of a long-term research, begun more than ten years ago, about the influence of gravity and electric fields on heat transfer. After a somehow detailed analysis of the impact of heat transfer on modern society and of the motivation of low gravity research on this subject, the authors describe their own research work on the effects of gravitational and electric forces on single-phase convection and pool boiling. This research has the twofold aim to investigate the basic mechanisms of convective heat transfer, without the masking effect of gravity, and to identify methods to make free convection possible also in the absence of buoyancy, for space applications. It has been experimentally shown that the application of an external electric field generally enhances the heat exchange between a heated wire and a liquid pool. The single-phase heat transfer coefficient is improved, the nucleate boiling region is extended to higher heat fluxes, by increasing the critical heat flux, CHF, as well as the heat transfer rate in film boiling is augmented. The convective heat exchange is an increasing function of gravity, therefore heat transfer generally deteriorates in low gravity. The application of a sufficiently intense electric field restores the same value of heat transfer coefficient and critical heat flux measured on earth, thus demonstrating the progressive overwhelming of the electrical force on the buoyancy one. (authors)

  12. [Liver resection in the treatment of intrahepatic lithiasis. Immediate and long-term results in a single-center series]. (United States)

    Marín, C; Robles, R; Pastor, P; Parrilla, P


    intrahepatic lithiasis (IHL) is an uncommon entity in our environment. When associated with Caroli s disease or stenosis of the biliary radicals it may be necessary to perform liver resection to provide definitive resolution. We present immediate and long term results in a Spanish series of patients with hepatic resection to treat hepatolithiasis. between January 1996 and December 2007 we performed a liver resection (LR) in 8 patients for IHL. The IHL was associated with Caroli s disease in 3 cases and with stenosis of segmentary radicals in the other 5 cases. It manifested itself as acute cholangitis in 5 cases, as biliary colic in two cases and recurrent pancreatitis in one case. The surgical technique was 1 right hepatectomy, 2 left hepatectomies and 5 segmentary resections. there was no intra- or postoperative mortality. The morbidity rate was 25%. One patient (12%) with Caroli s disease which had malignised to cholangiocarcinoma died in the follow-up period. The remaining 7 patients have had no IHL recurrence after a mean follow-up of 62 +/- 2 months (range: 31-106). in our experience liver resection, either lobar or segmentary, is the treatment for patients with IHL associated with stenosis and dilatation of the bile duct, as it provides complete resolution of the disease with low rates of morbidity and mortality.

  13. [Mitral percutaneous valvuloplasty with Inoue balloon. Long-term results at the National Medical Center " 20 of November" ISSSTE Mexico]. (United States)

    Flores Flores, Jesús; Sánchez Pazarán, José Luis; Vargas Cruz, Antonio; Jiménez Valverde, Arnoldo; Zaragoza Rodríguez, Gregorio; de la Cruz Díaz Cabañas, Alejandro; Robledo Nolasco, Rogelio; Blanco Canto, Mario


    Balloon mitral valvuloplasty has, over the last 15 years, become an established interventional procedure for patients with pliable non-calcified mitral stenosis. In this article we describe the long-term outcome of 100 patients from our hospital (National Medical Center "20 de Noviembre" ISSSTE, Mexico City), who were treated with this procedure. Average follow-up was 38.72 +/- 22.4 months. The procedure was successful in 83.3% of the patients. After the procedure, the average valvular area changed from 0.95 +/- 0.16 to 1.62 +/- 0.24 cm2 (P < 0.001) and, at the end of the follow-up time, it was 1.57 +/- 0.29. The trans-valvular mean gradient changed from 8.80 +/- 3.67 mm Hg to 4.74 +/- 1.90 mmHg (P < or = 0.001). Complications occurred in 7.0% of the patients, the most important one being acute mitral insufficiency due to valvular rupture. No deaths occurred. Balloon valvuloplasty is an effective method in patients with Wilkins score of 8 or less, with minimal risk of complications, and long lasting results. At the end of the follow-up time, patients were in NYAH functional class I.

  14. Does earlier lobectomy result in better long-term pulmonary function in children with congenital lung anomalies? A prospective study. (United States)

    Naito, Yoko; Beres, Alana; Lapidus-Krol, Eveline; Ratjen, Felix; Langer, Jacob C


    Management of asymptomatic congenital pulmonary airway malformations remains controversial when addressing the optimal timing of surgical resection. Neonatal resection is advocated by some based on the theory that earlier lobectomy results in greater compensatory lung growth. We examined whether age at lobectomy is correlated with better pulmonary outcomes as reflected by pulmonary function and exercise testing. Patients who had lobectomy for congenital pulmonary airway malformation between 1985 and 2002 were identified and underwent detailed clinical history, physical examination, pulmonary function testing (total lung capacity, forced vital capacity, forced expiratory volume in 1 second), and exercise testing (power, maximal oxygen uptake [Vo(2)max]). Of 87 patients identified, 47 met the inclusion criteria, and 28 were tested prospectively. Age at the time of lobectomy ranged from 3 days to 56 months. There was no correlation between age at lobectomy and pulmonary function (total lung capacity, P = .408; forced vital capacity, P = .319; forced expiratory volume in 1 second, P = .174) or maximal work capacity (power, P = .280). There was a trend toward lower Vo(2)max in patients who had undergone lobectomy at an older age (Vo(2)max, P = .055). Most children undergoing lobectomy have normal long-term pulmonary function. We found no correlation between age at lobectomy and future pulmonary function. Cardiopulmonary exercise testing should be considered in evaluating functional outcome in these patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. Bone marrow mononuclear cell implantation in myocardial laser channels in the ischemic heart disease surgery. Long-term results (United States)

    Chernyavskiy, Alexander; Fomichev, Alexey; Minin, Stanislav; Nikitin, Nikita


    Background: The problem of incomplete myocardial revascularization for diffuse and distal lesions of the myocardium is still relevant. We assessed the clinical and instrumental long-term results of autologous bone marrow cell (BMC) implantation in laser channels in ischemic heart disease with diffuse and distal coronary disease. 35 coronary heart disease (CHD) patients with diffuse and distal coronary disease during coronary artery bypass grafting (CABG) underwent BMC implantation in laser channels. The control group consisted of 29 patients. All patients in this group underwent only CABG. Clinical and instrumental assessment of the method's effect was carried out at two weeks, six months, and six years after surgery. Indirect revascularization showed more significant decreasing of the functional class (FC) New York Heart Association (NYHA), myocardial perfusion and contractility improvement. Autologous BMC implantation in laser channels is an effective method of CHD surgical treatment if it is impossible to perform direct myocardial revascularization. The indirect revascularization effect is formed in the first six months after surgery and remains at the same level for six years.

  16. Long-term Results of Single-Agent Thalidomide as Initial Therapy for Asymptomatic (Smoldering or Indolent) Myeloma (United States)

    Detweiler-Short, Kristen; Hayman, Suzanne; Gertz, Morie A.; Lacy, Martha Q.; Dispenzieri, Angela; Kumar, Shaji; Zeldenrust, Steven R.; Russell, Stephen J.; Lust, John A.; Kyle, Robert A.; Greipp, Philip R.; Witzig, Thomas E.; Rajkumar, S. Vincent


    We report the long-term follow-up results of a phase II trial of thalidomide for early stage multiple myeloma (MM). Patients were eligible if they had smoldering multiple myeloma (SMM) or indolent MM without need for immediate therapy. Thalidomide was initiated at a dose of 200 mg/day and adjusted as tolerated. Disease progression was defined using modified American Society of Hematology/Food and Drug Administration consensus panel criteria for SMM. Thirty-one patients were enrolled; 29 (19 SMM, 10 indolent MM) were eligible. The median age was 61 years. Median follow up of living patients was 10.2 years (range, 7.5–11.0 years). Ten patients (34%) had a partial response (PR) and nine had minimal response (MR) for an MR plus PR rate of 66%. The median time to progression (TTP) to symptomatic myeloma was 35 months. Median TTP was 61 months in those achieving PR, 39 months with MR, and 9 months among those failing to achieve either MR or PR, p=0.005. Median overall survival from diagnosis was 86 months; median survival from onset of symptomatic myeloma was 49 months. Grade 3–4 non-hematologic adverse events were noted in 55% of patients. Randomized trials are needed to determine the role of early therapy in SMM. PMID:20730790

  17. A Dual Expandable Stent for Treatment of Malignant Colorectal Obstruction: Long-Term Follow-Up Results

    Energy Technology Data Exchange (ETDEWEB)

    Son, Won Young; Kang, Hee; Jung, Gyoo Sik [Dept. of Radiology, Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)


    To analyze the long-term results and to evaluate the efficacy of a dual expandable stent for the treatment of malignant colorectal strictures. Under the fluoroscopic guidance, stents were placed in 60 patients with malignant colorectal strictures. A dual stent consists of two stents, the outer stent was placed into the stricture which was followed by coaxial placement of the inner bare stent. Technical and clinical success rates, complications, patient survival and stent patency during the follow-up period were evaluated in this study. Stent placement was technically successful in 57 of 60 patients (95%). Of them, obstructive symptoms resolved within two days in 12/12 (100%) patients in the preoperative group and in 36/45 (80%) patients in the palliative group. Complications associated with this procedure were perforation (n = 5), migration (n = 3), and tumor overgrowth (n = 2). Each of the six patients in the preoperative group underwent conventional laparotomy and laparoscopic surgery, respectively. The mean interval between stent insertion and surgery was nine days. In the palliative group, the median survival was 159 days (mean; 235) and the median patency of stent was 116 days (mean; 185). 1-month, 3-month, 6-month, 12-month and 24-month stent patency were 75%, 60%, 27%, 13% and 7%, respectively. Insertion of a dual expandable nitinol stent into malignant colorectal obstruction is a safe and effective procedure for the palliative treatment of malignant colorectal obstruction. This procedure is also effective for preoperative decompression.

  18. Comparison of Long-Term Results of Percutaneous Treatment Techniques for Hepatic Cystic Echinococcosis Types 2 and 3b. (United States)

    Akhan, Okan; Salik, Aysun E; Ciftci, Turkmen; Akinci, Devrim; Islim, Filiz; Akpinar, Burcu


    The purpose of this study was to determine the long-term results of a modified catheterization technique for percutaneous treatment of hepatic cystic echinococcosis (CE) types 2 and 3b and to retrospectively compare the results of puncture, aspiration, injection, and reaspiration (PAIR); standard catheterization; and the modified catheterization technique. Seventy-three patients (37 male, 36 female; 75 cysts) with CE types 2 and 3b who underwent percutaneous treatment from March 1991 to August 2008 were included. Informed consent from all patients and approval of the ethics board were obtained. Patients were 6-79 years old. Twenty-three cysts (30.6%) were treated with PAIR, 26 (34.7%) with standard catheterization, and 26 (34.7%) with the modified catheterization technique. The results of the three techniques were statistically compared. Among all patients, the cysts decreased in volume by 61.1% (range, 5-100%). Cysts recurred in 11 (47.8%) patients treated with PAIR, three (11.5%) treated with standard catheterization, and one (3.8%) treated with the modified catheterization technique. The recurrence rate was not significantly different between standard catheterization and the modified catheterization technique (p > 0.05), whereas significantly more recurrences developed after PAIR than with the other two techniques (p < 0.05). Twelve (16.4%) major and 16 (21.9%) minor complications developed. Significantly fewer major complications occurred with PAIR than with the modified catheterization technique, but the difference between standard catheterization and the other two techniques was not significant. Treatment of CE types 2 and 3b with the modified catheterization technique was associated with a recurrence rate lower than what is seen with other techniques, and therefore it appears to be a safe, reliable, and efficient alternative.

  19. Long-Term Follow-Up Comparative Study of Hydroxyapatite and Autologous Cranioplasties: Complications, Cosmetic Results, Osseointegration. (United States)

    Moles, Alexis; Heudes, Pierre Marie; Amelot, Aymeric; Cristini, Joseph; Salaud, Céline; Roualdes, Vincent; Riem, Tanguy; Martin, Stéphane André; Raoul, Sylvie; Terreaux, Luc; Bord, Eric; Buffenoir, Kevin


    A three-dimensional reconstruction technique using the CustomBone (CB) prosthesis allows custom-made cranioplasty (CP) possessing osseointegration properties owing to its porous hydroxyapatite (HA) composition. This reconstruction technique has replaced less expensive techniques such as subcutaneously preserved autologous bone (SP). Our primary objective was to evaluate complications between CB and SP CP techniques. A secondary objective was to assess cosmetic results and osseointegration of CPs. This single-center study comprised patients undergoing delayed CB or SP CP after craniectomy between 2007 and 2014. A prospective interview was conducted to collect all data, including 2-year follow-up clinical and radiologic data. Cosmetic results were assessed by a qualitative score, and osseointegration was assessed by measuring relative fusion at the CP margins. Of 100 patients undergoing CB or SP CP between 2007 and 2014, 92 (CB, n = 44; SP, n = 48) participated in the prospective interview. No significant difference in complication rates was observed between the 2 groups. The main complication specific to the CB group was fracture of the prosthesis observed in 20.8% patients. A higher rate of good cosmetic results was observed in the CB group (92.5% vs. 74.3%, P = 0.031). In the CB group, 51% of patients demonstrated no signs of bone fusion of the CP. Although the CB prosthesis is associated with cosmetic advantages, the porous hydroxyapatite composition makes it fragile in the short-term and long-term, and effective osseointegration remains uncertain. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of Hallux Valgus Deformity: Intermediate and Long-Term Results. (United States)

    Bock, Peter; Kluger, Rainer; Kristen, Karl-Heinz; Mittlböck, Martina; Schuh, Reinhard; Trnka, Hans-Joerg


    Little is known about the long-term results of surgical correction of hallux valgus deformity, in particular, the recurrence rate and factors leading to recurrence. Of one hundred and eight patients (115 feet) who underwent a Scarf osteotomy, ninety-three patients (ninety-three feet) were examined at an average duration of follow-up of 124 months. Clinical examination before surgery and at the time of final follow-up included an evaluation of range of motion, pain as measured with a visual analog scale, and American Orthopaedic Foot & Ankle Society (AOFAS) scores. The Foot and Ankle Outcome Score (FAOS) was also assessed postoperatively. Radiographic data were evaluated preoperatively, at six weeks postoperatively, and at the time of final follow-up. Additional radiographic data were available for seventy-nine patients of the same patient cohort at an average of twenty-seven months postoperatively. The median overall AOFAS score improved from 57 points preoperatively to 95 points at the time of final follow-up. All radiographic measurements (hallux valgus angle [HVA], intermetatarsal angle [IMA], distal metatarsal articular angle [DMAA], and sesamoid bone position) showed significant (p < 0.05) improvement at the time of final follow-up compared with preoperatively. The rate of recurrence (an HVA of ≥20°) at the time of final follow-up was 30%. We were unable to determine if recurrence resulted in functional impairment or consequences for quality of life. The recurrence rate after ten years was 30%, and a higher final HVA resulted in higher pain levels. The limitations imposed by nonvalidated outcome measures precluded conclusions about the influence of HVA on function or quality of life. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  1. Long-term results of non-valved Glaucoma drainage implant surgery and glaucoma drainage implant combined with trabeculectomy

    Directory of Open Access Journals (Sweden)

    Teruhiko Hamanaka


    Full Text Available Purpose: The purpose was to investigate the efficacy and complications of nonvalved glaucoma drainage implant (GDI surgery and GDI combined with trabeculectomy. Subjects and Methods: Serial Japanese patients who received GDI were retrospectively investigated. The survival rate of eyes was analyzed using the Kaplan-Meier method, defining death as: (1 Intraocular pressure (IOP <6 mmHg, or ≥22 mmHg, and <20% reduction of preoperative IOP, (2 additional glaucoma surgery, (3 loss of light perception. Prognostic factors of age, sex, previous surgery, type of glaucoma, synechial closure, preoperative IOP, type of GDI (single-, double-plate Molteno, Baerveldt 350 and GDI combined with trabeculectomy were investigated employing proportional hazards analysis. Results: One hundred and twenty-four eyes of 109 patients aged 53.3 ± 7.8 years old were analyzed. Types of GDI were single-plate (15.3%, double-plate Molteno (71.8%, and Baerveldt 350 (12.9%. The results of survival rate analysis were 86.1, 71.1, 71.1, and 64.6% for 1, 3, 5, and 10 years respectively. Thirty-four eyes (27.4% died because of uncontrolled IOP (19.4%, loss of light perception (5.6%, and additional glaucoma surgery (2.4%. Single-plate Molteno was the only risk factor for failure. Persistent unphysiological hypotony (0.8% and bullous keratopathy (5.6% were observed. Conclusion: Nonvalved GDI surgery and GDI combined with trabeculectomy using nonabsorbable tube ligature proved to be an excellent device for any type of glaucoma in Japanese patients. Hypotony and corneal endothelial loss are the most serious complication in the long-term results of our patients.

  2. Long-term Results of Lateral Band Translocation for the Correction of Swan Neck Deformity in Cerebral Palsy

    NARCIS (Netherlands)

    de Bruin, Marije; van Vliet, Daphne C.; Smeulders, Mark J.; Kreulen, Mick


    Purpose: The aim of this study was to evaluate the long-term effect of lateral band translocation for correcting swan neck deformity in patients with cerebral palsy at a minimum follow-up of 5 years. Methods: Swan neck deformities of 62 fingers were corrected using a modified lateral band

  3. Long-term results of NOPHO ALL-92 and ALL-2000 studies of childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Schmiegelow, K; Forestier, E; Hellebostad, M


    Analysis of 2668 children with acute lymphoblastic leukemia (ALL) treated in two successive Nordic clinical trials (Nordic Society of Paediatric Haematology and Oncology (NOPHO) ALL-92 and ALL-2000) showed that 75% of all patients are cured by first-line therapy, and 83% are long-term survivors...

  4. Changing forest water yields in response to climate warming: results from long-term experimental watershed sites across North America (United States)

    Irena F. Creed; Adam T. Spargo; Julia A. Jones; Jim M. Buttle; Mary B. Adams; Fred D. Beall; Eric G. Booth; John L. Campbell; Dave Clow; Kelly Elder; Mark B. Green; Nancy B. Grimm; Chelcy Miniat; Patricia Ramlal; Amartya Saha; Stephen Sebestyen; Dave Spittlehouse; Shannon Sterling; Mark W. Williams; Rita Winkler; Huaxia. Yao


    Climate warming is projected to affect forest water yields but the effects are expected to vary.We investigated how forest type and age affect water yield resilience to climate warming. To answer this question, we examined the variability in historical water yields at long-term experimental catchments across Canada and the United States over 5-year cool and warm...

  5. Whipple's operation for carcinoma of the pancreatic head and the ampullary region. Short-and long-term results

    DEFF Research Database (Denmark)

    Sørensen, M B; Banner, Jytte; Rokkjaer, M


    In this retrospective review short- and long-term perspectives have been evaluated for 108 patients who, during 1982 through 1992, had Whipple's operation performed for carcinoma of the pancreatic head (PC, n=63) or the ampullary region (AC, n=45). In 24 patients the operation was not radical (21...... with PC and 3 with AC)....

  6. The Results of Short-Term Bilingual Exchanges Keep on Ticking: Long-Term Impacts of Brief Bilingual Exchanges (United States)

    Mady, Callie


    This article presents the long-term impacts of brief bilingual (English/French) exchanges as identified by past exchange participants through questionnaire and interview responses. The findings indicate that former exchange participants (a) have confidence in their language abilities, (b) continue to use their second language, (c) choose leisure…

  7. Socio-demographic and clinical characteristics of benzodiazepine long-term users: Results from a tertiary care center. (United States)

    Cosci, F; Mansueto, G; Faccini, M; Casari, R; Lugoboni, F


    The use of benzodiazepines (BDZs) represents a critical issue since a long-term treatment may lead to dependence. This study aimed at evaluating socio-demographic and clinical characteristics of BZD long-term users who followed a detoxification program at a tertiary care center. Two hundred-five inpatients were evaluated. Socio-demographic (e.g., gender, age, education) and clinical information (e.g., BZD used, dose, reason of prescription) was collected. BZDs dose was standardized as diazepam dose equivalents and was compared via the Defined Daily Dose (DDD). Chi-square, Fisher test, ANOVA and Bonferroni analyses were performed. Females were more frequently BDZ long-term users than males. Hypnotic BZDs were frequently prescribed for problems different from sleep disturbances. Lorazepam, alprazolam, and lormetazepam were the most prescribed drugs. Lorazepam was more frequently used by males, consumed for a long period, in pills, and prescribed for anxiety. Lormetazepam was more frequently consumed by females with a high school education, having a psychiatric disorder, taken in drops and prescribed for insomnia. Lormetazepam had the highest DDD. A specific profile of BZD long-term user seems to exist and presents different socio-demographic and clinical characteristics according to the benzodiazepine taken into account. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Abductor pollicis longus tendon interposition for arthrosis of the first carpo-metacarpal joint. Long-term results. (United States)

    Lied, Line; Bjørnstad, Kari; Woje, Ann K N; Finsen, Vilhjalmur


    We performed an interposition arthroplasty using the abductor pollicis longus tendon for arthrosis in the basal joint of the thumb that needed surgery from 1995 to 2010. In 2001 47 patients (55 thumbs) were reviewed after 3.5 (1-5) years. The pain relief was excellent in 32 thumbs, and 25 patients improved their ability to perform daily tasks. Mobility was well preserved. Key pinch and grip strengths averaged 78% and 89%, respectively, of those in unaffected hands. We have now re-examined all 33 available patients (36 thumbs) 11-14 years after surgery. Fourty one of the originally examined patients were still alive. Seven were too ill to attend a follow-up and one refused. The remainder were examined in a fashion as similar as possible to that at the original review. The patients' subjective estimations of pain during the last week and satisfaction with the cosmetic and general results were recorded on visual analogue scales. The patients' ability to perform various activities of daily living were recorded and they completed the Disability of the arm, shoulder and hand (DASH) questionnaire. The mobility of the wrist and abduction of the thumb of the operated hands were recorded with a goniometer. Grip and pinch strength were measured and new radiographs were obtained. Key pinch strength had increased significantly over the last 10 years. The mobility was still good, except for thumb abduction, which had decreased with time. The median DASH score had fallen from 28 to 20 between the two reviews. There was insignificant further median loss of distance between the scaphoid and the metacarpal since the earlier review. The good results of this procedure found soon after surgery are maintained long-term.

  9. Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup

    Directory of Open Access Journals (Sweden)

    Nunzio Catena


    Full Text Available Background:In children less than 6 years, the treatment of femoral shaft fracture is often non surgical, using closed reduction and casting. The literature reports many experience about this type of trauma but none of these has a long term followup. We present a retrospective study on a group of femoral diaphyseal fractures treated nonsurgically in children up to 6 years of age, with a minimum of 10 year followup. Materials and Methods:48 cases (36 males/12 females with femoral diaphyseal fractures treated between January 1988 and December 1998 were reviewed. Patients with fractures due to obstetrical trauma and pathologic fractures were excluded. The mean age of the patients was 3.3 ± 1.1 years (range 5 months-6 years. Right side was involved in 21 cases (44%, and left side in 27 cases (56%. In 34 cases (71%, closed reduction was performed and hip spica was applied with the hip and knee flexed to 45΀. In 8 cases (17%, skeletal traction was applied to perform fracture reduction and the traction pin was embedded in plaster while in the remaining 6 cases (12%, the Delitala pressure apparatus was applied after casting. Results:All fractures healed in our study. There were no complications (infection or vascular nervous issues, axial deviations, consolidation delays, or pseudoarthrosis. In 13 cases (27%, followup examinations showed mean lengthening of 1.3 ± 0.75 (range 0.5-2.5 cm of the fractured lower limb. All these patients were treated with skin traction before treatment and presented with 2.08 ± 0.28 cm mean initial femoral shortening. In 1 case (2% with 2.5 cm lengthening, epiphysiodesis of the ipsilateral knee was performed. No patients showed prolonged difficulty with gait disorders. Conclusion:On the basis of our results conservative treatment of femoral shaft fractures in children can be considered less invasive and safe procedure.

  10. US-Guided Vacuum-Assisted Biopsy of Microcalcifications in Breast Lesions and Long-Term Follow-Up Results (United States)

    Kim, Hua Sun; Kim, Eun-Kyung; Kwak, Jin Young; Son, Eun Ju; Oh, Ki Keun


    Objective To evaluate the diagnostic accuracy of the use of an ultrasonography (US)-guided vacuum-assisted biopsy for microcalcifications of breast lesions and to evaluate the efficacy of the use of US-guided vacuum-assisted biopsy with long-term follow-up results. Materials and Methods US-guided vacuum-assisted biopsy cases of breast lesions that were performed between 2002 and 2006 for microcalcifications were retrospectively reviewed. A total of 62 breast lesions were identified where further pathological confirmation was obtained or where at least two years of mammography follow-up was obtained. These lesions were divided into the benign and malignant lesions (benign and malignant group) and were divided into underestimated group and not-underestimated lesions (underestimated and not-underestimated group) according to the diagnosis after a vacuum-assisted biopsy. The total number of specimens that contained microcalcifications was analyzed and the total number of microcalcification flecks as depicted on specimen mammography was analyzed to determine if there was any statistical difference between the groups. Results There were no false negative cases after more than two years of follow-up. Twenty-nine lesions were diagnosed as malignant (two invasive carcinomas and 27 carcinoma in situ lesions). Two of the 27 carcinoma in situ lesions were upgraded to invasive cancers after surgery. Among three patients diagnosed with atypical ductal hyperplasia, the diagnosis was upgraded to a ductal carcinoma in situ after surgery in one patient. There was no statistically significant difference in the number of specimens with microcalcifications and the total number of microcalcification flecks between the benign group and malignant group of patients and between the underestimated group and not-underestimated group of patients. Conclusion US-guided vacuum-assisted biopsy can be an effective alternative to stereotactic-guided vacuum-assisted biopsy in cases where

  11. Long-Term Results of Stent Placement in Patients with Outflow Block After Living-Donor-Liver Transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Fujimori, Masashi, E-mail: [Mie University School of Medicine, Department of Radiology (Japan); Yamakado, Koichiro, E-mail:; Takaki, Haruyuki, E-mail: [Hyogo College of Medicine, Department of Radiology (Japan); Nakatsuka, Atsuhiro, E-mail:; Uraki, Junji, E-mail:; Yamanaka, Takashi, E-mail:; Hasegawa, Takaaki, E-mail:; Sugino, Yuichi, E-mail:; Nakajima, Ken, E-mail:; Matsushita, Naritaka, E-mail: [Mie University School of Medicine, Department of Radiology (Japan); Mizuno, Shugo, E-mail: [Mie University School of Medicine, Hepatobiliary Pancreatic and Transplant Surgery (Japan); Sakuma, Hajime, E-mail: [Mie University School of Medicine, Department of Radiology (Japan); Isaji, Shuji, E-mail: [Mie University School of Medicine, Hepatobiliary Pancreatic and Transplant Surgery (Japan)


    PurposeTo evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT).Materials and MethodsFor this institutional review board approved retrospective study conducted during 2002–2012, stents were placed in outflow veins in 15 patients (11.3 %, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4–69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complications were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT.ResultsStents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100 %, 15/15). Clinical manifestations improved in 11 patients (73.3 %, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7 %, 4/15) who died in the hospital 1.0–3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2 %, p = .405).ConclusionStenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.

  12. Spot Scanning-Based Proton Therapy for Intracranial Meningioma: Long-Term Results From the Paul Scherrer Institute

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Damien C., E-mail: [Radiation Oncology, Geneva University Hospital, Geneva (Switzerland); Schneider, Ralf; Goitein, Gudrun; Koch, Tamara; Ares, Carmen; Geismar, Jan H.; Schertler, Andreas; Bolsi, Alessandra; Hug, Eugen B. [Center for Proton Therapy, Paul Scherrer Institute, Viligen (Switzerland)


    Background: To assess the long-term clinical results of spot scanning proton therapy (PT) in the treatment of intracranial meningiomas. Patients and Methods: Thirty-nine patients with meningioma (histologically proven 34/39) were treated with PT between July 1997 and January 2010. Thirty-two (82.1%) patients were treated as primary treatment (exclusive PT, n = 8; postoperative PT, n = 24). Mean age was 48.3 {+-} 17.9 years and 32 (82.1%) patients had skull base lesions. For patients undergoing surgery, 24 patients had a diagnosis of World Health Organization (WHO) Grade I and 10 of a WHO Grade II/III meningioma, respectively. The female-to-male ratio was 3.3. The median administered dose was 56.0 Gy (relative biologic effectiveness [RBE]) (range, 52.2-66.6) at 1.8-2.0 Gy (RBE) per fraction. Gross tumor volume (GTV) ranged from 0.76 to 546.5 cm{sup 3} (median, 21.5). Late toxicity was assessed according to Common Terminology Criteria for Adverse Events version 3.0. Mean follow-up time was 62.0 months and all patients were followed for >6 months. Results: Six patients presented with tumor recurrence and 6 patients died during follow-up, of which 4 of tumor progression. Five-year actuarial local control and overall survival rates were 84.8% and 81.8%, respectively, for the entire cohort and 100% for benign histology. Cumulative 5-year Grade {>=}3 late toxicity-free survival was 84.5%. On univariate analysis, LC was negatively influenced by WHO grade (p = 0.001), GTV (p = 0.013), and male gender (p = 0.058). Conclusions: PT is a safe and effective treatment for patients with untreated, recurrent, or incompletely resected intracranial meningiomas. WHO grade and tumor volume was an adverse prognostic factor for local control.

  13. Long-Term Outcomes of Bariatric and Metabolic Surgery in Japan: Results of a Multi-Institutional Survey. (United States)

    Haruta, Hidenori; Kasama, Kazunori; Ohta, Masayuki; Sasaki, Akira; Yamamoto, Hiroshi; Miyazaki, Yasuhiro; Oshiro, Takashi; Naitoh, Takeshi; Hosoya, Yoshinori; Togawa, Takeshi; Seki, Yosuke; Lefor, Alan Kawarai; Tani, Toru


    The number of bariatric procedures performed in Japan is increasing. There are isolated reports of bariatric surgery, but there have been no nationwide surveys including long-term data. We retrospectively reviewed data for patients who underwent bariatric and metabolic surgery throughout Japan and reviewed outcomes. Surveys were sent to ten institutions for number of procedures, preoperative patient weight and preoperative obesity-related comorbidities, and data at 1, 3, and 5 years postoperatively. Improvement of type 2 diabetes mellitus at 3 years after surgery was stratified by baseline ABCD score, based on age, body mass index, C-peptide level, and duration of diabetes. Replies were received from nine of the ten institutions. From August 2005 to June 2015, 831 patients, including 366 males and 465 females, underwent bariatric procedures. The mean age was 41 years, and mean BMI was 42 kg/m 2 . The most common procedure was laparoscopic sleeve gastrectomy (n = 501, 60 %) followed by laparoscopic sleeve gastrectomy with duodenojejunal bypass (n = 149, 18 %). Laparoscopic Roux-en-Y gastric bypass was performed in 100 patients (12 %), and laparoscopic adjustable gastric banding was performed in 81 (10 %). At 3 years postoperatively, the remission rate of obesity-related comorbidities was 78 % for diabetes, 60 % for hypertension, and 65 % for dyslipidemia. Patients with complete remission of diabetes at 3 years postoperatively had a higher ABCD score than those without (6.4 ± 1.6 vs 4.2 ± 2.0, P Bariatric and metabolic surgery for Japanese morbidly obese patients is safe and effective. These results are comparable with the results of previous studies.

  14. Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is technically feasible with acceptable long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Laxdal, E. [Department of Vascular Surgery, Haukeland University Hospital, Bergen (Norway) and Department of Surgical Sciences, University of Bergen, Bergen (Norway)]. E-mail:; Wirsching, J. [Department of Radiology, Haukeland University Hospital, Bergen (Norway); Jenssen, G.L. [Department of Radiology, Haukeland University Hospital, Bergen (Norway); Pedersen, G. [Department of Vascular Surgery, Haukeland University Hospital, Bergen (Norway); Department of Surgical Sciences, University of Bergen, Bergen (Norway); Aune, S. [Department of Vascular Surgery, Haukeland University Hospital, Bergen (Norway); Daryapeyma, A. [Department of Vascular Surgery, Haukeland University Hospital, Bergen (Norway)


    Objectives: To investigate the results of endovascular treatment of symptomatic, atherosclerotic lesions of the infrarenal aorta. Patients and method: This is a retrospective study including 30 procedures performed on 25 patients in the period from 1990 through 2003. There were 16 women (64%) and 9 men, with a mean age of 55 years (range 35-81 years). The indication was disabling intermittent claudication in all cases. Preoperative assessment was done with ankle-arm pressure measurement and angiography. The mean length of the lesions was 2.5 cm (range 1-6 cm). One lesion was a short occlusion and nine were >90% stenoses. The remaining 20 lesions were significant (>70%) stenoses. The procedure was done with PTA alone in 13 cases, and with additional stenting in 17. Results: The procedures were technically successful in 28 cases and clinically successful in all 30. In two cases, a >50% residual stenosis was not dilated further because of stretch pain. The mean observation time was 40 months (range 0-135 months). The primary 2 and 5 year patency rates calculated on basis of intention to treat were 90 and 77%. The primary assisted patency rate was 90% at 2 years and 83% at 5 years. Eight patients developed significant restenosis, of which five were treated with a new endovascular procedure. Two failures were treated conservatively and one with surgical thrombendarterectomy. Conclusion: Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is feasible in patients with suitable anatomy. Clinical success rates are high and long-term patency is good. Complications are few and minor. The majority of failures are amenable to new endovascular treatment.

  15. Long-term Results of Chronic Achilles Tendon Ruptures Repaired With V-Y Tendon Plasty and Fascia Turndown. (United States)

    Guclu, Berk; Basat, H Cagdas; Yildirim, Tugrul; Bozduman, Omer; Us, Ali Kemal


    This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society's (AOFAS's) Ankle-Hind Foot Scale score. Mean follow-up duration was 16 years (13-18 years). Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. Level III, retrospective comparative study. © The Author(s) 2016.

  16. 140 consecutive cases of minimally invasive, radio-guided parathyroidectomy: lessons learned and long-term results. (United States)

    Shabtai, M; Ben-Haim, M; Muntz, Y; Vered, I; Rosin, D; Kuriansky, J; Zmora, O; Olchovski, D; Ayalon, A; Zwas, S T


    The advent of highly accurate parathyroid imaging and the ever-increasing trend towards minimally invasive procedures have changed considerably the surgical approach to the patient with primary hyperparathyroidism (PHPT) caused by a single parathyroid adenoma. This study analyzes the short- and longer-term results of 140 patients who underwent minimally invasive, radio-guided parathyroidectomy. Demographic, clinical, and pre-operative imaging data, operative findings, and short- and long-term results of 140 consecutive patients operated within a 20 months period (8/1999-4/2002), were prospectively entered into a database. Immediate pre-operative sestamibi scintigraphy with skin marking of focal adenoma uptake were followed by intraoperative hand-held gamma probe for the removal of the parathyroid adenoma by unilateral minimal access surgery. Preoperative and surgical data were analyzed and correlated to outcomes, measured by success or failure to cure PHPT, associated morbidity and mortality, predictive value of localizing studies, and postoperative laboratory results in the immediate as well as long-term period. 140 patients, mean age: 55.1 +/- 14.1 years (range 19-88 years), female to male ratio 94:46 with PHPT proven by concomitantly elevated serum calcium and parathormone (PTH) levels, with a single adenoma identified by sestamibi single photon emission tomography (SPECT) scintigraphy and high-resolution sonography, underwent minimally invasive, radio-guided parathyroidectomy. Mean serum levels of preoperative calcium, phosphorus, and PTH were 11.6 +/- 0.8 mg/dL (range 9.1-14), 3.0 +/- 0.3 mg/dL, and 147.1 +/- 94.3 pg/mL (range 68-784), respectively. Overall, in 3 out of 140 patients (2.1%), focused, minimally invasive surgery failed to identify and remove the adenoma. Positive predictive value when both localizing modalities concurred was 99.2%. Positive predictive value of SPECT scan alone was 97.2%. Overall success rate was 97.8% (137/140). 24 hours

  17. The role of serotonin in the enhancement of long-term memory resulting from predator detection in Lymnaea. (United States)

    Il-Han, Jae; Janes, Tara; Lukowiak, Ken


    Serotonergic systems play important roles in modulating stress-induced arousal and vigilance behaviours. The pond snail, Lymnaea, shows multiple defensive vigilance behaviours in response to the stress associated with predator detection. Predator detection elicited by crayfish effluent (CE), increases the time to re-emerge from the shell and enhances the shadow withdrawal response. More importantly, in Lymnaea, CE enhances the ability to form long-term memory (LTM). We investigated the role of the serotonergic system in these anti-predator responses in Lymnaea. Using a serotonin-receptor antagonist, mianserin, we found that two defensive vigilance behaviours (e.g. increasing the time to re-emerge from their shell and shadow response) elicited by CE were not observed when the serotonergic system was disrupted. Also, methysergide, another serotonin antagonist, blocked the enhanced LTM formation after training in CE. Importantly, mianserin did not alter LTM formation in pond water (PW). These data suggest that a serotonergic system is activated only when Lymnaea detect a predator. When snails were trained in CE using a training procedure that in PW produces a 24-h LTM, a more persistent form of LTM (5 days) occurred. This more persistent form of LTM was abolished after mianserin treatment. Increasing 5-HT levels in the snail by the injection of 5-HT was also associated with enhanced LTM formation. Lastly, we tested whether the osphradium is implicated in CE detection and subsequent enhanced formation of LTM. Cutting the osphradial nerve to the CNS resulted in the loss of the ability to form enhanced LTM in CE. Together, these findings support the hypothesis that the serotonergic system plays a key role in modulating the predator-induced stress responses in Lymnaea.

  18. Intracranial ependymoma: long-term results in a series of 21 patients treated with stereotactic (125iodine brachytherapy.

    Directory of Open Access Journals (Sweden)

    Faycal El Majdoub

    Full Text Available BACKGROUND: We evaluated the long-term outcome in patients harboring intracranial ependymomas treated with interstitial brachytherapy (IBT. METHODS: Twenty-one patients (M/F = 9/12; median age: 29 years; range: 8-70 years, diagnosed with intracranial ependymoma (1 WHO I, 11 WHO II, 9 WHO III were treated with IBT using stereotactically implanted (125Iodine seeds between 1987 and 2010, either primarily, as adjuvant therapy following incomplete resection, or as salvage treatment upon tumor recurrence. Sixteen of 21 patients underwent microsurgical resection prior to IBT; in 5 patients, IBT was performed primarily after stereotactic biopsy for histological diagnosis. The cumulative tumor surface dose ranged from 50-65 Gy treating a median tumor volume of 3.6 ml (range, 0.3-11.6 ml. A median follow-up period of 105.3 months (range, 12.7-286.2 months was evaluated. RESULTS: Actuarial 2-, 5- and 10-years overall- and disease-specific survival rates after IBT were each 90% and 100% at all times for ependymomas WHO I/II, for anaplastic ependymomas WHO III 100%, 100%, 70% and 100%, 100%, 86%, respectively. The neurological status of seven patients improved, while there was no change in 12 and deterioration in 2 patients, respectively. Follow-up MR images disclosed a complete tumor remission in 3, a partial remission in 12 and a stable disease in 6 patients. Treatment-associated morbidity only occurred in a single patient. CONCLUSIONS: This study shows that stereotactic IBT for intracranial ependymomas is safe and can provide a high degree of local tumor control. Due to the low rate of side effects, IBT may evolve into an attractive alternative to microsurgery in ependymomas located in eloquent areas or as a salvage treatment.

  19. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results (United States)

    Valera-Garrido, Fermín; Minaya-Muñoz, Francisco; Medina-Mirapeix, Francesc


    Background Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle. Objective To evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time. Methods A one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4–6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients’ perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates. Results All outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as ‘successful’ at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a ‘successful’ outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks. Conclusions Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term. Trial registration number identifier: NCT02085928. PMID:25122629

  20. Long-term outcome of the adjustable transobturator male system (ATOMS): results of a European multicentre study. (United States)

    Friedl, Alexander; Mühlstädt, Sandra; Zachoval, Roman; Giammò, Alessandro; Kivaranovic, Danijel; Rom, Maximilian; Fornara, Paolo; Brössner, Clemens


    To evaluate the long-term effectiveness and safety of the adjustable transobturator male system (ATOMS ® , Agency for Medical Innovations A.M.I., Feldkirch, Austria) in a European-wide multicentre setting. In all, 287 men with stress urinary incontinence (SUI) were treated with the ATOMS device between June 2009 and March 2016. Continence parameters (daily pad test/pad use), urodynamics (maximum urinary flow rate, voiding volume, residual urine), and pain/quality of life (QoL) ratings (visual analogue scale/Leeds Assessment of Neuropathic Symptoms and Signs, International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]/Patient Global Impression of Improvement [PGI-I]) were compared preoperatively and after intermediate (12 months) as well as after individual maximum follow-up. Overall success rate, dry rate (ATOMS devices are still functioning; 56 (20%) were removed, the most common reason being local titanium intolerance (41%) and leak/dysfunction (30%). The operating time and continence outcome varied between port generations. In this regard the latest port generation (silicone-covered scrotal port) was superior to its predecessors. Primary implantation (P = 0.002), good physical health (P = 0.001), and no history of radiotherapy (P ATOMS device is safe and shows high treatment efficacy and patient satisfaction in the largest cohort study to date. The latest generation, with its pre-attached silicone-covered scrotal port, is superior to its predecessors. Significantly better results were achieved with primary implantation and in those without a history of radiotherapy. © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  1. Efficacy of Long-Term Oral Vitamin B12 Supplementation after Total Gastrectomy: Results from a Prospective Study

    Directory of Open Access Journals (Sweden)

    Joana Moleiro


    Full Text Available Background/Objectives: Vitamin B12 (VB12 deficiency is a common complication after total gastrectomy which may be associated with megaloblastic anemia and potentially irreversible neurologic symptoms. Intramuscular supplementation of VB12 has been considered the standard treatment, although it is associated with high costs and patient discomfort. Patients/Methods: We performed a prospective uncontrolled study (ACTRN12614000107628 in order to evaluate the clinical and laboratory efficacy of long-term oral VB12 supplementation in patients submitted to total gastrectomy. All patients received daily oral VB12 (1 mg/day and were evaluated every 3 months (clinical and laboratory evaluation: hemoglobin, VB12, total iron, ferritin, and folate. Results: A total of 26 patients were included with a mean age of 64 years (29-79. Patients were included with a mean period of 65 months (3-309 after total gastrectomy. At inclusion time, 17/26 patients were under intramuscular VB12, and 9 had not started supplementation yet. There were normal serum VB12 levels in 25/26 patients (mean VB12 serum levels: 657 pg/mL. The mean follow-up period was 20 (8.5-28 months. During follow-up, all patients had normal VB12 levels and there was no need for intramuscular supplementation. The patient with low VB12 levels had an increase to adequate levels, which remained stable. There were no differences with statistical significance among VB12 levels at 6 (867 pg/mL, 12 (1,008 pg/mL, 18 (1,018 pg/mL, and 24 (1,061 pg/mL months. Iron and folate supplementation was necessary in 21 and 7 patients, respectively. Conclusions: Oral VB12 supplementation is effective and safe in patients who underwent total gastrectomy and should be considered the preferential form of supplementation.

  2. Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases

    Directory of Open Access Journals (Sweden)

    Kienast B


    Full Text Available Abstract Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82, 104 patients were male (67,1%. Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AO-FAS-Score and radiographs. 92,7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5% the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63,7 (53-92. Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection.

  3. Long-term results of a randomized clinical trial comparing Roux-en-Y gastric bypass with vertical banded gastroplasty. (United States)

    Werling, M; Fändriks, L; Björklund, P; Maleckas, A; Brandberg, J; Lönroth, H; le Roux, C W; Olbers, T


    The long-term results of Roux-en-$\\hbox{Y}$ gastric bypass (gastric bypass) and vertical banded gastroplasty (VBG) from randomized studies have not been described in detail. Patients were randomized to gastric bypass or VBG. Body mass index (BMI), body composition, eating habits and gastrointestinal hormones were reviewed after 6 years. The frequency of reoperation was assessed up to 10 years after surgery. Sixty-six (80 per cent) of the 82 subjects randomized were assessed for weight and BMI 6 years after surgery, 30 (81 per cent) in the gastric bypass group and 36 (80 per cent) in the VBG group. Intention-to-treat analysis demonstrated greater weight loss after gastric bypass compared with VBG, 6 years after surgery: BMI reduced from 41·8 (95 per cent confidence interval 41·3 to 42·3) to 30·3 (28·6 to 32·0) kg/m(2) for gastric bypass and from 42·3 (42·8 to 44·8) to 32·9 (31·3 to 34·5) kg/m(2) for VBG (P = 0·036). Gastric bypass caused a larger loss of fat mass (P = 0·026) and better preservation of lean tissue (P = 0·009). Patients having a gastric bypass had greater postprandial responses to the satiety hormones glucagon-like peptide 1 and peptide YY (P = 0·003 and P = 0·004 respectively). Ghrelin levels did not differ between the groups. Patients with a gastric bypass maintained a lower intake of fat compared with those having VBG (P = 0·013). Some 89 per cent of patients who initially had VBG had undergone, or were scheduled for, conversion to gastric bypass at latest follow-up. Gastric bypass was superior to VBG regarding weight loss, body composition, dietary composition and postprandial satiety hormone responses. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  4. Long Term Water Level and Chemistry Evolution in Groundwater of the Mississippi Embayment, Arkansas, USA: Preliminary Results (United States)

    Neumann, K.; Dowling, C. B.; Moraru, C.; Hannigan, R. E.


    The Mississippi Embayment, located in the southeastern U.S., is a syncline formed by the northward excursion of the Gulf of Coastal Plain. Structurally, the Mississippi Embayment is a hydrogeological basin consisting of six regional aquifers. These productive aquifers yield good-quality waters. The Mississippi Embayment Regional Ground Water Study group located at Arkansas State University compiled and organized the available water chemistry and groundwater level data from the USGS groundwater monitoring database. The uppermost unconfined horizon forms the Mississippi River Valley Alluvial Aquifer (ALVM), one of the largest unconfined aquifers in the world. The Holocene and Pleistocene ALVM is formed from sand, gravel, and loess. The majority of the groundwater wells (approximately 80%) are drilled in the ALVM. As the groundwater levels have fallen in the unconfined ALVM, more groundwater wells are drilled in the deeper aquifers-the Upper, Middle, and Lower Claiborne Aquifers. The Ecocene Upper Claiborne Aquifer protolith is sand, silt, and clay while the Eocene Middle Claiborne and Lower Claiborne aquifers are sand and minor clay. We focused our investigation of the spatial and temporal evolution of groundwater in the Arkansas section of the Mississippi Embayment by using wells with long term monitoring records (1928 - 2005). Overall, the groundwater levels of the unconfined aquifer (ALVM) have decreased; we have not yet evaluated the lower aquifer water level changes. Attention was paid to rock-water interactions along flowpaths in the ALVM and Upper Claiborne aquifers, and to temporal changes at specific sampling sites. The study is utilizing groundwater pH, cation, anion, and nutrient data in the programs AquaChem and PHREEQE to describe mineral and CO2 saturations in groundwater. First results indicate that the modeling allows the identification of different processes (CO2 pressure, calcite saturation) that control distinct geochemical provinces, e.g. urban

  5. Long-term Results of Active Surveillance in the Göteborg Randomized, Population-based Prostate Cancer Screening Trial. (United States)

    Godtman, Rebecka Arnsrud; Holmberg, Erik; Khatami, Ali; Pihl, Carl-Gustaf; Stranne, Johan; Hugosson, Jonas


    missing the possibility of being able to cure the cancer. It is questionable whether men who are not in the lowest tumor risk group and who have a long remaining life expectancy are suitable candidates for this strategy. Long-term results from this study indicate that some men will miss their chance of cure with active surveillance and it is questionable whether active surveillance is a suitable strategy for men who are not in the lowest tumor risk group and who have a very long remaining life expectancy. Copyright © 2016. Published by Elsevier B.V.

  6. Cinco pacientes, once colgajos libres: resultados a largo plazo Five patients, eleven free flaps: long-term results

    Directory of Open Access Journals (Sweden)

    C. Olvera Caballero


    Full Text Available Los colgajos libres resuelven problemas complejos. En situaciones en donde existe gran pérdida de tejidos u otros métodos reconstructivos han fracasado se puede lograr restablecer la forma y la función utilizándolos. En este trabajo se presentan cinco pacientes en los que se usaron once colgajos libres (2 por paciente en cuatro casos, tres en otro y sus resultados a largo plazo con un mínimo de seguimiento de 7 años y un máximo de 17 años. Las indicaciones para utilizar más de un colgajo libre en un paciente son: reponer un primer colgajo perdido, por complejidad del problema, por experiencia del cirujano o por deseo expreso del paciente para una reconstrucción similar. En nuestra serie, la complejidad del problema fue la principal indicación de usar este método doble y triple. Cuatro pacientes recibieron los colgajos en los miembros inferiores y uno en la cara. Las etiologías encontradas fueron: secuelas de quemaduras en dos casos, secuelas posttraumáticas en otros dos y secuelas postquirúrgicas y de mielomeningocele en uno. Se utilizaron cuatro colgajos de dorsal ancho, cinco escapulares, uno de peroné y uno de gracilis. El seguimiento a largo plazo nos permite mostrar la gran adaptabilidad de los colgajos libres, su resistencia y su valor como procedimiento reconstructivo de primera opciónFree flaps are useful to solve complex problems. Whenever there is an extensive loss of tissues or when other reconstructive methods have failed, they may provide the means to restore shape and function. This paper deals with five patients in whom eleven free flaps were used (two in four patients and three in one more case to solve complex problems. Furthermore, long-term results are reported, with follow-up ranging from 7 to 17 years Indications to use more than one free flap in a patient are: replacing a first flap that was lost, a highly complex problem, the surgeon’s expertise, or when the patient wish for a similar reconstruction. In

  7. Triple valve surgery in the modern era: short- and long-term results from a single centre. (United States)

    Lio, Antonio; Murzi, Michele; Di Stefano, Gioia; Miceli, Antonio; Kallushi, Enkel; Ferrarini, Matteo; Solinas, Marco; Glauber, Mattia


    .002) were found to be significant predictors of late mortality following TVS. The freedom rates from valve-related complications and reoperation at 10 years were 95 ± 2 and 97 ± 2%, respectively. The 10-year freedom rates from thromboembolism and anticoagulation-related haemorrhage were 88 ± 5 and 88 ± 4%, respectively. TVS offers encouraging short-term and long-term patient survival; these good results after TVS in patients with advanced valvular heart disease justify aggressive surgical therapy in these patients. TVS with a minimally invasive approach is feasible and could be another treatment option. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Long-term performance of a transcatheter pacing system: 12-Month results from the Micra Transcatheter Pacing Study. (United States)

    Duray, Gabor Z; Ritter, Philippe; El-Chami, Mikhael; Narasimhan, Calambur; Omar, Razali; Tolosana, Jose M; Zhang, Shu; Soejima, Kyoko; Steinwender, Clemens; Rapallini, Leonardo; Cicic, Aida; Fagan, Dedra H; Liu, Shufeng; Reynolds, Dwight


    Early performance of the Micra transcatheter pacemaker from the global clinical trial reported a 99.2% implant success rate, low and stable pacing capture thresholds, and a low (4.0%) rate of major complications up to 6 months. The purpose of this report was to describe the prespecified long-term safety objective of Micra at 12 months and electrical performance through 24 months. The Micra Transcatheter Pacing Study was a prospective single-arm study designed to assess the safety and efficacy of the Micra VVIR leadless/intracardiac pacemaker. Enrolled patients met class I or II guideline recommendations for de novo ventricular pacing. The long-term safety objective was freedom from a system- or procedure-related major complication at 12 months. A predefined historical control group of 2667 patients with transvenous pacemakers was used to compare major complication rates. The long-term safety objective was achieved with a freedom from major complication rate of 96.0% at 12 months (95% confidence interval 94.2%-97.2%; P performance goal). The risk of major complications for patients with Micra (N = 726) was 48% lower than that for patients with transvenous systems through 12 months postimplant (hazard ratio 0.52; 95% confidence interval 0.35-0.77; P = .001). Across subgroups of age, sex, and comorbidities, Micra reduced the risk of major complications compared to transvenous systems. Electrical performance was excellent through 24 months, with a projected battery longevity of 12.1 years. Long-term performance of the Micra transcatheter pacemaker remains consistent with previously reported data. Few patients experienced major complications through 12 months of follow-up, and all patient subgroups benefited as compared to transvenous pacemaker historical control group. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Long-term analytical performance of hemostasis field methods as assessed by evaluation of the results of an external quality assessment program for antithrombin. (United States)

    Meijer, Piet; de Maat, Moniek P M; Kluft, Cornelis; Haverkate, Frits; van Houwelingen, Hans C


    It is important for a laboratory to know the stability of performance of laboratory tests over time. The aim of this study was to adapt from the field of clinical chemistry a method to assess the long-term analytical performance of hemostasis field methods. The linear regression model was used to compare the laboratory results with the consensus mean value of a survey. This model was applied to plasma antithrombin activity using the data for 82 laboratories, collected between 1996 and 1999 in the European Concerted Action on Thrombosis (ECAT) external quality assessment program. The long-term total, random, and systematic error were calculated. The variables introduced to define the long-term performance in this model were the long-term analytical CV (LCV(a)) and the analytical critical difference (ACD), which indicates the minimum difference necessary between two samples measured on a long-term time-scale to consider them statistically significantly different. The systematic error (bias) ranged from 4.5 to 103 units/L. The random error ranged from 24.4 to 242 units/L. For the majority of the laboratories, random error was the main component (>75%) of the total error. The LCV(a), after adjustment for the contribution of the bias, ranged from 2.8% to 48%. The ACD ranged from 78 to 1290 units/L with a median value of 190 units/L. No statistically significant differences were observed for either LCV(a) or ACD between the two different measurement principles for antithrombin activity based on the inhibition of either thrombin or factor Xa. This linear regression model is useful for assessing the total error, random error, and bias for hemostasis field methods. The LCV(a) and ACD for measurement on a long-term time-scale appear to be useful for assessing the long-term analytical performance.

  10. Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients

    Directory of Open Access Journals (Sweden)

    Cappello Gianfranco


    Full Text Available Abstract Background Only protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion. Methods 19,036 patients (age 44.3 ± 13, M:F = 2:5 with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50–65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females. Results After an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%. Conclusion Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.

  11. Long-term results of suture annuloplasty for degenerative mitral valve disease: a propensity-matched analysis. (United States)

    Garatti, Andrea; Canziani, Alberto; Parolari, Alessandro; Castelvecchio, Serenella; Guazzi, Marco; Daprati, Andrea; Farah, Ali Abu; Grimaldi, Francesco; Tripepi, Sonia; Menicanti, Lorenzo


    Ring annuloplasty is the gold standard of surgical repair in degenerative mitral valve disease. However, prosthetic annuloplasty has some drawbacks and potential hazards. Suture annuloplasty theoretically is able to preserve annular leaflet dynamics and left ventricular performance, but experience is limited. The aim of the study was to review the early and long-term outcome of the posterior double-suture annuloplasty (DSA) technique for degenerative mitral valve repair. From January 2002 to December 2008, 400 patients underwent primary mitral valve repair for degenerative disease either with posterior DSA [n = 147 (37%)] or with flexible posterior annuloplasty band [n = 253 (63%)]. Differences in patient characteristics were addressed by propensity-score matching (132 pairs). A composite end-point of mitral valve failure (MVF) was calculated as the incidence of mitral valve regurgitation greater than 2+ or need for mitral valve replacement at follow-up. After propensity-score matching, the distribution of preoperative variables among matched pairs was, on average, equal. Isolated annuloplasty and leaflet repair techniques were similarly performed in both groups (P = 0.20). In-hospital mortality was comparable between the two study groups (P = 0.48). Predischarge echocardiography showed excellent results regarding valve hemodynamics (P = 0.71). At a mean follow-up of 11 ± 3 years, all-cause mortality (P = 0.12), need for mitral valve replacement (P = 0.49), and cardiac re-hospitalization rate (P = 0.57) resulted comparable between the two groups. Ten-year survival (75 vs. 71%, P = 0.51) and freedom from MVF (92 vs. 84%, P = 0.39) were similar between posterior annuloplasty band and DSA groups. Suture annuloplasty demonstrated comparable results with posterior flexible band repair and could be a viable option for mitral valve surgery in selected patients, such as in the minimally invasive approach, in endocarditis, and in

  12. [Long-term results after multiple trauma with ISS ≥ 25. Outcome and predictors of quality of life]. (United States)

    Simmel, S; Drisch, S; Haag, S; Bühren, V


    The survival chances of multiple trauma patients have continually improved over the last decades; therefore, it is often not a question of whether a patient survives a severe accident but rather how the patient survives. In a retrospective study 127 patients were questioned regarding quality of life and health and possible influencing factors using the POLO chart an average of 70 months after suffering severe trauma (ISS Ø 35.6). The quality of life of severely injured patients is significantly reduced compared with the normal population even years after the trauma. In addition to four pretraumatic factors (older age, female gender, low education and previous illnesses) four posttraumatic variables (difficulties with authorities/institutions and unemployment as a consequence of the accident, long duration and subjectively inadequate treatment in hospital) were identified that have a negative impact on long-term quality of life. The self-reported quality of life after multiple trauma no longer permanently achieves the original level despite extensive rehabilitation measures. Post-traumatic factors have a greater impact on the long-term quality of life than the injury severity. A long-term care and specialized rehabilitation services are needed to improve outcome further.

  13. Consequences of a long-term raw food diet on body weight and menstruation: results of a questionnaire survey. (United States)

    Koebnick, C; Strassner, C; Hoffmann, I; Leitzmann, C


    To examine the relationship between the strictness of long-term raw food diets and body weight loss, underweight and amenorrhea. In a cross-sectional study 216 men and 297 women consuming long-term raw food diets (3.7 years; SE 0.25) of different intensities completed a specially developed questionnaire. Participants were divided into 5 groups according to the amount of raw food in their diet (70-79, 80-89, 90-94, 95-99 and 100%). A multiple linear regression model (n = 513) was used to evaluate the relationship between body weight and the amount of raw food consumed. Odds of underweight were determined by a multinomial logit model. From the beginning of the dietary regimen an average weight loss of 9.9 kg (SE 0.4) for men and 12 kg (SE 0.6) for women was observed. Body mass index (BMI) was below the normal weight range (raw food consumed and the duration of the raw food diet. About 30% of the women under 45 years of age had partial to complete amenorrhea; subjects eating high amounts of raw food (>90%) were affected more frequently than moderate raw food dieters. The consumption of a raw food diet is associated with a high loss of body weight. Since many raw food dieters exhibited underweight and amenorrhea, a very strict raw food diet cannot be recommended on a long-term basis.

  14. Ketogenic enteral nutrition as a treatment for obesity: short term and long term results from 19,000 patients. (United States)

    Cappello, Gianfranco; Franceschelli, Antonella; Cappello, Annalisa; De Luca, Paolo


    Only protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion. 19,036 patients (age 44.3 ± 13, M:F = 2:5) with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50-65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females. After an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%. Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.

  15. Long-term results of radiotherapy for pituitary adenomas. Evaluation of tumor control and hypopituitarism after radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchida, Emiko; Sakai, Kunio; Matsumoto, Yasuo; Sugita, Tadashi; Sasamoto, Ryuta [Niigata Univ. (Japan). School of Medicine


    years were 48.6%, 22.8%, and 75.1%, respectively. Conventional radiotherapy was effective in preventing tumor growth of pituitary adenomas. But the effect of reducing hormone levels in functioning adenomas appeared to require several years after radiotherapy in most cases. Because hypopituitarism occurs in the late period after radiotherapy, long-term follow-up is necessary and mandatory. (author)

  16. Spatial and temporal distribution of the dust deposition in Central Asia - results from a long term monitoring program (United States)

    Groll, M.; Opp, Chr.; Aslanov, I.


    The aeolian transport of dust is an important process in Central Asia. Anthropogenic desertification and the desiccation of the Aral Sea have increased the overall dust emission and transport from this region and the local dust storm frequency during the last decades. Reliable ground data, however, are collected only sporadically, so the knowledge about the spatial and temporal distribution and dynamics of the dust deposition in the Aral Sea basin is fragmented and inconsistent at best. A long-term monitoring program was installed and sustained by three research projects. The results included in this article cover the dust deposition between 2003 and 2010 from 21 stations in Uzbekistan, Kazakhstan, and Turkmenistan. They confirm that the aeolian dust transport occurs mainly in the Southern direction. The highest average monthly deposition rate was registered in Uzbekistan (56.2 g m-2), while the percentage of months with a very intense (and potentially harmful) dust deposition flux was highest in Turkmenistan (36.4%). A majority of samples were collected during months with a dust deposition of less than 10.0 g m-2, while only 6% of all samples showed high monthly deposition intensities of more than 100 g m-2. The Kyzyl Kum, Kara Kum, and Aral Kum were identified as the main sources for aeolian dust in the Aral Sea basin. The impact of the Aral Kum as the dominant source of aeolian dust is limited to a region of approximately 500,000 km2 surrounding the former Aral Sea. The Kara Kum is characterized by a very high frequency of dust storms of a local and regional magnitude, and close to the Kyzyl Kum, monthly dust deposition rates of up to 9,600 g m-2 were registered. An analysis of the temporal distribution of the dust deposition showed a slight increase in the dust deposition activity and intensity between 2003 and 2010, with a strong inter-annual and seasonal dynamic. The highest average dust deposition was registered in June, and a second phase of intense dust

  17. Long Term Sorption Diffusion Experiment (LTDE-SD). Performance of main in situ experiment and results from water phase measurements

    Energy Technology Data Exchange (ETDEWEB)

    Widestrand, Henrik; Byegaard, Johan; Nilsson, Kersti; Hoeglund, Susanne; Gustafsson, Erik (Geosigma AB, Uppsala (Sweden)); Kronberg, Magnus (Swedish Nuclear Fuel and Waste Management Co. (Sweden))


    The LTDE-SD experiment, (Long Term Sorption Diffusion Experiment) aimed at increasing the scientific knowledge of sorption and diffusion under in situ conditions and to provide data for performance and safety assessment calculations. Performance and results of the in situ experiment phase are presented in the report. In total, 21 radionuclide trace elements and one stable trace element were injected, circulated and sampled for approx6.5 months in a closed borehole section. The trace elements represented non-sorbing tracers and sorbing tracers for which the sorption was dominated by a cation exchange mechanism, a surface complexation mechanism, or dependent on an electrochemical reduction in order to reach the tetravalent state (oxidation state IV) considered very strongly sorbing. The borehole section in contact with the tracer labelled groundwater consisted in part of a natural fracture surface and a borehole section in the unaltered matrix rock, devoid of natural fractures. Water samples were regularly extracted and analysed for trace element concentration and a few ion exchange speciation and filtered samplings were also conducted. Independent colloid filtering and chemical speciation calculations were performed in support the evaluation. Sorption was demonstrated for a series of elements present in the experiment. The amounts lost of the different respective tracers from the aqueous phase follow very well the general understanding of the relative sorption strength of the tracers, as inferred from e.g. batch sorption experiments and dynamic in situ tracer experiments. The chemical speciation calculations of the different tracers were in line with the results of the ion exchange speciation performed during the experiment. With the exception of UO{sub 2} 2+ carbonate complexes formed, no strong indications were obtained that aqueous complexation prevents adsorption under the chemical conditions of the experiment. The 20 nm filtered sampling indicated that

  18. The Ross Procedure in Adults: Long-Term Results of Homografts and Stentless Xenografts for Pulmonary Valve Replacement. (United States)

    Christ, Torsten; Claus, Benjamin; Woythal, Nadine; Dushe, Simon; Falk, Volkmar; Grubitzsch, Herko


    Background The Ross procedure is an established method to treat aortic valve disease, offering excellent hemodynamic characteristics, growth potential, low risk of thromboembolism and no need for anticoagulation. Limitation of homograft quality and availability led to the use of different stentless xenografts. Long-term outcome and implications are yet to be addressed. Methods Forty five adult patients (mean age 38.8 ± 9.6 years) with aortic valve stenosis and/or insufficiency, who underwent the Ross procedure between 1995 and 2002 were identified for long-term evaluation. Patients younger than 18 years, with previous heart surgery and endocarditis were excluded. Stentless xenografts were used in 22 cases (Group X) and homografts in 23 cases (Group H). After review of the patients' history, morbidity and mortality were analyzed and risk stratification was performed. Results Between groups, baseline characteristics and operative data did not differ significantly. Total follow-up was 621.0 patient-years and 98.8% complete. Overall freedom from reoperation at 15 years was 68.4 ± 10.6% in group X and 85. ±  7.9% in group H (p = 0.09), respectively. Freedom from aortic valve reoperation at 15 years was comparable (83.9 ± 8.5% in group X and 85.3 ± 7.9% in group H, p = 0.61), whereas freedom from pulmonary valve reoperation at 15 years was significantly lower in group X (78.9 ± 9.4% versus 100%, p = 0.02). Long-term survival at 15 years was 79.7 ± 9.3% in group X and 94.4 ± 5.4% in group H (p = 0.07), respectively. Conclusions Stentless xenografts used as pulmonary valve substitute in the Ross procedure led to lower freedom from pulmonary valve reoperation compared with homografts. Additionally, there was a trend to inferior long-term survival with xenografts. Therefore, homografts should remain the preferred option for pulmonary valve replacement in the Ross procedure. Georg Thieme Verlag KG Stuttgart

  19. Long-term results and complications related to Crurasoft® mesh repair for paraesophageal hiatal hernias. (United States)

    Priego, P; Perez de Oteyza, J; Galindo, J; Carda, P; García-Moreno, F; Rodríguez Velasco, G; Lobo, E


    The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. However, the use of meshes has not completely extended in all the cases of large paraesophageal hiatal hernias (LPHH) due to the complications related to them. The aim of this study is to present our long-term results and complications related to Crurasoft® mesh (Bard) for the treatment of LPHH. From January 2004 to December 2014, 536 consecutive patients underwent open or laparoscopic fundoplication for gastroesophageal reflux disease or LPHH at Ramón y Cajal University Hospital. Primary simple suture of the crura and additional reinforcement with a Crurasoft® mesh (Bard) was performed in 93 patients (17.35 %). Radiologic hiatal hernia recurrence and mesh-related complications were investigated. Of the 93 patients undergoing mesh repair, there were 28 male and 65 female with a mean age of 67.27 years (range 22-87 years). Laparoscopic surgery was attended in 88.2 % of the cases, and open surgery in the rest 11.8 %. Mean operative time was 167.05 min (range 90-370 min). Median postoperative stay was 4.79 days (range 1-41 days). Conversion rate was 8.53 % (7 patients). Intraoperative complications were described in 10.75 % (10 patients), but all of them, except in one case, could be managed laparoscopically. Overall postoperative complications rate was 28 %. Early postoperative complications occurred in 11 patients (12 %), respectively, for grades 2 (6 cases), 3b (1 case) and 5 (4 cases) according to the Clavien-Dindo classification. Late postoperative complications occurred in 15 patients (16 %), respectively, for grades 1 (7 cases), 2 (2 cases), 3b (5 cases) and 5 (1 case) according to the Clavien-Dindo classification. Thirty day-mortality rate was 4.3 %. Mortality rate specific associated with the mesh was 1 %. Reoperation rate was 5.4 %. After a median follow-up of 76.33 months (range 3-130

  20. Reirradiation for recurrent head and neck cancer with salvage interstitial pulsed-dose-rate brachytherapy. Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Strnad, Vratislav; Lotter, Michael; Kreppner, Stephan; Fietkau, Rainer [University Hospital Erlangen, Dept. of Radiation Oncology, Erlangen (Germany)


    To assess the long-term results of protocol-based interstitial pulsed-dose-rate (PDR) brachytherapy as reirradiation combined with simultaneous chemotherapy and interstitial hyperthermia in selected patients with recurrent head and neck tumors. A total of 104 patients with biopsy-proven recurrent head and neck cancer were treated with interstitial PDR brachytherapy. Salvage surgery had also been undergone by 53/104 (51 %) patients (R1 or R2 resection in > 80 % of patients). Salvage brachytherapy alone was administered in 81 patients (78 %), with a median total dose of 56.7 Gy. Salvage brachytherapy in combination with external beam radiotherapy (EBRT) was performed in 23/104 patients (32 %), using a median total dose of D{sub REF} = 24 Gy. Simultaneously to PDR brachytherapy, concomitant chemotherapy was administered in 58/104 (55.8 %) patients. A single session of interstitial hyperthermia was also used to treat 33/104 (31.7 %) patients. The analysis was performed after a median follow-up of 60 months. Calculated according to Kaplan-Meier, local tumor control rates after 2, 5, and 10 years were 92.5, 82.4, and 58.9 %, respectively. Comparing results of salvage PDR brachytherapy with or without simultaneous chemotherapy, the 10-year local control rates were 76 vs. 39 % (p= 0014), respectively. No other patient- or treatment-related parameters had a significant influence on treatment results. Soft tissue necrosis or bone necrosis developed in 18/104 (17.3 %) and 11/104 (9.6 %) patients, respectively, but only 3 % of patients required surgical treatment. PDR interstitial brachytherapy with simultaneous chemotherapy is a very effective and, in experienced hands, also a safe treatment modality in selected patients with head and neck cancer in previously irradiated areas. (orig.) [German] Es erfolgte die Analyse der Langzeitergebnisse einer protokollbasierten interstitiellen Brachytherapie (Re-Bestrahlung) mit simultaner Chemotherapie und interstitieller Hyperthermie

  1. Long-term results of forward intensity-modulated radiation therapy for patients with early-stage breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Boram; Suh, Hyun Suk; Lee, Ji Hae; Lee, Kyung Ja; Lee, Rena; Moon, Byung In [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)


    To observe long-term clinical outcomes for patients with early-stage breast cancer treated with forward intensity-modulated radiation therapy (IMRT), including local control and clinical toxicities. We retrospectively analyzed a total of 214 patients with stage I-II breast cancer who were treated with breast conserving surgery followed by adjuvant breast radiation therapy between 2001 and 2008. All patients were treated using forward IMRT. The whole breast was irradiated to a dose of 50 to 50.4 Gy followed by an 8 to 12 Gy electron boost to the surgical bed. The median age was 46 years (range, 21 to 82 years) and the medial follow-up time was 7.3 years (range, 2.4 to 11.7 years). Stage T1 was 139 (65%) and T2 was 75 (35%), respectively. Ipsilateral breast recurrence was observed in 3 patients. The 5- and 10-year local control rates were 99.1% and 97.8%, respectively. The cosmetic outcome was evaluated according to the Harvard scale and 89.4% of patients were scored as excellent or good. The whole breast radiation therapy as an adjuvant treatment using a forward IMRT technique showed excellent long-term local control as well as favorable outcomes of toxicity and cosmesis.

  2. Esophageal variceal ligation in the secondary prevention of variceal bleeding: Result of long term follow-up. (United States)

    Lahbabi, Mounia; Mellouki, Ihssane; Aqodad, Nouredine; Elabkari, Mohammed; Elyousfi, Mounia; Ibrahimi, Sidi Adil; Benajah, Dafr Allah


    Long-term outcome of patients after band ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation in patients with portal hypertension in the Hassan II university hospital, Fes, Morocco. Over 118 months patients treated by endoscopic variceal ligation were received regular follow- up and detailed clinical assessment of at least 24 months. One hundred twenty five patients were followed up for a mean of 31 months (range 12-107 months). Obliteration of the varices was achieved in 89.6 % (N = 112) of patients, with 3 +/-1.99 (range 1-8) endoscopy sessions over a period of 14 + /-6.8 weeks (range 3-28). The percentage of variceal recurrence during follow-up after ligation was 20.5 % (N = 23). Recurrence were observed in a mean of 22 months +/- 7.3 (range 3-48). Bleeding rate from recurrent varices was 30.4 % (7/23). Rebleeding from esophageal ulcers occurred in 5.6 % (7/125) of patients. Portal hypertensive gastropathy before and after eradication of varices was 17.6% (N = 22) and 44.6% (N = 50) respectively; p 0.05. The overall mortality was 4 % (N = 5). Band ligation was an effective technical approach for variceal obliteration with low rates of variceal recurrence, rebleeding and development of gastric varices. Furthermore, it was associated with frequent development of portal hypertensive gastropathy.

  3. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms with stent-graft: Analysis of immediate and long-term results. (United States)

    Cappucci, Matteo; Zarco, Federico; Orgera, Gianluigi; López-Rueda, Antonio; Moreno, Javier; Laurino, Florindo; Barnes, Daniel; Tipaldi, Marcello Andrea; Gomez, Fernando; Macho Fernandez, Juan; Rossi, Michele


    The aim of this study is to analyze the safety and efficacy of stent-graft endovascular treatment for visceral artery aneurysms and pseudoaneurysms. Multicentric retrospective series of patients with visceral aneurysms and pseudoaneurysms treated by means of stent graft. The following variables were analyzed: Age, sex, type of lesion (aneurysms/pseudoaneurysms), localization, rate of success, intraprocedural and long term complication rate (SIR classification). Follow-up was performed under clinical and radiological assessment. Twenty-five patients (16 men), with a mean age of 59 (range 27-79), were treated. The indication was aneurysm in 19 patients and pseudoaneurysms in 6. The localizations were: splenic artery (12), hepatic artery (5), renal artery (4), celiac trunk (3) and gastroduodenal artery (1). Successful treatment rate was 96% (24/25 patients). Intraprocedural complication rate was 12% (4% major; 8% minor). Complete occlusion was demonstrated during follow up (mean 33 months, range 6-72) in the 24 patients with technical success. Two stent migrations (2/24; 8%) and 4stent thrombosis (4/24; 16%) were detected. Mortality rate was 0%. In our study, stent-graft endovascular treatment of visceral aneurysmns and pseudoaneurysms has demonstrated to be safe and is effective in the long-term in both elective and emergent cases, with a high rate of successful treatment and a low complication rate. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Long-term results of mechanical and biological heart valves in dialysis and non-dialysis patients. (United States)

    Böning, A; Boedeker, R H; Rosendahl, U P; Niemann, B; Haberer, S; Roth, P; Ennker, J A C


    We wanted to answer the question whether biological heart valves are inferior compared to mechanical heart valves in end-stage renal disease (ESRD) patients. Between 01/1996 und 12/2006, 44 of 3293 patients undergoing aortic valve replacement (AVR) in a single institution suffered from dialysis-dependent ESRD and underwent a follow-up investigation after 1.9 years (median). Twelve (28.9 %) of these patients received a biological, 32 (71.1 %) of these patients a mechanical aortic valve prosthesis. To evaluate a possible influence of the valve type (biological/mechanical) on survival, uni- and multivariate logistic regression was used. ESRD patients after AVR had a relatively poor short-term (30-day mortality: 22.7 %) and long-term survival (median survival time: 24.7 months; 95 % CI: 0.2-47.7 months), irrespective of the type of heart valve prosthesis (hazard ratio for mortality depending on heart valve type in dialysis patients: 1.31, P = 0.400). Dialysis-dependent patients were not reoperated due to valve-related reasons. The long-term survival of dialysis-dependent patients after AVR is low (5-year survival: 29.5 %) irrespective of the type of heart valve prosthesis. Therefore, the use of biological AVR is not contraindicated in this group of patients. © Georg Thieme Verlag KG Stuttgart · New York.

  5. The Erlangen Dose Optimization trial for low-dose radiotherapy of benign painful elbow syndrome. Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Ott, O.J.; Hertel, S.; Gaipl, U.S.; Frey, B.; Schmidt, M.; Fietkau, R. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany)


    To evaluate the long-term efficacy of pain reduction by two dose fractionation schedules used for low-dose radiotherapy of painful elbow syndrome. Between February 2006 and February 2010, 199 evaluable patients were recruited for this prospective trial. All patients received low-dose orthovoltage radiotherapy. One course consisted of 6 fractions in 3 weeks. In the case of insufficient pain remission after 6 weeks, a second course was administered. Patients were randomly assigned to one of two groups to receive single doses of either 0.5 or 1.0 Gy. Endpoint was pain reduction. Pain was measured before radiotherapy, as well as immediately after (early response), 6 weeks after (delayed response) and approximately 3 years after (long-term response) completion of radiotherapy using a questionnaire-based visual analogue scale (VAS) and a comprehensive pain score (CPS). Median follow-up was 35 months (range 9-57 months). The overall early, delayed and long-term response rates for all patients were 80, 90 and 94 %, respectively. The mean VAS scores before treatment and those for early, delayed and long-term response in the 0.5- and 1.0-Gy groups were 59.6 ± 20.2 and 55.7 ± 18.0 (p = 0.46); 32.1 ± 24.5 and 34.4 ± 22.5 (p = 0.26); 27.0 ± 27.7 and 23.5 ± 21.6 (p = 0.82) and 10.7 ± 15.0 and 21.5 ± 26.9 (p = 0.12), respectively. The mean CPS values before treatment and those for early, delayed and long-term response were 8.7 ± 2.9 and 8.1 ± 3.1 (p = 0.21); 4.5 ± 3.2 and 5.0 ± 3.4 (p = 0.51); 3.9 ± 3.6 and 2.8 ± 2.8 (p = 0.19) and 1.5 ± 2.3 and 2.4 ± 3.5 (p = 0.27), respectively. No significant differences in the quality of the long-term response were found between the 0.5- and 1.0-Gy arms (p = 0.28). Low-dose radiotherapy is an effective treatment for the management of benign painful elbow syndrome. For radiation protection reasons, the dose for a radiotherapy series should not exceed 3.0 Gy. (orig.) [German] Untersuchung der

  6. Long-term results of the randomized phase III trial EORTC 18991 of adjuvant therapy with pegylated interferon alfa-2b versus observation in resected stage III melanoma

    NARCIS (Netherlands)

    A.M.M. Eggermont (Alexander); S. Suciu (Stefan); A. Testori (Alessandro); M. Santinami (Mario); W.H.J. Kruit (Wim); J. Marsden (Jeremy); C.J.A. Punt (Cornelis); F. Salès (François); R. Dummer (Reinhard); C. Robert (Caroline); D. Schadendorf (Dirk); P. Patel (Poulam); G. de Schaetzen (Gaetan); A. Spatz (Alan); U. Keilholz (Ulrich)


    textabstractPurpose: Adjuvant pegylated interferon alfa-2b (PEG-IFN-α-2b) was approved for treatment of resected stage III melanoma in 2011. Here, we present long-term follow-up results of this pivotal trial. Patients and Methods: In all, 1,256 patients with resected stage III melanoma were randomly

  7. Evaluation of Long-Term Results of Surgical Treatment in Patients with Protrusions and Herniated Discs in Combination with Lumbar Instability

    Directory of Open Access Journals (Sweden)

    O.Ye. Pashkov


    Full Text Available The study of the data from 52 patients with lumbar instability and disc herniation was carried out. The short- and long-term results of surgical treatment, the nature and characteristics of their course in these periods were analyzed. The dependence of the incidence of recurrent pain radicular syndrome on the choice of method of surgical treatment is revealed.

  8. Long-term analysis of the efficacy and tolerability of sorafenib in advanced radio-iodine refractory differentiated thyroid carcinoma: final results of a phase II trial

    NARCIS (Netherlands)

    Schneider, T.C.; Abdulrahman, R.M.; Corssmit, E.P.; Morreau, H.; Smit, J.W.A.; Kapiteijn, E.


    OBJECTIVE: We conducted a prospective phase II clinical trial to determine the efficacy of sorafenib in patients with advanced radio-iodine refractory differentiated thyroid cancer. In this article, the long-term results are presented. PATIENTS AND METHODS: Thirty-one patients with progressive

  9. Long-Term Use of Everolimus in Patients with Tuberous Sclerosis Complex: Final Results from the EXIST-1 Study.

    Directory of Open Access Journals (Sweden)

    David N Franz

    Full Text Available Everolimus, a mammalian target of rapamycin (mTOR inhibitor, has demonstrated efficacy in treating subependymal giant cell astrocytomas (SEGAs and other manifestations of tuberous sclerosis complex (TSC. However, long-term use of mTOR inhibitors might be necessary. This analysis explored long-term efficacy and safety of everolimus from the conclusion of the EXIST-1 study (NCT00789828.EXIST-1 was an international, prospective, double-blind, placebo-controlled phase 3 trial examining everolimus in patients with new or growing TSC-related SEGA. After a double-blind core phase, all remaining patients could receive everolimus in a long-term, open-label extension. Everolimus was initiated at a dose (4.5 mg/m2/day titrated to a target blood trough of 5-15 ng/mL. SEGA response rate (primary end point was defined as the proportion of patients achieving confirmed ≥50% reduction in the sum volume of target SEGA lesions from baseline in the absence of worsening nontarget SEGA lesions, new target SEGA lesions, and new or worsening hydrocephalus. Of 111 patients (median age, 9.5 years who received ≥1 dose of everolimus (median duration, 47.1 months, 57.7% (95% confidence interval [CI], 47.9-67.0 achieved SEGA response. Of 41 patients with target renal angiomyolipomas at baseline, 30 (73.2% achieved renal angiomyolipoma response. In 105 patients with ≥1 skin lesion at baseline, skin lesion response rate was 58.1%. Incidence of adverse events (AEs was comparable with that of previous reports, and occurrence of emergent AEs generally decreased over time. The most common AEs (≥30% incidence suspected to be treatment-related were stomatitis (43.2% and mouth ulceration (32.4%.Everolimus use led to sustained reduction in tumor volume, and new responses were observed for SEGA and renal angiomyolipoma from the blinded core phase of the study. These findings support the hypothesis that everolimus can safely reverse multisystem manifestations of TSC in a

  10. Long-Term Use of Everolimus in Patients with Tuberous Sclerosis Complex: Final Results from the EXIST-1 Study. (United States)

    Franz, David N; Belousova, Elena; Sparagana, Steven; Bebin, E Martina; Frost, Michael D; Kuperman, Rachel; Witt, Olaf; Kohrman, Michael H; Flamini, J Robert; Wu, Joyce Y; Curatolo, Paolo; de Vries, Petrus J; Berkowitz, Noah; Niolat, Julie; Jóźwiak, Sergiusz


    Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, has demonstrated efficacy in treating subependymal giant cell astrocytomas (SEGAs) and other manifestations of tuberous sclerosis complex (TSC). However, long-term use of mTOR inhibitors might be necessary. This analysis explored long-term efficacy and safety of everolimus from the conclusion of the EXIST-1 study (NCT00789828). EXIST-1 was an international, prospective, double-blind, placebo-controlled phase 3 trial examining everolimus in patients with new or growing TSC-related SEGA. After a double-blind core phase, all remaining patients could receive everolimus in a long-term, open-label extension. Everolimus was initiated at a dose (4.5 mg/m2/day) titrated to a target blood trough of 5-15 ng/mL. SEGA response rate (primary end point) was defined as the proportion of patients achieving confirmed ≥50% reduction in the sum volume of target SEGA lesions from baseline in the absence of worsening nontarget SEGA lesions, new target SEGA lesions, and new or worsening hydrocephalus. Of 111 patients (median age, 9.5 years) who received ≥1 dose of everolimus (median duration, 47.1 months), 57.7% (95% confidence interval [CI], 47.9-67.0) achieved SEGA response. Of 41 patients with target renal angiomyolipomas at baseline, 30 (73.2%) achieved renal angiomyolipoma response. In 105 patients with ≥1 skin lesion at baseline, skin lesion response rate was 58.1%. Incidence of adverse events (AEs) was comparable with that of previous reports, and occurrence of emergent AEs generally decreased over time. The most common AEs (≥30% incidence) suspected to be treatment-related were stomatitis (43.2%) and mouth ulceration (32.4%). Everolimus use led to sustained reduction in tumor volume, and new responses were observed for SEGA and renal angiomyolipoma from the blinded core phase of the study. These findings support the hypothesis that everolimus can safely reverse multisystem manifestations of TSC in a significant

  11. Some results of long-term investigation population exposed as a result of release of radioactive wastes into the Techa River in Southern Urals

    Energy Technology Data Exchange (ETDEWEB)

    Degteva, M.O.; Kozheurov, V.P.; Vorobiova, M.I. [Ural research Center for Radiation Medicine, Chelyabinsk (Russian Federation)


    This paper describes results of a long-term investigation of a population exposed to radioactive waste release in 1949-1956 into the Techa River in the Southern Urals. Systematic measurements of radionuclide concentration in the river waters, sediments, and floodplain soils and measurements of exposure gamma dose rates as well as studies of the radionuclide composition in the contaminated areas began in the summer of 1951. As a result of the contamination, 124,000 residents were exposed to radiation and 28,100 received significant doses in terms of health effect potential. Covered results include the following: estimation of external radiation doses; content of strontium-90 in humans and estimation of radionuclide ingestion rates; age-dependent model of strontium metabolism in the human body; evaluation of doses of internal irradiation; distribution of exposed population according to accumulated doses. 11 refs; 15 figs.

  12. Sinus augmentation with intra- vs extraorally harvested bone grafts for the provision of dental implants: clinical long-term results. (United States)

    Deppe, Herbert; Mücke, Thomas; Wagenpfeil, Stefan; Hölzle, Frank


    To report the long-term outcome of sinus augmentation with intra- vs extraorally harvested autogenous bone grafts. Between January 1993 and August 2009, 146 patients (86 women and 60 men) were consecutively treated with sinus elevation procedures. In February 2010, 127 patients were re-evaluated. Bone grafts were harvested from the iliac crest (54 patients, group 1) and from the mandibular symphysis (73 patients, group 2). A total of 179 sinus augmentation procedures were performed (105 in group 1 and 74 in group 2). All patients received fixed prostheses. A total of 456 Frialit II implants were placed in the 127 patients: 244 implants in extraorally harvested bone (group 1) and 212 in intraorally harvested bone (group 2). Patients had a mean bone graft consolidation period of 5.8 months in group 1 and of 5.2 months in group 2. During a minimum 3-month healing phase following implant placement, 35 of 456 implants failed (12.0% of group 1 and 4.5% of group 2) to become integrated in grafted bone. A total of 421 implants proceeded to occlusal loading with a fixed prosthesis. After a mean follow-up period of 110.2 months (range, 6 to 204 months), 34 implants were lost (25 in group 1 and 9 in group 2, for a total of 387 implants (91.9%) still functioning. Sinus augmentation procedures using intra- and extraorally harvested bone grafts can provide implant stability in the long term. However, major preoperative discomfort and more bone loss was seen when bone was harvested from the iliac crest. If autogenous bone is mandatory in sinus elevation procedures, extraorally harvested bone grafts can still be recommended, especially when bilateral procedures are indicated.

  13. Intrathecal ziconotide for severe chronic pain: safety and tolerability results of an open-label, long-term trial. (United States)

    Wallace, Mark S; Rauck, Richard; Fisher, Robert; Charapata, Steven G; Ellis, David; Dissanayake, Sanjeeva


    Ziconotide is a non-opioid drug indicated for management of severe chronic pain in patients for whom intrathecal (IT) therapy is warranted and who are intolerant of or refractory to other treatments. Six-hundred and forty-four patients with severe chronic pain participated in this open-label, multicenter study. Ziconotide titration was followed by long-term infusion. Efficacy assessments included the Visual Analog Scale of Pain Intensity. Safety was assessed via adverse events (AEs), vital signs, and routine laboratory values. One-hundred and nineteen patients received ziconotide for > or = 360 days; total exposure was 350.9 patient years. Median duration of ziconotide therapy was 67.5 days (range, 1.2-1215.5 days); mean dose at last infusion was 8.4 microg/d (range, 0.048-240.0 microg/d). Median Visual Analog Scale of Pain Intensity scores at baseline, month 1, and the last available observation up to month 2 were 76 mm (range, 4-100 mm), 68 mm (range, 0-100 mm), and 73 mm (range, 0-100 mm), respectively. Most patients (99.7%) experienced > or = 1 AE. Most AEs were of mild (43.5%) or moderate (42.3%) severity; 58.6% of AEs were considered unrelated to ziconotide. The most commonly reported AEs (> or = 25% of patients) included nausea, dizziness, headache, confusion, pain, somnolence, and memory impairment. Clinically significant abnormalities (> 3 times the upper limit of normal) in creatine kinase levels were reported in 0.9% of patients at baseline, 5.7% at month 1, and 3.4% at ziconotide discontinuation. No drug-related deaths, IT granulomas, or permanent adverse sequelae occurred with ziconotide therapy. We conclude that long-term IT ziconotide is an option for patients with severe, refractory chronic pain.

  14. Sniff-Like Patterned Input Results in Long-Term Plasticity at the Rat Olfactory Bulb Mitral and Tufted Cell to Granule Cell Synapse. (United States)

    Chatterjee, Mahua; Perez de Los Cobos Pallares, Fernando; Loebel, Alex; Lukas, Michael; Egger, Veronica


    During odor sensing the activity of principal neurons of the mammalian olfactory bulb, the mitral and tufted cells (MTCs), occurs in repetitive bursts that are synchronized to respiration, reminiscent of hippocampal theta-gamma coupling. Axonless granule cells (GCs) mediate self- and lateral inhibitory interactions between the excitatory MTCs via reciprocal dendrodendritic synapses. We have explored long-term plasticity at this synapse by using a theta burst stimulation (TBS) protocol and variations thereof. GCs were excited via glomerular stimulation in acute brain slices. We find that TBS induces exclusively long-term depression in the majority of experiments, whereas single bursts ("single-sniff paradigm") can elicit both long-term potentiation and depression. Statistical analysis predicts that the mechanism underlying this bidirectional plasticity involves the proportional addition or removal of presynaptic release sites. Gamma stimulation with the same number of APs as in TBS was less efficient in inducing plasticity. Both TBS- and "single-sniff paradigm"-induced plasticity depend on NMDA receptor activation. Since the onset of plasticity is very rapid and requires little extra activity, we propose that these forms of plasticity might play a role already during an ongoing search for odor sources. Our results imply that components of both short-term and long-term olfactory memory may be encoded at this synapse.

  15. Sniff-Like Patterned Input Results in Long-Term Plasticity at the Rat Olfactory Bulb Mitral and Tufted Cell to Granule Cell Synapse

    Directory of Open Access Journals (Sweden)

    Mahua Chatterjee


    Full Text Available During odor sensing the activity of principal neurons of the mammalian olfactory bulb, the mitral and tufted cells (MTCs, occurs in repetitive bursts that are synchronized to respiration, reminiscent of hippocampal theta-gamma coupling. Axonless granule cells (GCs mediate self- and lateral inhibitory interactions between the excitatory MTCs via reciprocal dendrodendritic synapses. We have explored long-term plasticity at this synapse by using a theta burst stimulation (TBS protocol and variations thereof. GCs were excited via glomerular stimulation in acute brain slices. We find that TBS induces exclusively long-term depression in the majority of experiments, whereas single bursts (“single-sniff paradigm” can elicit both long-term potentiation and depression. Statistical analysis predicts that the mechanism underlying this bidirectional plasticity involves the proportional addition or removal of presynaptic release sites. Gamma stimulation with the same number of APs as in TBS was less efficient in inducing plasticity. Both TBS- and “single-sniff paradigm”-induced plasticity depend on NMDA receptor activation. Since the onset of plasticity is very rapid and requires little extra activity, we propose that these forms of plasticity might play a role already during an ongoing search for odor sources. Our results imply that components of both short-term and long-term olfactory memory may be encoded at this synapse.

  16. Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joon Woo; Myung, Jae Sung; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-do (Korea); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Seong Nam, Gyeongi-do (Korea); Kim, Ki-Jeong; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Seong Nam, Gyeongi-do (Korea)


    To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors. All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann-Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher's exact test. Two hundred and sixteen patients (male: female = 75:141; mean age 69.2 years; range 48{proportional_to}91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses. Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors. (orig.)

  17. Long-term variations of clay mineral composition in the Andaman Sea (IODP Exp. 353 Site U1447): preliminary result (United States)

    Lee, J.; Khim, B. K.; Cho, H. G.; Kim, S.; 353 Scientists, I. E.


    Clay mineral studies in the Bengal Fan have allowed the reconstruction of the erosional history of the Himalayan-Tibetan complex since the Early Miocene. Several factors such as climate change and tectonic activity are important for the erosion rate of the Himalaya-Tibet complex. IODP Expedition 353 Site U1447 (10°47.4'N, 93°00'E; 1391 mbsl) was drilled on a ridge 45 km offshore Little Andaman Island in the Andaman Sea, penetrating to total depths of 738 m. Riverine sediments supplied mainly by the Irrawaddy and Salween (draining the Indo-Burman Ranges; smectite-rich) and the Ganga/Brahmaputra (draining the Himalaya; illite-rich) via the surface currents have been known to deposit in the Andaman Sea. We measured clay minerals of 38 sediment samples collected from 150 to 737 m CSF-A at Site U1447 in order to reveal long-term variation patterns of clay minerals and their controlling factors. Age reconstruction of Site U1447 aided by shipboard biostratigraphic and paleomagnetic data defined the study interval spanning from the Late Miocene ( 10 Ma) to Early Pleistocene ( 1.25 Ma). At this interval, clay minerals consist mainly of smectite (28-61% with an average of 47%) followed by illite (20-41% with an average of 29%), kaolinite (9-19% with an average of 14%), and chlorite (5-15% with an average of 10%). Variation of clay mineral compositions is divided into three stages; almost consistent variations of all clay minerals (from 750 to 570 m CSF-A; 10.0 to 7.5 Ma), gradual decrease of smectite and increase of illite and chlorite (from 570 to 400 m CSF-A; 7.5 to 4.5 Ma), and great fluctuation of all clay minerals (from 400 to 150 m CSF-A; 4.5 to 1.1 Ma). Such long-term clay mineral changes may be related to provenance switches, tectonic evolution of the source regions, climatic variations, degree of volcanism with basin evolution, sedimentation history by sea level changes or some combination of these factors.

  18. [Treatment of anemia in chronic hemodialysis patients with recombinant human erythropoietin: long-term results in 15 patients]. (United States)

    Jacquot, C; Berthelot, J M; Chiappini-Judith, D; Ferragu-Haguet, M; Lefebvre, A; Masselot, J P; Moynot, A; Frydman, M O; Peterlongo, F


    Recombinant human erythropoietin (rHu-EPO) was given during 12 to 20 months in 15 long term haemodialysis anaemic (mean Hb: 6.6 +/- 1 g/dl) patients who required no blood transfusion. Patients over 65, or with severe arterial disease or with uncontrolled hypertension were not included in this trial. Correction of anaemia (mean Hb 12.1 +/- 0.6 g/dl) was achieved in all patients and maintained all along the study. An improved sense of wellbeing and increased exercise tolerance were reported by all patients. Appropriate maintenance dosage of rHu-EPO was 74 +/- 6 U/kg i.v. twice weekly. High dose oral and/or intravenous iron therapy was necessary in the absence of previous marked iron overload. One retinal venous thrombosis was the sole severe side-effect encountered. A slight but significant increase of blood pressure was observed with the need of intensifying previous anti-hypertensive therapy in one patient and of starting one in one another. Fine adjustment of the dry weight was necessary to maintain blood pressure in the normal range. Heparin requirements increased in the majority of patients because of hollow fibre clotting but there was no evidence of decreased efficacy of dialysis. In two patients clotting of arteriovenous fistula was not obviously related to the rHu-EPO treatment.

  19. Long-term inhibition of cyclophilin D results in intracellular translocation of calcein AM from mitochondria to lysosomes. (United States)

    Shinohe, Daisuke; Kobayashi, Asuka; Gotoh, Marina; Tanaka, Kotaro; Ohta, Yoshihiro


    Cyclophilin D is a peptidyl-prolyl cis-trans isomerase localized in the mitochondrial matrix. Although its effects on mitochondrial characteristics have been well studied, its relation to the uptake of molecules by mitochondria remains unknown. Here, we demonstrated the effects of cyclophilin D on the intracellular translocation of calcein AM. Following addition of calcein AM to control cells or cells overexpressing wild-type cyclophilin D, calcein fluorescence was observed in mitochondria. However, long-term inhibition of cyclophilin D in these cells altered the localization of calcein fluorescence from mitochondria to lysosomes without changing mitochondrial esterase activity. In addition, depletion of glucose from the medium recovered calcein localization from lysosomes to mitochondria. This is the first demonstration of the effects of cyclophilin D on the intracellular translocation of molecules other than proteins and suggests that cyclophilin D may modify mitochondrial features by inducing the translocation of molecules to the mitochondria through the mechanism associated with cellular energy metabolism. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Improved external valvuloplasty, intravenous laser photocoagulation and local sclerotheraphy treatment of primary deep venous valvular insufficiency: long term result (United States)

    Wang, Chun-xi; Han, Li-na; Gu, Ying; Liang, Fa-qi; Zhang, Li; Liu, Hong-yi; Zhao, Wen-guang; Wang, Qi; Wang, Xiao-ling


    The purpose of this article is to report long-term follow-up of improved external vulvuloplasty, intravenous laser photocoagulation and local sclerotherapy treatment of primary deep venous valvular insufficiency in eight hundred and seventy-two patients from Nov. 2000 to May 2006. Patients were evaluated clinically and with duplex ultrasound at 1, 3, and 12 months, and yearly thereafter until the fifth year to assess treatment efficacy and adverse reactions. Successful occlusion of the great saphenous vein and absence of deep vein reflux on color Doppler imaging, were noted in 956 limbs of 852 cases( 1 month follow-up), 946 limbs of 842 cases (6 month to 1 year follow-up), 717 of 626 (1~2 year follow-up), 501 of 417 (2~3 year follow-up), 352 of 296 (3~5year follow-up), 142 of 106 (5 year follow-up) after initial treatment. The cumulative total number of recurrence of reflux was fifteen cases. The respective competence rate was 95.18%, 96.23%, 94.23%, 95.25%, 94.23% and 94.12%. Of note, all recurrence occurred before 9 months, with the majority noted before 3 months. Bruising was noted in 0.7% of patients, tightness along the course of treated vein in 1.0% of limbs. There have been no paresthesia of cases, skin burns and deep vein thrombosis.

  1. Indirect decompression and reduction of lumbar spondylolisthesis does not result in higher rates of immediate and long term complications. (United States)

    Januszewski, Jacob; Beckman, Joshua M; Bach, Konrad; Vivas, Andrew C; Uribe, Juan S


    Nerve root decompression and spondylolisthesis reduction is typically reserved for open surgery. MIS techniques have been thought to be associated with higher rates of neurological complications. This study aims to report acute and chronic neurologic complications encountered with MIS surgery for spondylolisthesis, specifically, the incidence of nerve root injury and clinical and radiographic outcomes. A retrospective review of 269 patients who underwent MIS LIF or ALIF treatment for lumbar degenerative or isthmic grade 1 or 2 spondylolisthesis was conducted. Immediate and long-term complication rates were the primary outcome. Only patients who had symptomatic anterolisthesis and 2-year outcome data were included in the study. 52 patients met inclusion criteria with 54 lumbar spondylolisthesis levels treated. Five patients (9.6%) experienced postoperative anterior thigh numbness, which completely resolved within 3months. There were no permanent neurologic deficits; however, 2 patients (3.8%) suffered a transient foot weakness that resolved with physical therapy by 3months follow-up. There was one incidence of wound breakdown that required revision and one incidence of L5/S1 endplate/sacral promontory fracture and relisthesis 3months postoperatively. Overall fusion rate was 98% at 6months. Indirect decompression and closed anatomical reduction for treatment of low-grade spondylolisthesis using ALIF and LIF with posterior percutaneous fixation was not associated with an increased risk of neurologic deficit. This study suggests that this technique is safe, reproducible, durable, and provides adequate fusion rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Long-term results of paclitaxel plus cisplatin with concurrent radiotherapy for loco-regional esophageal squamous cell carcinoma. (United States)

    Zhu, Han-Ting; Ai, Da-Shan; Tang, Hua-Rong; Badakhshi, Harun; Fan, Jian-Hong; Deng, Jia-Ying; Zhang, Jun-Hua; Chen, Yun; Zhang, Zhen; Xia, Yi; Guo, Xiao-Mao; Jiang, Guo-Liang; Zhao, Kuai-Le


    To evaluate the long-term effectiveness and late toxicities of paclitaxel (PTX) plus cisplatin (DDP) with concurrent radiotherapy for locally advanced esophageal squamous cancer. Between 2008 and 2011, 76 patients were enrolled in a phase II study on the treatment of loco-regionally advanced esophageal cancer with radiotherapy (68.4 Gy/44 fractions or 61.2 Gy/34 fractions) combined with 4-cycle chemotherapy consisting of DDP (25 mg/m2 per day for 3 d) and PTX (175 mg/m2 for 3 h). The primary endpoints were overall survival and progression-free survival, and the secondary endpoints were toxicity and the treatment failure pattern. A total of 76 patients were enrolled in this study, of whom 63.2% finished the whole regimen. The 5-year survival rates for the per-protocol population and intent-to-treat population were 25.4% and 26.4%, respectively, and the median survival rates were 23.7 mo and 28.5 mo, respectively. Grade 3 or 4 late toxicity was observed in only one patient (heart failure). In log-rank analysis, the pretreatment stage (stage II + III: 36.1 mo vs stage IV: 14.9 mo) and the completed cycle (1-3 cycles: 16.1 mo vs 4 cycles: 35.5 mo) were significant prognostic factors (P = 0.037 loco-regionally advanced esophageal squamous cancer.

  3. Long-term collections

    CERN Multimedia

    Collectes à long terme


    The Committee of the Long Term Collections (CLT) asks for your attention for the following message from a young Peruvian scientist, following the earthquake which devastated part of her country a month ago.

  4. Long-term results of conversion from calcineurin inhibitors to sirolimus in 150 maintenance kidney transplant patients. (United States)

    Garrouste, Cyril; Kamar, Nassim; Guilbeau-Frugier, Céline; Guitard, Joëlle; Esposito, Laure; Lavayssière, Laurence; Nogier, Marie-Béatrice; Cointault, Olivier; Ribes, David; Rostaing, Lionel


    This retrospective single-center study evaluated long-term renal function after conversion from calcineurin inhibitors to sirolimus-based immunosuppression in kidney transplant recipients. From 2001 to 2009, one hundred fifty kidney transplant recipients were converted from calcineurin inhibitors to sirolimus at least 3 months after transplant. After a mean follow-up of 171 weeks, 56.7% of converted patients remained on sirolimus. The 5-year survival rate of the patients (including intent-to-treat) and grafts was 85.5% and 83.6%. Patients on sirolimus showed significant improvement in renal function with a creatinine clearance of 50.9 ± 20.7 and 52.9 ± 20.8 mL/minute at month 0 and month 24. Independent predictive factors associated with a stable estimated glomerular filtration rate at the last follow-up of sirolimus patients were (1) having a living donor, (2) absence of anti-HLA alloantibodies at month 0, and (3) cyclosporine versus tacrolimus used before conversion. Adverse effects were reported in 134 patients (89.3%). They included (1) hospitalization for infection (n=52), (2) de novo proteinuria (n=40), and (3) eight patients with biopsy-proven acute rejection. Sirolimus was stopped and replaced by calcineurin inhibitors in 37 patients after a mean of 16 months treatment. After stopping sirolimus, renal-allograft function remained stable at 2 years. Conversion of calcineurin inhibitors to sirolimus in kidney transplant recipients was associated with improved renal function. The reintroduction of calcineurin inhibitors was safe in patients who were withdrawn from sirolimus owing to adverse effects.

  5. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results. (United States)

    Valera-Garrido, Fermín; Minaya-Muñoz, Francisco; Medina-Mirapeix, Francesc


    Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle. To evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time. A one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4-6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients' perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates. All outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as 'successful' at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a 'successful' outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks. Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term. identifier: NCT02085928. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence

  6. Per-oral Endoscopic Myotomy (POEM) After the Learning Curve: Durable Long-term Results With a Low Complication Rate. (United States)

    Hungness, Eric S; Sternbach, Joel M; Teitelbaum, Ezra N; Kahrilas, Peter J; Pandolfino, John E; Soper, Nathaniel J


    We aimed to report long-term outcomes for patients undergoing per-oral endoscopic myotomy (POEM) after our initial 15-case learning curve. POEM has become an established, natural-orifice surgical approach for treating esophageal motility disorders. To date, published outcomes and comparative-effectiveness studies have included patients from the early POEM experience. Consecutive patients undergoing POEM after our initial 15 cases, with a minimum of 1-year postoperative follow-up, were included. Treatment success was defined as an Eckardt score ≤3 without reintervention. Gastroesophageal reflux was defined by abnormal pH-testing or reflux esophagitis >Los Angeles grade A. Between January 2012 and March 2015, 115 patients underwent POEM at a single, high-volume center. Operative time was 101 ± 29 minutes, with 95% (109/115) of patients discharged on postoperative day 1. Clavien-Dindo grade III complications occurred in 2.7%, one of which required diagnostic laparoscopy to rule out Veress needle injury to the gall bladder. The rate of grade I complications was 15.2%. At an average of 2.4 years post-POEM (range 12-52 months), the overall success rate was 92%. Objective evidence of reflux was present in 40% for all patients and 33% for patients with a body mass index POEM performed by experienced surgeons provided durable symptomatic relief in 94% of patients with nonspastic achalasia and 90% of patients with type 3 achalasia/spastic esophageal motility disorders, with a low rate of complications. The rate of gastroesophageal reflux was comparable with prior studies of both POEM and laparoscopic Heller myotomy.

  7. Long-Term Administration of Neuropeptide Y in the Subcutaneous Infusion Results in Cardiac Dysfunction and Hypertrophy in Rats. (United States)

    Zhang, Rong; Niu, Huifang; Kang, Xiaohui; Ban, Tao; Hong, Hong; Ai, Jing


    The purpose of the present study was to clarify whether chronically elevated plasma neuropeptide Y (NPY) might affect heart function and cardiac remodeling in rats. Male Wistar rats were administered NPY (85 μg for 30 days) by mini-osmotic pump subcutaneously implanted between the scapulae. Associated indices for heart function, cardiac remodeling and hypertrophy were evaluated. Compared to the sham group, the baseline systolic blood pressure (SBP) in rats administered NPY was significantly increased; cardiac function was significantly decreased, as indicated by reduced ejection fraction (EF), left ventricular end-systolic pressure (LVESP), maximum change velocity of left ventricular pressure in the isovolumic contraction or relaxation period (± dp/dtmax) and increased left ventricular end-diastolic pressure (LVEDP); hematoxylin-eosin (H&E) staining detection displayed enlarged cell areas and a consistent increase in heart-to-body weight ratios (HW/BW) was observed; quantitative real time PCR (qRT-PCR) and Western blot analysis showed markedly increased expressions of β-myosin heavy chain (β-MHC), calcineurin (CaN) and phosphorylated p38 proteins, while no changes were found in the expressions of p38 total protein and the phosphorylations of JNK and ERK. This study reported for the first time that long-term elevated plasma concentration of NPY could induce cardiac dysfunction and cardiac hypertrophy and this phenomenon could, in part, be mediated by the Ca2+/CaM-dependent CaN pathway and p38 mitogen-activated protein kinase (MAPK) signal pathway in rats. © 2015 S. Karger AG, Basel.

  8. Understanding the fate of black (pyrogenic) carbon in soil: Preliminary results from a long term field trial (United States)

    Meredith, Will; Ascough, Philippa; Bird, Michael; Large, David; Shen, Licheng; Snape, Colin


    Black carbon (BC, also known as pyrogenic carbon) is an 'inert' form of carbon and has been proposed as a means of long-term carbon sequestration, particularly by amending soils and sediments with BC known as biochar. While there is abundant anecdotal evidence of biochar stability over extended timescales it is essential to gain a greater understanding of the degree and mechanisms of biochar degradation in the environment. This study aims to quantitatively assess the stability of biochar by investigating samples from field degradation trials first buried during 2009 in a tropical soil, and recovered after 12 and 36 month intervals. Catalytic hydropyrolysis (HyPy) is a novel analytical tool for the isolation of BC [1] in which high hydrogen pressure (150 bar) and a sulphided Mo catalyst reductively remove the non-BC fraction of the chars, and so isolate the most stable portion of the biochar, defined as BC(HyPy). This method also allows for the non-BC(HyPy) fraction of a sample, which from charcoal is known to include small ring PAHs (history may also be useful. [1] Meredith, W. et al., 2012. Geochimica et Cosmochimica Acta 97, 131-147. [2] Ascough, P.L. et al., 2010. Radiocarbon 52, 1336-1350. [3] Lockhart, R.S. et al., 2013. Journal of Analytical and Applied Pyrolysis 104, 640-652. [4] Hockaday, W.C. et al., 2007. Geochimica et Cosmochimica Acta 71, 3432-3445. [5] Jaffe, R. et al., 2013. Science 340, 345-347. [6] Zimmerman, M. et al., 2012. Global Change Biology 18, 3306-3316.

  9. Unsafe Drug Use and Arrhythmic Events in Brugada Patients with ICD: Results of a Long-Term Follow-Up. (United States)

    de Almeida Fernandes, Diogo; António, Natália; Madeira, Marta; Sousa, Pedro; Ventura, Miguel; Cristóvão, João; Nascimento, José; Elvas, Luís; Gonçalves, Lino; Pego, Guilherme Mariano


    Brugada syndrome is a hereditary disease linked with an increased risk of sudden death that may require an implantable cardioverter-defibrillator (ICD) in order to halt the arrhythmic events. The aim of this study was to identify possible triggers for appropriate ICD therapies in patients with Brugada syndrome, focusing on their past and current therapeutic profiles. Thirty patients with high-risk Brugada syndrome, with ICD implanted at the Coimbra Hospital and University Center, were enrolled. Patients were questioned about their Brugada syndrome history, previous cardiac events, comorbidities, present and past medications, and physical activity. Patients were followed up during 5.8 ± 5.3 years. The ICD was interrogated, and arrhythmic events and device therapies were recorded. The cohort who received appropriate ICD therapies was compared with the remaining patients to determine the potential link between clinical variables and potentially fatal arrhythmic events. More than half of the patients (53.3%) took at least one non-recommended drug, and 16.7% received appropriate ICD therapies, with a long-term rate of 4.0%/year. There was a tendency for more appropriate ICD therapies in patients who took unsafe drugs (85.7 versus 45.5%, p = 0.062), and the mean time between unsafe drug intake and appropriate ICD therapies was 3.8 ± 7.5 days. This study revealed that the medical community is still unaware of the pharmacological restrictions imposed by Brugada syndrome. Patients who took non-recommended drugs seem to have a higher risk of ventricular arrhythmic events.

  10. Paclitaxel, epirubicin, and cisplatin (TEP) regimen as neoadjuvant treatment in locally advanced cervical cancer: long-term results. (United States)

    Ferrandina, G; Distefano, M G; De Vincenzo, R; Salutari, V; Petrillo, M; Scarciglia, M L; Pietragalla, A; Conte, C; Scambia, G


    We evaluated the rates of response, operability and long term survival and toxicities in a large series of locally advanced cervical cancer (LACC) patients administered neoadjuvant chemotherapy (NACT) with paclitaxel, epirubicin and cisplatin (TEP) followed by radical surgery (RS). Patients and methods The study included 75 consecutive stages IB2-IVA patients administered NACT with paclitaxel (175mg/m(2)), epirubicin (100mg/m(2)) and cisplatin (100mg/m(2)) on day 1 of a 3-weekly cycle for 2-4cycles. Patients were evaluated for objective response by RECIST criteria and triaged to RS. Progression-free survival (PFS) and overall survival (OS) were calculated from the date of diagnosis to recurrence/progression of disease or death, respectively. Complete and partial clinical response was observed in 13 and 28 patients (56.1% objective responses); radical surgery was amenable in 52 patients (71.2%): 14 patients showed complete/microscopic response to treatment. Overall, recurrence/progression of disease was observed in 36 patients, and all of them experienced death of disease. In the whole series median PFS was 48months (5-year PFS=51.0%), and median OS was 72months (5-year OS=53.0%). Overall, 195 courses were administered; treatment was delayed in 6.7% of patients, while dose reduction was required in 36.5% of patients. Grade 3 leukopenia affected 22 patients (29.7%), while Grades 3 and 4 neutropenia was documented in 17 (22.9%) and 6 (8.1%) patients. In the whole series, we recorded 1 death whose relation with treatment-induced toxicity could not be ruled out. TEP provided favorable rates of response and operability in LACC patients, and allowed the obtainment of encouraging survival data without carrying out an excessive toxicity. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Long-term survival results of a randomized trial comparing gemcitabine/cisplatin and methotrexate/vinblastine/doxorubicin/cisplatin in patients with locally advanced and metastatic bladder cancer

    DEFF Research Database (Denmark)

    Roberts, J T; von der Maase, H; Sengeløv, L


    PURPOSE: To compare long-term survival in patients with locally advanced and metastatic transitional cell carcinoma (TCC) of the urothelium treated with gemcitabine plus cisplatin (GC) or methotrexate/vinblastine/doxorubicin/cisplatin (MVAC). PATIENTS AND METHODS: Efficacy data from a large....... These results strengthen the role of GC as a standard of care in patients with locally advanced and metastatic transitional-cell carcinoma (TCC)....

  12. Long-term results of endosteal implants following radical oral cancer surgery with and without adjuvant radiation therapy. (United States)

    Linsen, Sabine S; Martini, Markus; Stark, Helmut


    The aim of this study was to analyze the long-term survival of implants and implant-retained prostheses in patients after ablative surgery of oral cancer with or without adjunctive radiation therapy. Between 1997 and 2008, 66 patients who had undergone ablative tumor surgery in the oral cavity were treated with dental implants (n = 262). Thirty-four patients received radiation therapy in daily fractions of 2 Gy administered on 18 to 30 days. Implants were inserted in the maxilla (49; 18.7%) or mandible (213; 81.3%), in non-irradiated residual (65; 24.8%) or grafted bone (44; 16.8%) and in irradiated residual (15.6%) or grafted bone (39; 14.9%). Seventeen fixed protheses and 53 removable dentures (34 bar attachments, 9 telescopic and 10 ball retained dentures) were inserted. Mean follow-up after implant insertion was 47.99 (±34.31) months (range 12-140 months). The overall 1-, 5-, and 10-year survival rates of all implants were 96.6%, 96.6%, and 86.9%, respectively. Fourteen implants were lost in nine patients (5.3% of all implants); eight implants were primary losses, and five secondary losses because of an operation of tumor recurrence. There was no significantly lower implant survival for implants inserted into irradiated bone (p = .302), bone and/or soft-tissue grafts (p = .436), and maxilla or mandible (p = .563). All prosthetic restorations in patients without tumor recurrence could be maintained during the observation period. Implant survival is not significantly influenced by radiation therapy, grafts (bone and/or soft tissue), or location (maxilla or mandible). However, implants placed in irradiated bone exhibit a higher failure rate during the healing period than those placed in non-irradiated bone. No superstructure was particularly favorable. Osseointegrated implants can be used successfully in patients with prior history of ablative surgery with and without additional radiation therapy. © 2009 Wiley Periodicals, Inc.

  13. Long Term Results after 3 Courses of ABVD plus Subtotal Nodal Radiotherapy in 188 Adult Patients with Stage I, II and IIIA Hodgin Lymphoma

    Directory of Open Access Journals (Sweden)

    Pauline Brice


    Full Text Available In patients with Hodgkin lymphoma (HL a continued improvement in outcome with a high cure rate is observed but with an increased treatment-induced late effects. We report the long-term results from 188 (stage I to IIIA patients treated during the period 1985-94 with 3 courses of ABVD-like chemotherapy and subtotal nodal radiotherapy. 10 year overall survival is of 88% and no secondary leukaemia was observed. The main long term toxicity was cardiac, mainly related to a mediastinal dose of 45 Grays in patients with partial remission. New strategies are aiming to reduce the mediastinal dose at 30 Grays after chemotherapy-induced complete remission.

  14. Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long-term oncological, functional, and quality of life results. (United States)

    Nagele, Udo; Anastasiadis, Aristotelis G; Stenzl, Arnulf; Kuczyk, Markus


    The present contribution analyses long-term data regarding oncological, functional, and quality of life aspects of patients subjected to cystectomy due to malignancy with subsequent orthotopic bladder substitution. A literature search was conducted to review literature published from 1887 until today. Oncological aspects, special considerations on female patients, quality of life, geriatric patients, and impact of minimally invasive surgery were also addressed and discussed. After more than three decades, orthotopic bladder substitution subsequent to radical cystectomy has stood the test of time by providing adequate long-term survival and low local recurrence rates. Compared to radical cystectomy, neither radiation nor chemotherapy, nor a combination of both, offer similar long-term results. Orthotopic bladder substitution does not compromise oncological outcome and can be performed with excellent results regarding functional and quality of life issues. Chronological age is generally not a contraindication for cystectomy. Orthotopic bladder substitution should be the diversion of choice both in men and in women, whenever possible. For orthotopic urinary diversion, a careful patient selection considering tumor extent, patient motivation, preoperative sphincter function, other local and systemic adverse confounding factors, and overall life expectancy must be taken into account. Minimally invasive techniques are promising concepts for the future, awaiting confirmation in larger patient cohorts.

  15. A Meta-Analysis of the Short- and Long-Term Results of Randomized Controlled Trials That Compared Laparoscopy-Assisted and Conventional Open Surgery for Colorectal Cancer

    Directory of Open Access Journals (Sweden)

    Hiroshi Ohtani, Yutaka Tamamori, Yuichi Arimoto, Yukio Nishiguchi, Kiyoshi Maeda, Kosei Hirakawa


    Full Text Available Purpose: We conducted a meta-analysis to evaluate and compare the short- and long-term results of laparoscopic colorectal surgery (LCRS and conventional open surgery (OCRS for colorectal cancer (CRC.Methods: We searched relevant papers published between January 1990 and May 2011. We analyzed the outcomes of each type of surgery over the short- and long-term periods.Results: In the short-term period, we found no significant differences in overall perioperative complications and anastomotic leakage between LCRS and OCRS groups. We found no significant differences in overall, distant, local and wound-site recurrence, overall mortality, 3 and 5 year disease-free survival rate, and cancer-related mortality between the 2 groups.Conclusions: LCRS has the benefits of reducing intraoperative blood loss, earlier resumption of oral intake, and shorter duration of hospital stay in the short-term. The long-term outcomes of LCRS seem to be similar to those of OCRS.

  16. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. (United States)

    Gilling, Peter J; Wilson, Liam C; King, Colleen J; Westenberg, Andre M; Frampton, Christopher M; Fraundorfer, Mark R


    To assess the durability of holmium laser enucleation of prostate in comparison to transurethral resection of the prostate (TURP). Patients were enrolled in the present study between June 1997 and December 2000 and followed per protocol. All patients were urodynamically obstructed with a prostate volume of between 40 and 200 mL. At long-term follow-up, variables assessed included Benign Prostatic Hyperplasia Impact Index (BPHII), International Continence Society Short Form Male questionnaire (ICSmale-SF) and the International Index of Erectile Function (IIEF). Adverse events, including the need for retreatment, were specifically assessed. Thirty-one (14 holmium laser enucleation of the prostate [HoLEP] and 17 TURP) of the initial 61 patients were available, with 12 deceased and 18 lost to follow-up. The mean (range) follow-up was 7.6 (5.9-10.0) years and the mean (±sd) age at follow-up was 79.8 (±6.2) years. The mean (±sd) values (HoLEP vs TURP) were as follows: maximum urinary flow rate (Q(max)), 22.09 ± 15.47 vs 17.83 ± 8.61 mL/s; American Urological Association (AUA) symptom score, 8.0 ± 5.2 vs 10.3 ± 7.42; quality of life (QOL) score 1.47 ± 1.31 vs 1.31 ± 0.85; BPHII, 1.53 ± 2.9 vs 0.58 ± 0.79; IIEF-EF (erectile function), 11.6 ± 7.46 vs 9.21 ± 7.17; ICSmale Voiding Score (VS), 4.2 ± 3.76 vs 3.0 ± 2.41; ICSmale Incontinence Score (IS), 3.07 ± 3.3 vs 1.17 ± 1.4. There were no significant differences in any variable between the two groups beyond the first year. Of the assessable patients, none required re-operation for recurrent BPH in the HoLEP arm and three (of 17) required re-operation in the TURP arm . The results of this randomized trial confirm that HoLEP is at least equivalent to TURP in the long term with fewer re-operations being necessary. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  17. Long-term side effects of radiotherapy for pediatric localized neuroblastoma. Results from clinical trials NB90 and NB94

    Energy Technology Data Exchange (ETDEWEB)

    Ducassou, Anne [Institut Claudius Regaud, Departement de Radiotherapie, Toulouse (France); Gambart, Marion; Munzer, Caroline; Rubie, Herve [Hopital des Enfants, Departement d' Onco-Hematologie Pediatrique, Toulouse (France); Padovani, Laetitia [Centre Hospitalier et Universitaire, Departement de Radiotherapie, Marseille (France); Carrie, Christian; Claude, Line [Centre Leon Berard, IHOP, Departement de Radiotherapie, Lyon (France); Haas-Kogan, Daphne [University of California, Department of Radiation Oncology, San Francisco (United States); Bernier-Chastagner, Valerie [Centre Alexis Vautrin, Departement de Radiotherapie, Nancy (France); Demoor, Charlotte [Centre Rene Gauducheau, Departement de Radiotherapie, Nantes (France); Helfre, Sylvie [Institut Curie, Departement de Radiotherapie, Paris (France); Bolle, Stephanie [Institut Gustave Roussy, Departement de Radiotherapie, Villejuif (France); Leseur, Julie [Centre Eugene Marquis, Departement de Radiotherapie, Rennes (France); Huchet, Aymeri [Centre Hospitalier et Universitaire, Departement de Radiotherapie, Bordeaux (France); Valteau-Couanet, Dominique [Institut Gustave Roussy, Departement d' Onco-Hematologie Pediatrique, Villejuif (France); Schleiermacher, Gudrun [Institut Curie, Departement d' Onco-Hematologie Pediatrique, Paris (France); Coze, Carole [Aix-Marseille Univ et APHM, Hopital d' Enfants de la Timone, Departement d' hemato-Oncologie Pediatrique, Marseille (France); Defachelles, Anne-Sophie [Centre Oscar Lambret, Departement d' Onco-Hematologie Pediatrique, Lille (France); Marabelle, Aurelien [IHOP, Departement d' Onco-Hematologie Pediatrique, Lyon (France); Ducassou, Stephane [Hopital des Enfants, Departement d' Onco-Hematologie Pediatrique, Bordeaux (France); Devalck, Christine [Hopital des enfants Reine Fabiola, Departement d' Onco-hematologie Pediatrique, Bruxelles (Belgium); Gandemer, Virginie [Centre hospitalier, Departement d' Onco-Hematologie Pediatrique, Rennes (France); Munzer, Martine [Centre hospitalier, Departement d' Onco-hematologie Pediatrique, Reims (France); Laprie, Anne [Institut Claudius Regaud, Departement de Radiotherapie, Toulouse (France); Universite Toulouse III Paul Sabatier, Toulouse (France); INSERM, Toulouse (France); Collaboration: Neuroblastoma study group and radiotherapy group of the French Society of Children with Cancer (SFCE)


    Neuroblastoma (NB) is the most frequent indication for extracranial pediatric radiotherapy. As long-term survival of high-risk localized NB has greatly improved, we reviewed treatment-related late toxicities in pediatric patients who received postoperative radiotherapy (RT) for localized NB within two French prospective clinical trials: NB90 and NB94. From 1990-2000, 610 children were enrolled. Among these, 35 were treated with induction chemotherapy, surgery, and RT. The recommended RT dose was 24 Gy at ≤ 2 years, 34 Gy at > 2 years, ± a 5 Gy boost in both age groups. The 22 patients still alive after 5 years were analyzed. The median follow-up time was 14 years (range 5-21 years). Late effects after therapy occurred in 73 % of patients (16/22), within the RT field for 50 % (11/22). The most frequent in-field effects were musculoskeletal abnormalities (n = 7) that occurred only with doses > 31 Gy/1.5 Gy fraction (p = 0.037). Other effects were endocrine in 3 patients and second malignancies in 2 patients. Four patients presented with multiple in-field late effects only with doses > 31 Gy. After a median follow-up of 14 years, late effects with multimodality treatment were frequent. The most frequent effects were musculoskeletal abnormalities and the threshold for their occurrence was 31 Gy. (orig.) [German] Das Neuroblastom (NB) ist die haeufigste Indikation fuer eine extrakranielle paediatrische Strahlentherapie. Da sich beim lokalisierten Hochrisiko-NB das langfristige Ueberleben stark verbessert hat, ueberprueften wir die behandlungsbedingte spaete Toxizitaet bei paediatrischen Patienten, die im Rahmen zweier prospektiver klinischer Studien in Frankreich (NB90 und NB94) eine postoperative Strahlentherapie (RT) bei lokalisiertem NB erhalten hatten. Von 1990-2000 wurden 610 Kinder eingeschlossen. Von diesen wurden 35 mit Chemotherapie, Chirurgie und RT behandelt. Die empfohlene Bestrahlungsdosis war 24 Gy bei ≤ 2 Jahren, 34 Gy bei > 2 Jahren, ± 5-Gy

  18. Long-term study of Artisan phakic intraocular lens implantation for the correction of moderate to high myopia: ten-year follow-up results. (United States)

    Tahzib, Nayyirih G; Nuijts, Rudy M; Wu, Wendy Y; Budo, Camille J


    To determine the long-term performance of the Artisan phakic intraocular lens (PIOL) for the correction of myopia. Long-term (10 years) retrospective follow-up study. Eighty-nine eyes of 49 patients who underwent Artisan PIOL implantation for the correction of myopia. Comparisons were made between preoperative clinical data and the clinical data at 1, 6, and 10 years after surgery. Refractive stability, refractive predictability, safety, efficacy, best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), intraocular pressure, intraoperative problems, corneal endothelial cell density, corneal endothelial cell loss, and glare levels were evaluated. The mean spherical equivalent (SE) after 10 years was -0.70+/-1.00 diopters (D; range, -4.00 to 2.00 D), with no significant change in mean SE between 1, 6, and 10 years. At 10 years, 68.8% of all eyes were within 1.0 D of the intended correction. At 10 years, 31.2% (n = 24) gained 1 or more Snellen lines of BCVA and 2.6% (n = 2) lost more than 2 Snellen lines of BCVA; 93.3% reached a BCVA of 20/40 or better, and 82.0% reached a UCVA of 20/40 or better. The mean intraocular pressure remained stable and was 15.5+/-3.5 mmHg (range, 7-25 mmHg) at 10 years. The mean endothelial cell loss was -8.86+/-16.01% (range, -51.69% to 34.43%) at 10 years. Long-term results demonstrate that the implantation of an Artisan PIOL for the correction of moderate to high myopia is a stable, predictable, and safe method when strict inclusion criteria for surgery are applied. There was no significant loss of corneal endothelial cells and no reports of long-term glare.

  19. What contributes to long-term quality of life in breast cancer patients who are undergoing surgery? Results of a multidimensional study. (United States)

    Wittmann, Victoria; Látos, Melinda; Horváth, Zoltán; Simonka, Zsolt; Paszt, Attila; Lázár, György; Csabai, Márta


    This study aims to examine the key determinants of long-term quality of life in breast cancer patients who are undergoing surgery using a multidimensional approach and taking into account preoperative and post-operative psychological characteristics such as anxiety, depression, posttraumatic growth, body image, and physical activity as well as medical parameters. The study involved 63 breast cancer patients from the Department of Surgery at the University of Szeged. Assessments occurred 1 day before surgery as well as 3 days and 18 months after surgery using the Spielberger State and Trait Anxiety Inventory (STAI), Beck's Depression Inventory (BDI), Functional Assessment of Cancer Therapy-Breast Cancer Scale (FACT-B), Posttraumatic Growth Inventory (PTGI) and Breast Impact of Treatment Scale (BITS). Data relating to physical activity, medical parameters and sociodemographic characteristics were also collected. The level of depression did not change over time. State anxiety decreased 18 months after the surgery compared to before the surgery; however, there was a greater decrease immediately after the surgery and then anxiety increased again 18 months later. Trait anxiety was associated with quality of life, posttraumatic growth and body image. Posttraumatic growth and the level of depression were found to be possible contributing factors to the increase in long-term quality of life. The results show that the timely detection and proper management of psychological distress and the enhancement of posttraumatic growth are of great value, as they might be important contributing factors to long-term quality of life in breast cancer patients.

  20. CT-guided radiofrequency (RF) ablation of osteoid osteoma. Clinical long-term results; CT-gesteuerte Radiofrequenz(RF)-Ablation von Osteoidosteomen. Klinische Langzeitergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, Diethard; Clasen, S.; Schaefer, J.F.; Rempp, H.; Koenig, C.W.; Claussen, C.D. [Universitaetsklinikum Tuebingen (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Duda, S.; Truebenbach, J. [Juedisches Krankenhaus, Berlin (Germany). Radiologen Praxis; Erdtmann, B. [Radiologie Zentrum Stuttgart, Bad Cannstatt (Germany). Praxis; Pereira, P.L. [SLK-Kliniken, Heilbronn (Germany). Klinik fuer Radiologie, Minimal-Invasive Therapien und Nuklearmedizin


    Purpose: To evaluate CT-guided radiofrequency (RF) ablation of osteoid osteoma using internally cooled monopolar RF electrodes for technical success, complications and clinical long-term success. Materials and Methods: Between April 1999 and July 2009, 23 patients were treated under general anesthesia with CT-guided RF ablation using an internally cooled monopolar single RF electrode (Cool-tip, Valleylab, TycoHealthcare, Boulder, USA; active tip: 10 mm). For the removal of the nidus, we used either a manual or an automated drill. The technical success was evaluated by a CT scan (MSCT, Siemens Medical Solutions, Forchheim). The clinical long-term success was investigated by questioning patients prior to discharge, and after 6, 12 and 18 months. After 18 months, patients were interviewed on an annual basis. Results: The technical success rate was 100 %. The nidus was located in n = 19 cases at the lower extremity and in n = 4 cases at the upper extremity. Minor complications were observed for n = 2 patients. The mean hospitalization time was 1.5 d (1-2 d). The mean follow-up was 75.9 months (18-120 months) for n = 23 patients. No local recurrence was observed. One patient had intermediate pain one week after RF ablation without recurrent symptoms. Conclusion: CT-guided RF ablation using an internally cooled monopolar single RF electrode is an effective and safe minimally invasive method for the treatment of osteoid osteoma with excellent clinical long-term success. (orig.)

  1. Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Randomized Phase 2 Trial of Neoadjuvant Preoperative Paclitaxel/Cisplatin/Radiation Therapy (RT) or Irinotecan/Cisplatin/RT in Esophageal Adenocarcinoma: Long-Term Outcome and Implications for Trial Design

    Energy Technology Data Exchange (ETDEWEB)

    Kleinberg, Lawrence R., E-mail: [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland (United States); Catalano, Paul J. [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (United States); Forastiere, Arlene A. [Department of Oncology, Johns Hopkins University, Baltimore, Maryland (United States); Keller, Steven M. [Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY (United States); Mitchel, Edith P. [Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Anne, Pramila Rani [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Benson, Al B. [Department of Medicine-Hematology/Oncology, Lurie Cancer Center, Northwestern University, Chicago, Illinois (United States)


    Purpose: Toxicity, pathologic complete response, and long-term outcomes are reported for the neoadjuvant therapies assessed in a randomized phase 2 Eastern Cooperative Oncology Group and American College of Radiology Imaging Network trial for operable esophageal adenocarcinoma, staged as II-IVa by endoscopy/ultrasonography (EUS). Methods and Materials: A total of 86 eligible patients began treatment. For arm A, preoperative chemotherapy was cisplatin, 30 mg/m{sup 2}, and irinotecan, 50 mg/m{sup 2}, on day 1, 8, 22, 29 during 45 Gy radiation therapy (RT), 1.8 Gy per day over 5 weeks. Adjuvant therapy was cisplatin, 30 mg/m{sup 2}, and irinotecan, 65 mg/m{sup 2} day 1, 8 every 21 days for 3 cycles. Arm B therapy was cisplatin, 30 mg/m{sup 2}, and paclitaxel, 50 mg/m{sup 2}, day 1, 8, 15, 22, 29 with RT, followed by adjuvant cisplatin, 75 mg/m{sup 2}, and paclitaxel, 175 mg/m{sup 2}, day 1 every 21 days for 3 cycles. Stratification included EUS stage and performance status. Results: In arm A, median overall survival was 35 months, and 5-, 6-, and 7-year survival rates were 46%, 39%, and 35%, respectively, whereas for arm B, they were 21 months and 27%, 27%, and 23%, respectively. Median progression- or recurrence-free survival (PFS) was 39.8 months with a 3-year PFS of 50% for arm A and 12.4 months (P=.046) with 3-year PFS of 28% for arm B. Eighty percent of the observed incidents of progression occurred within 19 months. Survival did not differ significantly by EUS and performance status strata. Conclusions: Long-term survival was similar for both arms and did not appear superior to results achieved with other standard regimens.

  2. Correlates of preferences for autonomy in long-term care: results of a population-based survey among older individuals in Germany

    Directory of Open Access Journals (Sweden)

    Hajek A


    Full Text Available André Hajek,1 Thomas Lehnert,1 Annemarie Wegener,1 Steffi G Riedel-Heller,2 Hans-Helmut König1 1Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, 2Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany Purpose: Thus far, there is little evidence concerning the factors associated with preferences for autonomy in long-term care. Therefore, the aim of the present study was to investigate the correlates of preferences for autonomy in long-term care among older individuals in Germany. Methods: Data were gathered from a population-based survey of the German population aged ≥65 years in 2015 (N=1,006. Results: Multiple logistic regressions revealed that preferences for freedom of choice for foods were positively associated with living with partner or spouse (OR: 1.5 [1.0–2.2], being born in Germany (OR: 1.9 [1.1–3.3], and lower self-rated health (OR: 1.3 [1.1–1.6]. Preferences for freedom in choosing bedtime and sleep duration were positively associated with lower age (OR: 1.1 [1.0–1.1] and having children (OR: 2.2 [1.0–4.9]. Preferences for customized living space were positively associated with being female (OR: 2.5 [1.4–4.5] and being born in Germany (OR: 3.7 [1.9–7.1]. Neither preferences for decent and sanitary housing nor preferences for shared decision-making were associated with any of the independent variables. Conclusion: Various independent variables were associated with preferences for autonomy in long-term care. This suggests that preferences for care-related autonomy are complex. Knowing these might help refine long-term care health services. Keywords: caregivers, older adult, long-term care, Germany

  3. Long-Term Collections

    CERN Multimedia

    Comité des collectes à long terme


    It is the time of the year when our fireman colleagues go around the laboratory for their traditional calendars sale. A part of the money of the sales will be donated in favour of the long-term collections. We hope that you will welcome them warmly.

  4. [Results and predictors of long-term outcomes of off-pump coronary artery bypass grafting: 2 831 cases from a single center]. (United States)

    Liu, Xi; Chen, Yu; Zhao, Zhou; Dong, Suixin; Liu, Gang; Chen, Shenglong; Ling, Yunpeng; Li, Hui; Lian, Bo; Bao, Liming; Yang, Wei


    To describe the long-term survival of off-pump coronary artery bypass grafting (CABG) and to analysis the risk factors of operative mortality and long-term survival. From January 2001 to December 2012, 2 831 patients undergoing off-pump CABG in Peking University People's Hospital, 2 099 cases (74.1%) of them were male, the average age was (63±9) years. The perioperative data was retrospectively collected. Binary Logistic regression was used to find the risk factors which affect the operative mortality. Follow-up evaluation was completed regularly. Kaplan-Meier survival curve, Log-rank test and Cox regression model were used to find out factors which affect the long-term result. Totally 2 831 patients underwent isolating off-pump CABG, in whom 45 patients died perioperative, 2 786 patients discharged successfully. Binary Logistic regression showed that sex (female) (χ2=4.4, OR=2.307, P=0.035), peripheral vascular disease (χ2=17.4, OR=6.616, P=0.000), New York Heart Association (NYHA) class grade≥3 (χ2=10.5, OR=3.491, P=0.001), ejection fraction≤40% (χ2=16.9, OR=5.230, P=0.000), emergency surgery (χ2=11.9, OR=5.127, P=0.001) are risk factors of operative mortality. The follow-up time was (74±44) months. Totally 107 patients were lost from follow-up, 109 patients died in follow-up. The survival rate at 1, 3, 5 , 8 and 10 years was 97.2%, 95.5%, 94.3%, 93.6%, 92.1%, respectively. Univariate analysis showed that age (>65 years), hypertension, renal insufficiency, peripheral vascular disease, history of myocardial infarction, NYHA class grade≥3 and emergency surgery were risk factors of the long-term survival (χ2=8.150 to 88.241, P65 years) (χ2=12.1, RR=2.295, P=0.000), renal insufficiency (χ2=12.3, RR=3.160, P=0.000), peripheral vascular disease (χ2=42.5, RR=5.626, P=0.000), NYHA class grade≥3 (χ2=9.1, RR=1.994, P=0.002) and emergency surgery (χ2=5.5, RR=2.247, P=0.019) were independent risk factors that affect the long-term survival. Sex (female

  5. Electrophysiologically guided amiodarone therapy versus the implantable cardioverter-defibrillator for sustained ventricular tachyarrhythmias after myocardial infarction: results of long-term follow-up. (United States)

    Schläpfer, Jürg; Rapp, Fabrice; Kappenberger, Lukas; Fromer, Martin


    We sought to compare the long-term survival rates of patients with sustained ventricular tachyarrhythmia after myocardial infarction (MI) who were treated according to the results of electrophysiological (EP) study either with amiodarone or an implantable cardioverter-defibrillator (ICD). Patients with sustained ventricular tachyarrhythmias after MI are at high risk of sudden cardiac death (SCD). However, data comparing the long-term survival rates of patients treated with amiodarone or ICD, according to the results of EP testing, are lacking. Patients underwent a first EP study at baseline and a second one after a loading dose of amiodarone of 14 +/- 2.9 g. According to the results of the second EP study, patients were classified either as responders or non-responders to amiodarone; non-responders were eventually treated with an ICD. Eighty-four consecutive patients with MI (78 men; 21-77 years old; mean left ventricular (LV) ejection fraction 36 +/- 11%) were consecutively included. Forty-three patients (51%) were responders, and 41 patients (49%) were non-responders to amiodarone therapy. During a mean follow-up period of 63 +/- 30 months, SCD and total mortality rates were significantly higher in the amiodarone-treated patients (p = 0.03 and 0.02, respectively). The long-term survival of patients with sustained ventricular tachyarrhythmias after MI, with depressed LV function, is significantly better with an ICD than with amiodarone therapy, even when stratified according to the results of the EP study. These patients should benefit from early ICD placement, and any previous amiodarone treatment seems to have no additional value.

  6. Parental knowledge reduces long term anxiety induced by false-positive test results after newborn screening for cystic fibrosis

    NARCIS (Netherlands)

    Vernooij-van Langen, A.M.M.; Pal, S.M. van der; Reijntjens, A.J.T.; Loeber, J.G.; Dompeling, E.; Dankert-Roelse, J.E.


    Background: False-positive screening results in newborn screening for cystic fibrosis may lead to parental stress, family relationship problems and a changed perception of the child's health. Aim of the study: To evaluate whether parental anxiety induced by a false positive screening result

  7. Cutting Balloon Angioplasty (CBA) for the Treatment of Renal Artery Fibromuscular Dysplasia (FMD) in Six Patients: 5-Year Long-Term Results. (United States)

    Cotroneo, Antonio Raffaele; Amoroso, Luigi; Giammarino, Alberto; Galasso, Daniele; Taglialatela, Francesco; Timpani, Carmine; Gabrielli, Daniela


    To evaluate long-term outcomes in terms of hypertension control, recurrent stenosis, and reinterventions from patients who underwent cutting balloon angioplasty (CBA) for symptomatic renal artery fibromuscular dysplasia (FMD). From 2011, six consecutive renal artery FMD women underwent CBA for poorly controlled hypertension, despite antihypertensive therapy. Follow-up consisted of blood pressure monitoring and duplex ultrasonography at 1, 6, and 12 months and thereafter annually for 5 years. All treatments were technically successful. Recurrence of hypertension was found in two patients within 12 months, and reinterventions were performed using CBA. Results show the efficacy of CBA for renal artery FMD.

  8. Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: Long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Froeling, V., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Meckelburg, K., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Schreiter, N.F., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Scheurig-Muenkler, C., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Kamp, J., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Maurer, M.H., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Beck, A., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); Hamm, B., E-mail: [Department of Radiology, Charité – Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin (Germany); and others


    Objectives: To compare the long-term outcome after uterine artery embolization (UAE) versus magnetic resonance-guided high-intensity focused ultrasound (MR-g HIFU) for symptomatic uterine fibroids. Methods: Seventy-seven women (median age, 39.3 years; range, 29.2–52.2 years) with symptomatic uterine fibroids, equally eligible for UAE and MR-g HIFU based on our exclusion criteria underwent treatment (UAE, N = 41; MR-g HIFU, N = 36) from 2002 to 2009 at our institution. Symptom severity (SS) and total health-related quality of life (Total HRQoL) scores were assessed by the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire before treatment and at long-term follow-up after UAE (median 61.9 months) and after MR-g HIFU (median: 60.7 months). Re-intervention rates were assessed for each therapy and compared. Results: Re-intervention was significantly lower after UAE (12.2%) than after MR-g HIFU (66.7%) at long-term follow-up (p < 0.001). After UAE changes in SS (50 pre-treatment vs. 6.3 post-treatment) and Total HRQoL (57.8 pre-treatment vs. 100 post-treatment) were significantly better than changes in SS (42.2 pre-treatment vs. 26.6 post-treatment) and Total HRQoL score (66.4 pre-treatment vs. 87.9 post-treatment) after MR-g HIFU (p = 0.019 and 0.049 respectively). Conclusions: Improvement of SS and Total HRQoL scores was significantly better after UAE resulting in a significant lower re-intervention rate compared to MR-g HIFU.

  9. Long-term survival among older patients with myocardial infarction differs by educational level: results from the MONICA/KORA myocardial infarction registry (United States)


    Background Socioeconomic disparities in survival after acute myocardial infarction (AMI) have been found in many countries. However, population-based results from Germany are lacking so far. Thus, the objective of this study was to examine the association between educational status and long-term mortality in a population-based sample of people with AMI. Methods The sample consisted of 2,575 men and 844 women, aged 28–74 years, hospitalized with a first-time AMI between 1 January 2000 and 31 December 2008, recruited from a population-based AMI registry. Patients were followed up until December 2011. Data on education, risk factors and co-morbidities were collected by individual interviews; data on clinical characteristics and AMI treatment by chart review. Cox proportional hazards models were used to assess the relationship between educational status and long-term mortality. Results During follow-up, 19.1% of the patients with poor education died compared with 13.1% with higher education. After adjustment for covariates, no effect of education on mortality was found for the total sample and for patients aged below 65 years. In older people, however, low education level was significantly associated with increased mortality (hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.05–1.98, p = 0.023). Stratified analyses showed that women older than 64 years with poor education were significantly more likely to die than women in the same age group with higher education (HR 1.57, 95% CI 1.02–2.41, p = 0.039). Conclusions Elderly, poorly educated patients with AMI, and particularly women, have poorer long-term survival than their better educated peers. Further research is required to illuminate the reasons for this finding. PMID:24552463

  10. Working conditions predict incidence of long-term spells of sick leave due to depression: results from the Belstress I prospective study. (United States)

    Clumeck, N; Kempenaers, C; Godin, I; Dramaix, M; Kornitzer, M; Linkowski, P; Kittel, F


    During the last few years, a high incidence of sick leave due to depression has been reported, resulting in important economic and social impacts. Only a limited number of studies investigating the influence of psychosocial working conditions on sick leave have been prospective and have utilised a valid methodology, while none have studied sick leave due to depression. In this study, the impact of adverse psychosocial working conditions is analysed on the risk for long-term sick leave due to depression. This study resulted from the large-scale Belstress I study on the relationship between perceived job stress and health problems. Subjects were Belgian employees selected from 11 large companies (n = 9396). Using a longitudinal design, the association between the three Karasek stress dimensions (job control, psychological demand, and social support) was explored, separately and combined according to the demand-control and demand-control-support models and the incidence of long-term sick leave for depression as diagnosed by the family physician. After adjusting for age, occupational categories, living situation, and baseline depression score, 'passive jobs' (OR 2.67; 95% CI 1.15 to 6.19) and 'high strain' jobs (OR 3.23; 95% CI 1.40 to 7.43) predicted sick leave due to depression at follow-up in men. Job control predicted sick leave due to depression in both men (OR 2.43; 95% CI 1.27 to 4.66) and women (OR 2.21; 95% CI 1.05 to 4.68). This study provides evidence that the psychosocial working environment influences long-term sick leave due to depression. Efforts to improve skill discretion and decision authority at work could help prevent depression.

  11. Visual Input Enhancement via Essay Coding Results in Deaf Learners' Long-Term Retention of Improved English Grammatical Knowledge (United States)

    Berent, Gerald P.; Kelly, Ronald R.; Schmitz, Kathryn L.; Kenney, Patricia


    This study explored the efficacy of visual input enhancement, specifically "essay enhancement", for facilitating deaf college students' improvement in English grammatical knowledge. Results documented students' significant improvement immediately after a 10-week instructional intervention, a replication of recent research. Additionally, the…

  12. Effects of organic farming on weed abundance - long-term results from a site in northern Germany


    Verschwele, Arnd; Zwerger, Peter


    One of the aims of organic farming systems is to maintain or enhance the agricultural and natural biodiversity in agro-ecosystems. Weeds can contribute to biodiversity but also need to be controlled. Compared to conventional farming the weed density and diversity in organic farming is expected to be enhanced because of reduced fertilisation and low efficacy of control measures. It is also assumed that the diversity of crops, especially alternation of summer and winter crops, results in a grea...

  13. Visual input enhancement via essay coding results in deaf learners' long-term retention of improved English grammatical knowledge.