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Sample records for carcinoma long-term outcomes

  1. Hepatocellular carcinoma: Advances in diagnosis, management, and long term outcome.

    Science.gov (United States)

    Bodzin, Adam S; Busuttil, Ronald W

    2015-05-28

    Hepatocellular carcinoma (HCC) remains a common and lethal malignancy worldwide and arises in the setting of a host of diseases. The incidence continues to increase despite multiple vaccines and therapies for viruses such as the hepatitis B and C viruses. In addition, due to the growing incidence of obesity in Western society, there is anticipation that there will be a growing population with HCC due to non-alcoholic fatty liver disease. Due to the growing frequency of this disease, screening is recommended using ultrasound with further imaging using magnetic resonance imaging and multi-detector computed tomography used for further characterization of masses. Great advances have been made to help with the early diagnosis of small lesions leading to potential curative resection or transplantation. Resection and transplantation maybe used in a variety of patients that are carefully selected based on underlying liver disease. Using certain guidelines and clinical acumen patients may have good outcomes with either resection or transplantation however many patients are inoperable at time of presentation. Fortunately, the use of new locoregional therapies has made down staging patients a potential option making them potential surgical candidates. Despite a growing population with HCC, new advances in viral therapies, chemotherapeutics, and an expanding population of surgical and transplant candidates might all contribute to improved long-term survival of these patients.

  2. Hepatocellular carcinoma: Advances in diagnosis, management, and long term outcome

    OpenAIRE

    Bodzin, AS; Busuttil, RW

    2015-01-01

    © 2015 Baishideng Publishing Group Inc. Hepatocellular carcinoma (HCC) remains a common and lethal malignancy worldwide and arises in the setting of a host of diseases. The incidence continues to increase despite multiple vaccines and therapies for viruses such as the hepatitis B and C viruses. In addition, due to the growing incidence of obesity in Western society, there is anticipation that there will be a growing population with HCC due to non-alcoholic fatty liver disease. Due to the grow...

  3. Adverse impact of intermittent portal clamping on long-term postoperative outcomes in hepatocellular carcinoma.

    Science.gov (United States)

    Hao, S; Chen, S; Yang, X; Wan, C

    2017-01-01

    Introduction To evaluate the impact of intermittent portal clamping (IPC) on long-term postoperative outcomes in patients with hepatocellular carcinoma (HCC). Methods Clinical records of 355 patients underwent curative liver resection for HCC in January 2007 to December 2010 were retrospectively reviewed. According to how portal clamping was performed, patients were grouped as: IPC, n=113; other portal clamping (OPC), n=190; and no portal clamping (NPC), n=52. Results Median recurrence-free survival (RFS) was statistically significantly shorter in the IPC (39.4 months) than OPC (47.3 months, p=0.010) and NPC groups (51.4 months, p=0.008). Median overall survival (OS) was also significantly shorter with IPC (46.3 months), versus 52.9 months with OPC (p=0.022) and 56.2 months with NPC (p=0.015). Kaplan-Meier survival analysis revealed that 5-year cumulative RFS was much lower in the IPC (42.5%) than OPC (50.9%, p=0.014) and NPC groups (49.6%, p=0.013). Five-year cumulative OS was also much lower in the IPC (44.9%) than OPC (58.0%, p=0.020) and NPC groups (57.7%, p=0.025). On univariate analysis, tumour grade, size and number, TNM stage, blood transfusion, vascular invasion and IPC were significantly inversely correlated with RFS and OS. On multivariate analysis, tumour size and number, blood transfusion, vascular invasion and IPC remained significant. Conclusions Our study suggests that IPC is an independent risk factor for poor long-term postoperative outcomes in patients with HCC.

  4. Long-term outcome of percutaneous ethanol injection therapy for minimum-sized hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Miyuki Taniguchi; Masatoshi Kudo; Yoshitake Hayashi; Soo Ryang Kim; Susumu Imoto; Hirotsugu Ikawa; Kenji Ando; Keiji Mita; Shuichi Fuki; Noriko Sasase; Toshiyuki Matsuoka

    2008-01-01

    AIM: To evaluate long-term follow-up of minimum-sized hepatocellular carcinoma (HCC) treated with percutaneous ethanol injection (PEI).METHODS: PEI was applied to 42 lesions in 31 patients (23 male and eight female) with HCC < 15 mm in diameter, over the past 15 years.RESULTS: Overall survival rate was 74.1% at 3 years, 49.9% at 5 years, 27.2% at 7 years and 14.5% at 10 years. These results are superior to, or at least the same as those for hepatic resection and radiofrequency ablation. Survival was affected only by liver function, but not by sex, age, etiology of Hepatitis B virus or Hepatitis C virus, a-fetoprotein levels, arterial and portal blood flow, histological characteristics, and tumor multiplicity or size. Patients in Child-Pugh class A and B had 5-, 7- and 10-years survival rates of 76.0%, 42.2% and 15.8%, and 17.1%, 8.6% and 0%, respectively (p = 0.025).CONCLUSION: Treatment with PEI is best indicated for patients with HCC < 15 mm in Child-Pugh class A.

  5. Long-term outcomes of hepatectomy vs percutaneous ablation for treatment of hepatocellular carcinoma ≤4 cm

    Institute of Scientific and Technical Information of China (English)

    Toshifumi Wakai; Yutaka Aoyagi; Katsuyoshi Hatakeyama; Yoshio Shirai; Takeshi Suda; Naoyuki Yokoyama; Jun Sakata; Pauldion V Cruz; Hirokazu Kawai; Yasunobu Matsuda; Masashi Watanabe

    2006-01-01

    AIM: To determine which treatment modality -hepatectomy or percutaneous ablation - is more beneficial for patients with small hepatocellular carcinoma (HCC) (≤ 4 cm) in terms of long-term outcomes.METHODS: A retrospective analysis of 149 patients with HCC ≤4 cm was conducted. Eighty-five patients underwent partial hepatectomy (anatomic in 47 and nonanatomic in 38) and 64 underwent percutaneous ablation (percutaneous ethanol injection in 37, radiofrequency ablation in 21, and microwave coagulation in 6). The median follow-up period was 69 mo.RESULTS: Hepatectomy was associated with larger tumor size (P<0.001), whereas percutaneous ablation was significantly associated with impaired hepatic functional reserve. Local recurrence was less frequent following hepatectomy (P< 0.0001). Survival was better following hepatectomy (median survival time:122 mo) than following percutaneous ablation (median survival time: 66 mo; P=0.0123). When tumor size was divided into ≤ 2 cm vs > 2 cm, the favorable effects of hepatectomy on long-term survival was seen only in patients with tumors >2 cm (P= 0.0001). The Cox proportional hazards regression model revealed that hepatectomy (P= 0.006) and tumors ≤ 2 cm (P= 0.017) were independently associated with better survival.CONCLUSION: Hepatectomy provides both better local control and better long-term survival for patients with HCC ≤4 cm compared with percutaneous ablation. Of the patients with HCC ≤ 4 cm, those with tumors > 2 cm are good candidates for hepatectomy, provided that the hepatic functional reserve of the patient permits resection.

  6. Survival outcome of radioiodine therapy in post thyroidectomy thyroid carcinoma patients: Outcome of long term follow up

    Science.gov (United States)

    Haque, F.; Nahar, N.; Sultana, S.; Nasreen, F.; Jabin, Z.; Alam, A. S. M. M.

    2016-03-01

    The overall prognosis of patients with thyroid carcinoma is excellent whenever managed following best practice guidelines. Objective: To calculate sex and age group affected by thyroid cancer; to compare between single or multiple dose of radio ablation needed after thyroidectomy and to determine the percentage of patients become disease free during their follow up. Methods: This was a retrospective study done in NINMAS, Bangladesh on 687 patients from 1984 to 2004. In all cases total or near total thyroidectomy was done before commencing radioiodine therapy. Patients TG level, neck ultrasonography, thyroid scan, whole body I131 scans, neck examination were done every six monthly/yearly. Results: Among 687 patients, female were more sufferers (68.1%) and female to male ratio was 2:1. Age group 19-40 years was mostly affected (57.8%). Most common type seen was papillary carcinoma (81.8%). After ablation 100 patients did not follow-up. Total 237 patients discontinued within 4 years. Remaining 450 patients undergone regular follow-up for 5 years and more, 394 were disease free (87.6%). Total recurrence of metastasis was 23 and 12 patients expired at different times. Conclusions: Long-term regular follow-up is necessary after radioiodine ablation to become free of disease.

  7. Long-Term Outcome and Quality of Life of Patients With Endometrial Carcinoma Treated With or Without Pelvic Radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) Trial

    NARCIS (Netherlands)

    Nout, Remi A.; van de Poll-Franse, Lonneke V.; Lybeert, Marnix L. M.; Warlam-Rodenhuis, Carla C.; Jobsen, Jan J.; Mens, Jan Willem M.; Lutgens, Ludy C. H. W.; Pras, Betty; van Putten, Wim L. J.; Creutzberg, Carien L.

    2011-01-01

    Purpose To determine the long-term outcome and health-related quality of life (HRQL) of patients with endometrial carcinoma (EC) treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial. Patients and Methods Between 1990 and 1997

  8. Radio(chemo)therapy for locally advanced squamous cell carcinoma of the esophagus. Long-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Ordu, Arif Deniz; Deymann, Lisa Felicia; Scherer, Vera; Combs, Stephanie E. [Technische Universitaet Muenchen, Department of Radiation Oncology, Klinikum rechts der Isar, Muenchen (Germany); Nieder, Carsten [University of Tromsoe, Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodoe (Norway); Institute of Clinical Medicine, Faculty of Health Sciences, Tromsoe (Norway); Geinitz, Hans [Technische Universitaet Muenchen, Department of Radiation Oncology, Klinikum rechts der Isar, Muenchen (Germany); Krankenhaus der Barmherzigen Schwestern Linz, Department of Radiation Oncology, Linz (Austria); Kup, Philipp Guenther [Marien Hospital Herne, Universitaetsklinikum der Ruhr-Universitaet Bochum, Department of Radiation Oncology, Herne (Germany); Fakhrian, Khashayar [Technische Universitaet Muenchen, Department of Radiation Oncology, Klinikum rechts der Isar, Muenchen (Germany); Marien Hospital Herne, Universitaetsklinikum der Ruhr-Universitaet Bochum, Department of Radiation Oncology, Herne (Germany); Universitaetsklinikum der Ruhr-Universitaet Bochum, Department of Radiation Oncology, Sankt Josef Hospital Bochum, Bochum (Germany)

    2014-11-18

    The purpose of this work is to report the long-term outcomes of three-dimensional conformal radio(chemo)therapy in the curative management of esophageal squamous cell carcinoma (ESCC). A retrospective analysis of patients treated with radio(chemo)therapy between 1988 and 2011 at Klinikum rechts der Isar, Technische Universitaet Muenchen was performed. In all, 168 patients received radio(chemo)therapy for ESCC in curative intention. The median follow-up time was 91 months (range 1-212 months). There were 128 men and 40 women with a median age of 63 years. Selection criteria for radio(chemo)therapy were unfit for surgery and/or unresectable primary tumor (n = 146, 87 %) or patients' choice (n = 22, 13 %). The majority of the patients received a combination of cisplatin and 5-fluorouracil chemotherapy with 54 Gy in 30 fractions of radiotherapy. The median overall survival (OS) was 20 months (95 % confidence interval 17-23 months). The OS at 2 and 5 years for the whole cohort was 41 ± 4 % and 22 ± 3 %, respectively. Forty patients (24 %) suffered an in-field recurrence. The most common acute nonhematologic toxicity >grade 2 was dysphagia in 35 % of the patients. Acute hematologic toxicity > grade 2 was recorded in 14 % of the patients. There was no grade 5 toxicity observed during the study. Poor ECOG performance status (0-1 vs. 2-3, HR = 1.70, p = 0.002) and weight loss ≥ 10 % before the start of therapy (HR = 1.99, p = 0.001) were among the factors significantly associated with poor OS in multivariate analysis. Three-dimensional conformal definitive radio(chemo)therapy is well tolerated and leads to long-term survival in more than 20 % of patients with advanced disease and/or contraindication to surgery. However, 24 % in-field recurrence remains a major concern. Prospective trials are warranted to assess if a well-tailored conformal radiochemotherapy can improve the local control and obviate the need for surgical resection in patients with good general

  9. Long-term outcomes after severe shock.

    Science.gov (United States)

    Pratt, Cristina M; Hirshberg, Eliotte L; Jones, Jason P; Kuttler, Kathryn G; Lanspa, Michael J; Wilson, Emily L; Hopkins, Ramona O; Brown, Samuel M

    2015-02-01

    Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcomes to general intensive care unit survivor populations.

  10. Long-term outcome of meniscectomy

    DEFF Research Database (Denmark)

    Roos, Ewa M.; Ostenberg, A; Roos, H;

    2001-01-01

    To describe the long-term influence of meniscectomy on pain, functional limitations, and muscular performance. To assess the effects of radiographic osteoarthritis (OA), gender and age on these outcomes in patients with meniscectomy....

  11. Early Life Environments and Long Term Outcomes

    OpenAIRE

    Bolbocean, Corneliu

    2015-01-01

    A large literature has linked “in utero” environment to health and socio-economic outcomes in adulthood. We consider the effect of early life environments on health and skill formation outcomes. We first evaluate the impact of perinatal-neonatal level of technology at birth, which varies across delivery institutions, on the long-term neurodevelopmental outcomes of children with Cerebral Palsy. The level of technology at delivery determines the type of therapy newborns receive immediately afte...

  12. Long-Term Outcome in Patients With Ductal Carcinoma In Situ Treated With Breast-Conserving Therapy: Implications for Optimal Follow-up Strategies

    Energy Technology Data Exchange (ETDEWEB)

    Shaitelman, Simona F. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wilkinson, J. Ben [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Kestin, Larry L. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ye Hong [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Goldstein, Neal S. [Advanced Diagnostics Laboratory, Redford, Michigan (United States); Martinez, Alvaro A. [Michigan HealthCare Professionals, Pontiac, Michigan (United States); Vicini, Frank A., E-mail: fvicini@pol.net [Michigan HealthCare Professionals, Pontiac, Michigan (United States)

    2012-07-01

    Purpose: To determine 20-year rates of local control and outcome-associated factors for ductal carcinoma in situ (DCIS) after breast-conserving therapy (BCT). Methods and Materials: All DCIS cases receiving BCT between 1980 and 1993 were reviewed. Patient demographics and pathologic factors were analyzed for effect on outcomes, including ipsilateral breast tumor recurrence (IBTR) and survival. Results: One hundred forty-five cases were evaluated; the median follow-up time was 19.3 years. IBTR developed in 25 patients, for 5-, 10-, 15-, and 20-year actuarial rates of 9.9%, 12.2%, 13.7%, and 17.5%, respectively. One third of IBTRs were elsewhere failures, and 68% of IBTRs occurred <10 years after diagnosis. Young age and cancerization of lobules predicted for IBTR at <10 years, and increased slide involvement and atypical ductal hyperplasia were associated with IBTR at later time points. Conclusions: Patients with DCIS treated with BCT have excellent long-term rates of local control. Predictors of IBTR vary over time, and the risk of recurrence seems highest within 10 to 12 years after diagnosis.

  13. Long-term outcome and late toxicities of simultaneous integrated boost-intensity modulated radiotherapy in pediatric and adolescent nasopharyngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Chang-Juan Tao; Ai-Hua Lin; Jun Ma; Ying Sun; Xu Liu; Ling-Long Tang; Yan-Ping Mao; Lei Chen; Wen-Fei Li; Xiao-Li Yu; Li-Zhi Liu; Rong Zhang

    2013-01-01

    The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8-20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrol ed in this retrospective study. The disease stage distribution was as fol ows:stage I, 1 (2.9%);stage III, 14 (41.2%);and stage IV, 19 (55.9%). Al patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64-68 Gy in 29-31 fractions to the nasopharyngeal gross target volume. Within the median fol ow-up of 52 months (range, 9-111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse-free survival, distant metastasis-free survival, disease-free survival, and overal survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3-4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1-2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure.

  14. Long-term outcome of neuroparacoccidioidomycosis treatment

    Directory of Open Access Journals (Sweden)

    Fabio Francesconi

    2011-02-01

    Full Text Available INTRODUCTION: Neuroparacoccidioidomycosis (NPCM is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS: All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS: Fourteen (3.8% cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM. A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS: All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.

  15. Pediatric polytrauma : Short-term and long-term outcomes

    NARCIS (Netherlands)

    vanderSluis, CK; Kingma, J; Eisma, WH; tenDuis, HJ

    1997-01-01

    Objective: To assess the short-term and long-term outcomes of pediatric polytrauma patients and to analyze the extent to which short-term outcomes can predict long-term outcomes. Materials and Methods: Ail pediatric polytrauma patients (Injury Severity Score of greater than or equal to 16, less than

  16. Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center

    Energy Technology Data Exchange (ETDEWEB)

    Al-Mamgani, Abrahim, E-mail: a.al-mamgani@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Rooij, Peter van [Department of Biostatistics, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Verduijn, Gerda M. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Meeuwis, Cees A. [Department of Otorhinolaryngology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Levendag, Peter C. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2012-09-01

    Purpose: To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Methods and Materials: Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. Results: After a median follow-up of 58 months (range, 4-172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p = 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade {>=}2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Conclusions: Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in

  17. Long-term outcome in patients with juvenile dermatomyositis

    DEFF Research Database (Denmark)

    Mathiesen, P; Hegaard, H; Herlin, Troels

    2012-01-01

    To evaluate a group of 53 patients with juvenile dermatomyositis (JDM), on average 13.9 years after disease onset, in order to describe the long-term disease outcome and to identify disease-related parameters associated with poor disease outcome.......To evaluate a group of 53 patients with juvenile dermatomyositis (JDM), on average 13.9 years after disease onset, in order to describe the long-term disease outcome and to identify disease-related parameters associated with poor disease outcome....

  18. Long-term oncologic outcomes of laparoscopic nephroureterectomy versus open nephroureterectomy for upper tract urothelial carcinoma: a systematic review and meta-analysis

    Science.gov (United States)

    Zhang, Su; Luo, You; Wang, Cheng; Fu, Sheng-Jun

    2016-01-01

    Background. Several factors have been validated as predictors of disease recurrence in upper tract urothelial carcinoma. However, the oncological outcomes between different surgical approaches (open nephroureterectomy versus laparoscopic nephroureterectomy, ONU vs LNU) remain controversial. Therefore, we performed a meta-analysis to evaluate the oncological outcomes associated with different surgical approaches. Methods. We conducted an electronic search of the PubMed, Embase, ISI Web of Knowledge and Cochrane Library electronic databases through November 2015, screened the retrieved references, collected and evaluated the relevant information. We extracted and synthesized the corresponding hazard ratios (HRs) and 95% confidence intervals (95% CI) using Stata 13. Results. Twenty-one observational studies were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed no differences in the intravesical recurrence-free survival (IRFS), unspecified recurrence-free survival (UnRFS) and overall survival (OS) between LNUandONU. However, improvements in the extravesical recurrence free survival (ExRFS) and cancer specific survival (CSS) were observed inLNU. The pooled hazard ratios were 1.05 (95% CI [0.92–1.18]) for IRFS, 0.80 (95% CI [0.64–0.96]) for ExRFS, 1.10 (95% CI [0.93–1.28]) for UnRFS, 0.91 (95% CI [0.66–1.17]) for OS and 0.79 (95% CI [0.68–0.91]) for CSS. Conclusion. Based on current evidence, LNU could provide equivalent prognostic effects for upper tract urothelial carcinoma, and had better oncological control of ExRFS and CSS compared to ONU. However, considering all eligible studies with the intrinsic bias of retrospective study design, the results should be interpreted with caution. Prospective randomized trials are needed to verify these results. PMID:27280069

  19. Long-term oncologic outcomes of laparoscopic nephroureterectomy versus open nephroureterectomy for upper tract urothelial carcinoma: a systematic review and meta-analysis.

    Science.gov (United States)

    Zhang, Su; Luo, You; Wang, Cheng; Fu, Sheng-Jun; Yang, Li

    2016-01-01

    Background. Several factors have been validated as predictors of disease recurrence in upper tract urothelial carcinoma. However, the oncological outcomes between different surgical approaches (open nephroureterectomy versus laparoscopic nephroureterectomy, ONU vs LNU) remain controversial. Therefore, we performed a meta-analysis to evaluate the oncological outcomes associated with different surgical approaches. Methods. We conducted an electronic search of the PubMed, Embase, ISI Web of Knowledge and Cochrane Library electronic databases through November 2015, screened the retrieved references, collected and evaluated the relevant information. We extracted and synthesized the corresponding hazard ratios (HRs) and 95% confidence intervals (95% CI) using Stata 13. Results. Twenty-one observational studies were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed no differences in the intravesical recurrence-free survival (IRFS), unspecified recurrence-free survival (UnRFS) and overall survival (OS) between LNUandONU. However, improvements in the extravesical recurrence free survival (ExRFS) and cancer specific survival (CSS) were observed inLNU. The pooled hazard ratios were 1.05 (95% CI [0.92-1.18]) for IRFS, 0.80 (95% CI [0.64-0.96]) for ExRFS, 1.10 (95% CI [0.93-1.28]) for UnRFS, 0.91 (95% CI [0.66-1.17]) for OS and 0.79 (95% CI [0.68-0.91]) for CSS. Conclusion. Based on current evidence, LNU could provide equivalent prognostic effects for upper tract urothelial carcinoma, and had better oncological control of ExRFS and CSS compared to ONU. However, considering all eligible studies with the intrinsic bias of retrospective study design, the results should be interpreted with caution. Prospective randomized trials are needed to verify these results.

  20. Long-term Outcomes of Childhood Onset Nephrotic Syndrome.

    Science.gov (United States)

    Hjorten, Rebecca; Anwar, Zohra; Reidy, Kimberly Jean

    2016-01-01

    There are limited studies on long-term outcomes of childhood onset nephrotic syndrome (NS). A majority of children with NS have steroid-sensitive nephrotic syndrome (SSNS). Steroid-resistant nephrotic syndrome (SRNS) is associated with a high risk of developing end-stage renal disease. Biomarkers and analysis of genetic mutations may provide new information for prognosis in SRNS. Frequently relapsing and steroid-dependent NS is associated with long-term complications, including dyslipidemia, cataracts, osteoporosis and fractures, obesity, impaired growth, and infertility. Long-term complications of SSNS are likely to be under-recognized. There remain many gaps in our knowledge of long-term outcomes of childhood NS, and further study is indicated.

  1. Long-term Outcomes of Childhood Onset Nephrotic Syndrome

    OpenAIRE

    Hjorten, Rebecca; Anwar, Zohra; Reidy, Kimberly Jean

    2016-01-01

    There are limited studies on long-term outcomes of childhood onset nephrotic syndrome (NS). A majority of children with NS have steroid-sensitive nephrotic syndrome (SSNS). Steroid-resistant nephrotic syndrome (SRNS) is associated with a high risk of developing end-stage renal disease. Biomarkers and analysis of genetic mutations may provide new information for prognosis in SRNS. Frequently relapsing and steroid-dependent NS is associated with long-term complications, including dyslipidemia, ...

  2. Medium- to long-term outcome of ankle arthrodesis

    NARCIS (Netherlands)

    R.P.M. Hendrickx; S.A.S. Stufkens; E.E. de Bruijn; I.N. Sierevelt; C.N. van Dijk; G.M.M.J. Kerkhoffs

    2011-01-01

    Despite improvement in outcome after ankle arthroplasty, fusion of the ankle joint is still considered the gold standard. A matter of concern is deterioration of clinical outcome as a result of loss of motion and advancing degeneration of adjacent joints. We performed a long-term study to address th

  3. Long-term outcome and MGMT as a predictive marker in 24 patients with atypical pituitary adenomas and pituitary carcinomas given treatment with temozolomide

    DEFF Research Database (Denmark)

    Bengtsson, Daniel; Schrøder, Henrik Daa; Andersen, Marianne;

    2015-01-01

    CONTEXT/OBJECTIVE: Locally aggressive pituitary tumors (LAPT) and pituitary carcinomas respond poorly to conventional therapy and cytotoxic drugs. Temozolomide (TMZ) is an oral alkylating drug with good tolerability, approved for treatment of malignant gliomas. The experience of its use in pituit......CONTEXT/OBJECTIVE: Locally aggressive pituitary tumors (LAPT) and pituitary carcinomas respond poorly to conventional therapy and cytotoxic drugs. Temozolomide (TMZ) is an oral alkylating drug with good tolerability, approved for treatment of malignant gliomas. The experience of its use...

  4. Brachial plexus neuropathy - A long-term outcome study

    NARCIS (Netherlands)

    Geertzen, JHB; Groothoff, JW; Nicolai, JP; Rietman, JS

    2000-01-01

    This retrospective study assessed the long-term outcome of brachial plexus neuropathy in 16 patients. The mean follow up was 8 years. Nine patients complained of persistent pain and muscle weakness, four had continuing problems with various activities of daily living and 11 had trouble with some hou

  5. Long-Term Outcome in Pyridoxine-Dependent Epilepsy

    Science.gov (United States)

    Bok, Levinus A.; Halbertsma, Feico J..; Houterman, Saskia; Wevers, Ron A.; Vreeswijk, Charlotte; Jakobs, Cornelis; Struys, Eduard; van der Hoeven, Johan H.; Sival, Deborah A.; Willemsen, Michel A.

    2012-01-01

    Aim: The long-term outcome of the Dutch pyridoxine-dependent epilepsy cohort and correlations between patient characteristics and follow-up data were retrospectively studied. Method: Fourteen patients recruited from a national reference laboratory were included (four males, 10 females, from 11 families; median age at assessment 6y; range 2y…

  6. Long-term outcome in pyridoxine-dependent epilepsy.

    NARCIS (Netherlands)

    Bok, L.A.; Halbertsma, F.J.; Houterman, S.; Wevers, R.A.; Vreeswijk, C.; Jakobs, C.; Struys, E.; Hoeven, J.H. van; Sival, D.A.; Willemsen, M.A.A.P.

    2012-01-01

    Aim The long-term outcome of the Dutch pyridoxine-dependent epilepsy cohort and correlations between patient characteristics and follow-up data were retrospectively studied. Method Fourteen patients recruited from a national reference laboratory were included (four males, 10 females, from 11 familie

  7. Long-term outcome in pyridoxine-dependent epilepsy

    NARCIS (Netherlands)

    Bok, Levinus A.; Halbertsma, Feico J.; Houterman, Saskia; Wevers, Ron A.; Vreeswijk, Charlotte; Jakobs, Cornelis; Struys, Eduard; Van der Hoeven, Johan H.; Sival, Deborah A.; Willemsen, Michel A.

    2012-01-01

    AIM: The long-term outcome of the Dutch pyridoxine-dependent epilepsy cohort and correlations between patient characteristics and follow-up data were retrospectively studied. METHOD: Fourteen patients recruited from a national reference laboratory were included (four males, 10 females, from 11 famil

  8. Long-term Outcomes of Hypofractionation Versus Conventional Radiation Therapy After Breast-Conserving Surgery for Ductal Carcinoma In Situ of the Breast

    Energy Technology Data Exchange (ETDEWEB)

    Lalani, Nafisha; Paszat, Lawrence [University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Sutradhar, Rinku; Thiruchelvam, Deva [Institute for Clinical Evaluative Sciences, Toronto, Ontario (Canada); Nofech-Mozes, Sharon; Hanna, Wedad; Slodkowska, Elzbieta [University of Toronto, Toronto, Ontario (Canada); Department of Anatomic Pathology, Sunnybrook Health Sciences Centre and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Done, Susan J. [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Campbell Family Institute for Breast Cancer Research, Toronto, Ontario (Canada); Miller, Naomi; Youngson, Bruce [University of Toronto, Toronto, Ontario (Canada); Laboratory Medicine Program, University Health Network and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Tuck, Alan [Pathology and Laboratory Medicine, London Health Sciences Centre and Saint Joseph' s Health Care, London, Ontario (Canada); Sengupta, Sandip [Department of Pathology and Molecular Medicine, Kingston General Hospital, Kingston, Ontario (Canada); Elavathil, Leela [Department of Anatomical Pathology, Juravinski Hospital, Hamilton Health Sciences, Hamilton, Ontario (Canada); Chang, Martin C. [Department of Pathology and Laboratory Medicine, Mount Sinai Hospital and Department of Laboratory Medicine and Pathobiology, Toronto, Ontario (Canada); Jani, Prashant A. [Department of Anatomical Pathology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario (Canada); Bonin, Michel [Pathology and Laboratory Medicine, Sudbury Regional Hospital, Sudbury, Ontario (Canada); and others

    2014-12-01

    Purpose: Whole-breast radiation therapy (XRT) after breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS) may decrease the risk of local recurrence, but the optimal dose regimen remains unclear. Past studies administered 50 Gy in 25 fractions (conventional); however, treatment pattern studies report that hypofractionated (HF) regimens (42.4 Gy in 16 fractions) are frequently used. We report the impact of HF (vs conventional) on the risk of local recurrence after BCS for DCIS. Methods and Materials: All women with DCIS treated with BCS and XRT in Ontario, Canada from 1994 to 2003 were identified. Treatment and outcomes were assessed through administrative databases and validated by chart review. Survival analyses were performed. To account for systematic differences between women treated with alternate regimens, we used a propensity score adjustment approach. Results: We identified 1609 women, of whom 971 (60%) received conventional regimens and 638 (40%) received HF. A total of 489 patients (30%) received a boost dose, of whom 143 (15%) received conventional radiation therapy and 346 (54%) received HF. The median follow-up time was 9.2 years. The median age at diagnosis was 56 years (interquartile range [IQR], 49-65 years). On univariate analyses, the 10-year actuarial local recurrence–free survival was 86% for conventional radiation therapy and 89% for HF (P=.03). On multivariable analyses, age <45 years (hazard ratio [HR] = 2.4; 95% CI: 1.6-3.4; P<.0001), high (HR=2.9; 95% CI: 1.2-7.3; P=.02) or intermediate nuclear grade (HR=2.7; 95% CI: 1.1-6.6; P=.04), and positive resection margins (HR=1.4; 95% CI: 1.0-2.1; P=.05) were associated with an increased risk of local recurrence. HF was not significantly associated with an increased risk of local recurrence compared with conventional radiation therapy on multivariate analysis (HR=0.8; 95% CI: 0.5-1.2; P=.34). Conclusions: The risk of local recurrence among individuals treated with HF regimens

  9. Long term functional outcome of idiopathic inflammatory myopathies

    Directory of Open Access Journals (Sweden)

    G. Pasero

    2011-09-01

    Full Text Available The idiopathic inflammatory myopathies (IIM comprise a group of diseases characterized by chronic inflammation of the skeletal muscles. The definition of the long-term outcome of IIM, has been limited by the difficulty in objectively evaluating the rate of muscle function impairment. Aim of our study, was to define the long term outcome in a group of 37 IIM patients, followed at our centres between 1979 and 1999. A protocol, evaluating CK levels, muscle function, and disability in daily life activity was prospectively designed. The disease outcome was defined on the basis the patient’s functional evaluation. Disease activity was defined as the presence of an increase in serum CK levels associated with an increase of therapy. At the end of follow up, 27% of the patients had an active disease and 35% had a poor functional outcome. On the basis of our results we could distinguish three different outcomes of IIM: (i good functional outcome (65%; (ii poor functional outcome with inactive disease (13.5%; (iii poor functional outcome and active disease (21,5%. In conclusion, although IIM seem to have a good evolution in terms of disease activity, in about 46% of patients they are associated with an elevated incidence of functional impairement, probably attributable both to the disease’s damage and to the side effects of therapy.

  10. Long-term outcome of presymptomatic testing in Huntington disease

    OpenAIRE

    Gargiulo, Marcela; Lejeune, Séverine; Tanguy, Marie-Laure; Lahlou-Laforêt, Khadija; Faudet, Anne; Cohen, David; Feingold, Josué; Durr, Alexandra

    2008-01-01

    Our study on long-term outcome of presymptomatic testing for Huntington disease had two aims: the comparison of the psychological well-being and social adjustment of carriers and non-carriers of the mutation, and the identification of psychological determinants to improve care/support of testees. We performed a cross-sectional study of 351 persons who underwent presymptomatic testing. Those who had motor signs were excluded from the comparison of asymptomatic carrier and non-carriers. A struc...

  11. Focal cortical dysplasia: long term seizure outcome after surgical treatment

    Science.gov (United States)

    Kral, T; von Lehe, M; Podlogar, M; Clusmann, H; Süßmann, P; Kurthen, M; Becker, A; Urbach, H; Schramm, J

    2007-01-01

    Background Studies of long term outcome after epilepsy surgery for cortical malformations are rare. In this study, we report our experience with surgical treatment and year to year long term outcome for a subgroup of patients with focal cortical dysplasia (FCD). Methods We retrospectively analysed the records of 49 patients (females n = 26; males n = 23; mean age 25 (11) years) with a mean duration of epilepsy of 18 years (range 1–45). Preoperative MRI, histological results based on the Palmini classification and clinical year to year follow‐up according to the International League Against Epilepsy (ILAE) classification were available in all patients. Results 98% of patients had a lesion on preoperative MRI. In addition to lobectomy (n = 9) or lesionectomy (n = 40), 14 patients had multiple subpial transections of the eloquent cortex. The resected tissue was classified as FCD type II b in 41 cases with an extratemporal (88%) and FCD type II a in 8 cases with a temporal localisation (100%). After a mean follow‐up of 8.1 (4.5) years, 37 patients (76%) were seizure free, a subgroup of 23 patients (47%) had been completely seizure free since surgery (ILAE class 1a) and 4 patients (8%) had only auras (ILAE class 2). Over a 10 year follow‐up, the proportion of satisfactory outcomes decreased, mainly within the first 3 years. During long term follow‐up, 48% stopped antiepileptic drug treatment, 34% received a driver's license and 57% found a job or training. Conclusion Surgical treatment of epilepsy with FCD is not only successful in the short term but also has a satisfying long term outcome which remains constant after 3 years of follow‐up but is not associated with better employment status or improvement in daily living. PMID:17287239

  12. Long term surgical treatment outcome of talar body fracture

    Institute of Scientific and Technical Information of China (English)

    Ramesh Kumar Sen; Sujit Kumar Tripathy; Shakthivel RR Manoharan; Vibhu Krishnan; Tajir Tamuk; Vanyambadi Jagadeesh

    2011-01-01

    Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures.Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level Ⅰ trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views) and ankle (antero-posterior, lateral and mortise views) were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI) after 3 weeks, 6 weeks, 3 months, 6 months and then annually.Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear),with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis oftalar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome.Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation.

  13. Early nutrition and health: short- and long-term outcomes.

    Science.gov (United States)

    Gruszfeld, Dariusz; Socha, Piotr

    2013-01-01

    Maternal diet, nutritional status during pregnancy, and the early diet of the offspring play an important role in later health. The short- and long-term outcomes of early nutrition have been extensively studied in recent decades. One of the most commonly investigated nutritional interventions is breastfeeding, which is associated with a number of positive short- and long-term outcomes. A short-term effect of breastfeeding is reduced morbidity and mortality in children from poor living conditions and in preterm infants. Breastfeeding is associated with better cognitive development and also has a long-term protective effect on obesity risk, prevalence of type 2 diabetes, and a lowering effect on blood pressure. Selected nutrients have undergone extensive investigation to show their role in disease prevention or improved development, e.g. protein intake in infancy seems to be associated with a later risk of obesity or docosahexaenoic acid supplementation has a positive impact on cognitive function. Another consideration is the fast catch-up growth in small for gestational age infants as an important factor associated with adult risk of cardiovascular problems. On the other hand, high protein and energy intake seems to be positively associated with some indicators of cognitive development. Most of the evidence comes from observational studies that cannot exclude potential confounders. Animal studies demonstrate causality but should not be directly extrapolated to humans. The number of randomized controlled studies is increasing but long-term follow-ups are necessary to obtain convincing results. The majority of these trials compare different infant formula compositions and macro- or micronutrient supplementation. One of the major questions is to define a critical (or opportunity) window and a mechanism of nutritional influence on several health outcomes.

  14. Long-Term Outcome of En Bloc Extensive Resection of the Penis and Prepuce Associated with a Permanent Perineal Urethrostomy in a Gelding Affected by Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Paola Straticò

    2016-01-01

    Full Text Available A 15-year-old gelding was referred for a florid, cauliflower-like ulcerated mass, enclosing penis and prepuce together with penile urethra showing a malodorous purulent and blood-stained discharge and larvae infestation. En bloc extensive resection of the penis and prepuce, without penile retroversion or pexy to ventral abdomen associated with a permanent perineal urethrostomy, was performed. Histology of the mass revealed a squamous cell carcinoma of penis and prepuce. The surgical technique that was adopted is a modified version of that already described that allows a more proximal resection of the penile body and is a valid option for treating advanced SCC lesions involving the penis. Early postsurgical complications (mild strangury, haemorrhage from the urethrostomy site and its partial dehiscence, and infection of the abdominal wound were managed with a medical treatment and resolved within 5 to 12 days. Three years after surgery the horse is in good body condition and does not show any sign of recurrence or disorders related to the surgery.

  15. Neurologic long term outcome after drowning in children

    Directory of Open Access Journals (Sweden)

    Suominen Pertti K

    2012-08-01

    Full Text Available Abstract Drowning is a major source of mortality and morbidity in children worldwide. Neurocognitive outcome of children after drowning incidents cannot be accurately predicted in the early course of treatment. Therefore, aggressive out-of-hospital and in-hospital treatment is emphasized. There are "miracle" cases after long submersion times that have been reported in the medical literature, which mostly concern small children. However, many of the survivors will remain severely neurologically compromised after remarkably shorter submersion times and will consequently be a great burden to their family and society for the rest of their lives. The duration of submersion, the need of advanced life support at the site of the accident, the duration of cardiopulmonary resuscitation, whether spontaneous breathing and circulation are present on arrival at the emergency room are important factors related to survival with mild neurological deficits or intact function in drowned children. Data on long-term outcome are scarce. The used outcome measurement methods and the duration of follow-up have not been optimal in most of the existing studies. Proper neurological and neurophysiological examinations for drowned children are superior to outcome scales based chart reviews. There is evidence that gross neurological examination at the time of discharge from the hospital in young children does not reveal all the possible sequelae related to hypoxic brain injury and thus long-term follow-up of drowned resuscitated children is strongly recommended.

  16. Long term surgical treatment outcome of talar body fracture

    Directory of Open Access Journals (Sweden)

    Sen Ramesh Kumar

    2012-02-01

    Full Text Available 【Abstract】Objective: Talar body fractures are rare and have poor treatment outcome. The purpose of this study is to report the long term surgical treatment outcome of closed talar dome fractures. Methods: Eight closed talar body fractures, treated by open reduction and internal fixation with small fragment cancellous screws and/or Herbert screws in our level I trauma centre were retrospectively analyzed. Preoperative and postoperative radiographs of the foot (antero-posterior, lateral and oblique views and ankle (antero-posterior, lateral and mortise views were obtained. The patients were followed up both radiologically and functionally (foot function index, FFI after 3 weeks, 6 weeks, 3 months, 6 months and then annually. Results: There were five crush fractures and three shear fractures (two sagittal shear and one coronal shear, with average follow-up of 5 years. No early complications were noticed in these patients. Late complications included osteoarthrosis of subtalar/ankle joints in six patients and osteonecrosis of talar body in four patients. On functional assessment, mean FFI after 5 years was 104.63 points and worse outcome was noticed in crush injury and coronal shear fractures. Sagittal shear fractures had a good functional and radiological outcome. Conclusions: Late complications subsequent to surgically treated talar body fractures are inevitable, even though exact reduction and rigid fixation are achieved, thus patients are supposed to be counseled about the adverse outcome. Although crush and coronal shear fractures have poor outcome, sagittal injuries have good prognosis on long term evaluation. Key words: Fractures, bone; Talus; Fracture fixation, internal

  17. Long-Term Neuropsychological Outcome in Preterm Twins

    Directory of Open Access Journals (Sweden)

    Giovanni Iannone

    2006-01-01

    Full Text Available Few long-term studies have yet described neuropsychological outcome in preterm twins. Our aim was to assess, by long-term evaluation, neuropsychological outcome in preterm twins in order to define a correct follow-up program. Our study was a cohort one, with an index and a comparison group. Neonatal medical records of all preterm newborns admitted to our centre between 1991 and 1997 were reviewed and selected patients were recalled. The sample population included two matched groups of children aged 6—12 years, 86 twins and 86 singletons, submitted to paediatric, neurological, psychological, and ophthalmological examinations. Inclusion criteria were twin pregnancy and gestational age 27—36 weeks for index group; same gestational age, but single pregnancy, for the comparison group. All children underwent paediatric and neuropsychiatric examinations, cognitive assessment, and psychological evaluation by standardized tests for screening of learning specific disorders and language difficulties, and finally, ophthalmological examination. In order to study their role in predicting neuropsychological outcome, we examined some perinatal prognostic factors by statistical analysis. Unfavourable neuropsychological outcome was observed in 55/172 (32% children, with different prevalence in the two groups, 42/172 (24% in twins and 13/172 (8% in singletons. Statistical analysis performed for examined prognostic factors showed significant differences in neuropsychological outcome with regard only to gestational age < 32 weeks, low birth weight, intraventricular haemorrhage, and periventricular leukomalacia. The incidence of neuropsychological diseases in the two groups showed significant difference about language and learning difficulties. Our data suggest that preterm twins represent a particular high-risk category of premature babies, mostly regarding the risk of so-called “minimal brain dysfunction”, so a careful follow-up is recommended.

  18. Parotid small cell carcinoma presenting with long-term survival after surgery alone: a case report

    Directory of Open Access Journals (Sweden)

    Kanazawa Takeharu

    2012-12-01

    Full Text Available Abstract Introduction Primary involvement of the salivary glands in small cell carcinoma is rare, and has one of the worst prognoses of salivary gland neoplasms. However, it has been reported that some cases have a favorable outcome, although the prognostic factors are still under consideration. Multidisciplinary therapy was usually required to achieve long-term survival. Recently, a resemblance of some small cell carcinomas of the salivary gland to cutaneous Merkel cell carcinoma was suggested; the latter have the potential for spontaneous regression, which is related to a favorable clinical outcome. Case presentation We present a locoregional advanced parotid small cell carcinoma with multiple lymph node metastases in an 87-year-old Asian woman. The tumor was controlled by surgery alone, and nine-year disease-free survival was achieved without any adjunctive therapy. To the best of our knowledge, this is the longest reported follow-up of head and neck small cell carcinoma. Conclusion We believe this to be the first case of small cell carcinoma with involvement of the salivary glands reported in the literature with a good outcome after surgery alone without any adjunctive therapy.

  19. Long-term visual outcome of dense bilateral congenital cataract

    Institute of Scientific and Technical Information of China (English)

    YE He-hua; DENG Da-ming; QIAN Yi-yong; LIN Zhi; CHEN Wei-rong

    2007-01-01

    Background Dense congenital cataracts often cause severe visual impairment. The results of long-term follow-up of dense bilateral congenital cataract in China have not been well documented. The purpose of this study was to evaluate the long-term visual function in children who underwent cataract extraction for dense bilateral congenital cataract in southern part of China.Methods Medical records of children who underwent surgery of dense bilateral congenital cataract between January 1992 and December 2000 at Zhongshan Ophthalmic Center of Sun Yat-sen University were retroactively reviewed. In 38 children available for current follow-up, best corrected visual acuity (BCVA) and stereoscopic vision, as well as nystagmus, strabismus, and other complications, were evaluated. The mean follow-up period was 107.6 months (range 60 to 167 months).Results The mean age of cataract extraction and secondary intraocular lens implantation were 5.6 months (range 3 to 12 months) and 4.2 years (range 2.4 to 15 years), respectively. The mean BCVA was 0.25 in the better eye and 0.16 in the fellow eye. Stereoscopic vision was absent in all patients, and 3 children had simultaneous perception. Nystagmus was detected in all cases and strabismus in 35 cases. A high correlation was found between timing of cataract extraction and final BCVA of the better eye (r=-0.55, P=0.00). A statistically significant difference was found in BCVA between postand pre-treatment of amblyopia (t=5.65, P=0.00).Conclusions Long-term visual function in children with dense bilateral congenital cataract was poor when cataract surgery was performed at age of 3 months or later. Earlier cataract surgery with adequate optical rehabilitation contributed to better visual outcome.

  20. Alcohol Consumption and Long-Term Labor Market Outcomes.

    Science.gov (United States)

    Böckerman, Petri; Hyytinen, Ari; Maczulskij, Terhi

    2017-03-01

    This paper examines whether alcohol consumption is related to long-term labor market outcomes. We use twin data for Finnish men and women matched to register-based individual information on employment and earnings. The twin data allow us to account for the shared environmental and genetic factors. The quantity of alcohol consumption was measured by weekly average consumption using self-reported data from three surveys (1975, 1981 and 1990). The average of an individual's employment months and earnings were measured in adulthood over the period 1990-2009. The models that account for the shared environmental and genetic factors reveal that former drinkers and heavy drinkers both have almost 20% lower earnings compared with moderate drinkers. On average, former drinkers work annually approx. 1 month less over the 20-year observation period. These associations are robust to the use of covariates, such as education, pre-existing health endowment and smoking. Copyright © 2015 John Wiley & Sons, Ltd.

  1. LONG-TERM OUTCOMES OF FENESTRATED DISCECTOMY FOR LUMBAR DISC

    Institute of Scientific and Technical Information of China (English)

    PAN Yu-tao; CAO Peng; LIANG Yu; GONG Yao-cheng; ZHENG Tao; ZHANG Xing-kai; WU Wen-jian

    2008-01-01

    Objective To evaluate the long-term outcomes of fenestrated discectomy for lumbar disc herniation and analyze the correlative influence factors.Methods Eighty-two cases of lumbar disc herniation, from February 1996 to May 1999, were retrospectively studied. All patients were treated with simple fenestrated discectomy. The average follow-up time was 8 years and 7 months (from 7 years to10 years and 3months). There were 13, 38 and 31 cases at L3-L4, L4-L5 and L5-S1 level, respectively.Results The average scales before operation were as following: Japanes Orthopaedics Association (JOA) scale 6.5 (5-9), visual analysis scale (VAS) of low back pain 4.8 (0-8), and VAS of sciatica 7.2 (4-10). At the final follow-up, the above parameters were 13.2 (10-14), 1.8 (0-10) and 1.2 (0-7), respectively. The average increase ratio of JOA scale was 78.8%. The average disc-vertebra height ratio (Mochida method) was 80.2%. At the final follow-up, 7 cases reoccurred disc herniation. The final clinical satisfaction rate was 80% (modified Macnab method).Conclusion With appropriate surgical indications, the successful long-term outcomes could be expected with fenestrated discectomy. Discectomy improves sciatica to a greater extent than low back pain. The occurrence of low back pain is related to intervertebral disc height, segment stability, disc degeneration, and lumbar muscle disability.

  2. Long-term outcomes five years after selective dorsal rhizotomy

    Directory of Open Access Journals (Sweden)

    Lagergren Jan

    2008-12-01

    Full Text Available Abstract Background Selective dorsal rhizotomy (SDR is a well accepted neurosurgical procedure performed for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP. The goal is to improve function, but long-term outcome studies are rare. The aims of this study were to evaluate long-term functional outcomes, safety and side effects during five postoperative years in all children with diplegia undergoing SDR combined with physiotherapy. Methods This study group consisted of 35 children, consecutively operated, with spastic diplegia, of which 26 were Gross Motor Function Classification System (GMFCS levels III–V. Mean age was 4.5 years (range 2.5–6.6. They were all assessed by the same multidisciplinary team at pre- and at 6, 12, 18 months, 3 and 5 years postoperatively. Clinical and demographic data, complications and number of rootlets cut were prospectively registered. Deep tendon reflexes and muscle tone were examined, the latter graded with the modified Ashworth scale. Passive range of motion (PROM was measured with a goniometer. Motor function was classified according to the GMFCS and measured with the Gross Motor Function Measure (GMFM-88 and derived into GMFM-66. Parent's opinions about the children's performance of skills and activities and the amount of caregiver assistance were measured with Pediatric Evaluation Disability Inventory (PEDI. Results The mean proportion of rootlets cut in S2-L2 was 40%. Muscle tone was immediately reduced in adductors, hamstrings and dorsiflexors (p Conclusion SDR is a safe and effective method for reducing spasticity permanently without major negative side effects. In combination with physiotherapy, in a group of carefully selected and systematically followed young children with spastic diplegia, it provides lasting functional benefits over a period of at least five years postoperatively.

  3. Long- term outcome of paediatric patients with ANCA vasculitis

    Directory of Open Access Journals (Sweden)

    Pusey Charles D

    2011-06-01

    Full Text Available Abstract Background Primary systemic vasculitis presenting in childhood is an uncommon but serious condition. As these patients transfer to adult clinics for continuing care, defining long term outcomes with emphasis on disease and treatment- related morbidity and mortality is important. The aim of this study is to describe the long- term clinical course of paediatric patients with ANCA vasculitis. Methods The adult patients in our vasculitis clinics who had presented in childhood, with a follow up time of greater than 10 years were included. We also reviewed the literature for articles describing the clinical outcome of paediatric patients with ANCA vasculitis. Results We describe the clinical course of 8 adults who presented in childhood with ANCA vasculitis. 7 patients had Wegener's granulomatosis and 1 had microscopic polyangiitis. The median age at presentation was 11.5 years, and follow up time ranged form 11 to 30 years. Induction therapy for all patients was steroids and/or cyclophosphamide. Maintenance therapy was with azathioprine or mycophenolate mofetil. Biological agents were used in 3 patients for relapsed disease in adulthood only. Seven patients achieved complete remission. All patients experienced disease relapse, with a median of 4 episodes. Kidney function was generally well preserved, with median eGFR 76 ml/min. Only one patient developed end-stage renal failure and one patient died after 25 years of disease. Treatment-related morbidity rates were high; 7 suffered from infections, 4 were infertile, 2 had skeletal complications, and 1 developed malignancy. Conclusion Close long- term follow up of paediatric patients with ANCA vasculitis is imperative, as this patient cohort is likely to live long enough to develop significant treatment and disease- related morbidities. Prospective cohort studies with novel therapies including paediatric patients are crucial to help us determine the best approach to managing this complex group

  4. Diagnosis, management, and long-term outcomes of rectovaginal endometriosis

    Directory of Open Access Journals (Sweden)

    Moawad NS

    2013-11-01

    Full Text Available Nash S Moawad,1 Andrea Caplin21Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Florida, 2University of Florida College of Medicine, Gainesville, FL, USAAbstract: Rectovaginal endometriosis is the most severe form of endometriosis. Clinically, it presents with a number of symptoms including chronic pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and rectal bleeding. The gold standard for diagnosis is laparoscopy with histological confirmation; however, there are a number of options for presurgical diagnosis, including clinical examination, transvaginal/transrectal ultrasound, magnetic resonance imagining, colonoscopy, and computed tomography colonography. Treatment can be medical or surgical. Medical therapies include birth control pills, oral progestins, gonadotropin-releasing hormone agonists, danazol, and injectable progestins. Analgesics are often used as well. Surgery improves up to 70% of symptoms. Surgery is either ablative or excisional, and is conducted via transvaginal, laparoscopic, laparotomy, or combined approaches. Common surgical techniques involve shaving of the superficial rectal lesion, laparoscopic anterior discoid resection, and low anterior bowel resection and reanastomosis. Outcomes are generally favorable, but postoperative complications may include intra-abdominal bleeding, anastomotic leaks, rectovaginal fistulas, strictures, chronic constipation, and the need for reoperation. Recurrence of rectal endometriosis is a possibility as well. Other outcomes are improved pain-related symptoms and fertility. Long-term outcomes vary according to the management strategy used. This review will provide the most recent approaches and techniques for the diagnosis and treatment of rectovaginal endometriosis.Keywords: pelvic pain, dyspareunia, bowel resection, endometriosis, rectovaginal

  5. Long-term outcomes of treatment of hyperthyroidism in Ireland.

    LENUS (Irish Health Repository)

    Leary, A C

    2012-02-03

    We investigated the long-term outcome of treatment in 159 patients with hyperthyroidism first seen between 1979 and 1992. Median duration of follow-up was 10 1\\/2 years. We also inquired into current practice for the follow-up of hyperthyroidism by other endocrinologists in Ireland. Seven cases of unrecognised hyperthyroidism (4 per cent) and one of unrecognised hypothyroidism were identified. Among patients with Graves\\' disease, of those treated with an antithyroid drug, 28 per cent were in remission, 68 per cent had relapsed and 4 per cent had become hypothyroid. Of those treated by sub-total thyroidectomy, 31 per cent were in remission, 19 per cent had relapsed, 19 per cent were hypothyroid and 31 per cent were sub-clinically hypothyroid. Among patients treated with radioiodine, 19 per cent were euthyroid, 3 per cent were still hyperthyroid and three-quarters had become hypothyroid. In contrast, after radioiodine for toxic nodular goitre, 63 per cent were euthyroid and only 32 per cent had become hypothyroid (Chi Squared v. Graves\\' disease, P = 0.001). Of 73 patients receiving thyroxine replacement, plasma TSH was normal in only 41 per cent, although 82 per cent of patients had been seen by the family doctor within the previous 12 months. Seven of 17 other endocrinologists undertook long-term follow-up of hyperthyroid patients in their specialist clinics but none was using a computerised system to co-ordinate this. The findings confirm that careful follow-up is required for all hyperthyroid patients. The family doctor is well positioned to undertake this, but education and auditing are required.

  6. Long-term outcomes for adult craniopharyngioma following radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Masson-Cote, Laurence; Masucci, Giuseppina Laura; Millar, Barbara-Ann; Laperriere, Normand J. [Dept. of Radiation Oncology, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada); Atenafu, Eshetu G. [Dept. of Biostatistics, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada); Cusimano, Michael [Dept. of Surgery, Div. of Neurosurgery, St. Michaels Hospital, Toronto (Canada); Croul, Sidney [Dept. of Pathology, Univ. of Toronto, Toronto (Canada); Mason, Warren [Dept. of Medicine, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada); Sahgal, Arjun [Dept. of Radiation Oncology, Princess Margaret Hospital, Univ. of Toronto, Toronto (Canada), E-mail: Arjun.sahgal@rmp.uhn.on.ca; Dept. of Radiation Oncology, Sunnybrook Health Sciences Center, Univ. of Toronto, Toronto (Canada)

    2013-01-15

    Background. We report long-term outcomes in adult patients with craniopharyngioma following surgery and radiation therapy (RT). Material and methods. Fifty-three patients treated with RT (median, 50 Gy in 25 fractions) between 1980 and 2009 with pathologically confirmed craniopharyngioma were reviewed (53% solid and 47% cystic/solid). The median age was 53 years (range, 22-76), 53% were female, 83% were sub-totally resected, 6% were gross totally resected and 11% had a biopsy and/or cyst aspiration alone. RT was delivered adjuvantly in 53% of patients as opposed to salvage intent upon progression. Results. Median follow-up was seven years (86 months, range, 8-259). The 5- and 10-year progression-free survival (PFS) rates were 85% and 69%, overall survival (OS) rates were 76% and 70%, and cause-specific survival (CSS) rates were both 88%, respectively. Both univariable and multivariable analysis identified age (<53 or {>=}53) as a prognostic factor for OS (p =0.0003) and CSS (p =0.05). PFS was observed to be worse in patients with >2 surgeries prior to RT (p =0.01). Neither the intent of radiation or tumor type (cystic vs. solid/cystic) were prognostic or predictive. New endocrinopathies and visual dysfunction were observed in 53% and 17% of patients post-surgery, and in 11% and 6% post-RT, respectively. Conclusion. We report long-term favorable PFS, CSS and OS for craniopharyngioma post-RT. We observe age as a significant prognostic factor, however, timing of radiation was not.

  7. Cause and Long-Term Outcome of Cardiac Tamponade.

    Science.gov (United States)

    Sánchez-Enrique, Cristina; Nuñez-Gil, Iván J; Viana-Tejedor, Ana; De Agustín, Alberto; Vivas, David; Palacios-Rubio, Julián; Vilchez, Jean Paul; Cecconi, Alberto; Macaya, Carlos; Fernández-Ortiz, Antonio

    2016-02-15

    Cardiac tamponade is a life-threatening condition, whose current specific cause and outcome are unknown. Our purpose was to analyze it. We performed a retrospective observational study with prospective follow-up data including 136 consecutive patients admitted with diagnosis of cardiac tamponade, from 2003 to 2013. We thoroughly recorded variables as clinical features, drainage/pericardiocentesis, fluid characteristics, and long-term events (new cardiac tamponade ± death). The median age was 65 ± 17 years (55% men). In the baseline characteristics, 70% were no smokers, 12% were on anticoagulation, and 13 had suffered a previous myocardial infarction. In the preceding month, 15 patients had undergone a cardiac catheterization, 5 cardiac surgery, and 5 pacemaker insertion. Fever was observed in 16% of patients and 21% displayed other inflammatory symptoms. In 81% of patients, pericardiocentesis was needed. The fluid was hemorrhagic or a transudate in the majority, with positive cytology in 15% and bacteria in 3.7%. Main causes were malignancy (32%), infection (24%), idiopathic (16%), iatrogenic (15%), postmyocardial infarction (7%), uremic (4%), and other causes (2%). After a maximum follow-up of 10.4 years, cardiac tamponade recurred in 10% of the cases (62% in the neoplastic group) and the 48% of patients died (89% in the neoplastic cohort). In conclusion, most cardiac tamponades are due to malignancy, having this specific cause a poorer outcome, probably as a manifestation of an advanced disease. The rest of causes, after an aggressive intensive management, have a good prognosis, especially the iatrogenic.

  8. Long-term outcomes of pediatric hypospadias and surgical intervention

    Directory of Open Access Journals (Sweden)

    De Win G

    2012-10-01

    Full Text Available Gunter De Win,1,2 Peter Cuckow,3 Piet Hoebeke,4 Dan Wood21Adolescent and Pediatric Urology, University Hospital, Antwerp, Belgium; 2Adolescent Urology, University College London Hospitals, UK; 3Pediatric Urology, Great Ormond Street Hospital for Sick Children, London, UK; 4Pediatric Urology, University Hospital, Gent, BelgiumAbstract: Hypospadias is one of the most commonly diagnosed male congenital disorders. Many surgical techniques are described and complications often reported include fistula, wound dehiscence, and meatal stenosis. Many surgeons still believe that hypospadias should be surgically corrected before the age of 12 months. However, it is clear that the longer the follow up, the more complications are reported. Correction of a failed hypospadias repair in adult patients can be challenging. While the need for repair of proximal hypospadias during childhood is evident, distal repair during childhood is questionable. Evidence suggests that the psychosexual and functional outcomes of nonoperated distal hypospadias in the adult population are good. Therefore, the benefit of surgery and the burden of complications must be carefully evaluated. This paper highlights the difficulties inherent in decisions related to the assessment of hypospadias, the need for repair, and the paucity of good long-term data.Keywords: hypospadias, chordee, urethroplasty, fistula, stricture, hypospadias complications

  9. Long-Term Outcome of Percutaneous Coronary Intervention for Chronic Total Occlusions

    NARCIS (Netherlands)

    R. Mehran; B.E. Claessen; C. Godino; G.D. Dangas; K. Obunai; S. Kanwal; M. Carlino; J.P.S. Henriques; C. di Mario; Y.H. Kim; S.J. Park; G.W. Stone; M.B. Leon; J.W. Moses; A. Colombo

    2011-01-01

    Objectives The aim of this study was to evaluate long-term clinical outcomes after percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). Background Despite technical advancements, there is a paucity of data on long-term outcomes after PCI of CTO. Methods We evaluated long-term

  10. Induction Chemotherapy Improved Long-term Outcomes of Patients with Locoregionally Advanced Nasopharyngeal Carcinoma: A Propensity Matched Analysis of 5-year Survival Outcomes in the Era of Intensity-modulated Radiotherapy

    Science.gov (United States)

    Peng, Hao; Chen, Lei; Zhang, Jian; Li, Wen-Fei; Mao, Yan-Ping; Zhang, Yuan; Liu, Li-Zhi; Tian, Li; Lin, Ai-Hua; Sun, Ying; Ma, Jun

    2017-01-01

    Background: The aim of this study is to evaluate the long-term therapeutic gain of induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC) in the era of intensity-modulated radiotherapy (IMRT). Methods: Data on 957 patients with stage T1-2N2-3 or T3-4N1-3 NPC treated with IMRT were retrospectively reviewed. Propensity score matching (PSM) method was adopted to balance influence of various covariates. Patient survival between IC and non-IC groups were compared. Results: For the 318 pairs selected from the original 957 patients by PSM, the median follow-up duration was 57.13 months (range, 1.27-78.1 months). The 5-year overall survival (OS), distant metastasis-free survival (DMFS), disease-free survival (DFS) and locoregional relapse-free survival (LRRFS) rates for IC group vs. non-IC group were 87.2% vs. 80.8% (P = 0.023), 88.1% vs. 83.2% (P = 0.071), 80.7% vs. 71.4% (P = 0.011) and 92.1% vs. 86.7% (P = 0.081), respectively. Multivariate analysis identify IC as an independent prognostic factor for OS (HR, 0.595; 95% CI, 0.397-0.891; P = 0.012) and DFS (HR, 0.627; 95% CI, 0.451-0.872; P = 0.006). After excluding the patients not receiving concurrent chemotherapy, IC was found to be an independent prognostic factor for OS (HR, 0.566; 95% CI, 0.368-0.872; P = 0.01), DMFS (HR, 0.580; 95% CI, 0.367-0.916; P = 0.02) and DFS (HR, 0.633; 95% CI, 0.444-0.903; P = 0.012). Conclusions: IC is an effective treatment modality for patients with stage T1-2N2-3 and T3-4N1-3 NPC, and the incorporation of IC with standard CCRT could achieve the best therapeutic gain. PMID:28261337

  11. Long term outcome and follow up of electrical injury

    Institute of Scientific and Technical Information of China (English)

    Hamid Karimi; Mahnoush Momeni; Mahtab Vasigh

    2015-01-01

    Objective: To evaluate the outcome of electrical burn on a patient's life performance and the disability induced by this type of injury.Methods:This study is a prospective 6 years descriptive study. The injured patients admitted to our center between 2006 and 2008 were followed for 6 years to estimate the ability of their life and job performance after the injury.Results:In the patients, 96.8% were male. The mean age of patients was 27.9 years. 73.9% of those injuries were occupational injuries. 86.5% were pure electrical injuries. 81% of patients went back to their previous job within a 5-6 year period. Only 5% had the ability to perform their usual daily activities-these patients needed financial support from family, insurance companies and government. Unfortunately 6.3% were totally disabled and needed complete help even for their minor natural needs. These patients are young and probably have a long-term life expectancy and would have a huge financial impact on the government and society. The mean length of hospital stay was 17.7 d. The mean total body surface area burned was 13.3%±11.5%. We could see an association between high voltage burns and falling down (P=0.005). High voltage burns needed longer periods away from work (197 d) in comparison with low voltage injuries (145.8 d) (P=0.003). Conclusions: High voltage electrical burns are severe, needing more flap repairs and/or amputations and cause longer periods away from work.

  12. Long-term outcomes of choledochoduodenostomy for hepatolithiasis

    Institute of Scientific and Technical Information of China (English)

    LING Xiao-feng; XU Zhi; WANG Li-xin; HOU Chun-sheng; XIU Dian-rong; ZHANG Tong-lin; ZHOU Xiao-si

    2010-01-01

    Background Oddi sphincter plays an important role in preventing reflux cholangitis. There exists the controversy on application of choledochoduodenostomy in hepatolithiasis management. The present study aimed at evaluating long-term outcomes of choledochoduodenostomy for the treatment of hepatolithiasis.Methods Forty-six consecutive cases of hepatolithiasis who underwent choledochoduodenostomy were analyzed retrospectively. The pre- and postoperative rates of recurrent cholangitis and acute cholangitis severe type were compared. Paired chi-square test was applied.Results The mean follow-up time was 17.3 years ranging from 1.6 to 40 years with a follow-up rate of 97.8% (45/46). High rates of remnant stones (39.1%, 18/46), recurrent stones (31.1%, 14/45), uncorrected strictures (85%, 17/20), and mortality (24.4%, 11/45) were observed in this group. Regurgitation of food debris and duodenal content into the biliary tract through the anastomosis was observed. The rate of recurrent cholangitis was equal to the preoperative period (93.3%, 42/45). The rate of acute cholangitis severe type after choledochoduodenostomy (46.7%, 21/45) increased significantly (P<0.01) when compared to the preoperative period (20.0%, 9/45).Conclusions Choledochoduodenostomy did not entirely achieve the goal of clearance of stones, correction of strictures, and removing of hepatobiliary lesions by itself. Choledochoduodenostomy without cholangioplasty resulted in an increase of severe reflux cholangitis due to the loss of the anti-reflux function of the sphincter of Oddi. Therefore, choledochoduodenostomy is not an ideal approach to reduce cholangitis in hepatolithiasis and is not the best choice in the management of hepatolithiasis.

  13. Rheumatic Fever Prevention Program: long term evolution and outcomes

    Directory of Open Access Journals (Sweden)

    Cleonice Carvalho Coelho Mota

    2015-01-01

    Full Text Available This investigation aims to analyze the profile of long term evolution of rheumatic fever in children and adolescents and outcomes after the control of recurrences. The cohort involved 702 patients followed from 1.3 to 16.9 years covering the two periods, before and after the implementation of a prevention program. Besides the establishment of the Reference Center in the State of Minas Gerais and the implementation of strategies to promote the compliance to prophylaxis, a project for education of health professionals was carried out in 23 cities. In addition to the clinical and epidemiological profile, the severity of the disease was analyzed. Mixed lesions were found in 27.1%, valvar regurgitation in 72.9% and complete regression of the valvar lesions was seen in 34.4% of the patients, mostly presenting mild dysfunctions. The recurrence rate per patient-year was 0,058 and out of a total of 85 recurrences, 21,4% occurred in the first and 7,5% in the second period. More severe degrees of carditis and significant valvar sequels presented a higher prevalence in patients with recurrences. The comparative analysis between the two periods showed no changes regarding the age at the primary attack, gender, type and site of valvar lesions and affected joints; however, important modifications in the indices of severity were observed after the control of recurrences. A significant decrease in the prevalence of severe carditis, obstructive valvar sequels, hospital admissions, surgical approach and deaths was seen. This investigation showed that although the clinical profile of presentation remains unchanged, the control of repeated attacks can improve the morbimortality rates. In this context, the secondary prophylaxis should be the first priority in the control of the disease in developing countries, taking into account the difficulties found for effective primordial and primary prevention. Keywords: rheumatic fever, rheumatic heart disease, secondary

  14. Long-Term Follow-up in Medullary Thyroid Carcinoma.

    Science.gov (United States)

    Raue, Friedhelm; Frank-Raue, Karin

    2015-01-01

    After surgery, patients with medullary thyroid carcinoma (MTC) should be assessed regarding the presence of residual disease, the localization of metastases, and the identification of progressive disease. Postoperatively, patients with MTC are staged to separate those at low risk from those at high risk of recurrence. The TNM staging system is based on tumor size, extra-thyroidal invasion, nodal metastasis, and distant spread of cancer. In addition, the number of lymph-node metastases, the number of compartments involved, and the postoperative calcitonin (CTN) and carcinoembryonic antigen (CEA) levels should be documented. The postoperative normalization of the serum CTN level is associated with a favorable outcome. When patients have basal serum CTN levels less than 150 pg/ml after a thyroidectomy, any persistent or recurrent disease is nearly always confined to lymph nodes in the neck. When the postoperative serum CTN level exceeds 150 pg/ml, patients should be evaluated with imaging procedures, including computed tomography (CT) of the neck and chest, contrast-enhanced magnetic resonance imaging (MRI) and ultrasound (US) of the liver, bone scintigraphy, MRI of the bone, and positron emission tomography (PET)/CT. One can estimate the growth rate of MTC metastases by quantifying increases in tumor size over time from sequential imaging studies analyzed with response evaluation criteria in solid tumors (RECIST), and by determining the tumor marker doubling time from sequential measures of serum CTN or CEA levels over multiple time points. One of the main challenges remains to find effective adjuvant and palliative options for patients with metastatic disease. Patients with persistent or recurrent MTC localized to the neck following thyroidectomy are candidates for neck operations, depending on the tumor extension. Once metastases appear, the clinician must decide which patients require therapy. This requires a balance between the (often) slow rate of tumor

  15. Long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions

    Institute of Scientific and Technical Information of China (English)

    王国清

    2013-01-01

    Objective To evaluate the long-term outcomes of endoscopic argon plasma coagulation (APC) therapy for early esophageal cancer and precancerous lesions.Methods One-hundred and seventy one cases with early esophageal cancer (intramucosal carcinoma) and precancerous lesions were treated by APC from 1994 to 2005,

  16. Brachytherapy in Lip Carcinoma: Long-Term Results

    Energy Technology Data Exchange (ETDEWEB)

    Guibert, Mireille, E-mail: mireilleguib@voila.fr [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)

    2011-12-01

    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.

  17. The Long-Term Outcome of Four-Corner Fusion

    Science.gov (United States)

    Trail, Ian A.; Murali, Raj; Stanley, John Knowles; Hayton, Michael John; Talwalkar, Sumedh; Sreekumar, Ramankutty; Birch, Ann

    2015-01-01

    , a functional range of motion, and a satisfactory functional outcome. The bulk of the complications appear to occur in the first 2 years after surgery. Thereafter, analysis shows long-term satisfaction with little deterioration. Nonunion, particularly around the triquetrum, continues to be a problem, but it may be that this bone should be excised along with the scaphoid, resulting in a three-part fusion only. Alternatively, a simple capitolunate fusion may be satisfactory. PMID:25945298

  18. For better or worse? Long-term outcome of critical illness in childhood : Long-term outcome of critical illness in childhood

    NARCIS (Netherlands)

    L. van Zellem (Lennart)

    2015-01-01

    markdownabstract__Abstract__ The aim of this thesis was to investigate the long-term outcome of critically ill children admitted to the pediatric intensive care unit (PICU) of the Erasmus MC – Sophia Children’s’ Hospital in Rotterdam, the Netherlands. Our main focus was to investigate the long-term

  19. Long-term outcome of equestrian injuries in children

    NARCIS (Netherlands)

    Dekker, R; van der Sluis, CK; Kootstra, J; Groothoff, JW; Eisma, Willem; ten Duis, HJ

    2004-01-01

    Purpose : To investigate the possible development of long-term disabilities arising from paediatric equestrian injuries. Method : All patients, aged 17 years or younger, treated in a hospital setting because of an equestrian injury during a five-year period received a questionnaire. A reference popu

  20. Long-Term Outcomes of an Urban Farming Internship Program

    Science.gov (United States)

    Sonti, Nancy Falxa; Campbell, Lindsay K.; Johnson, Michelle L.; Daftary-Steel, Sarita

    2016-01-01

    Long-term impacts of an urban farming youth internship were evaluated in Brooklyn, New York. Alumni surveyed 1 to 9 years after program completion were enrolled in college or graduate school at higher rates than their peers and reported connections to the environment and healthy eating. Participants reported learning job skills through the…

  1. Long-term outcome in children of patients after stroke

    NARCIS (Netherlands)

    van de Port, Ingrid G. L.; Visser-Meily, Anne M. A.; Post, Marcel W. M.; Lindeman, Eline

    2007-01-01

    Objective: To investigate the long-term effects on children of parental stroke, with respect to care-giving tasks, children's behavioural problems and stress, and to study the relationship between stress and child, patient and partner characteristics. Subjects: A total of 44 children (age range 10-2

  2. Long-term outcomes of young people who attempted suicide

    NARCIS (Netherlands)

    Grisham, Jessica R; Williams, Alishia D

    2014-01-01

    IMPORTANCE Suicidal behavior has increased since the onset of the global recession, a trend that may have long-term health and social implications. OBJECTIVE To test whether suicide attempts among young people signal increased risk for later poor health and social functioning above and beyond a pree

  3. Radiotherapy for pituitary adenomas: long-term outcome and complications

    Energy Technology Data Exchange (ETDEWEB)

    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung AE; Kim, Chul Yong [Korea University Medical Center, Seoul (Korea, Republic of)

    2011-09-15

    To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. We retrospectively reviewed the medical records of 60 patients treated with EBRT for pituitary adenoma at Korea University Medical Center from 1996 and 2006. Thirty-fi ve patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had received RT alone. Median total dose was 54 Gy (range, 36 to 61.2 Gy). The definition of tumor progression were as follows: evidence of tumor progression on computed tomography or magnetic resonance imaging, worsening of clinical sign requiring additional operation or others, rising serum hormone level against a previously stable or falling value, and failure of controlling serum hormone level so that the hormone level had been far from optimal range until last follow-up. Age, sex, hormone secretion, tumor extension, tumor size, and radiation dose were analyzed for prognostic significance in tumor control. Median follow-up was 5.7 years (range, 2 to 14.4 years). The 10-year actuarial local control rates for non-secreting and secreting adenomas were 96% and 66%, respectively. In univariate analysis, hormone secretion was significant prognostic factor (p = 0.042) and cavernous sinus extension was marginally significant factor (p = 0.054) for adverse local control. All other factors were not significant. In multivariate analysis, hormone secretion and gender were significant. Fifty-three patients had mass-effect symptoms (headache, dizziness, visual disturbance, hypopituitarism, loss of consciousness, and cranial nerve palsy). A total of 17 of 23 patients with headache and 27 of 34 patients with visual impairment were improved. Twenty-seven patients experienced symptoms of endocrine hypersecretion (galactorrhea, amenorrhea, irregular menstruation, decreased libido, gynecomastia, acromegaly, and Cushing

  4. Long-term clinical outcome of neonatal EEG findings.

    Science.gov (United States)

    Almubarak, Salah; Wong, Peter K H

    2011-04-01

    The aim of the study is to determine how specific EEG findings during neonatal period correlate with clinical outcome on follow-up. This is a retrospective study of 118 term newborns who had EEG in the first month of life and subsequent clinical assessment between 4 and 16 years. Clinical neurologic outcome was classified into "favorable" when patients had no or only mild limitation in assessment, "unfavorable" when patients had moderate to severe abnormalities in assessment, and "epilepsy" when patients had seizures. Of the 118 neonates, 36 (30.5%) had favorable and 82 (69.5%) had unfavorable outcome; 89 (75.4%) had epilepsy and 28 (23.7%) had not. Sixty-seven (57%) had abnormal EEG background of which 56 had both unfavorable outcome and epilepsy; 102 (86%) had sharp transient discharges of which 75 had unfavorable outcome; 20 (17%) had ictal epileptiform discharges of which 18 had unfavorable outcome; 98 (83%) had abnormal overall EEG impression of which 77 had unfavorable outcome and 80 had epilepsy. Abnormal EEG background (particularly suppression) during neonatal period may be predictive of Unfavorable outcome. Overall impression of EEG may be predictive of clinical outcome, even when individual parameters were not predictive. Other findings did not appear to be predictive.

  5. Long-term mortality and renal outcome in a cohort of 100 patients with lupus nephritis

    DEFF Research Database (Denmark)

    Faurschou, Mikkel; Kamper, Anne-Lise; Starklint, Henrik

    2010-01-01

    To evaluate the long-term mortality and renal outcome in a cohort of Danish patients with lupus nephritis (LN) and to identify outcome predictors among findings registered at the time of the first renal biopsy.......To evaluate the long-term mortality and renal outcome in a cohort of Danish patients with lupus nephritis (LN) and to identify outcome predictors among findings registered at the time of the first renal biopsy....

  6. Long-term physical outcome in patients with septic shock

    DEFF Research Database (Denmark)

    Poulsen, J B; Møller, K; Kehlet, H

    2009-01-01

    Limited information is available on physical function after septic shock. The aim of the present study was to assess the physical outcome in survivors 1 year after septic shock.......Limited information is available on physical function after septic shock. The aim of the present study was to assess the physical outcome in survivors 1 year after septic shock....

  7. Long-term outcome in anorexia nervosa in the community

    NARCIS (Netherlands)

    Mustelin, Linda; Raevuori, Anu; Bulik, Cynthia M.; Rissanen, Aila; Hoek, Hans W.; Kaprio, Jaakko; Keski-Rahkonen, Anna

    2015-01-01

    ObjectiveFew studies have assessed outcomes of anorexia nervosa (AN) outside clinical settings. We aimed to assess mortality, recovery, and socio-demographic outcomes of AN in a community sample. MethodWomen in the nationwide FinnTwin16 cohort (born 1975-1979) were followed for 10 years after baseli

  8. [Hypertensive disorders during pregnancy: Cardiovascular long-term outcomes].

    Science.gov (United States)

    Alvarez-Alvarez, B; Martell-Claros, N; Abad-Cardiel, M; García-Donaire, J A

    2016-07-06

    Pregnancy-induced hypertension (PIH) induces maternal and fetal damage, but it can also be the beginning of future metabolic and vascular disorders. The relative risk of chronic hypertension after PIH is between 2.3 and 11, and the likelihood of subsequent development of type 2 diabetes is multiplied by 1.8. Women with prior preeclampsia/eclampsia have a twofold risk of stroke and a higher frequency of arrhythmias and hospitalization due to heart failure. Furthermore, a tenfold greater risk for long-term chronic kidney disease is observed as well. The relative risk of cardiovascular death is 2.1 times higher compared to the group without pregnancy-induced hypertension problems, although the risk is between 4 and 7 times higher in preterm birth associated with gestational hypertension or pre-existing hypertension The postpartum period is a great opportunity to intervene on lifestyle, obesity, make an early diagnosis of chronic hypertension and DM and provide the necessary treatments to prevent cardiovascular complications in women.

  9. Long-Term Social Outcomes in Childhood Epilepsy

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-12-01

    Full Text Available Population-based longitudinal and cross-sectional studies of social outcomes of children with epilepsy in different countries are reviewed by researchers at Dalhousie University, Halifax, Nova Scotia, Canada.Epilepsy, Chronic Disease, Idiopathic Epilepsy.

  10. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1999-01-01

    these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...... compared with SIP scores obtained from 33 patients with a unilateral tibial fracture. RESULTS: Marked variation was observed between the groups. CONCLUSION: Physiotherapists expected the lowest degree of disability and orthopedic surgeons the highest. In the three groups of students, white collar workers...

  11. Long-term outcome of sacroiliac disruptions in children

    NARCIS (Netherlands)

    Heeg, M; Klasen, HJ

    1997-01-01

    We retrospectively evaluated the outcome of sacroiliac-joint disruption in 18 children, ranging in age from 2 to 16 years. Ten patients were treated with bedrest; eight were treated surgically. Follow-up was performed at an average of 14 years (range, 8-23); three patients had daily back pain, and s

  12. Long-term symptomatic outcome and radiologic assessment of laparoscopic hiatal hernia repair

    NARCIS (Netherlands)

    Furnee, Edgar J. B.; Draaisma, Werner A.; Simmermacher, Rogier K.; Stapper, Gerard; Broeders, Ivo A. M. J.

    2010-01-01

    BACKGROUND: The long-term durability of laparoscopic repair of paraesophageal hiatal herniation is uncertain. This study focuses on the long-term symptomatic and radiologic outcome of laparoscopic paraesophageal herniation repair. METHODS: Between 2000 and 2007, 70 patients (49 females, mean age +/-

  13. Long-term reproductive outcomes in women whose first pregnancy is ectopic

    DEFF Research Database (Denmark)

    Lund Kårhus, Line; Egerup, Pia; Wessel Skovlund, Charlotte;

    2013-01-01

    How does long-term reproductive prognosis among women whose first pregnancy is ectopic differ from prognosis in women with other initial pregnancy outcomes? SUMMARY ANSWER: Women with a first recorded ectopic pregnancy (EP) have a significantly lower long-term delivery rate and a manifold increased...

  14. Long-Term Refugee Health: Health Behaviors and Outcomes of Cambodian Refugee and Immigrant Women

    Science.gov (United States)

    Nelson-Peterman, Jerusha L.; Toof, Robin; Liang, Sidney L.; Grigg-Saito, Dorcas C.

    2015-01-01

    Refugees in the United States have high rates of chronic disease. Both long-term effects of the refugee experience and adjustment to the U.S. health environment may contribute. While there is significant research on health outcomes of newly resettled refugees and long-term mental health experiences of established refugees, there is currently…

  15. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1999-01-01

    these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...... compared with SIP scores obtained from 33 patients with a unilateral tibial fracture. RESULTS: Marked variation was observed between the groups. CONCLUSION: Physiotherapists expected the lowest degree of disability and orthopedic surgeons the highest. In the three groups of students, white collar workers...... and blue collar workers only minor variations were observed and their SIP scores showed better correlation with the SIP scores obtained from the patients than those of orthopedic surgeons and physiotherapists....

  16. Acute Ischemic Stroke and Long-Term Outcome After Thrombolysis

    DEFF Research Database (Denmark)

    Schmitz, Marie Louise; Simonsen, Claus Z; Hundborg, Heidi;

    2014-01-01

    , in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used...... to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long...

  17. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    OpenAIRE

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Vijendra K Jain; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospec...

  18. Long-Term Outcome of the Lidcombe Program for Early Stuttering Intervention

    Science.gov (United States)

    Miller, Barbara; Guitar, Barry

    2009-01-01

    Purpose: To report long-term outcomes of the first 15 preschool children treated with the Lidcombe Program by speech-language pathologists (SLPs) who were inexperienced with the program and independent of the program developers. Research questions were: Would the treatment have a similar outcome with inexperienced SLPs compared to outcomes when…

  19. Long Term Outcome of Unprotected Left Main Stem Percutaneous Coronary Intervention, a Single Centre Experience

    Directory of Open Access Journals (Sweden)

    Egred M

    2014-11-01

    Full Text Available Percutaneous coronary intervention (PCI is increasingly used for unprotected left main coronary artery disease (UPLMS revascularization. Data regarding long-term mortality in this subset of patients remain sparse. We aim to present our outcome data on all comers who had UPLMS PCI. Methods: Retrospective dataset analysis of prospectively collected data evaluating all UPLMS PCI performed in a large tertiary cardiac centre, between September 2003 and December 2012. Long-term mortality data were available over a median duration of 21 months (IQR 10 months to 43 months. Results: In total there were 483 procedures performed. The cohort consisted of 58% with non ST elevation myocardial infarction (NSTEMI, 17% with STEMI and 25% with stable angina (SA. The overall in-hospital and long-term mortality were 7% and 22% respectively. The in-hospital mortality was 23%, 6%, and 1.6% in STEMI, NSTEMI, and SA respectively. Long-term mortality was 31% in STEMI patients, 26% in NSTEMI and 10% in SA. The use of drug eluting stents (DES [adjusted RR 0.40 (95% CI, 0.23-0.69] and Intravascular ultrasound (IVUS [adjusted RR 0.17 (95% CI 0.04-0.72] were independently associated with improved long-term survival. Conclusion: UPLMS PCI is associated with favourable long-term survival. The use of DES and IVUS guided PCI appear to be associated with improved long-term outcome and should be considered in the routine management of this cohort of patients.

  20. Long-Term Health Outcomes in Offspring Born to Women with Diabetes in Pregnancy

    OpenAIRE

    Fraser, Abigail; Lawlor, Debbie A

    2014-01-01

    In this review, we critically assess recent evidence from human studies regarding the potential implications of exposure to maternal diabetes in-utero for long-term adiposity, cardiometabolic outcomes, and cognitive ability of the offspring. Evidence supports a direct causal role for exposure to maternal diabetes in utero in determining offspring long-term greater adiposity and adverse cardiometabolic health. Although a majority of observational studies report associations of exposure to mate...

  1. Long-Term Outcomes in Children Diagnosed with Autism Spectrum Disorders in India

    Science.gov (United States)

    Mhatre, Dimpi; Bapat, Deepa; Udani, Vrajesh

    2016-01-01

    We investigated long-term outcomes in children with diagnosis of autism spectrum disorders based on Childhood Autism Rating Scale (CARS score). Information about outcomes such as speech, friendships and activities of daily living (ADLs) was collected through telephone-based interviews. Gilliam Autism Rating Scale-2 and Vineland Social Maturity…

  2. Long-Term Gynecological Outcomes in Women with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

    DEFF Research Database (Denmark)

    Johannsen, T H; Ripa, Caroline P.L.; Carlsen, E;

    2010-01-01

    Background. Our knowledge on long-term outcome in CAH remains incomplete. Methods. In a prospective study (33 CAH patients, 33 age-matched controls), reproductive outcomes, self-rating of genital appearance and function, and sexuality were correlated to degree of initial virilisation, genotype, a...

  3. Long-term outcomes of trimodality treatment for squamous cell carcinoma of the esophagus with cisplatin and/or 5-FU. More than 20 years' experience at a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Fakhrian, Khashayar [Ruhr-Universitaet Bochum, Department of Radiation Oncology, Marien Hospital Herne and Sankt Josef Hospital Bochum, Bochum (Germany); Technische Universitaet Muenchen, Department of Radiation Oncology, Klinikum rechts der Isar, Munich (Germany); Universitaetsklinikum der Ruhr-Universitaet Bochum, Klinik fuer Strahlentherapie und Radio-Onkologie, Marienhospital Herne, Herne (Germany); Ordu, Arif Deniz; Molls, Michael [Technische Universitaet Muenchen, Department of Radiation Oncology, Klinikum rechts der Isar, Munich (Germany); Lordick, Florian [University Clinic Leipzig, University Cancer Center Leipzig (UCCL), Leipzig (Germany); Technische Universitaet Muenchen, Department of Internal Medicine III (Hematology/Oncology), Munich (Germany); Theisen, Joerg [Technische Universitaet Muenchen, Department of Surgery, Klinikum rechts der Isar, Munich (Germany); Haller, Bernhard [Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Klinikum rechts der Isar, Munich (Germany); Omrcen, Tomislav [Technische Universitaet Muenchen, Department of Radiation Oncology, Klinikum rechts der Isar, Munich (Germany); University Hospital Split, Center of Oncology and Radiotherapy, Split (Croatia); Nieder, Carsten [Department of Oncology and Palliative Medicine, Nordland Hospital Trust, Bodoe (Norway); University of Tromsoe, Institute of Clinical Medicine, Faculty of Health Sciences, Tromsoe (Norway); Geinitz, Hans [Technische Universitaet Muenchen, Department of Radiation Oncology, Klinikum rechts der Isar, Munich (Germany); Krankenhaus der Barmherzigen Schwestern Linz, Department of Radiation Oncology, Linz (Austria)

    2014-12-15

    The purpose of this article is to report the outcome of neoadjuvant radiochemotherapy (N-RCT) + surgery in patients with squamous cell carcinoma of the esophagus at a single institution. We retrospectively reviewed data from patients who were referred to our department for N-RCT. From 1988-2011, 103 patients were treated with N-RCT with cisplatin and/or 5-fluorouracil (5-FU). Group 1: (n = 55) from 1988-2006 with 39.6-40 Gy and 5-FU with (n = 17) or without cisplatin (n = 38). Group 2: from 2003-2010 with 44-45 Gy and 5-FU with (n = 40) or without cisplatin (n = 8). All patients underwent radical resection with reconstruction according to tumor location and 2-field lymph node dissection. The degree of histomorphologic regression was defined as grade 1a (pCR, 0 % residual tumor), grade 1b (pSTR, < 10 % residual tumor), grade 2 (10-50 % residual tumor), and grade 3 (> 50 % residual tumor). Median follow-up time from the start of N-RCT was 100 months (range 2-213 months). The median overall survival (OS) for the whole cohort was 42 months and the 5-year OS was 45 ± 5 %. In the multivariate analysis, worse ECOG performance status (p < 0.001), weight loss > 10 % before the start of the N-RCT (p = 0.025), higher pT category (p = 0.001), and grade 2/3 pathologic remission (p < 0.001) were significantly associated with a poor OS. PCR and pSTR rates for group 1 were 36 % and 18 % compared to 53 % and 22 % for group 2 (p = 0.011). There was a tendency for a better outcome in group 2 patients without statistical significance. The 5-year OS, disease-free survival and recurrent-free survival were 36 ± 7 %, 35 ± 6, and 36 ± 7 % for group 1 and 55 ± 7, 49 ± 7, and 53 ± 7 in group 2 (p = 0.117, p = 0.124, and p = 0.087). There was no significant difference between the two groups considering the postoperative morbidity and mortality. Higher radiation doses and more use of simultaneous cisplatin lead to higher pathologic response rates to N-RCT and may be associated with

  4. Gender differences in success at quitting smoking: Short- and long-term outcomes.

    Science.gov (United States)

    Marqueta, Adriana; Nerín, Isabel; Gargallo, Pilar; Beamonte, Asunción

    2016-06-14

    Smoking cessation treatments are effective in men and women. However, possible sex-related differences in the outcome of these treatments remain a controversial topic. This study evaluated whether there were differences between men and women in the success of smoking cessation treatment, including gender-tailored components, in the short and long term (> 1 year). A telephone survey was carried out between September 2008 and June 2009 in smokers attended in a Smoking Cessation Clinic. All patients who have successfully completed treatment (3 months) were surveyed by telephone to determine their long-term abstinence. Those who remained abstinent were requested to attend the Smoking Cessation Clinic for biochemical validation (expired CO ≤10 ppm). The probability of remaining abstinent in the long-term was calculated using a Kaplan-Meier survival analysis. The treatment success rate at 3-months was 41.3% (538/1302) with no differences by sex 89% (479/538) among those located in the telephonic follow-up study and 47.6% (256/479) were abstinent without differences by sex (p = .519); abstinence was validated with CO less than 10 ppm in 191 of the 256 (53.9% men and 46.1% women). In the survival analysis, the probability of men and women remaining abstinent in the long-term was not significant. There are no differences by sex in the outcome of smoking cessation treatment that included gender-tailored components in the short and long term (> 1 year).

  5. Short and long term perinatal outcome in twin pregnancies affected by weight discordance

    DEFF Research Database (Denmark)

    Vedel, Cathrine; Oldenburg, Anna; Worda, Katharina;

    2017-01-01

    OBJECTIVE: To investigate the association between chorionicity-specific intertwin birthweight (BW) discordance and adverse outcomes including long-term follow-up at 6, 18, and 48-60 months after term via Ages and Stages Questionnaire (ASQ). MATERIAL AND METHODS: In this secondary analysis of a co...

  6. Cognitive performance and poor long-term functional outcome after young stroke

    NARCIS (Netherlands)

    Synhaeve, N.E.; Schaapsmeerders, P.; Arntz, R.M.; Maaijwee, N.A.M.M.; Rutten-Jacobs, L.C.A.; Schoonderwaldt, H.C.; Dorresteijn, L.D.; Kort, P.L. de; Dijk, E.J. van; Kessels, R.P.C.; Leeuw, F.E. de

    2015-01-01

    OBJECTIVE: To investigate the influence of cognitive performance on long-term functional outcome after ischemic stroke (IS) in young adults aged 18 through 50 years (young IS). METHODS: This study is part of a prospective cohort study among 277 stroke survivors with a young IS admitted to our depart

  7. Hand dermatitis: a review of clinical features, therapeutic options, and long-term outcomes.

    Science.gov (United States)

    Warshaw, Erin; Lee, Gina; Storrs, Francis J

    2003-09-01

    Hand dermatitis is a common skin condition that may be chronic, debilitating, and costly for patients, insurers, and employers. The epidemiology, clinical features, occupational issues, and long-term outcomes of hand dermatitis are summarized in this review. Therapeutic options are also discussed in detail, focusing on treatment of recalcitrant hand dermatitis.

  8. Long-term outcome of childhood absence epilepsy : Dutch Study of Epilepsy in Childhood

    NARCIS (Netherlands)

    Callenbach, Petra M. C.; Bouma, Paul A. D.; Geerts, Ada T.; Arts, Willem Frans M.; Stroink, Hans; Peeters, Els A. J.; van Donselaar, Cees A.; Peters, A. C. Boudewijn; Brouwer, Oebele F.

    2009-01-01

    We determined long-term outcome and the predictive value of baseline and EEG characteristics on seizure activity evolution in 47 children with newly diagnosed childhood absence epilepsy (CAE) included in the Dutch Study of Epilepsy in Childhood. All children were followed for 12-17 years. The childr

  9. A Long-Term Outcome Study of Selective Mutism in Childhood

    Science.gov (United States)

    Steinhausen, Hans-Christoph; Wachter, Miriam; Laimbock, Karin; Metzke, Christa Winkler

    2006-01-01

    Objective: Controlled study of the long-term outcome of selective mutism (SM) in childhood. Method: A sample of 33 young adults with SM in childhood and two age- and gender-matched comparison groups were studied. The latter comprised 26 young adults with anxiety disorders in childhood (ANX) and 30 young adults with no psychiatric disorders during…

  10. Ethnic Similarity, Therapist Adherence, and Long-Term Multisystemic Therapy Outcomes

    Science.gov (United States)

    Chapman, Jason E.; Schoenwald, Sonja K.

    2011-01-01

    The current study investigated relations among ethnic similarity in caregiver-therapist pairs of youth participating in Multisystemic Therapy, therapist adherence, and youth long-term behavioral and criminal outcomes. Participants were 1,979 youth and families treated by 429 therapists across provider organizations in 45 sites. Relations were…

  11. Excellent long-term outcome for survivors of apple peel atresia

    NARCIS (Netherlands)

    Festen, S; Brevoord, JCD; Goldhoorn, GA; Festen, C; Hazebroek, FWJ; van Heurn, LWE; de Langen, ZJ; van der Zee, DC; Aronson, DC

    2002-01-01

    Background: Apple peel atresia is the rarest type of small bowel atresia. Because of its rare occurrence and high mortality rate, little is known about the long-term outcome of these children. Methods: The patient charts, operative reports, and office notes of 15 children with apple peel atresia fro

  12. Long-term Clinical Outcomes of Splanchnic Vein Thrombosis Results of an International Registry

    NARCIS (Netherlands)

    Ageno, Walter; Riva, Nicoletta; Schulman, Sam; Beyer-Westendorf, Jan; Bang, Soo Mee; Senzolo, Marco; Grandone, Elvira; Pasca, Samantha; Di Minno, Matteo Nicola Dario; Duce, Rita; Malato, Alessandra; Santoro, Rita; Poli, Daniela; Verhamme, Peter; Martinelli, Ida; Kamphuisen, Pieter; Oh, Doyeun; D'Amico, Elbio; Becattini, Cecilia; De Stefano, Valerio; Vidili, Gianpaolo; Vaccarino, Antonella; Nardo, Barbara; Di Nisio, Marcello; Dentali, Francesco

    2015-01-01

    IMPORTANCE Little information is available on the long-term clinical outcome of patients with splanchnic vein thrombosis (SVT). OBJECTIVE To assess the incidence rates of bleeding, thrombotic events, and mortality in a large international cohort of patients with SVT. DESIGN, SETTING, AND PARTICIPANT

  13. Impact of Diabetes on Long-Term Outcome After Primary Angioplasty

    DEFF Research Database (Denmark)

    De Luca, Giuseppe; Dirksen, Maurits T; Spaulding, Christian;

    2012-01-01

    Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents...

  14. Long-term Follow-up of Children Treated with Neonatal Extracorporeal Membrane Oxygenation: neuropsychological outcome

    NARCIS (Netherlands)

    M.J. Madderom (Marlous)

    2013-01-01

    textabstractThis thesis aims to describe the long-term neuropsychological outcome of children and adolescents treated with neonatal extracorporeal membrane oxygenation (ECMO). ECMO is a pulmonary bypass technique providing temporary life support in potentially acute reversible (cardio)respiratory fa

  15. Comparison of Long-Term Outcomes in Adolescents with Anorexia Nervosa Treated with Family Therapy

    Science.gov (United States)

    Lock, James; Couturier, Jennifer; Agras, W. Stewart

    2006-01-01

    Objective: To describe the relative effectiveness of a short versus long course of family-based therapy (FBT) for adolescent anorexia nervosa at long-term follow-up. Method: This study used clinical and structured interviews to assess psychological and psychosocial outcomes of adolescents (ages 12-18 years at baseline) who were previously treated…

  16. Long-term diagnostic stability and outcome in recent first-episode cohort studies of schizophrenia.

    Science.gov (United States)

    Bromet, Evelyn J; Naz, Bushra; Fochtmann, Laura J; Carlson, Gabrielle A; Tanenberg-Karant, Marsha

    2005-07-01

    Knowing the long-term outcomes of schizophrenia and stability of a schizophrenia diagnosis are important from a clinical standpoint as well as essential to future research on diagnostic classifications and outcome. As in prior research on schizophrenia, prospectively designed long-term studies over the past 30 years find that the predominant course of illness includes chronically poor functioning, with little evidence of long-term improvement. Mortality due to suicide is significant at about 10% over 10-year periods of follow-up. Within studies, outcome domains are interrelated, and the relatively consistent predictors of poorer outcome include family history of schizophrenia, insidious onset, poor premorbid functioning, severity of negative symptoms, and severity and duration of untreated psychosis. Residing in a developed rather than a developing country is also associated with a poorer long-term course. The diagnostic stability of schizophrenia is less well studied. The positive predictive value exceeds 90%, and preliminary findings from the 10-year follow-up of the Suffolk County Mental Health Project cohort have found that the agreement across time increased from k = .52 (baseline to 10 years) to k = .76 (6 or 24 months to 10 years). After discussing several limitations of the existing body of research, we suggest that future studies incorporate more "modifiable" risk factors into the assessment battery that could potentially be used as building blocks in experimental intervention designs.

  17. Long-term quality-of-life outcome after mesh sacrocolpopexy for vaginal vault prolapse.

    LENUS (Irish Health Repository)

    Thomas, Arun Z

    2009-12-01

    To evaluate the long-term outcome of mesh sacrocolpopexy (MSC, which aims to restore normal pelvic floor anatomy to alleviate prolapse related symptoms) and its effect on patient\\'s quality of life, as women with vaginal vault prolapse commonly have various pelvic floor symptoms that can affect urinary, rectal and sexual function.

  18. Long-term outcome of electrical cardioversion in patients with chronic atrial flutter

    NARCIS (Netherlands)

    Crijns, HJGM; VanGelder, IC; Tieleman, RG; Brugemann, J; DeKam, PJ; Gosselink, ATM; BinkBoelkens, MTE; Lie, KI

    1997-01-01

    Objective-To determine she long-term outcome of serial electrical cardioversion therapy in patients with chronic atrial flutter. Design-Prospective study, case series. Setting-University hospital. Patients-50 consecutive patients with chronic (> 24 hours) atrial flutter without a previous relapse on

  19. Long-Term Social and Emotional Outcomes of Subject-Area Acceleration on Gifted Learners

    Science.gov (United States)

    King, Dana Cantrell

    2012-01-01

    This qualitative phenomenological study utilizing transcendental phenomenology methods sought to understand the long-term social and emotional outcomes associated with subject-area acceleration. The participants were high school gifted juniors and seniors from one rural high school the southeastern United States. Data was collected through…

  20. Long-Term Outcome of Social Skills Intervention Based on Interactive LEGO[C] Play

    Science.gov (United States)

    Legoff, Daniel B.; Sherman, Michael

    2006-01-01

    LEGO[C] building materials have been adapted as a therapeutic modality for increasing motivation to participate in social skills intervention, and providing a medium through which children with social and communication handicaps can effectively interact. A 3 year retrospective study of long-term outcome for autistic spectrum children participating…

  1. Long-term outcomes of thrombotic microangiopathy treated with plasma exchange: A systematic review.

    Science.gov (United States)

    Thejeel, Bashiar; Garg, Amit X; Clark, William F; Liu, Aiden R; Iansavichus, Arthur V; Hildebrand, Ainslie M

    2016-06-01

    With the adoption of plasma exchange as standard treatment for thrombotic microangiopathy (TMA), more patients are surviving and long-term outcomes have greater relevance. We conducted a systematic review to synthesize and evaluate the quality of evidence on long-term outcomes of TMA among adults treated with plasma exchange and to identify factors that may be associated with a worse long-term prognosis. We searched databases from 1980 to 2013 for eligible articles published in any language. We included studies that reported outcomes in at least ten adults with a history of TMA treated with plasma exchange and at least 6 months of follow-up. We abstracted data in duplicate and assessed the methodological quality of each study using an assessment tool developed based on recommended validity criteria. We screened 6672 articles, reviewed 213, and included 34 studies totaling 1182 patients (study median [range], 24 [10-118]). The mean (or median) follow-up ranged from 6 months to 13 years. The cumulative incidence of relapse and mortality was highly variable and ranged from 3 to 84 and 0 to 61%, respectively. The incidence of other outcomes across 10 studies also varied (outcomes included hypertension, kidney disease, preeclampsia, stroke, seizure, severe cognitive impairment, and depression); in three other studies, long-term neurocognitive function and health-related quality of life were significantly lower than in the general population. Patients who survive an episode of TMA may be susceptible to long-term vascular complications, but the magnitude of this risk and how to mitigate it remains unclear. Am. J. Hematol. 91:623-630, 2016. © 2016 Wiley Periodicals, Inc.

  2. Long-term functional outcome of bilateral spontaneous and simultaneous Achilles tendon ruptures.

    LENUS (Irish Health Repository)

    Ellanti, Prasad

    2012-10-01

    Bilateral simultaneous ruptures are rare comprising less than 1% of all Achilles tendon ruptures. Risk factors for bilateral ruptures include chronic diseases and medications such as corticosteroids and fluoroquinolones. There is little in the literature on the long-term functional outcome of bilateral Achilles tendon ruptures. This article present a series of 3 cases of simultaneous and spontaneous bilateral Achilles tendon ruptures with a minimum of 5-year follow up suggesting a good functional outcome.

  3. Long-term outcome of chronic hepatitis C patients with sustained virological response to peginterferon plus ribavirin

    Institute of Scientific and Technical Information of China (English)

    María Trapero-Marugán; Jorge Mendoza; María Chaparro; Leticia González-Moreno; José Andrés Moreno-Monteagudo

    2011-01-01

    AIM: To assess the clinical, biochemical and virological long-term outcome in chronic hepatitis C (CHC) patients with a sustained virological response (SVR) after peginterferon (PEG-IFN) plus ribavirin combination therapy. METHODS: One hundred and fifty three patients with a SVR after treatment with PEG-IFN plus ribavirin were included in a 5-year follow-up study in a single Spanish center, based on standard clinical practice. Clinical anamnesis, biochemical analysis, hepatitis C virus RNA and alpha-fetoprotein measurement, ultrasonography and transient elastography were performed annually. RESULTS: The mean follow-up period of the 153 patients was 76 ± 13 mo after they obtained a SVR. Five patients (3.26%) presented with cirrhosis before treatment and 116 (75.8%) had genotype 1. No patient showed evidence of hepatic decompensation. One patient (0.65%) developed a hepatocellular carcinoma at month 30 after achieving SVR. There were no virological relapses during this follow-up period. Persistently elevated alanine aminotransferase was found in only one patient (0.65%). At the end of the 5-year follow-up, the mean value of transient elastography was 7 ± 4.3 kPa (F1). There were no deaths and no other tumors. CONCLUSION: The long-term outcome of 153 CHC patients with SVR to PEG-IFN plus ribavirin was good. No evidence of a virological relapse was seen. One patient (0.65%) developed a hepatocellular carcinoma.

  4. Long-term oncologic outcomes of laparoscopic versus open partial nephrectomy

    Institute of Scientific and Technical Information of China (English)

    ZHENG Jun-hua; ZHANG Xiao-long; GENG Jiang; GUO Chang-cheng; ZHANG Xiao-peng; CHE Jian-ping; YAN Yang

    2013-01-01

    Background Most of the literatures on laparoscopic partial nephrectomy (LPN) versus open partial nephrectomy (OPN)focus on technical details and early or mid-term oncologic outcomes,reflecting that the approach is safe and provides midterm benefits compared with traditional open surgery.However,the difference of long-term oncologic outcome between LPN and OPN remains unclear.The aim of this meta-analysis was to evaluate the long-term oncologic outcome of LPN in the treatment of localized renal tumors compared with that of OPN.Methods A systematic search of electronic databases including Medline,Embase,and Cochrane library was conducted.Comparative studies reporting on long-term oncologic outcome of LPN versus OPN were regarded eligible.The odds ratio (OR) and its corresponding 95% confidence intervals (CI) were calculated for the oncologic outcomes.The methodologic quality of the included studies was evaluated using the strict criteria of the Newcastle-Ottawa scale.Results Six comparative studies (1495 participants including 555 LPN and 940 OPN) were included in the present study.There was no significant difference between LPN and OPN in 5-year overall survival (OS) rates (OR=1.83,95% CI (0.80,4.19)),5-year cancer specific survival (CSS) rates (OR=1.09,95% CI (0.62,1.92)),and 5-year recurrence free survival (RFS) rates (OR=0.68,95% CI (0.37,1.26)).Conclusion The results of this meta-analysis revealed that there was no significant difference in long-term oncologic outcome between LPN and OPN for treatment of localized renal tumors.

  5. Long-term effect on carcinoma of esophagus of distal subtotal gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Yu-Ping Chen; Jie-Sheng Yang; Di-Tian Liu; Yu-Quan Chen; Wei-Ping Yang

    2004-01-01

    AIM: To investigate the surgical treatment and long-term survival for patients with carcinoma of esophagus after distal subtotal gastrectomy.METHODS: Resections of the tumor through left thoracotomy were performed in 85 patients with esophageal carcinoma following distal subtotal gastrectomy. The procedure involved preserving the left short gastric artery and transporting the residual stomach, the spleen and tail of the pancreas into the left thoracic cavity, and using the residual stomach to reconstruct the alimentary tract.RESULTS: The resectable rate was 91.8%, complication rate 10.3%, and no death occurred in the postoperative period. The 1-, 3-, 5-, and 10-year survival rates were 85.7%, 50.7%, 30.6% and 18.8%, respectively.CONCLUSION: Surgical resection is the optimal management method for the patients with esophageal carcinoma after distaJ subtotal gastrectomy. The reconstruction of digestive tract using anastomosis of the esophagus and the residual stomach is not only simple but also can achieve a better curative effect, promoting the digestive function and improving the quality of life.

  6. Long-term outcomes of a phase II randomized controlled trial comparing intensity-modulated radiotherapy with or without weekly cisplatin for the treatment of locally recurrent nasopharyngeal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Ying Guan; Shuai Liu; HanYu Wang; Ying Guo; WeiWei Xiao; ChunYan Chen; Chong Zhao; TaiXiang Lu; Fei Han

    2016-01-01

    Background: Salvage treatment for locally recurrent nasopharyngeal carcinoma (NPC) is complicated and relatively limited. Radiotherapy, combined with effective concomitant chemotherapy, may improve clinical treatment out‑comes. We conducted a phase II randomized controlled trial to evaluate the efcacy of intensity‑modulated radio‑therapy with concomitant weekly cisplatin on locally recurrent NPC. Methods: Between April 2002 and January 2008, 69 patients diagnosed with non‑metastatic locally recurrent NPC were randomly assigned to either concomitant chemoradiotherapy group (n = 34) or radiotherapy alone group(n= 35). All patients received intensity‑modulated radiotherapy. The radiotherapy dose for both groups was 60 Gy in 27 fractions for 37 days (range 23–53 days). The concomitant chemotherapy schedule was cisplatin 30 mg/m2 by intravenous infusion weekly during radiotherapy. Results: The median follow‑up period of all patients was 35 months (range 2–112 months). Between concomitant chemoradiotherapy and radiotherapy groups, there was only significant difference in the 3‑year and 5‑year overall survival (OS) rates (68.7% vs. 42.2%, P = 0.016 and 41.8% vs. 27.5%, P = 0.049, respectively). Subgroup analysis showedthat concomitant chemoradiotherapy significantly improved the 5‑year OS rate especially for patients in stage rT3–4 (33.0% vs. 13.2%, P = 0.009), stages III–IV (34.3% vs. 13.2%, P = 0.006), recurrence interval >30 months (49.0% vs. 20.6%,P= 0.017), and tumor volume >26 cm3 (37.6% vs. 0%, P = 0.006). Conclusion: Compared with radiotherapy alone, concomitant chemoradiotherapy can improve OS of the patients with locally recurrent NPC, especially those with advanced T category (rT3–4) and stage (III–IV) diseases, recurrence intervals >30 months, and tumor volume >26 cm3.

  7. Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): a Meta-Analysis.

    Science.gov (United States)

    Burton, Karen L O; Williams, Tracey A; Catchpoole, Sarah E; Brunsdon, Ruth K

    2017-03-31

    The long-term neurocognitive prognosis of childhood onset acute disseminated encephalomyelitis (ADEM) is unclear. This review and quantitative synthesis of the available literature examined whether there are long-term impacts of childhood ADEM on neurocognitive functioning. A search of online databases (MEDLINE, EMBASE, EBSCO CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews) from their inception to October 2015 and reference lists identified 13 papers eligible for inclusion in the systematic review; seven of these were eligible for inclusion in meta-analyses. The systematic review indicated that, at a group level there is a positive long-term neuropsychological outcome from childhood onset ADEM. However, despite the apparent absence of long-term negative impacts of ADEM at a group level, at an individual level impairments in the areas of IQ, attention, executive functioning, processing speed, learning and memory, visuospatial skills and internalising symptoms were found in up to 43% of patients when aggregated across the studies. No significant negative effect of ADEM for any of the neuropsychological domains examined was found in meta-analyses. However, the effects for Processing Speed (r mean = -0.296 (CI 95% = -0.605-0.013)) and Internalising symptoms (r mean = 0.242 (CI 95% = -0.014-0.564)) approached significance (p = 0.06), suggesting a trend towards ADEM leading to long-term reduced processing speed and elevated internalising symptoms. Together, our findings suggest that despite a generally positive neurocognitive outcome post childhood ADEM there are a subset of individuals who can suffer from ongoing specific cognitive impairments. Clinical implications and research priorities are discussed.

  8. Obesity and long term functional outcomes following elective total hip replacement

    Directory of Open Access Journals (Sweden)

    Vincent Heather K

    2012-04-01

    Full Text Available Abstract Introduction Obesity rates continue to rise and more total hip arthroplasty procedures are being performed in progressively younger, obese patients. Hence, maintenance of long term physical function will become very important for quality of life, functional independence and hip prosthesis survival. Presently, there are no reviews of the long term efficacy of total hip arthroplasty on physical function. This review: 1 synopsized available data regarding obesity effects on long term functional outcomes after total hip arthroplasty, and 2 suggested future directions for research. Methods A literature search was conducted from 1965 to January of 2011 for studies that evaluated long term functional outcomes at one year or longer after THA in obese (body mass index values ≥30 kg/m2 and non-obese patients (body mass index 2. Results Five retrospective studies and 18 prospective studies were identified as those that assessed physical function before surgery out to ≥ one year after total hip arthroplasty. Study sample sizes ranged from 108–18,968 and followed patients from one to twenty years. Total hip arthroplasty confers significant pain reduction and improvement in quality of life irrespective of body mass index. Functional improvement occurred after total hip arthroplasty among all studies, but obese patients generally did not attain the same level of physical function by the follow-up time point. Discussion Uncontrolled obesity after total hip arthroplasty is related to worsening of comorbidities and excessive health care costs over the long term. Aggressive and sustainable rehabilitation strategies that include physical exercise, psychosocial components and behavior modification may be highly useful in maximizing and maintaining weight loss after total hip arthroplasty.

  9. Long-term functional and radiological outcome after displaced sacral fractures

    OpenAIRE

    Adelved, Aron

    2015-01-01

    Background and objectives Displaced, unstable sacral fractures are severe injuries resulting in considerable morbidity and functional sequelae. Several authors report neurologic deficits, bladder, bowel, and sexual dysfunction, as well as residual pain and poor self-reported health, in short, and medium-term follow-up studies. However, there is a lack of information on long-term functional outcome following these injures, nor whether any changes occur in functional status many years after ...

  10. Bronchopulmonary Dysplasia: Chronic Lung Disease of Infancy and Long-Term Pulmonary Outcomes

    Science.gov (United States)

    Davidson, Lauren M.; Berkelhamer, Sara K.

    2017-01-01

    Bronchopulmonary dysplasia (BPD) is a chronic lung disease most commonly seen in premature infants who required mechanical ventilation and oxygen therapy for acute respiratory distress. While advances in neonatal care have resulted in improved survival rates of premature infants, limited progress has been made in reducing rates of BPD. Lack of progress may in part be attributed to the limited therapeutic options available for prevention and treatment of BPD. Several lung-protective strategies have been shown to reduce risks, including use of non-invasive support, as well as early extubation and volume ventilation when intubation is required. These approaches, along with optimal nutrition and medical therapy, decrease risk of BPD; however, impacts on long-term outcomes are poorly defined. Characterization of late outcomes remain a challenge as rapid advances in medical management result in current adult BPD survivors representing outdated neonatal care. While pulmonary disease improves with growth, long-term follow-up studies raise concerns for persistent pulmonary dysfunction; asthma-like symptoms and exercise intolerance in young adults after BPD. Abnormal ventilatory responses and pulmonary hypertension can further complicate disease. These pulmonary morbidities, combined with environmental and infectious exposures, may result in significant long-term pulmonary sequalae and represent a growing burden on health systems. Additional longitudinal studies are needed to determine outcomes beyond the second decade, and define risk factors and optimal treatment for late sequalae of disease. PMID:28067830

  11. Long-term cardiovascular mortality in patients with differentiated thyroid carcinoma : an observational study

    NARCIS (Netherlands)

    Klein Hesselink, Esther; Klein Hesselink, Mariëlle; de Bock, Truuske; Gansevoort, Ronald; Bakker, Stephan; Vredeveld, Eline; van der Horst-Schrivers, Anouk N. A.; van der Horst, Iwan; Kamphuisen, Pieter Willem; Plukker, John; Links, Thera P.; Lefrandt, Johan

    2013-01-01

    Purpose The primary aim was to study the risk of cardiovascular mortality in patients with differentiated thyroid carcinoma (DTC). Secondary aims were to evaluate all-cause mortality and explore the relation between thyroid-stimulating hormone (TSH; also known as thyrotropin) level and these outcome

  12. Learning curves and long-term outcome of simulation-based thoracentesis training for medical students

    Directory of Open Access Journals (Sweden)

    Chen Kezhong

    2011-06-01

    Full Text Available Abstract Background Simulation-based medical education has been widely used in medical skills training; however, the effectiveness and long-term outcome of simulation-based training in thoracentesis requires further investigation. The purpose of this study was to assess the learning curve of simulation-based thoracentesis training, study skills retention and transfer of knowledge to a clinical setting following simulation-based education intervention in thoracentesis procedures. Methods Fifty-two medical students were enrolled in this study. Each participant performed five supervised trials on the simulator. Participant's performance was assessed by performance score (PS, procedure time (PT, and participant's confidence (PC. Learning curves for each variable were generated. Long-term outcome of the training was measured by the retesting and clinical performance evaluation 6 months and 1 year, respectively, after initial training on the simulator. Results Significant improvements in PS, PT, and PC were noted among the first 3 to 4 test trials (p 0.05. Clinical competency in thoracentesis was improved in participants who received simulation training relative to that of first year medical residents without such experience (p Conclusions This study demonstrates that simulation-based thoracentesis training can significantly improve an individual's performance. The saturation of learning from the simulator can be achieved after four practice sessions. Simulation-based training can assist in long-term retention of skills and can be partially transferred to clinical practice.

  13. Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients.

    Directory of Open Access Journals (Sweden)

    Liesbeth Hempenius

    Full Text Available The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined.A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life.Data of 260 patients (intervention n = 127, Control n = 133 were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02-6.88, an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02-5.87 and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07-0.49.A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed.Nederlands Trial Register, Trial ID NTR 823.

  14. Long Term Outcomes of a Geriatric Liaison Intervention in Frail Elderly Cancer Patients

    Science.gov (United States)

    Hempenius, Liesbeth; Slaets, Joris P. J.; van Asselt, Dieneke; de Bock, Truuske H.; Wiggers, Theo; van Leeuwen, Barbara L.

    2016-01-01

    Background The aim of this study was to evaluate the long term effects after discharge of a hospital-based geriatric liaison intervention to prevent postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. In addition, the effect of a postoperative delirium on long term outcomes was examined. Methods A three month follow-up was performed in participants of the Liaison Intervention in Frail Elderly study, a multicentre, prospective, randomized, controlled trial. Patients were randomized to standard treatment or a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium and daily visits by a geriatric nurse during the hospital stay. The long term outcomes included: mortality, rehospitalisation, Activities of Daily Living (ADL) functioning, return to the independent pre-operative living situation, use of supportive care, cognitive functioning and health related quality of life. Results Data of 260 patients (intervention n = 127, Control n = 133) were analysed. There were no differences between the intervention group and usual-care group for any of the outcomes three months after discharge. The presence of postoperative delirium was associated with: an increased risk of decline in ADL functioning (OR: 2.65, 95% CI: 1.02–6.88), an increased use of supportive assistance (OR: 2.45, 95% CI: 1.02–5.87) and a decreased chance to return to the independent preoperative living situation (OR: 0.18, 95% CI: 0.07–0.49). Conclusions A hospital-based geriatric liaison intervention for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour did not improve outcomes 3 months after discharge from hospital. The negative effect of a postoperative delirium on late outcome was confirmed. Trial Registration Nederlands Trial Register, Trial ID NTR 823

  15. Long-term outcome of a metal-on-polyethylene cementless hip resurfacing.

    Science.gov (United States)

    Tan, Timothy L; Ebramzadeh, Edward; Campbell, Patricia A; Al-Hamad, Mariam; Amstutz, Harlan C

    2014-04-01

    Due to the well-documented problems surrounding metal-on-metal bearings, the use of hip resurfacing has declined. Since the potential benefits of hip resurfacing remain desirable, it may be beneficial to investigate the long-term outcome of hip resurfacings using metal-on-polyethylene in the 1980's. We report the long-term survivorship and modes of failure of a cementless metal-on-polyethylene resurfacing (n = 178) with different porous ingrowth surfaces. While acetabular loosening was absent, a high incidence of femoral failures (femoral loosening = 18.1%, osteolytic neck fracture = 21%) occurred despite using the same ingrowth surface for both components. Ongoing developments using the lessons learned from these previous generation components and utilizing modern low wear materials, e.g., cross-linked polyethylene, may lead to improved implants for future hip resurfacings.

  16. Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients

    DEFF Research Database (Denmark)

    Meyer, Steffen; Pedersen, Kirsten Mølsted

    2013-01-01

    The objective was to assess the long-term outcome of secondary alveolar bone grafting (SABG) in cleft lip and palate patients and to examine relationships between preoperative and postoperative factors and overall long-term bone graft success. The records of 97 patients with cleft lip and palate......, who had secondary alveolar bone grafting of 123 alveolar clefts, were examined. Interalveolar bone height was assessed radiographically a minimum of 10 years after grafting using a 4-point scale (I-IV), where types I and II were considered a success. After an average follow-up of 16 years after SABG...... to the cleft. No significant differences were found with regard to the other parameters investigated. The timing of secondary alveolar bone grafting is critical with regard to the age of the patient and the stage of eruption of the tooth distal to the cleft....

  17. Use of pulmonary artery catheter in coronary artery bypass graft. Costs and long-term outcomes.

    Directory of Open Access Journals (Sweden)

    Fei Xu

    Full Text Available Pulmonary artery catheters (PAC are used widely to monitor hemodynamics in patients undergoing coronary bypass graft (CABG surgery. However, recent studies have raised concerns regarding both the effectiveness and safety of PAC. Therefore, our aim was to determine the effects of the use of PAC on the short- and long-term health and economic outcomes of patients undergoing CABG.1361 Chinese patients who consecutively underwent isolated, primary CABG at the Cardiovascular Institute of Fuwai Hospital from June 1, 2012 to December 31, 2012 were included in this study. Of all the patients, 453 received PAC during operation (PAC group and 908 received no PAC therapy (control group. Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis and propensity score matched-pair analysis was used to yield two well-matched groups for further comparison.The patients who were managed with PAC more often received intraoperative vasoactive drugs dopamine (70.9% vs. 45.5%; P<0.001 and epinephrine (7.7% vs. 2.6%; P<0.001. In addition, costs for initial hospitalization were higher for PAC patients ($14,535 vs. $13,873, respectively, p = 0.004. PAC use was neither associated with the perioperative mortality or major complications, nor was it associated with long-term mortality and major adverse cardiac and cerebrovascular events. In addition, comparison between two well-matched groups showed no significant differences either in baseline characteristics or in short-term and long-term outcomes.There is no clear indication of any benefit or harm in managing CABG patients with PAC. However, use of PAC in CABG is more expensive. That is, PAC use increased costs without benefit and thus appears unjustified for routine use in CABG surgery.

  18. A systematic review of the long-term outcome of early onset schizophrenia

    DEFF Research Database (Denmark)

    Clemmensen, Lars; Vernal, Ditte Lammers; Steinhausen, Hans-Christoph

    2012-01-01

    of onset in these studies was 10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970. CONCLUSIONS: In contrast to the adult manifestation, the early manifestation of schizophrenia in childhood......ABSTRACT: BACKGROUND: The current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies onset schizophrenia based on previously published studies in 1980. METHODS: A systematic search of articles published in the English......-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS) or both EOS and other psychotic disorders (MIX). The authors of the current review scored the outcome as either "good," "moderate," or "poor." The mean age...

  19. Cardiopulmonary resuscitation of apparently stillborn infants: survival and long-term outcome.

    Science.gov (United States)

    Jain, L; Ferre, C; Vidyasagar, D; Nath, S; Sheftel, D

    1991-05-01

    To determine the outcome of apparently stillborn infants who received cardiopulmonary resuscitation, we studied the short- and long-term outcome of 93 infants who had an Apgar score of 0 at 1 minute of age and were resuscitated at birth. Sixty-two (66.6%) responded and left the delivery room alive; 26 (42%) of the 62 infants died in the neonatal period and 36 infants were discharged home; of the 36 infants, three subsequently died during infancy. Of the 33 survivors, ten were lost to follow-up after discharge. Developmental assessment of 23 of 33 long-term survivors revealed normal outcome in 14 (61.7%), abnormal results in 6 (26%), and suspect status in 3 (13%). Fifty-eight infants had an Apgar score of 0 at greater than or equal to 10 minutes of age and all except one died; the surviving infant has an abnormal developmental outcome. We conclude that 39% of apparently stillborn infants who were resuscitated survived beyond the neonatal period and that 61% of the 23 survivors who were available for developmental follow-up had normal development at the time of last examination. Survival was unlikely if there was no response after 10 minutes of resuscitation.

  20. Usefulness of diabetes mellitus to predict long-term outcomes in patients with unstable angina pectoris.

    Science.gov (United States)

    Farkouh, Michael E; Aneja, Ashish; Reeder, Guy S; Smars, Peter A; Lennon, Ryan J; Wiste, Heather J; Traverse, Kay; Razzouk, Louai; Basu, Ananda; Holmes, David R; Mathew, Verghese

    2009-08-15

    The objective of this study was to determine short- and long-term cardiovascular outcomes in unselected patients with diabetes mellitus (DM) with acute ischemic chest pain (AICP). In patients with DM presenting to the emergency department with AICP, short-term cardiovascular outcomes remain discordant between trials and registries, whereas long-term outcomes are not well-described. A consecutive cohort of all residents of Olmsted County, Minnesota, presenting with AICP from January 1, 1985, to December 31, 1992, was followed for a median duration of 16.6 years. The primary outcome was long-term all-cause mortality. Other outcomes included a composite of death, myocardial infarction, stroke, and revascularization (major adverse cardiovascular and cerebrovascular events [MACCEs]) as well as heart failure (HF) events at 30 days and at a median of 7.3 years, respectively. Of the 2,271 eligible patients, 336 (14.8%) were classified with DM. The crude 30-day MACCE rate was 10.1% in patients with DM and 6.1% in those without DM (p = 0.007). HF events were more common in patients with DM at 30 days (9.8% vs 3.1%, p <0.001). At 7.3 years, patients with DM were more likely to experience MACCEs and HF events than those without DM (71.2% vs 45.1%, unadjusted hazard ratio 2.15%, 95% confidence interval 1.87 to 2.48, p <0.001, and 45.1% vs 18.2%, p <0.001, respectively). Over the follow-up period, 272 patients with DM (81.9%) died, compared with 936 (49.2%) without DM (p <0.001). In conclusion, DM is associated with a higher short-term risk for MACCEs and HF and a higher long-term risk for mortality in unselected patients with AICP. DM should be included as a high-risk variable in national acute coronary syndrome guidelines.

  1. Long-term Outcome of Lupus Nephritis Class II in Argentine Patients

    Science.gov (United States)

    Collado, Maria Victoria; Dorado, Enrique; Rausch, Silvia; Gomez, Graciela; Khoury, Marina; Zazzetti, Federico; Gargiulo, María; Suarez, Lorena; Chaparro, Rafael; Paira, Sergio; Galvan, Laura; Juarez, Vicente; Pisoni, Cecilia; Garcia, Mercedes; Martinez, Liliana; Alvarez, Analia; Alvarez, Clarisa; Barreira, Juan; Sarano, Judith

    2016-01-01

    Background There is controversy in medical literature over the outcome of patients with lupus nephritis (LN) class II. The aim of this study was to explore the risk of histological transformation (HT) and possible factors related to negative response to treatment in patients with mesangial LN class II. Methods A retrospective and multicenter study was carried out that includes patients who had received a diagnosis of LN class II on their first renal biopsy. Creatinine, urine sediment, and proteinuria were recorded at the time of the first biopsy, 6 months, and 1, 2, and 5 years after the first biopsy. Response to treatment, HT, and long-term outcome were evaluated. Results Forty-one patients were included. The manifestation at first biopsy was proteinuria greater than 0.5 g/d in 28 patients (68.29%; 8 [28.57%] of 28 patients had nephrotic syndrome), hematuria in 18 patients (43.90%), and deterioration of renal function in 3 patients (7.31%). During the follow-up (median, 8 years; range, 1–35 years), a new biopsy was performed in 18 patients (43.90%), and in 17 patients (17/18 [94.44%]), there was HT. Median time at rebiopsy was 32 months (range, 11–305 months). Of the 18 patients who had a second biopsy, 10 (55.55%) were on hydroxychloroquine versus 100% (19/19) of patients who did not undergo the procedure (P = 0.001). A year after the first renal biopsy, there are data available from 34 patients; of them, 24 patients (70.58%) had achieved response, and 10 patients (29.41%) had no response (NR) (missing data in 7). A higher 24-hour urinary protein at 6 months was predictor of worse outcome at 1 year, with statistical significance difference for the nonresponder group (median proteinuria, 2.3 g/d [range, 0–4.7 g/d]) compared with responders (median proteinuria, 0.28 g/d [range, 0–1.7 g/d]) (P = 0.0133). In the long-term follow-up (5 years), HT was the main cause of unfavorable outcome and was measured in 78.57% of patients (11/14 patients). Conclusions This

  2. Long-Term Clinical Outcomes of Invasive Giant Prolactinomas after a Mean Ten-Year Followup

    Science.gov (United States)

    Wu, Ze Rui; Zhang, Yong; Lin, Shao Jian; Su, Zhi Peng; Wei, Yong Xu; Shang, Han Bing; Yang, Wen Lei; Zhao, Wei Guo

    2016-01-01

    Objective. The aim of this study is to observe clinical outcomes after more than ten years of followup in a group of patients with invasive giant prolactinomas (IGPs) treated with dopamine agonists (DAs). Methods. Twenty-five patients met the criteria of IGPs, among which 16 patients primarily received bromocriptine (BRC) and the other nine had undergone unsuccessful microsurgery prior to BRC treatment. Results. After a mean follow-up period of 135.5 ± 4.7 months, the clinical symptoms in all patients improved by different degrees. Tumor volume was decreased by a mean of 98.6%, and the tumors of 19 patients had almost completely disappeared. The mean duration of treatment at maximal doses of BRC was 48.5 months. At the last follow-up visit, nineteen patients had normal PRL levels, and 14 of these patients had received the low-dose BRC treatment (at an average of 2.9 ± 0.3 mg/d). Younger patients < 25 years had a significantly higher rate of persistent hyperprolactinemia after long-term BRC treatment (p = 0.043). Conclusion. DAs are a first-line therapy for IGPs because they can effectively achieve long-term control in both shrinking tumor volume and normalizing the PRL level, and majority of patients need low-dose DA maintenance. Younger patients are prone to persistent hyperprolactinemia despite long-term DA treatment. PMID:27999593

  3. Long-Term Clinical Outcomes of Invasive Giant Prolactinomas after a Mean Ten-Year Followup

    Directory of Open Access Journals (Sweden)

    Ze Rui Wu

    2016-01-01

    Full Text Available Objective. The aim of this study is to observe clinical outcomes after more than ten years of followup in a group of patients with invasive giant prolactinomas (IGPs treated with dopamine agonists (DAs. Methods. Twenty-five patients met the criteria of IGPs, among which 16 patients primarily received bromocriptine (BRC and the other nine had undergone unsuccessful microsurgery prior to BRC treatment. Results. After a mean follow-up period of 135.5±4.7 months, the clinical symptoms in all patients improved by different degrees. Tumor volume was decreased by a mean of 98.6%, and the tumors of 19 patients had almost completely disappeared. The mean duration of treatment at maximal doses of BRC was 48.5 months. At the last follow-up visit, nineteen patients had normal PRL levels, and 14 of these patients had received the low-dose BRC treatment (at an average of 2.9±0.3 mg/d. Younger patients < 25 years had a significantly higher rate of persistent hyperprolactinemia after long-term BRC treatment (p=0.043. Conclusion. DAs are a first-line therapy for IGPs because they can effectively achieve long-term control in both shrinking tumor volume and normalizing the PRL level, and majority of patients need low-dose DA maintenance. Younger patients are prone to persistent hyperprolactinemia despite long-term DA treatment.

  4. Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes

    Science.gov (United States)

    Adams, Julie; Bracka, Aivar

    2016-01-01

    Introduction: Research on long-term results of hypospadias has focused on surgical techniques and functional outcomes, and it is only recently that patient satisfaction with appearance and psychosocial outcomes have been considered. The aim of this study was to provide an evidence-based systematic review of adolescent and adult patient perceptions of cosmetic outcomes following childhood surgery for hypospadias. Methods: A systematic review was performed in accordance with the PRISMA and PICO guidelines, and studies assessed using the Oxford Centre for Evidence-Based Medicine system. MEDLINE, PsycInfo, EMBASE, and CINAHL databases were searched from 1974 to 2014 for clinical studies containing patient perceptions of appearance, deformity, and social embarrassment following hypospadias surgery. Results: A total of 495 publications were retrieved, of which 28 met the inclusion criteria. Due to study design/outcome measure, heterogeneity data were synthesized narratively. Results indicate (i) patient perceptions of penile size do not differ greatly from the norm; (ii) perceptions of appearance findings are inconsistent, partially due to improving surgical techniques; (iii) patients who are approaching, or have reached, sexual maturity hold more negative perceptions and are more critical about the cosmetic outcomes of surgery than their prepubertal counterparts; (iv) patients report high levels of perceptions of deformity and social embarrassment; and (v) there is a lack of data using validated measurement tools assessing long-term patient perceptions of cosmetic outcomes, particularly with patients who have reached genital maturity. Conclusions: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery. PMID:27127350

  5. Microdecompression for lumbar synovial cysts: an independent assessment of long term outcomes

    Directory of Open Access Journals (Sweden)

    Torretti Joel

    2007-04-01

    Full Text Available Abstract Background Outcomes of surgical intervention for lumbar synovial cysts have been evaluated in the short and intermediate term. Concerns regarding cyst recurrence, the development of late instability at the involved level, and instability/stenosis at adjacent levels (when concomitant fusion is performed suggest that long term follow-up is needed. This study aims to fill that void. Methods Forty-six patients operated by a single surgeon not involved in the study were followed up long term at an average of 9.7 years (range 5 to 22 years post-operatively. All patients underwent decompression (+/- concomitant arthrodesis in the presence of associated degenerative spondylolisthesis using the operative microscope for magnification/illumination. Outcomes were assessed using a customized questionnaire evaluating: relief of pain/claudicant symptoms, numbness/parasthesias, and weakness; as well as late onset low back pain, new radicular symptoms, need for additional surgery, and patient satisfaction. Outcomes in patients with or without fusion were compared as well. Results 87% of patients noted resolution of their pre-operative pain, numbness, and weakness. 28% of patients developed late onset low back pain. 17% developed late onset radicular symptoms in a new nerve root distribution. 15% required subsequent additional surgery. 89% of patients were satisfied with the surgical outcome. No differences were found for any outcome measure between patients undergoing concomitant fusion and those undergoing decompression alone using the two-sample t-test. Conclusion This study provides outcome data at an average of nearly ten years post-operative. This information should allow surgeons to provide realistic expectations for their patients regarding outcomes and should enhance the informed consent and surgical decision-making process.

  6. Adolescent marriage and childbearing: the long-term economic outcome, Canada in the 1980s.

    Science.gov (United States)

    Grindstaff, C F

    1988-01-01

    The purpose of this paper is to examine the long-term economic outcomes (education, labor force participation, occupation, and income) associated with female adolescent marriage and childbearing. The 1981 Canadian census is the data source for all women in Canada at age 30, controlling for age at marriage and at first birth. The data suggest that women at age 30 in Canada are in the best economic circumstances when they remain single or when they marry at age 20 or older and either remain childless or begin their childbearing at age 25 or older. The implications of these findings are discussed.

  7. Apolipoprotein D is associated with long-term outcome in patients with schizophrenia

    DEFF Research Database (Denmark)

    Hansen, T; Hemmingsen, R P; Wang, A G;

    2006-01-01

    , genetic variation in the ApoD is associated with long-term clinical outcome to antipsychotic treatment. We genotyped two single-nucleotide polymorphisms in the ApoD gene in 343 chronic patients with schizophrenia spectrum disorders (ICD-10) and 346 control subjects of Danish origin. We did not find Apo......Accumulating evidence implicates deficiencies in apolipoprotein D (ApoD) function and arachidonic acid signaling in schizophrenic disorders. We addressed two hypotheses in relation to ApoD: first, polymorphisms in the ApoD gene confer susceptibility to or are markers of disease, and, second...

  8. Apolipoprotein D is associated with long-term outcome in patients with schizophrenia

    DEFF Research Database (Denmark)

    Hansen, Thomas Folkmann; Hemmingsen, R P; Wang, A G;

    2006-01-01

    Accumulating evidence implicates deficiencies in apolipoprotein D (ApoD) function and arachidonic acid signaling in schizophrenic disorders. We addressed two hypotheses in relation to ApoD: first, polymorphisms in the ApoD gene confer susceptibility to or are markers of disease, and, second......, genetic variation in the ApoD is associated with long-term clinical outcome to antipsychotic treatment. We genotyped two single-nucleotide polymorphisms in the ApoD gene in 343 chronic patients with schizophrenia spectrum disorders (ICD-10) and 346 control subjects of Danish origin. We did not find Apo...

  9. The long-term health outcomes of childhood abuse. An overview and a call to action.

    Science.gov (United States)

    Springer, Kristen W; Sheridan, Jennifer; Kuo, Daphne; Carnes, Molly

    2003-10-01

    While the association between abuse in childhood and adverse adult health outcomes is well established, this link is infrequently acknowledged in the general medical literature. This paper has 2 purposes: (1) to provide a broad overview of the research on the long-term effects of child abuse on mental and physical health including some of the potential pathways, and (2) to call for collaborative action among clinicians, psychosocial and biomedical researchers, social service agencies, criminal justice systems, insurance companies, and public policy makers to take a comprehensive approach to both preventing and dealing with the sequelae of childhood abuse.

  10. Endoscopic treatment of post‐surgical bile duct injuries: long term outcome and predictors of success

    Science.gov (United States)

    de Reuver, Philip R; Rauws, Erik A; Vermeulen, Mattijs; Dijkgraaf, Marcel G W; Gouma, Dirk J; Bruno, Marco J

    2007-01-01

    Objective To analyse the short and long term outcome of endoscopic stent treatment after bile duct injury (BDI), and to determine the effect of multiple stent treatment. Design, setting and patients A retrospective cohort study was performed in a tertiary referral centre to analyse the outcome of endoscopic stenting in 67 patients with cystic duct leakage, 26 patients with common bile duct leakage and 110 patients with a bile duct stricture. Main outcome measures Long term outcome and independent predictors for successful stent treatment. Results Overall success in patients with cystic duct leakage was 97%. In patients with common bile duct leakage, stent related complications occurred in 3.8% (n = 1). The overall success rate was 89% (n = 23). In patients with a bile duct stricture, stent related complications occurred in 33% (n = 36) and the overall success rate was 74% (n = 81). After a mean follow up of 4.5 years, liver function tests did not identify “occult” bile duct strictures. Independent predictors for outcome were the number of stents inserted during the first procedure (OR 3.2 per stent; 95% CI 1.3 to 8.4), injuries classified as Bismuth III (OR 0.12; 95% CI 0.02 to 0.91) and IV (OR 0.04; CI 0.003 to 0.52) and endoscopic stenting before referral (OR 0.24; CI 0.06 to 0.88). Introduction of sequential insertion of multiple stents did not improve outcome (before 77% vs after 66%, p = 0.25), but more patients reported stent related pain (before 11% vs after 28%, p = 0.02). Conclusions In patients with a postoperative bile duct leakage and/or strictures, endoscopic stent treatment should be regarded as the choice of primary treatment because of safety and favourable long term outcome. Apart from the early insertion of more than one stent, the benefit from sequential insertion of multiple stents did not become readily apparent from this series. PMID:17595232

  11. 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;

    1998-01-01

    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...

  12. Long-Term Outcomes on Antiretroviral Therapy in a Large Scale-Up Program in Nigeria

    Science.gov (United States)

    Meloni, Seema T.; Chang, Charlotte A.; Eisen, Geoffrey; Jolayemi, Toyin; Banigbe, Bolanle; Okonkwo, Prosper I.; Kanki, Phyllis J.

    2016-01-01

    Background While there has been a rapid global scale-up of antiretroviral therapy programs over the past decade, there are limited data on long-term outcomes from large cohorts in resource-constrained settings. Our objective in this evaluation was to measure multiple outcomes during first-line antiretroviral therapy in a large treatment program in Nigeria. Methods We conducted a retrospective multi-site program evaluation of adult patients (age ≥15 years) initiating antiretroviral therapy between June 2004 and February 2012 in Nigeria. The baseline characteristics of patients were described and longitudinal analyses using primary endpoints of immunologic recovery, virologic rebound, treatment failure and long-term adherence patterns were conducted. Results Of 70,002 patients, 65.2% were female and median age was 35 (IQR: 29–41) years; 54.7% were started on a zidovudine-containing and 40% on a tenofovir-containing first-line regimen. Median CD4+ cell counts for the cohort started at 149 cells/mm3 (IQR: 78–220) and increased over duration of ART. Of the 70,002 patients, 1.8% were reported as having died, 30.1% were lost to follow-up, and 0.1% withdrew from treatment. Overall, of those patients retained and with viral load data, 85.4% achieved viral suppression, with 69.3% achieving suppression by month 6. Of 30,792 patients evaluated for virologic failure, 24.4% met criteria for failure and of 45,130 evaluated for immunologic failure, 34.0% met criteria for immunologic failure, with immunologic criteria poorly predicting virologic failure. In adjusted analyses, older age, ART regimen, lower CD4+ cell count, higher viral load, and inadequate adherence were all predictors of virologic failure. Predictors of immunologic failure differed slightly, with age no longer predictive, but female sex as protective; additionally, higher baseline CD4+ cell count was also predictive of failure. Evaluation of long-term adherence patterns revealed that the majority of patients

  13. Long Term Outcomes of BRCA1/BRCA2 Testing: Risk Reduction and Surveillance

    Science.gov (United States)

    Schwartz, Marc D.; Isaacs, Claudine; Graves, Kristi D.; Poggi, Elizabeth; Peshkin, Beth N.; Gell, Christy; Finch, Clinton; Kelly, Scott; Taylor, Kathryn L.; Perley, Lauren

    2012-01-01

    Purpose For BRCA1/BRCA2 gene testing to benefit public health, mutation carriers must initiate appropriate risk management strategies. There has been little research examining the long-term use and prospective predictors of the full range of risk management behaviors among women who have undergone BRCA1/2 testing. We evaluated long-term uptake and predictors of risk reducing mastectomy (RRM), risk reducing oophorectomy (RRBSO), chemoprevention and cancer screening among women at a mean of 5.3 years post testing. Patients and Methods Participants were 465 women who underwent BRCA1/2 testing. Prior to genetic counseling, we measured family/personal cancer history, sociodemographics, perceived risk, cancer-specific and general distress. We contacted patients at a mean of 5.3-years post-testing to measure use of: RRM; RRBSO; chemoprevention; breast and ovarian cancer screening. Results Among participants with intact breasts and/or ovaries at the time of testing, BRCA1/2 carriers were significantly more likely to obtain RRM (37%) and RRBSO (65%) compared to women who received uninformative (RRM=6.8%; RRBSO=13.3%) or negative (RRM=0%; RRBSO=1.9%) results. Among carriers, pre-counseling anxiety was associated with subsequent uptake of RRM. RRO was predicted by age. Carriers were also more likely have used breast cancer chemoprevention and have obtained a screening MRI. Conclusion This prospective evaluation of the uptake and predictors of long-term management outcomes provides a clearer picture of decision making in this population. By a mean of 5.3 years post-testing, more than 80% of carriers had obtained RRM, RRBSO or both, suggesting that BRCA1/2 testing is likely to favorably impact breast and ovarian cancer outcomes. PMID:21717445

  14. Pediatric cochlear implants in prelingual deafness: medium and long-term outcomes.

    Science.gov (United States)

    Kaplan, Daniel M; Puterman, Moshe

    2010-02-01

    Unfortunately, no large-scale, well-designed, comprehensive studies on medium and long-term effect of cochlear implants in prelingual children exist. Furthermore, the few studies listed have addressed different aspects of this issue, in a non-standardized manner. With the question of outcomes becoming so important in modern medicine, standardized reporting methods are essential. This would enable a fair comparison between the different commercial devices and between rehabilitation-education methods. The studies presented above were published between 1999 and 2008. Due to the long follow-up period required for reporting medium and long-term outcomes, they actually represent patients implanted one and two decades ago. At present and in the near future, we may expect better results from patients who were implanted in the last few years for several reasons: a) superior cochlear implants with better coding strategies; b) developments in rehabilitation and higher awareness among parents and staff; c) better health care and universal screening programs, leading to implants being performed in an earlier age; and d) a high rate of performing bilateral cochlear implants (either simultaneously or sequentially) in the last decade, which accomplishes even better results compared to unilateral implants. From the studies reviewed above, mainstreaming the child who has auditory-verbal and oral communication is the preferred educational setting for maximizing the medium and long-term benefit from a cochlear implant. Hearing and speech skills continue to improve many years after the implant. Non-use and failure rates (as reported by the authors from the medical centers and not solely by the cochlear implant manufacturers) are low, ranging from 1% to 2.7% per year. Overall, patients have a high rate of employment, close to that of the general population. However, they may be less satisfied, as the individual and the parents may feel compromised by their communication skills.

  15. Intermediate and Long-term Outcomes of Giant Fibroadenoma Excision in Adolescent and Young Adult Patients.

    Science.gov (United States)

    Cerrato, Felecia E; Pruthi, Sandhya; Boughey, Judy C; Simmons, Patricia S; Salje, Barbara; Nuzzi, Laura C; Lemaine, Valerie; Labow, Brian I

    2015-01-01

    Giant fibroadenomas (5 cm or greater) are benign breast masses that often present in adolescence and require surgical excision. Long-term outcomes, recurrence rates, and the need for additional reconstructive surgery in this population are unknown. Patients aged 11-25 years whose pathology reports indicated the presence of a giant fibroadenoma were eligible for this study. Medical records were reviewed for presentation, treatment, and outcomes. A subset of patients completed an investigator-designed long-term outcome survey to measure additional outcomes and the desire or need for subsequent reconstructive surgery. Forty-six patients with at least one giant fibroadenoma (mean size 7.4 ± 2.8 cm) were identified. Most patients underwent excision with a periaroeolar incision (n = 31), and an enucleation technique (n = 41), and four patients underwent immediate breast reconstruction. Thirty-three patients had complete medical records with a mean follow-up time of 2.2 ± 4.1 years and no complaints of asymmetry, additional breast deformities, or reconstructive surgery procedures documented. In addition, nine patients completed the investigator-designed survey with a mean follow-up time of 10.1 ± 8.7 years (range 1.5-27.0). Three of these patients reported postoperative breast asymmetry and the desire to pursue reconstructive surgery. Aesthetic outcomes of giant fibroadenoma excision may be satisfactory for many patients without immediate reconstruction, but for others, the need for reconstructive surgery may arise during development. Providers should address this potential need prior to discussing treatment options and during postoperative follow-up. Caution should be exercised before recommending immediate reconstruction.

  16. Radiofrequency ablation of chondroblastoma: long-term clinical and imaging outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Xie, Cheng; Jeys, Lee [The Royal Orthopaedic Hospital Foundation Trust, Department of Oncology, Birmingham (United Kingdom); James, Steven L.J. [The Royal Orthopaedic Hospital Foundation Trust, Department of Radiology, Birmingham (United Kingdom)

    2015-04-01

    To investigate the long-term clinical and imaging outcomes of patients with chondroblastoma treated by radiofrequency ablation (RFA). Retrospective analysis of 25 consecutive patients treated with RFA from September 2006 to December 2013. Patients were reviewed within one month of the procedure, then every 3-6 months, and yearly for up to three years. Serial magnetic resonance imaging (MRI) was performed at follow-up to monitor recovery. Functional outcome was assessed using the Musculoskeletal Tumour Society Score (MSTS). Pre-procedure MRI confirmed osteolytic lesions (size range 1.0-3.3 cm; mean 2.0 cm). Patients reported continued symptomatic improvement at four months review. Serial MRI confirmed progressive resolution of inflammation with fatty consolidation of cavity. 88 % of patients became asymptomatic during the follow up period. Three patients' (12 %) symptoms returned at 16, 22 and 24 months respectively after RFA. MRI and biopsy confirmed recurrence in these patients. Functional assessment using MSTS score had an average score of 97.5 %. Mean follow up for the study group was 49 months. RFA is an effective alternative to surgery in the management of chondroblastoma. We recommend a multi-disciplinary approach and RFA should be considered as a first-line treatment. Long-term follow-up is required for timely detection of recurrences. (orig.)

  17. Occurrence and long-term outcome of tumefactive demyelinating lesions in multiple sclerosis.

    Science.gov (United States)

    Totaro, Rocco; Di Carmine, C; Splendiani, A; Torlone, S; Patriarca, L; Carrocci, C; Sciamanna, S; Marini, C; Carolei, A

    2016-07-01

    Although tumefactive multiple sclerosis is a well recognized variant of multiple sclerosis, prognostic uncertainty still exists about long term prognosis. The aim of this study was to estimate the occurrence and long term outcome of tumefactive demyelinating lesions (TDLs) in a cohort of multiple sclerosis patients. We reviewed brain MRI of 443 patients referred to our MS clinic. All patients meeting the McDonald criteria for multiple sclerosis and showing at least one TDL were included. Kaplan-Meier estimates of disease-free survival in patient cohort were compared with control group without TDLs using a log-rank test. Seven cases with TDLs were identified (occurrence 1.58 %). Tumefactive demyelinating lesion recurrence was 16.6 %. Cumulative proportion of patients free from clinical relapse and from new T2 lesions was lower in the control group although not reaching statistical significance (30 vs 50 %; P = 0.666 and 21.7 vs 33.3 %; P = 0.761, respectively). Disability progression analysis showed a not significant trend towards lower probability of remaining progression free for TDL patients (50 vs 61 %; P = 0.295). Occurrence of tumefactive demyelinating lesions in our cohort was higher than those reported in other studies. Overall, TDLs were not predictive of poor outcome in terms of disability progression.

  18. Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?

    Science.gov (United States)

    Garcia-Portilla, Maria Paz; Bobes-Bascaran, Maria Teresa; Bascaran, Maria Teresa; Saiz, Pilar Alejandra; Bobes, Julio

    2014-02-01

    The aim of this review was to update and summarize the scientific knowledge on the long term outcomes of the different pharmacological treatment options for opioid dependence currently available and to provide a critical discussion on the different treatment options based on these results. We performed a literature search using the PubMed databases and the reference lists of the identified articles. Data from research show that the three pharmacological options reviewed are effective treatments for opioid dependence with positive long term outcomes. However, each one has its specific target population and setting. While methadone and buprenorphine are first line options, heroin-assisted treatment is a second line option for those patients refractory to treatment with methadone with concomitant severe physical, mental, social and/or functional problems. Buprenorphine seems to be the best option for use in primary care offices. The field of opioid dependence treatment is poised to undergo a process of reinforcement and transformation. Further efforts from researchers, clinicians and authorities should be made to turn new pharmacological options into clinical reality and to overcome the structural and functional obstacles that maintenance programmes face in combatting opioid dependence.

  19. Is there evidence that long-term outcomes have improved with intensive care?

    Science.gov (United States)

    Wilson-Costello, Deanne

    2007-10-01

    Advances in perinatal interventions over the past three decades, such as antenatal steroid therapy, ventilator techniques, surfactant therapy, and enhanced nutrition have resulted in a dramatic improvement in the survival of very low birth weight (VLBW) infants. Simultaneously, other advances in reproductive technology procedures have resulted in greater numbers of preterm and multiple births. These extremely premature births account for the vast majority of infant mortality and morbidity in the developed world. Despite the innovative interventions, VLBW infants remain at substantial risk for a wide spectrum of long-term morbidity including cerebral palsy (CP), mental retardation, developmental delay, school problems, behavioral issues, growth failure, and overall poor health status. Recently, ethical concerns have been expressed that improved survival rates for the most immature infants may result in increased rates of disability with substantial resource utilization and declining quality of life for the survivors. This chapter critically evaluates the available neurodevelopmental and health outcomes of very premature infants from the developed world in an attempt to determine if there is evidence that long-term outcomes have improved with neonatal intensive care. Studies on the rates of neurodevelopmental impairment including CP, early childhood and school age functional problems, and special health care issues are surveyed in order to evaluate changes over time and provide an assessment of the success of neonatal intensive care over the past three decades.

  20. The long-term functional outcome of type II odontoid fractures managed non-operatively.

    LENUS (Irish Health Repository)

    Butler, J S

    2010-10-01

    Odontoid fractures currently account for 9-15% of all adult cervical spine fractures, with type II fractures accounting for the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire (CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome. Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures. The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients >65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14 vs. 0%) than patients <65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of non-union.

  1. An assessment of the long-term health outcome of renal transplant recipients in Ireland.

    LENUS (Irish Health Repository)

    Al-Aradi, A

    2009-06-04

    BACKGROUND: Renal transplantation remains the preferred method of renal replacement therapy in terms of patient survival, quality of life and cost. However, patients have a high risk of complications ranging from rejection episodes, infection and cancer, amongst others. AIMS AND METHODS: In this study, we sought to determine the long-term health outcomes and preventive health measures undertaken for the 1,536 living renal transplant patients in Ireland using a self-reported questionnaire. Outcomes were divided into categories, namely, general health information, allograft-related information, immunosuppression-related complications and preventive health measures. RESULTS: The results demonstrate a high rate of cardiovascular, neoplastic and infectious complications in our transplant patients. Moreover, preventive health measures are often not undertaken by patients and lifestyle choices can be poor. CONCLUSIONS: This study highlights the work needed by the transplantation community to improve patient education, adjust immunosuppression where necessary and aggressively manage patient risk factors.

  2. Correlation between MRI findings and long-term outcome in patients with severe brain trauma

    Energy Technology Data Exchange (ETDEWEB)

    Pierallini, A.; Pantano, P.; Fantozzi, L.M.; Bonamini, M. [Dept. of Neurological Sciences, Univ. di Roma (Italy); Vichi, R.; Zylberman, R.; Pisarri, F. [Hospital San Giovanni Battista, SMOM, Roma (Italy); Colonnese, C. [IRCCS Neuromed, Pozzilli (Italy); Bozzao, L. [Dept. of Neurological Sciences, Univ. di Roma (Italy); IRCCS Neuromed, Pozzilli (Italy)

    2000-12-01

    Our aim was to relate MRI findings in patients with severe traumatic brain injury (TBI) to clinical severity and long-term outcome. We studied 37 patients with severe TBI, who were submitted to clinical assessment for disability and cognition and to MRI 60-90 days after trauma. Clinical assessment was also performed 3, 6 and 12 months later. The number and volume of lesions in various cerebral structures were calculated semiautomatically from FLAIR and fast field-echo images. Possible correlations between total and regional lesion volume and clinical deficits were then investigated. The frontal and temporal lobes were most frequently involved. Total lesion volume on FLAIR images correlated significantly with clinical outcome, whereas that on FFE images did not. Regional analysis showed that FLAIR lesion volume in the corpus callosum correlated significantly with scores on disability and cognition scales at the first clinical assessment. FLAIR lesion volume in the frontal lobes correlated significantly with clinical scores 1 year later. (orig.)

  3. Lesion length impacts long term outcomes of drug-eluting stents and bare metal stents differently.

    Directory of Open Access Journals (Sweden)

    Shang-Hung Chang

    Full Text Available BACKGROUND: Long lesions have been associated with adverse outcomes in percutaneous coronary interventions with bare metal stents (BMS. However, the exact impact of lesion length on the short- and long-term outcomes of drug-eluting stent (DES implantations is not as clear. METHODS AND RESULTS: This study compared the impact of lesion length on angiographic and clinical outcomes of BMS and DES in a single-center prospective registry. Lesion length was divided into tertiles. The primary endpoints were angiographically defined binary in-stent restenosis (ISR rate and major adverse cardiac event (MACE. Of the 4,312 de novo lesions in 3,447 consecutive patients in the CAPTAIN registry, 2,791 lesions (of 2,246 patients received BMS, and the remaining 1,521 lesions (of 1,201 patients received DES. The mean follow-up duration was 4.5 years. The longer the lesion, the higher the ISR rate (14%, 18%, and 29%, p<0.001 and the lower the MACE-free survivals (p = 0.007 in the BMS group. However, lesion length showed no such correlation with ISR rates (4.7%, 3.3%, and 7.8%, p = 0.67 or MACE-free survivals (p = 0.19 in the DES group. CONCLUSIONS: In our single-center prospective registry, lesion length defined in tertiles has no impact on the short-term (ISR or long-term (MACE outcomes of patients implanted with DES. In contrast, longer lesion correlates with higher ISR and MACE rates in BMS group.

  4. Valve surgery in octogenarians: In-hospital and long-term outcomes

    Science.gov (United States)

    Bossone, Eduardo; Di Benedetto, Giuseppe; Frigiola, Alessandro; Carbone, Giannignazio Luigi; Panza, Antonello; Cirri, Silvia; Ballotta, Andrea; Messina, Stefano; Rega, Saverio; Citro, Rodolfo; Trimarchi, Santi; Fang, Jianming; Righini, Paolo; Distante, Alessandro; Eagle, Kim A; Mehta, Rajendra H

    2007-01-01

    BACKGROUND: Global population aging and greater age-related incidence of ischemic, degenerative and calcific valve disease have led to an increasing number of very elderly patients being referred for valve surgery. However, their preoperative risk factors, and in-hospital and long-term outcomes have not been thoroughly investigated. METHODS: Three hundred seven consecutive patients 80 years and older (60% female; mean age 83±2.4 years) attending three major Italian cardiac centres to undergo valve surgery were evaluated. Seventy-nine patients underwent mitral valve surgery (isolated n=30, combined n=49) and 228 underwent aortic valve surgery (isolated n=134, combined n=94). RESULTS: The most frequent in-hospital complications were atrial arrhythmias, need for inotropic support for more than 48 h, renal insufficiency, congestive heart failure, respiratory failure, and stroke or transient ischemic attack. The in-hospital mortality rate was 9.7% (30 of 307). Multivariate logistic regression identified the following clinical variables as predictors of in-hospital death: New York Heart Association functional class IV, diabetes, hypertension, renal insufficiency at presentation, rheumatic etiology and left ventricular ejection fraction of less than 45%. Late mortality occurred in 45 of 277 patients (16.2%), but there was a substantial improvement in the New York Heart Association functional class of the 232 long-term survivors (from 3.0±0.7 to 1.7±0.6; P<0.0001). CONCLUSIONS: Surgery seems to be an effective therapeutic option for selected symptomatic octogenarians with valve disease, associated with good long-term survival and an improved functional class. Operative mortality is related more to patients’ preoperative clinical status and increased comorbidity than the type of surgery per se. PMID:17347695

  5. Long-Term Outcome after Rehabilitation of Bilateral Total Hip Arthroplasty in Renal Transplant Recipient – A Case Report

    Directory of Open Access Journals (Sweden)

    Erieta Nikolikj Dimitrova

    2016-02-01

    CONCLUSION: Rehabilitation is integral part of multidisciplinary treatment of renal transplant recipient after total hip arthroplasty. Regular exercise training of these patients is very important for improving of their long-term outcome.

  6. The long-term outcome of endovascular treatment versus medical treatment for severe intracranial artery stenosis of anterior circulation

    Institute of Scientific and Technical Information of China (English)

    蔡乾昆

    2013-01-01

    Objective To compare long-term outcome by endovascular treatment and medical treatment in severe intracranial atherosclerotic stenosis of anterior circulation.Methods Consecutive patients in Nanjing Stroke Registry Program who had transient ischemic attack or stroke

  7. Determinants of long-term outcome in patients undergoing simultaneous resection of synchronous colorectal liver metastases.

    Directory of Open Access Journals (Sweden)

    Qi Lin

    Full Text Available BACKGROUND: It remains unclear which patients can benefit from simultaneous resection of synchronous colorectal liver metastases (SCRLMs. This study aimed to examine the prognostic value of patient- and tumor-related factors in predicting long-term outcomes of patients undergoing simultaneous resection of SCRLMs and to help patients select a suitable therapeutic regimen and proper surveillance. METHODS: Clinicopathological and outcome data of 154 consecutive SCRLM patients who underwent simultaneous resection between July 2003 and July 2013 were collected from our prospectively established SCRLM data and analyzed with univariate and multivariate methods, and the prognostic index (PI was formulated based on the regression coefficients (β of the Cox model. The patients were classified into high- and low-risk groups according to the PI value; the cut-off point was the third quartile. RESULTS: The 5-year overall survival rate was 46%, and the 5-year disease-free survival rate was 35%. Five factors were found to be independent predictors of poor overall survival (OS by multivariate analysis: positive lymph node status, vascular invasion, BRAF mutation, the distribution of bilobar liver metastases (LMs and non-R0 resection of LMs. Compared to low PI (≤5.978, high PI (>5.978 was highly predictive of shorter OS. Three factors were found to be independent predictors of poor disease-free survival (DFS by multivariate analysis: tumor deposits, BRAF mutation and bilobar LM distribution. We also determined the PI for DFS. Compared to low PI (≤2.945, high PI (>2.945 was highly predictive of shorter DFS. CONCLUSIONS: Simultaneous resection of SCRLM may lead to various long-term outcomes. Patients with low PI have longer OS and DFS, while those with high PI have shorter OS and DFS. Thus, patients with high PI may receive more aggressive treatment and intensive surveillance, This model needs further validation.

  8. Long-term outcomes of percutaneous lumbar facet synovial cyst rupture

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Bos, Stijn A.; Torriani, Martin; Simeone, F.J.; Chang, Connie Y.; Pomerantz, Stuart R.; Bredella, Miriam A. [Massachusetts General Hospital and Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2017-01-15

    To evaluate the therapeutic value, safety, and long-term clinical outcomes of percutaneous lumbar facet synovial cyst (LFSC) rupture. Our study was institutional review board (IRB)-approved and Health Insurance Portability and Accountability Act (HIPAA)-compliant. The study group comprised 71 patients (44 women, mean age: 65 ± 17 years) who underwent CT- or fluoroscopy-guided percutaneous LFSC rupture. The technical success of LFSC rupture, the long-term clinical outcome, including repeat procedures or surgery, and imaging findings on MRI and CT were recorded. Seventy-nine LFSC ruptures were performed in 71 patients. CT guidance was used in 57 cases and fluoroscopy guidance in 22 cases. LFSC rupture was technically successful in 58 out of 79 cases (73 %). Mean injection volume for cyst rupture was 3.6 ± 2.2 mL and a combination of steroid and anesthetic was injected in all cases. Over a mean follow-up time of 44 months, 12 % of patients underwent repeat cyst rupture, and 46 % eventually underwent surgery, whereas the majority of patients (55 %) experienced symptomatic relief and did not undergo surgery. There was no significant association between a successful outcome and age, sex, level, or size of LFSC (p > 0.1). LFSCs with T2 hypointensity were more likely to require surgery (p = 0.02). There was one complication, a bacterial skin infection that completely resolved following antibiotic therapy. Percutaneous LFSC rupture is an effective and safe nonsurgical treatment option for LFSC. More than half of treated patients were able to avoid subsequent surgery. Therefore, percutaneous LFSC rupture should be considered before surgical intervention. (orig.)

  9. Long-Term Cognitive and Behavioral Outcomes following Resolution of Sleep Disordered Breathing in Preschool Children

    Science.gov (United States)

    Biggs, Sarah N.; Walter, Lisa M.; Jackman, Angela R.; Nisbet, Lauren C.; Weichard, Aidan J.; Hollis, Samantha L.; Davey, Margot J.; Anderson, Vicki; Nixon, Gillian M.; Horne, Rosemary S. C.

    2015-01-01

    This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35) and non-snoring controls (N = 25), underwent repeat polysomnography (PSG) and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI) ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35) of children with SDB received treatment, with SDB resolving in 60% (12/20). 43% (15/35) were untreated, of whom 40% (6/15) had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype. PMID:26418065

  10. Long-Term Cognitive and Behavioral Outcomes following Resolution of Sleep Disordered Breathing in Preschool Children.

    Directory of Open Access Journals (Sweden)

    Sarah N Biggs

    Full Text Available This study aimed to determine the long term effects of resolution of SDB in preschool children, either following treatment or spontaneous recovery, on cognition and behavior. Children diagnosed with SDB at 3-5y (N = 35 and non-snoring controls (N = 25, underwent repeat polysomnography (PSG and cognitive and behavioral assessment 3 years following a baseline study. At follow-up, children with SDB were grouped into Resolved and Unresolved. Resolution was defined as: obstructive apnea hypopnea index (OAHI ≤1 event/h; no snoring detected on PSG; and no parental report of habitual snoring. 57% (20/35 of children with SDB received treatment, with SDB resolving in 60% (12/20. 43% (15/35 were untreated, of whom 40% (6/15 had spontaneous resolution of SDB. Cognitive reduced between baseline and follow-up, however this was not related to persistent disease, with no difference in cognitive outcomes between Resolved, Unresolved or Control groups. Behavioral functioning remained significantly worse in children originally diagnosed with SDB compared to control children, regardless of resolution. Change in OAHI did not predict cognitive or behavioral outcomes, however a reduction in nocturnal arousals, irrespective of full resolution, was associated with improvement in attention and aggressive behavior. These results suggest that resolution of SDB in preschool children has little effect on cognitive or behavioral outcomes over the long term. The association between sleep fragmentation and behavior appears independent of SDB, however may be moderated by concomitant SDB. This challenges the assumption that treatment of SDB will ameliorate associated cognitive and behavioural deficits and supports the possibility of a SDB phenotype.

  11. Concurrent hyperglycemia does not influence the long-term prognosis of unresectable hepatocellular carcinomas

    Institute of Scientific and Technical Information of China (English)

    Xiao-Ping; Zhen Chen; Zhi-Qiang Meng; Wen-Xia Huang; Lu-Ming Liu

    2003-01-01

    AIM: The association has been established between the disorder of carbohydrate metabolism and liver cancer.However, little is known regarding the impact of concurrent hyperglycemia on prognosis of hepatocellular carcinoma (HCC). The present study aimed at solving this problem.METHODS: A total of 225 patients included in this study,were admitted from January 1998 to December 2001 for an unresectable HCC proven by histological and imaging examinations. Most of the patients received interventional treatment, radiation and biotherapy. Response was evaluated by computerized tomography (CT) scan conducted 4-6 weeks following completion of the treatment, and then every 3months, Survival was calculated from the beginning of treatment using the Kaplan-Meier method. Pretreatment,treatment and follow-up variables with possible prognostic significance were analyzed. A stepwise multivariate analysis was performed using the Cox regression model, and a prognostic index was obtained.RESULTS: No differences were observed in survival parameters between the patients with and without hyperglycemia, median survival times of the patients were being 26±3.46 months and 29.5±2.04 months, respectively, and the 3-year survival rate was 8.36%and 9.62%, respectively. The univariate analysis indicated that there were several survival-associated variables including serum AFP level, clinical stage, Child-Pugh grade,method of treatment, size and number of tumor nodule (s).However, only the clinical stage, Child-Pugh grade and the treatment procedure were proved to be independent prognostic factors in the multivariate analysis.CONCLUSION: This study indicates that hyperglycemia does not influence the long-term prognosis of HCC, and concurrent hyperglycemia should not be considered as an unfavorable prognostic factor during the treatment of patients with HCC.

  12. Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids

    Institute of Scientific and Technical Information of China (English)

    Ming-Yao Su; Cheng-Tang Chiu; Wei-Pin Lin; Chen-Ming Hsu; Pang-Chi Chen

    2011-01-01

    AIM: To assess the long-term outcome of endoscopic hemorrhoid ligation (EHL) for the treatment of symptomatic internal hemorrhoids. METHODS: A total of 759 consecutive patients (415 males and 344 females) were enrolled. Clinical presentations were rectal bleeding (593 patients) and mucosal prolapse (166 patients). All patients received EHL at outpatient clinics. Hemorrhoid severity was classified by Goligher's grading. The mean follow-up period was 55.4 mo (range, 45-92 mo). RESULTS: The number of band ligations averaged 2.35 in the first session for bleeding and 2.69 for prolapsed patients. Bleeding was controlled in 587 (98.0%) patients, while prolapse was reduced in 137 (82.5%) patients. After treatment, 93 patients experienced anal pain and 48 patients had mild bleeding. Patient subjective satisfaction was 93.6%. Repeat treatment or surgery was performed if symptoms were not relieved in the first session. In the bleeding group, the recurrence rate was 3.7% (22 patients) at 1 year, and 6.6% and 13.0% at 2 and 5 years. In the prolapsed group, the recurrence rate was 3.0%, 9.6% and 16.9% at 1, 2 and 5 years, respectively. CONCLUSION: EHL is an easy and well-tolerated procedure for the treatment of symptomatic internal hemorrhoids, with good long-term results.

  13. Extended long term functional outcome of inflatable penile prosthesis in a single institution.

    LENUS (Irish Health Repository)

    Thomas, A Z

    2011-02-01

    We sought to evaluate the extended long term functional outcome of the AMS700 three piece inflatable prosthesis in men with erectile dysfunction in a single urological department and assess our revision rates. Patients that underwent first-time insertion or revision of an AMS700 3 piece inflatable penile prosthesis between 1984-2007 were included. Data was obtained from medical records and long term follow up of patients was conducted by telephone interview. The medical records of 38 patients were available for review. Of these 38 men, 56 prostheses were inserted. The mean follow up was 8.4 years (101 months). The revision rate at 50 months postoperatively was 7\\/38 (18%). The overall revision rate was 18\\/38 (47%). The mean time to revision in these 18 patients was 72 months (12-156 months) after initial insertion of AMS700 penile prosthesis. This study highlights that with longer follow u revision rates markedly increase after 72 months.

  14. Clinical course and long-term outcome of hantavirus-associated nephropathia epidemica, Germany.

    Science.gov (United States)

    Latus, Joerg; Schwab, Matthias; Tacconelli, Evelina; Pieper, Friedrich-Michael; Wegener, Daniel; Dippon, Juergen; Müller, Simon; Zakim, David; Segerer, Stephan; Kitterer, Daniel; Priwitzer, Martin; Mezger, Barbara; Walter-Frank, Birgit; Corea, Angela; Wiedenmann, Albrecht; Brockmann, Stefan; Pöhlmann, Christoph; Alscher, M Dominik; Braun, Niko

    2015-01-01

    Human infection with Puumala virus (PUUV), the most common hantavirus in Central Europe, causes nephropathia epidemica (NE), a disease characterized by acute kidney injury and thrombocytopenia. To determine the clinical phenotype of hantavirus-infected patients and their long-term outcome and humoral immunity to PUUV, we conducted a cross-sectional prospective survey of 456 patients in Germany with clinically and serologically confirmed hantavirus-associated NE during 2001-2012. Prominent clinical findings during acute NE were fever and back/limb pain, and 88% of the patients had acute kidney injury. At follow-up (7-35 mo), all patients had detectable hantavirus-specific IgG; 8.5% had persistent IgM; 25% had hematuria; 23% had hypertension (new diagnosis for 67%); and 7% had proteinuria. NE-associated hypertension and proteinuria do not appear to have long-term consequences, but NE-associated hematuria may. All patients in this study had hantavirus-specific IgG up to years after the infection.

  15. Long-term outcome of patients with POEMS syndrome: An update of the Mayo Clinic experience.

    Science.gov (United States)

    Kourelis, Taxiarchis V; Buadi, Francis K; Kumar, Shaji K; Gertz, Morie A; Lacy, Martha Q; Dingli, David; Go, Ronald S; Kapoor, Prashant; Lust, John A; Hayman, Suzanne R; Hwa, Yi; Rajkumar, S Vincent; Zeldenrust, Steven R; Russell, Stephen J; Lin, Yi; Leung, Nelson; Kyle, Robert A; Gonsalves, Wilson I; Dispenzieri, Angela

    2016-06-01

    Over the past decade, a number of changes have occurred in the diagnostic evaluation, management, and long-term follow-up of patients with POEMS syndrome at our institution. This study included 291 patients with POEMS syndrome diagnosed at the Mayo Clinic between 1974 and 2014. Patients diagnosed after 2003 had more features of the syndrome identified at diagnosis and were more likely to receive an autologous transplant (49% versus 8%, P complete response (CR) to treatment (41% vs 25%, P C.I., 56%, 67%). On multivariate analysis, the three factors associated with superior OS were younger age (RR 0.98 [0.96-1.00]), albumin greater-than 3.2 g/dL (RR 0.5 [0.32-0.89]) and attainment of complete hematologic response (RR 0.4 [0.2, 0.9]). This study confirms the very good long-term outcomes of patients with POEMS syndrome and identifies two new prognostic risk factors: albumin at diagnosis and attainment of complete hematologic response. Am. J. Hematol. 91:585-589, 2016. © 2016 Wiley Periodicals, Inc.

  16. Brain Biomarkers of Long-Term Outcome of Neonatal Onset Urea Cycle Disorder

    Directory of Open Access Journals (Sweden)

    Maha Mourad

    2016-11-01

    Full Text Available Urea cycle disorders (UCDs are common inborn errors of metabolism, with an incidence of one in 30,000 births. They are caused by deficiencies in any of six enzymes and two carrier proteins, the most common being Ornithine Transcarbamylase Deficiency (OTCD. OTCD results in impairment to excrete nitrogen, causing toxic buildup of ammonia with resultant encephalopathy. Hyperammonemia (HA induces the conversion of glutamate to glutamine in the brain. Excess glutamine in the brain causes osmotic changes, cerebral edema, changes in astrocyte morphology, and cell death. Acute symptoms of HA include vomiting, hyperventilation, seizures, and irritability. Long-term neurological effects include deficits in working memory and executive function. To date, there are no predictors of prognosis of infants with neonatal onset OTCD outside of the plasma ammonia level at presentation and duration of a hyperammonemic coma. We provide a comprehensive analysis of a 16-year-old male with neonatal onset of OTCD as an example of how brain biomarkers may be useful to monitor disease course and outcome. This male presented at 8 days of life with plasma ammonia and glutamine of 677 and 4024 micromol/L respectively, and was found to have a missense mutation in Exon 4 (p. R129H. Treatment included protein restriction, sodium benzoate, and citrulline, arginine, and iron. Despite compliance, he suffered recurrent acute hyperammonemic episodes triggered by infections or catabolic stressors. We discuss the long-term effects of the hyperammonemic episodes by following MRI-based disease biomarkers.

  17. Decrypting cryptogenic hepatocellular carcinoma: clinical manifestations, prognostic factors and long-term survival by propensity score model.

    Directory of Open Access Journals (Sweden)

    Chia-Yang Hsu

    Full Text Available BACKGROUND AND AIMS: The clinical aspects of cryptogenic hepatocellular carcinoma (HCC, defined as HCC in patients without hepatitis B, C or alcoholism, are not clear. We investigated its clinical presentations, long-term survival and prognostic predictors. METHODS: A total of 2645 HCC patients were studied. One-to-one matched pairs between viral/alcoholic and cryptogenic HCC patients were generated by using the propensity model. The survival analysis was performed with the Kaplan-Meier method and log-rank test, and hazard ratios were calculated with Cox proportional hazards model. RESULTS: Among 366 (14% patients with cryptogenic HCC, 34% of patients were presented with abdominal discomfort, and 31% of patients were identified incidentally. Compared to patients with viral/alcoholic HCC, cryptogenic HCC patients were significantly older (p<0.0001, with poorer performance status (p = 0.0031 and less often underwent curative treatment (p = 0.0041. They also had larger tumor burden (p<0.0001, poorer renal function (p<0.0001, lower α-fetoprotein level (p<0.0001, and more advanced Barcelona Clinic Liver Cancer stages (p<0.0001. With propensity score model, 366 pairs of similar HCC patients were selected and similar long-term survival between the two groups of patients was found (p = 0.1038. For cryptogenic HCC patients, α-fetoprotein ≧49 ng/mL (hazard ratio [HR]: 1.955, p = 0.0002, Child-Turcotte-Pugh class B/C (HR: 2.798, p<0.0001, performance status ≧1 (HR: 2.463, p<0.0001 and vascular invasion (HR: 1.608, p = 0.0257 were independent predictors of poor prognosis. CONCLUSIONS: Patients with cryptogenic HCC are usually diagnosed with poor general condition at late stages. However, cryptogenic HCC patients have similar prognostic predictors and long-term survival compared with viral/alcoholic HCC patients. Diagnosis at an early stage may improve their clinical outcomes.

  18. TWENTY-THREE-YEAR LONG-TERM HEALTH OUTCOME AFTER THE WAR IN VUKOVAR.

    Science.gov (United States)

    Habek, Dubravko; Dujaković, Tatjana; Habek, Jasna Cerkez; Jurković, Ivana

    2016-03-01

    Results of the first research of this kind on the 23-year long-term outcome in children born during the war in Vukovar are presented. This retrospective clinical study surveyed the potential 23-year long-term consequences and morbidity of children born between May 1, 1991 and November 19, 1991, during the siege and occupation of Vukovar. Data were obtained from women having delivered their babies in that period and from delivery protocols of the Department of Gynecology and Obstetrics, Vukovar County Hospital. According to the survey and the data collected, there were 9 (3.98%) preterm deliveries, 60 (81%) of the total of 77 subjects were breastfed, 14 (19%) were not breastfed, while three babies died in the postpartum period. However, the breastfeeding period was evidently shorter, as only 10 women breastfed for a period longer than 6 months, while the mean length of the breastfeeding period was 9.9 weeks, i.e. 2.5 months. Allergy-related illnesses and proneness to infections in childhood and preschool age were found in 27.3% and 16.9% of children, respectively, while two children developed diabetes type 1. One child had atopic diathesis, two started speaking after the age of two, one child started walking late (after 20 months) and started speaking after the age of two, one child had loud sound phobia, and one used to overreact and express anger in inconvenient situations, all of them being of female gender and born prematurely. Cognitive and attention disorders and stress reactions were found in 6.5% of the children. Regular elementary school education was completed by 74 (96%) children, while three (3.8%) children experienced failure at school due bad behavior, i.e. delinquency. At the age of 23, 34 (46%) children had developed bad habits, i.e. 33 of them smoked, 2 were addicted to alcohol, whereas one was addicted to both smoking and alcohol. Forty (54%) subjects did not use any harmful substances. Psychiatric disorders related to anxiety, depression or other

  19. Long-term outcome for gastric marginal zone lymphoma treated with radiotherapy

    DEFF Research Database (Denmark)

    Wirth, A; Gospodarowicz, M; Aleman, B M P;

    2013-01-01

    We evaluated the long-term results of radiotherapy for patients with gastric marginal zone lymphoma (GMZL).......We evaluated the long-term results of radiotherapy for patients with gastric marginal zone lymphoma (GMZL)....

  20. A systematic review of the long-term outcome of early onset schizophrenia

    Directory of Open Access Journals (Sweden)

    Clemmensen Lars

    2012-09-01

    Full Text Available Abstract Background The current review analyzes the long-term outcome and prognosis of early onset schizophrenia based on previously published studies in 1980. Methods A systematic search of articles published in the English-language literature after 1980 identified a total of 21 studies, which included 716 patients who were either suffering from early onset schizophrenia (EOS or both EOS and other psychotic disorders (MIX. The authors of the current review scored the outcome as either “good,” “moderate,” or “poor.” The mean age of onset in these studies was Results In general, the outcome in studies with EOS is worse than the outcome in MIX studies. Only 15.4% of the patients in EOS studies versus 19.6% of the patients in MIX studies experienced a “good” outcome. In contrast, 24.5% of the patients in EOS studies versus 33.6% in MIX studies experienced a “moderate” outcome, and 60.1% in EOS studies versus 46.8% in MIX studies experienced a “poor” outcome. The authors identified various significant effects on outcome. In EOS, the findings were significantly affected by sample attrition, indicating that in studies with a high dropout rate, fewer patients experienced a “moderate” outcome, and more patients experienced a “poor” outcome; however, the effect sizes were small. Furthermore, the effects were also small and more favourable for specific functioning measures, as opposed to more global measures, small to moderate in terms of worse outcomes for follow-up periods >10 years, small to moderate for more unfavourable outcomes in males, and small to large for worse outcomes in studies including patients diagnosed before 1970. Conclusions In contrast to the adult manifestation, the early manifestation of schizophrenia in childhood and adolescence still carries a particularly poor prognosis. According to these aggregated data analyses, longer follow-up periods, male sex, and patients having been diagnosed before 1970

  1. Long-term outcome of social skills intervention based on interactive LEGO play.

    Science.gov (United States)

    Legoff, Daniel B; Sherman, Michael

    2006-07-01

    LEGO building materials have been adapted as a therapeutic modality for increasing motivation to participate in social skills intervention, and providing a medium through which children with social and communication handicaps can effectively interact. A 3 year retrospective study of long-term outcome for autistic spectrum children participating in LEGO therapy (N = 60) compared Vineland Adaptive Behavior Scale socialization domain (VABS-SD) and Gilliam Autism Rating Scale social interaction subscale (GARS-SI) scores preand post-treatment with a matched comparison sample (N = 57) who received comparable non-LEGO therapy. Although both groups made significant gains on the two outcome measures, LEGO participants improved significantly more than the comparison subjects. Diagnosis and pre-treatment full-scale IQ scores did not predict outcome scores; however, Vineland adaptive behavior composite, Vineland communication domain, and verbal IQ all predicted outcome on the VABS-SD, especially for the LEGO therapy group. Results are discussed in terms of implications for methods of social skills intervention for autistic spectrum disorders.

  2. Short- and long-term outcomes of AL amyloidosis patients admitted into intensive care units.

    Science.gov (United States)

    Guinault, Damien; Canet, Emmanuel; Huart, Antoine; Jaccard, Arnaud; Ribes, David; Lavayssiere, Laurence; Venot, Marion; Cointault, Olivier; Roussel, Murielle; Nogier, Marie-Béatrice; Pichereau, Claire; Lemiale, Virginie; Arnulf, Bertrand; Attal, Michel; Chauveau, Dominique; Azoulay, Elie; Faguer, Stanislas

    2016-09-01

    Amyloidosis is a rare and threatening condition that may require intensive care because of amyloid deposit-related organ dysfunction or therapy-related adverse events. Although new multiple myeloma drugs have dramatically improved outcomes in AL amyloidosis, the outcomes of AL patients admitted into intensive care units (ICUs) remain largely unknown. Admission has been often restricted to patients with low Mayo Clinic staging and/or with a complete or very good immunological response at admission. In a retrospective multicentre cohort of 66 adult AL (n = 52) or AA (n = 14) amyloidosis patients, with similar causes of admission to an ICU, the 28-d and 6-month survival rates of AA patients were significantly higher compared to AL patients (93% vs. 60%, P = 0·03; 71% vs. 45%, P = 0·02, respectively). In AL patients, the simplified Index of Gravity Score (IGS2) was the only independent predictive factor for death by day 28, whereas the Mayo-Clinic classification stage had no influence. In Cox's multivariate regression model, only cardiac arrest and on-going chemotherapy at ICU admission significantly predicted death at 6 months. Short-term outcomes of AL patients admitted into an ICU were mainly related to the severity of the acute medical condition, whereas on-going chemotherapy for active amyloidosis impacted on long-term outcomes.

  3. Endemic Burkitt Lymphoma: Long-term Outcome in 87 Patients Who Presented With Paraplegia in Cameroon.

    Science.gov (United States)

    Hesseling, P B; Mbah, G; Kouya, F; Kimbi, C; Nfor, P; Kaah, J; Kuruvilla, R; Best, A; Wharin, P

    2015-01-01

    The reported long-term outcome of endemic Burkitt lymphoma (eBL) patients who present with paraplegia is largely unknown. Records of BL patients treated with comparable short-interval cyclophosphamide chemotherapy schedules between 2004 and 2014 at three Baptist mission hospitals in Cameroon were reviewed. Survivors were followed up and examined at home or in hospital. Eighty-seven of 948 (9.2%) patients had paraplegia at diagnosis. The survival rate in eBL patients with paraplegia at diagnosis was 33% (n = 29) after follow-up of between 2 and 96 (median 40) months. Seven patients (24%) had neurological sequelae and needed rehabilitation. There was no relationship between the duration of symptoms (4 weeks) and the survival rate or the risk to have neurological sequelae. The survival rate and risk for sequelae were similar in patients with confirmed St. Jude stage III and IV diseases.

  4. The long-term mechanically ventilated patient. An outcomes management approach.

    Science.gov (United States)

    Burns, S M

    1998-03-01

    -management model, we recognize that other models may also result in comparable, favorable outcomes. It is important that those who adopt similar models of care delivery for managing patients requiring prolonged ventilation be scientific in their approach. Long-term studies of the efficacy of these models are essential if we are to truly provide quality care for our patients in the future. Unfortunately, as noted earlier, bias will be hard to overcome. Hospitals vested in rapidly establishing a stable financial bottom-line are likely to embrace quick applications. Projects with a true experimental design to evaluate efficacy, such as this one, will be rare in these organizations. Finally, it is critical that variables of interest be inclusive of specific quality indicators such as ventilator duration and complications rather than global institutional markers such as LOS. Standardization of variables of interest is imperative if outcomes are to be compared. For example, patients requiring long-term mechanical ventilation are identified by the AACN's Third National Study Group on weaning as those who require mechanical ventilation for more than 3 days. If we are to compare other variables of interest such as total ventilator duration, such as definition is essential or we will be comparing apples and oranges in the future. Provision of quality, cost-effective care for patients requiring prolonged ventilation is a true clinical challenge. Outcomes management is a multidisciplinary method of care delivery that is systematic and comprehensive in approach. Although little science exists related to the application of the model for patients requiring prolonged ventilation, preliminary reports are promising and warrant future applications and evaluation of the same.

  5. Impact of Multidrug Resistance on Tuberculosis Recurrence and Long-Term Outcome in China

    Science.gov (United States)

    Sun, Yanni; Harley, David; Vally, Hassan; Sleigh, Adrian

    2017-01-01

    Little is known about the impact of drug resistance on recurrence in TB. We conducted a cohort study to measure the impact of multi-drug resistance (MDR) on TB recurrence over nine years in Henan Province China. We reviewed medical records and conducted field interviews of 100 MDR and 150 non-MDR TB patients who were treated between 2001 and 2002. We compared long-term recurrence rates, risk factors, and outcomes in 2010 for 234 individuals who could be followed up. About one third (29.5%, 69/234) suffered recurrence after completion of treatment. The overall recurrence rate was 35/1,000 patient-years (PY), with a much higher rate (65/1,000 PY) among MDR-TB patients. MDR (HR: 2.75; CI: 1.58–4.79) and patient annual household income less than 10,000 Yuan (HR: 2.05; CI 1.11–3.80) were associated with recurrence. The mean time for recurrence among MDR-TB patients was 5.7 years, compared to 7.2 years among non-MDR-TB patients. Among the recurrence group members, 61.3% died, and 18.8% had failed treatments. We believe that the high TB recurrence rate after 9 years suggests that a high cure rate cannot accurately predict long-term outcome. We recommend that TB surveillance and control should be strengthened with a focus on MDR-TB and directly observed treatment, to reduce TB recurrence and transmission of MDR-TB. PMID:28118372

  6. A systematic review of long-term outcomes in ADHD: global publication trends

    Directory of Open Access Journals (Sweden)

    Paul eHodgkins

    2012-01-01

    Full Text Available There is increased global recognition of attention deficit hyperactivity disorder (ADHD as a serious medical condition with long-term consequences. Although originally conceived of as a childhood disorder, ADHD is being increasingly recognized in adults. Individual geographic regions may have specific interests and objectives for the study of ADHD. A systematic review of long-term outcomes (LTOs in ADHD was conducted to evaluate research on ADHD LTOs on a global scale. Studies that were at least two years in duration were examined. We identified nine outcomes of interest and classified studies by specific geographical regions, age groups studied and study design by region and over time. Published studies of LTOs in ADHD have increased in all geographical regions over the past three decades, with a peak number of publications in 2008. Although many world regions have published on ADHD LTOs, the majority of studies have emerged from the US and Canada, followed by Europe. While investigators in the US and Canada were predominantly interested in drug addiction as a LTO, European researchers were more interested in antisocial behavior, and Eastern Asian investigators focused on both of these LTOs as well as self-esteem. Proportionally fewer prospective longitudinal studies and proportionally more retrospective and cross-sectional studies have been published in more recent decades. Finally, more studies focusing on ADHD in adolescents and adults have been conducted in recent years, and particularly adolescents in Eastern Asia. This systematic review analysis of publication trends in ADHD LTOs reflects geographically-based interests that change over time.

  7. Long-term Outcomes Following Abdominal Sacrocolpopexy for Pelvic Organ Prolapse

    Science.gov (United States)

    Nygaard, Ingrid; Brubaker, Linda; Zyczynski, Halina M.; Cundiff, Geoffrey; Richter, Holly; Gantz, Marie; Fine, Paul; Menefee, Shawn; Ridgeway, Beri; Visco, Anthony; Warren, Lauren Klein; Zhang, Min; Meikle, Susan

    2013-01-01

    Importance Over 225,000 surgeries are performed annually in the U.S. for pelvic organ prolapse (POP). Abdominal sacrocolpopexy is considered the most durable POP surgery, but little is known about long-term effectiveness and adverse events. Objective To describe anatomic and symptomatic outcomes up to 7 years after abdominal sacrocolpopexy, and to determine whether these are affected by concomitant anti-incontinence surgery (Burch urethropexy). Design, setting, participants Long-term follow-up of the randomized, masked 2-year CARE trial (Colpopexy And urinary Reduction Efforts). Participants were stress continent women undergoing abdominal sacrocolpopexy between 2002–5 for symptomatic POP randomized to concomitant urethropexy or not. 92% (215/233) of eligible 2-year CARE trial completers enrolled into this extended study with 181 (84%) and 126 (59%) completing 5 and 7 years follow-up, respectively. Median follow-up was 7 years. Main Outcome Measures POP: Symptomatic failure: POP retreatment or reporting bulge on Pelvic Floor Distress Inventory (PFDI); Anatomic failure: POP retreatment or Pelvic Organ Prolapse Quantification demonstrating descent of the vaginal apex descend below upper third of the vagina or anterior or posterior vaginal wall prolapse beyond the hymen. Urinary incontinence (UI): Stress UI: more than 1 stress urinary incontinence symptom on PFDI or interval treatment; Overall UI: score ≥ 3 on Incontinence Severity Index. Results By year 7, the estimated probabilities of failure (POP, SUI, UI) from parametric survival modeling for the urethropexy and no urethropexy groups respectively were were 0.27 and 0.22 for anatomic POP (difference 0.050; 95% CI −0.161, 0.271), 0.29 and 0.24 for symptomatic POP (0.049; −0.060, 0.162), 0.48 and 0.34 for composite POP (0.134; −0.096, 0.322), 0.62 and 0.77 for SUI (−0.153; −0.268, 0.030) 0.75 and 0.81 for overall UI (−0.064; −0.161, 0.032). Mesh erosion probability estimated by Kaplan-Meier method

  8. Effects of perceptual body image distortion and early weight gain on long-term outcome of adolescent anorexia nervosa.

    Science.gov (United States)

    Boehm, Ilka; Finke, Beatrice; Tam, Friederike I; Fittig, Eike; Scholz, Michael; Gantchev, Krassimir; Roessner, Veit; Ehrlich, Stefan

    2016-12-01

    Anorexia nervosa (AN), a severe mental disorder with an onset during adolescence, has been found to be difficult to treat. Identifying variables that predict long-term outcome may help to develop better treatment strategies. Since body image distortion and weight gain are central elements of diagnosis and treatment of AN, the current study investigated perceptual body image distortion, defined as the accuracy of evaluating one's own perceived body size in relation to the actual body size, as well as total and early weight gain during inpatient treatment as predictors for long-term outcome in a sample of 76 female adolescent AN patients. Long-term outcome was defined by physical, psychological and psychosocial adjustment using the Morgan-Russell outcome assessment schedule as well as by the mere physical outcome consisting of menses and/or BMI approximately 3 years after treatment. Perceptual body image distortion and early weight gain predicted long-term outcome (explained variance 13.3 %), but not the physical outcome alone. This study provides first evidence for an association of perceptual body image distortion with long-term outcome of adolescent anorexia nervosa and underlines the importance of sufficient early weight gain.

  9. Excision of Painful Bipartite Patella: Good Long-term Outcome in Young Adults

    Science.gov (United States)

    Parviainen, Mickael; Pihlajamäki, Harri K.

    2008-01-01

    Excision of the accessory bipartite fragment is widely used, but its long-term outcome is not known. We evaluated the outcome after surgical excision of a symptomatic accessory bipartite or multipartite patella fragment in young adult men performing their compulsory military service and determined the incidence of painful bipartite patellae in this group of skeletally mature adults. We followed 25 of 32 patients for a minimum of 10 years (mean, 15 years; range, 10–22 years). The incidence of painful, surgically treated bipartite patella was 9.2 per 100,000 recruits. Patients’ median age at surgery was 20 years. There were 19 superolateral and six lateral bipartite fragments. Other radiographic findings were rare. At followup, the Kujala score mean was 95 points (range, 75–100 points), and osteoarthrotic changes (Kellgren-Lawrence Grade 1) were seen in two knees. No reoperations related to bipartite patella occurred during the followup. Symptomatic bipartite patella is rare and does not seem primarily associated with anatomic deviations, but when incapacitating pain persists despite nonoperative treatment, surgical excision seems to yield reasonable functional outcome and quick recovery with no apparent adverse sequelae. Our data suggest there is no reason to avoid this technically undemanding procedure for treating persistent symptoms of bipartite patella in young adults. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18607662

  10. Transobturator Tape Technique For Stress Urinary Incontinance and Long Term Outcomes

    Directory of Open Access Journals (Sweden)

    Musa Ekici

    2013-08-01

    Full Text Available Purpose: Even though vairous surgical procedures are developed to treatment of stress urinary incontinance, there has not been yet a gold standard treatment. In this study, we aimed to discuss the application of TOT technique, its complications, safety and the six year follow up results. Material And Methods: 30 patients applied to our clinic and diagnosed SUI were performed TOT. Mean patient age was 49,9±9,4 (23-64. Demographic parameters, physical and pelvic examination, q tip test, stress test, cystoscopy, ICIQ-SF score, duration of surgery, intraoperative complications, early and late postoperative complications were recorded. Mean follow up was 72,5±7,1 (44-88 months. Patients were evaluated after 1, 3, 6, 12 and 24 months after surgery. Operations were performed by outside-inside method and by using Safyre(promedon. The outcomes were analysed using Shapiro wilk, paired sample t test, Friedman test and Wilcoxon test. Outcomes: Mean operation time and hospital stay were 21,8(15-35 and 1,3 days(1-2 respectively. Peroperatively, one patient(3,3% had her vaginal wall pierced by the needle. Bladder, uretral or vascular damage were not seen in any patients. Self catheterization was required for only one (3,3% patient. At late postoperative period, 1 patient developed de novo urge incontinence (3,3% and one patient developed (3,3% left leg pain. 73% of the patients with a median follow up of 72,5±7,1 (44-88 months were dry. Preopearative ICIQ-SF median value of 12.4 (8-20 were decreased to 1.7 (0-6, and similarly, ped use was decreased from 2,9 (1-8 to 0,4 (0-3. Results: TOT is a safe and effective treatment of SUI with its long term outcomes. However, long term outcomes with comparison with other techniques and including higher cohorts is required. [Cukurova Med J 2013; 38(4.000: 574-580

  11. Long-term outcomes in idiopathic membranous nephropathy using a restrictive treatment strategy.

    Science.gov (United States)

    van den Brand, Jan A J G; van Dijk, Peter R; Hofstra, Julia M; Wetzels, Jack F M

    2014-01-01

    Recently published Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend limiting the use of immunosuppressive drugs in idiopathic membranous nephropathy to patients at the highest risk of kidney failure. However, recommendations are based on natural history rather than direct assessment of a restrictive treatment strategy. Here, we describe the long-term outcomes of treating a large cohort of patients with idiopathic membranous nephropathy according to a restrictive treatment policy. We analyzed data for 254 patients who visited our outpatient clinic between 1995 and 2009. All patients were treated with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Immunosuppressive therapy was recommended in cases of deteriorating renal function or untreatable nephrotic syndrome. Primary outcomes for the present study were renal replacement therapy and death. Secondary outcomes included adverse events during follow-up and remission of proteinuria. In total, 124 patients (49%) received immunosuppressive therapy, which predominantly consisted of cyclophosphamide combined with steroids. Ten-year cumulative incidence rates were 3% for renal replacement therapy and 10% for death. Partial remission rates were 39%, 70%, and 83% after 1, 3, and 5 years, respectively; complete remission rates were 5%, 24%, and 38% at 1, 3, and 5 years, respectively. A serious adverse event occurred in 23% of all patients. The most notable complications were infections (17%), leukopenia (18%), cardiovascular events (13%), and malignancies (8%). In conclusion, the use of a restrictive treatment strategy in this cohort of patients with idiopathic membranous nephropathy yielded favorable outcomes while limiting the number of patients exposed to toxic drugs. These results support current KDIGO guidelines.

  12. Assessment of long-term outcomes for the STRokE DOC telemedicine trial.

    Science.gov (United States)

    Meyer, Brett C; Raman, Rema; Ernstrom, Karin; Tafreshi, Gilda M; Huisa, Branko; Stemer, Andrew B; Hemmen, Thomas M

    2012-05-01

    Telemedicine can provide stroke evaluations in locations with limited available expertise. The reliability of telestroke has been established. Decision making efficacy has been shown in the National Institutes of Health's STRokE DOC trial. No prospective trial has assessed long-term telestroke outcomes, however. In an institutional review board-approved trial (NCT00936455), we contacted patients originally enrolled in the STRokE DOC trial. A telephone script was used to verify consent. Patients were asked standardized questions regarding disposition, modified Rankin Scale (mRS) score, mortality, and recurrent stroke for 2 retrospective time points (6 and 12 months postevent) and one current time point. Blind was maintained. Primary outcome measures of mortality and percent mRS score of 0-1 [%mRS(0-1)] at 6 months are reported. Wilcoxon's rank-sum test was used for continuous variables, and Fisher's exact was used for categorical variables. Of the original 222 participants, 75 patients or surrogates could be contacted. Mean time from enrollment was 3.96 ± 1.0 years (range, 2.33-5.45 years). Mean National Institutes of Health Stroke Scale (NIHSS) score was 8 ± 7 (5 ± 8 for telephone; 12 ± 8 for telemedicine; P = .002). The rate of intravenous recombinant tissue plasminogen activator (rt-PA) use was 31%. Six-month %mRS(0-1) outcome was not different, at 42%. Mortality after imputation to the entire study sample also was not different, at 18%. There was no difference in the rate of recurrent stroke (P = .61). Some 85% of patients were home at 6 months. This study reports a good 6-month outcome for stroke patients evaluated by telemedicine or telephone. This design is limited by the time since original enrollment and resultant inability to contact participants. Although these findings can add to the limited data on telemedicine outcomes, a prospective trial is needed.

  13. Proliferation rate but not mismatch repair affects the long-term response of colon carcinoma cells to 5FU treatment.

    Science.gov (United States)

    Choudhary, B; Hanski, M L; Zeitz, M; Hanski, C

    2012-07-01

    The role of mismatch repair (MMR) in the response of colon carcinoma cells to 5-fluorouracil (5FU) is not well understood. In most of the in vitro studies only short-term response was investigated. We focussed here on the influence of MMR status on the mechanism of the short- and long-term response to clinically relevant 5FU concentrations by using isogenic or semiisogenic cell line pairs expressing/nonexpressing the hMLH1 protein, an important component of the MMR system. We show that the lower survival of MMR-proficient than of MMR-deficient cells in the clonogenic survival assay is due to a more frequent early cell arrest and to subsequent senescence. By contrast, the long-term cell growth after treatment, which is also affected by long-term arrest and senescence, is independent from the MMR status. The overall effect on the long-term cell growth is a cumulative result of cell proliferation rate-dependent growth inhibition, apoptosis and necrotic cell death. The main long-term cytotoxic effect of 5FU is the inhibition of growth while apoptosis and the necrotic cell death are minor contributions.

  14. Long-term outcome in children with nutritional vitamin B12 deficiency

    Directory of Open Access Journals (Sweden)

    Melike Sezgin Evim

    2011-12-01

    Full Text Available Objective: Vitamin B12 deficiency is frequently observed in developing countries. Herein we report the long-term clinical and laboratory outcomes in 45 children presented with various symptoms of vitamin B12 deficiency.Materials and Methods: Symptoms and physical findings, and percentiles for weight, height, and head circumference at presentation were recorded. The educational level of the patients’ mothers, vitamin B12 deficiency-related diseases and family income data were collected. Complete blood count, serum vitamin B12, folate, iron, iron binding capacity and ferritin, and plasma homocysteine levels were recorded measured at presentation. The patients were treated with vitamin B12, as follows: 1 mg/d IM for 1 week, followed by 1 mg IM QWK for 2 weeks, and then monthly 1mg injections. Patients were neurologically and hematologically re-evaluated after treatment. The visual evoked potential (VEP test was used to examine the integrity and function of the visual pathway. Brainstem evoked potential (BAEP responses were used to analyze auditory function. Neuromotor development was assessed using Denver II Development Screening Test. Results: The mean age of 20 male and 25 female patients was 5.6±5.9 years (range: 1.4 months-17 years. The most common symptoms at presentation were weakness, failure to thrive, and hematologic manifestations (pallor, petechiae, ecchymosis. Abnormal neurologic findings at presentation were observed in 20% of the patients, and were more commonly observed in those <2 years. VEP, BAEP, and Denver II Development tests were performed in 66% of the patients one year after vitamin B12 replacement was started. VEP and BAEP interval prolongation was observed in 37% and 17% of the cases, respectively. Denver II Development Test results showed developmental delay in 20% of the patients tested.Conclusion: All the patients achieved full hematologic recovery within 1 month of treatment onset. Neurological symptoms resolved

  15. Long-term outcome of symptomatic severe ostial vertebral artery stenosis (OVAS)

    Energy Technology Data Exchange (ETDEWEB)

    Karameshev, Alexander [University of Bern, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern (Switzerland); University of Bern, Neurology, Bern (Switzerland); Medical University of Sofia, Department of Neurology, Sofia (Bulgaria); Schroth, Gerhard; Mordasini, Pasquale; Gralla, Jan; Brekenfeld, Caspar [University of Bern, Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern (Switzerland); Arnold, Marcel; Mono, Marie-Luise; Mattle, Heinrich P. [University of Bern, Neurology, Bern (Switzerland); Do, Do-Dai [University of Bern, Angiology, Bern (Switzerland); Nedeltchev, Krassen [University of Bern, Neurology, Bern (Switzerland); Triemli Hospital, Department of Neurology, Zurich (Switzerland)

    2010-05-15

    The optimal management of patients with symptomatic severe ostial vertebral artery stenosis (OVAS) is currently unclear. We analyzed the long-term outcome of consecutive patients with OVAS who received either medical treatment (MT) or vertebral artery stenting (VAS). Thirty-nine (>70%) patients with severe OVAS were followed for a mean period of 2.8 years. The decision for VAS (n=10) or MT (n=29) was left to the clinician. The Kaplan-Meier method was used to assess the risk of recurrent stroke, transient ischemic attack (TIA), or death over the study period. Patients in the VAS group were significantly younger and more likely to have bilateral VA disease (P=0.04 and P=0.02). VAS was successfully performed in all ten patients. The periprocedural risk within 30 days was 10% (one TIA). The overall restenosis rate was 10%. One restenosis occurred after 9 months in a patient treated with bare-metal stent. At 4 years of follow-up, VAS showed a nonsignificant trend toward a lower risk for the combined endpoint of TIA and stroke in posterior circulation compared to medical treatment (10% vs. 45%, P=0.095; relative risk (RR)=0.24, 95% confidence interval (CI) 0.031-1.85). Patients with bilateral VA disease had a significantly lower recurrence risk after VAS compared with medical treatment (0% vs. 91% at 4 years, P=0.004; RR 0.10, 95% CI 0.022-0.49) VAS was performed without permanent complications in this small series of patients with symptomatic severe OVAS. The long-term benefit seems to be confined to patients with bilateral but not to those with unilateral VA disease. (orig.)

  16. Can long-term thiamine treatment improve the clinical outcomes of myotonic dystrophy type 1?

    Institute of Scientific and Technical Information of China (English)

    Antonio Costantini; Erika Trevi; Maria Immacolata Pala; Roberto Fancellu

    2016-01-01

    Myotonic dystrophy type 1, also known as Steinert’s disease, is an autosomal dominant disorder with multisystemic clinical features affecting the skeletal and cardiac muscles, the eyes, and the endocrine system. Thiamine (vitamin B1) is a cofactor of fundamental enzymes involved in the energetic cell me-tabolism; recent studies described its role in oxidative stress, protein processing, peroxisomal function, and gene expression. Thiamine deifciency is critical mainly in the central and peripheral nervous system, as well as in the muscular cells. Our aim was to investigate the potential therapeutical effects of long-term treatment with thiamine in myotonic dystrophy type 1 in an observational open-label pilot study. We de-scribed two patients with myotonic dystrophy type 1 treated with intramuscular thiamine 100 mg twice a week for 12 or 11 months. We evaluated the patients using the grading of muscle strength according to Medical Research Council (MRC), the Muscular Impairment Rating Scale (MIRS), and the Modiifed Barthel index. High-dose thiamine treatment was well tolerated and effective in improving the motor symptomatology, particularly the muscle strength evaluated with the MRC scale, and the patients’ activi-ties of daily living using the Modiifed Barthel Index. At the end of treatment, the MRC score was 5 in the proximal muscles and 2–4 in the distal muscles (the MRC score before the treatment was 3–4 and 1–3, re-spectively). The MIRS grade improved by 25% compared to baseline for both patients. In patient #1, the Modiifed Barthel Index improved by 44%, and in patient #2 by 29%. These ifndings suggest that clinical outcomes are improved by long-term thiamine treatment.

  17. Endovascular Management of the Arteria Profunda Femoralis: Long-Term Angiographic and Clinical Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Karnabatidis, Dimitrios, E-mail: karnaby@med.upatras.gr; Spiliopoulos, Stavros; Pastromas, Georgios; Katsanos, Kostantinos; Siablis, Dimitrios [Patras University Hospital, School of Medicine, Department of Diagnostic and Interventional Radiology (Greece)

    2012-10-15

    Purpose: This study was designed to investigate the long-term angiographic and clinical outcomes of percutaneous transluminal angioplasty (PTA) of the arteria profunda femoralis (PFA), in a series of patients suffering from critical limb ischemia (CLI) or severe intermittent claudication (IC). Methods: Our department's database was searched to identify patients who underwent PTA or bail-out stenting of the PFA. Among the study's inclusion criteria were Rutherford categories 3-6 and {>=}70% stenosis of the PFA. Only de novo stenotic lesions were assessed. Primary endpoints were technical success, angiographic lesion primary patency, angiographic binary in-lesion restenosis, and target lesion recanalization (TLR) rates. Secondary endpoints included patient survival, limb salvage, and complication rates. Patient's baseline demographics, lesion, and procedural details were analyzed. Results: Between 2001 and 2011, 20 consecutive patients (17 males) with a mean age of 73 {+-} 9 (range 53-87) years underwent PTA or bail-out stenting in 23 PFA lesions. Critical limb ischemia was the indication in eight of 20 patients (40%). The mean lesion length was 31 {+-} 9.5 mm. The procedural technical success was 100% (23/23), whereas mean time angiographic and clinical follow-up was 26.8 {+-} 24.6 months. According to the Kaplan-Meier analysis, primary patency and binary restenosis rate were 95 and 86.1% respectively up to 8 years follow-up. No TLR procedures were performed. The 8-year patient survival and limb salvage rates were 87.5 and 84.7% respectively. Conclusions: PTA or stenting of focal, stenotic, PFA lesions, in patients suffering from CLI or IC, exhibit high long-term primary patency rates, as well as low binary restenosis and TLR rates. Large, multicenter studies are required to validate these results.

  18. Dexamethasone and long-term outcome of tuberculous meningitis in Vietnamese adults and adolescents.

    Directory of Open Access Journals (Sweden)

    M Estée Török

    Full Text Available BACKGROUND: Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. METHODS: Vietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjunctive dexamethasone were followed-up at five years, to determine the effect of dexamethasone on long-term survival and neurological disability. RESULTS: 545 patients were randomised to receive either dexamethasone (274 patients or placebo (271 patients. 50 patients (9.2% were lost to follow-up at five years. In all patients two-year survival, probabilities tended to be higher in the dexamethasone arm (0.63 versus 0.55; p = 0.07 but five-year survival rates were similar (0.54 versus 0.51, p = 0.51 in both groups. In patients with grade 1 TBM, but not with grade 2 or grade 3 TBM, the benefit of dexamethasone treatment tended to persist over time (five-year survival probabilities 0.69 versus 0.55, p = 0.07 but there was no conclusive evidence of treatment effect heterogeneity by TBM grade (p = 0.36. The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group (17/128, 13.2% vs. 17/116, 14.7% and there was no significant association between dexamethasone treatment and disability status at five years (p = 0.32. CONCLUSIONS: Adjunctive dexamethasone appears to improve the probability of survival in patients with TBM, until at least two years of follow-up. We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM. TRIAL REGISTRATION: ClinicalTrials.gov NCT01317654.

  19. Efficacy and long-term outcome of gastritis therapy in cheetahs (Acinonyx jubatus).

    Science.gov (United States)

    Citino, Scott B; Munson, Linda

    2005-09-01

    A prospective clinical trial evaluating efficacy and long-term outcome of treatments for lymphoplasmacytic gastritis in cheetahs (Acinonyx jubatus) was conducted. The study evaluated efficacy of 11 different antibiotic and antiinflammatory treatment protocols in 32 cheetahs (19 male, 13 female) for reducing gastric inflammation and Helicobacter colonization and monitored the course of disease through histologic grading of gastric biopsies. All cheetahs were biopsied up to I wk before treatment and then rebiopsied within 1 mo after treatment. Most animals were reassigned to a second treatment regimen within 6 mo. Each animal received from one to three treatments during the study period. After the trial, gastric biopsies were obtained from each cheetah annually until death or transfer from the facility to assess disease progression. The trial and follow-up period spanned 10 yr. At onset of the trial, all 32 cheetahs had some degree of gastritis, and 26 cheetahs (81%) were colonized with Helicobacter. Inflammatory lesions worsened regardless of treatment or the presence of Helicobacter. No treatment had a significant effect on inflammatory changes except the lansoprazole/clarithromycin/amoxicillin treatment group, which produced a short-term decrease in inflammation when compared to controls. Prednisone had no effect on gastric inflammation. Overall, 65% of colonized cheetahs were initially cleared of histologic evidence of Helicobacter by treatment, with short-term eradication occurring in 100% of the animals treated with omeprazole/clarithromycin/amoxicillin or tetracycline/metronidazole/Pepto-Bismol for 28 days. Long-term follow-up of treated animals in this study clearly demonstrated that these treatments had little effect on life-long progression of gastritis or on Helicobacter burden in individual cheetahs, although some treatments provided short-term reduction in gastritis and Helicobacter. These results provide evidence that Helicobacter alone is not the cause

  20. Long-Term Outcomes of Stereotactic Radiosurgery for Treatment of Cavernous Sinus Meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcos Antonio dos, E-mail: marcosrxt@gmail.com [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Bustos Perez de Salcedo, Jose; Gutierrez Diaz, Jose Angel [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Neurosurgery Department, Sanatorio San Francisco de Asis, Madrid (Spain); Calvo, Felipe A. [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Department of Oncology, Hospital General Universitario Gregorio Maranon, Madrid (Spain); Samblas, Jose [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Neurosurgery Department, Sanatorio San Francisco de Asis, Madrid (Spain); Marsiglia, Hugo [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Sallabanda, Kita [Radiotherapy Department, Instituto Madrileno de Oncologia/Grupo IMO, Madrid (Spain); Neurosurgery Department, Sanatorio San Francisco de Asis, Madrid (Spain)

    2011-12-01

    Purpose: Patients with cavernous sinus meningiomas (CSM) have an elevated risk of surgical morbidity and mortality. Recurrence is often observed after partial resection. Stereotactic radiosurgery (SRS), either alone or combined with surgery, represents an important advance in CSM management, but long-term results are lacking. Methods and Materials: A total of 88 CSM patients, treated from January 1991 to December 2005, were retrospectively reviewed. The mean follow-up was 86.8 months (range, 17.1-179.4 months). Among the patients, 22 were followed for more than 10 years. There was a female predominance (84.1%). The age varied from 16 to 90 years (mean, 51.6). In all, 47 patients (53.4%) received SRS alone, and 41 patients (46.6%) had undergone surgery before SRS. A dose of 14 Gy was prescribed to isodose curves from 50% to 90%. In 25 patients (28.4%), as a result of the proximity to organs at risk, the prescribed dose did not completely cover the target. Results: After SRS, 65 (73.8%) patients presented with tumor volume reduction; 14 (15.9%) remained stable, and 9 (10.2%) had tumor progression. The progression-free survival was 92.5% at 5 years, and 82.5% at 10 years. Age, sex, maximal diameter of the treated tumor, previous surgery, and complete target coverage did not show significant associations with prognosis. Among the 88 treated patients, 17 experienced morbidity that was related to SRS, and 6 of these patients spontaneously recovered. Conclusions: SRS is an effective and safe treatment for CSM, feasible either in the primary or the postsurgical setting. Incomplete coverage of the target did not worsen outcomes. More than 80% of the patients remained free of disease progression during long-term follow-up.

  1. Intraoperative Electron-Beam Radiation Therapy for Pediatric Ewing Sarcomas and Rhabdomyosarcomas: Long-Term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Sole, Claudio V., E-mail: csole@iram.cl [Department of Radiation Oncology, Instituto de Radiomedicina, Santiago (Chile); School of Medicine, Complutense University, Madrid (Spain); Calvo, Felipe A. [School of Medicine, Complutense University, Madrid (Spain); Department of Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Polo, Alfredo [Service of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid (Spain); Cambeiro, Mauricio [Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona (Spain); Gonzalez, Carmen [School of Medicine, Complutense University, Madrid (Spain); Service of Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Desco, Manuel [School of Medicine, Complutense University, Madrid (Spain); Department of Experimental Surgery and Medicine, Hospital General Universitario Gregorio Marañón, Madrid (Spain); Martinez-Monge, Rafael [Service of Radiation Oncology, Clínica Universidad de Navarra, Pamplona (Spain)

    2015-08-01

    Purpose: To assess long-term outcomes and toxicity of intraoperative electron-beam radiation therapy (IOERT) in the management of pediatric patients with Ewing sarcomas (EWS) and rhabdomyosarcomas (RMS). Methods and Materials: Seventy-one sarcoma (EWS n=37, 52%; RMS n=34, 48%) patients underwent IOERT for primary (n=46, 65%) or locally recurrent sarcomas (n=25, 35%) from May 1983 to November 2012. Local control (LC), overall survival (OS), and disease-free survival were estimated using Kaplan-Meier methods. For survival outcomes, potential associations were assessed in univariate and multivariate analyses using the Cox proportional hazards model. Results: After a median follow-up of 72 months (range, 4-310 months), 10-year LC, disease-free survival, and OS was 74%, 57%, and 68%, respectively. In multivariate analysis after adjustment for other covariates, disease status (P=.04 and P=.05) and R1 margin status (P<.01 and P=.04) remained significantly associated with LC and OS. Nine patients (13%) reported severe chronic toxicity events (all grade 3). Conclusions: A multimodal IOERT-containing approach is a well-tolerated component of treatment for pediatric EWS and RMS patients, allowing reduction or substitution of external beam radiation exposure while maintaining high local control rates.

  2. Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

    Science.gov (United States)

    Pozzoli, Alberto; Elisabetta, Lapenna; Vicentini, Luca; Alfieri, Ottavio; De Bonis, Michele

    2016-09-01

    The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

  3. Long-Term Outcomes of Balloon Dilation for Acquired Subglottic Stenosis in Children

    Directory of Open Access Journals (Sweden)

    Aliye Filiz

    2014-01-01

    Full Text Available Objectives. Balloon dilation laryngoplasty has been suggested as an alternative treatment to open surgical treatment of acquired subglottic stenosis in children. We describe long-term outcomes of balloon dilation for acquired subglottic stenosis in children. Methods. The medical charts of children who had balloon dilation for subglottic stenosis secondary to intubation were reviewed. Data included demographics, relevant history and physical examination, diagnostic workup, and management. Outcomes of balloon dilation were assessed based on improvement in preoperative symptoms, grading of stenosis, complications, and need for additional procedures. Results. Three children (2 male, 1 female, age range: 14 weeks–1 year underwent balloon dilation for acquired subglottic stenosis. Patients presented with stridor and increased work of breathing. Duration of intubation ranged from 2 days to 3 weeks. Patients became symptomatic 5 days to 6 weeks after extubation. Grade of subglottic stenosis was II in 2 patients and III in one. Subglottic stenosis patients had 2-3 dilations within 2–10 weeks. All patients were asymptomatic during 14–21-month follow-up. Conclusions. Serial balloon dilation was safe and successful method to manage acquired subglottic stenosis in this group of children. No recurrence was noted in a follow-up more than a year after resolution of symptoms.

  4. Long-term outcomes of balloon dilation for acquired subglottic stenosis in children.

    Science.gov (United States)

    Filiz, Aliye; Ulualp, Seckin O

    2014-01-01

    Objectives. Balloon dilation laryngoplasty has been suggested as an alternative treatment to open surgical treatment of acquired subglottic stenosis in children. We describe long-term outcomes of balloon dilation for acquired subglottic stenosis in children. Methods. The medical charts of children who had balloon dilation for subglottic stenosis secondary to intubation were reviewed. Data included demographics, relevant history and physical examination, diagnostic workup, and management. Outcomes of balloon dilation were assessed based on improvement in preoperative symptoms, grading of stenosis, complications, and need for additional procedures. Results. Three children (2 male, 1 female, age range: 14 weeks-1 year) underwent balloon dilation for acquired subglottic stenosis. Patients presented with stridor and increased work of breathing. Duration of intubation ranged from 2 days to 3 weeks. Patients became symptomatic 5 days to 6 weeks after extubation. Grade of subglottic stenosis was II in 2 patients and III in one. Subglottic stenosis patients had 2-3 dilations within 2-10 weeks. All patients were asymptomatic during 14-21-month follow-up. Conclusions. Serial balloon dilation was safe and successful method to manage acquired subglottic stenosis in this group of children. No recurrence was noted in a follow-up more than a year after resolution of symptoms.

  5. Latent profiles of nonresidential father engagement six years after divorce predict long-term offspring outcomes.

    Science.gov (United States)

    Modecki, Kathryn Lynn; Hagan, Melissa J; Sandler, Irwin; Wolchik, Sharlene A

    2015-01-01

    This study examined profiles of nonresidential father engagement (i.e., support to the adolescent, contact frequency, remarriage, relocation, and interparental conflict) with their adolescent children (N = 156) 6 to 8 years following divorce and the prospective relation between these profiles and the psychosocial functioning of their offspring, 9 years later. Parental divorce occurred during late childhood to early adolescence; indicators of nonresidential father engagement were assessed during adolescence, and mental health problems and academic achievement of offspring were assessed 9 years later in young adulthood. Three profiles of father engagement were identified in our sample of mainly White, non-Hispanic divorced fathers: Moderate Involvement/Low Conflict, Low Involvement/Moderate Conflict, and High Involvement/High Conflict. Profiles differentially predicted offspring outcomes 9 years later when they were young adults, controlling for quality of the mother-adolescent relationship, mother's remarriage, mother's income, and gender, age, and offspring mental health problems in adolescence. Offspring of fathers characterized as Moderate Involvement/Low Conflict had the highest academic achievement and the lowest number of externalizing problems 9 years later compared to offspring whose fathers had profiles indicating either the highest or lowest levels of involvement but higher levels of conflict. Results indicate that greater paternal psychosocial support and more frequent father-adolescent contact do not outweigh the negative impact of interparental conflict on youth outcomes in the long term. Implications of findings for policy and intervention are discussed.

  6. Radical treatment strategies improve the long-term outcome of recurrent atypical meningiomas

    Institute of Scientific and Technical Information of China (English)

    LI Fei; LAI Zhao-pan; LIN Jiang-kai; ZHU Gang; FENG Hua

    2011-01-01

    Background Atypical meningioma is one of the rare subtypes of meningioma, which is lacking of optimal consensus on treatment strategies. This study aimed to investigate the radical treatment strategies to improve the long-term outcome of recurrent atypical meningiomas. Methods The prognostic factors including the age and gender of patients; the location, histology, recurrence pattern and mitotic cell rate of the tumors; and the resection extents, surgical strategies and adjuvant therapies of 15 cases of recurrent atypical meningiomas were analyzed retrospectively. Results The age and gender of patients were not associated with tumor recurrence. However, high recurrence rates and poor prognosis for atypical meningiomas were associated with the high mitotic cell rate, failure to achieve Simpson gradeⅠ-Ⅱ resection, and without the dura and bone flap replacement intraoperatively. Post-operative radiotherapy improved the outcomes of tumors in patients after the second surgery. Conclusion Radical treatment strategies such as dura and bone flap replacements and radiotherapy should be considered in patients diagnosed with atypical meningiomas.

  7. Long-term subjective and objective outcome after primary repair of traumatic facial nerve injuries.

    Science.gov (United States)

    Frijters, Erik; Hofer, Stefan O P; Mureau, Marc A M

    2008-08-01

    Although traumatic facial nerve paralysis is a severe handicap, there are no follow-up studies evaluating outcome after primary repair of traumatic facial nerve injuries. From May 1988 to August 2005, 27 patients (mean age, 27 years) were operated for traumatic facial nerve lesions (mean number of affected branches, 2.2). End-to-end facial nerve repair was always performed. All patients were invited to our outpatient clinic for standardized questionnaires (Facial Disability Index, Short Form-36 Health Survey), physical examination (Sunnybrook Facial Grading System), and clinical photographs. Sixteen patients participated in the follow-up study (mean, 9.2 years). Mean Facial Disability Index Physical and Social scores were 86 and 81, respectively, indicating good subjective facial functioning. The mean Sunnybrook Facial Grading System score was 74 indicating adequate facial functioning. Mean physical and mental health scores (Short Form-36 Health Survey) were comparable with normative data. Primary end-to-end repair of traumatic facial nerve injuries results in good long-term objective and subjective functional and emotional outcome.

  8. Long-term treatment results for nasopharyngeal carcinoma: The Sahlgrenska Univ. Hospital experience

    Energy Technology Data Exchange (ETDEWEB)

    Taheri-Kadkhoda, Zahra; Bjoerk-Eriksson, Thomas; Mercke, Claes [Dept. of Oncology, Sahlgrenska Univ. Hospital, Goeteborg (Sweden); Johansson, Karl-Axel [Dept. of Radiophysics, Sahlgrenska Univ. Hospital, Goeteborg (Sweden)

    2007-08-15

    Nasopharyngeal carcinoma (Nc) is a rare disease in Sweden. For evaluation of the treatment outcomes in our NPC patients, 52 new cases that were referred to our department between 1991 and 2002 were retrospectively analysed. Tumor stage, according to the 1997 AJCC staging system, was I in five, II in ten, III in 12 and IV in 25 patients. Majority of the patients (87%) had World Health Organization type II-III tumors. Neoadjuvant chemotherapy was delivered in 33 patients. Thirty-two patients received hyperfractionated accelerated radiation therapy with a median dose of 64.6Gy (1.7Gy/fr bid). Conventional external irradiation with a median dose of 66Gy (2Gy/fr) was delivered to 18 patients. An intracavitary brachy-boost of 4.5-12Gy was delivered to 40 patients. Two patients were excluded from the analysis due to treatment refusal. For the patients with tumor stages I-IVB, the 5-year disease-free and overall survival rates were 61% and 55%, respectively. The 5-year local, regional, and distant relapse-free survival rates were 70%, 92% and 77%, respectively. The most frequent late side effects were xerostomia (98%), otitis (70%) and hearing deterioration (64%). Our data suggest that optimization of the treatment outcomes in NPC patients requires implementation of new therapeutic strategies.

  9. Preschool speech intelligibility and vocabulary skills predict long-term speech and language outcomes following cochlear implantation in early childhood.

    Science.gov (United States)

    Castellanos, Irina; Kronenberger, William G; Beer, Jessica; Henning, Shirley C; Colson, Bethany G; Pisoni, David B

    2014-07-01

    Speech and language measures during grade school predict adolescent speech-language outcomes in children who receive cochlear implants (CIs), but no research has examined whether speech and language functioning at even younger ages is predictive of long-term outcomes in this population. The purpose of this study was to examine whether early preschool measures of speech and language performance predict speech-language functioning in long-term users of CIs. Early measures of speech intelligibility and receptive vocabulary (obtained during preschool ages of 3-6 years) in a sample of 35 prelingually deaf, early-implanted children predicted speech perception, language, and verbal working memory skills up to 18 years later. Age of onset of deafness and age at implantation added additional variance to preschool speech intelligibility in predicting some long-term outcome scores, but the relationship between preschool speech-language skills and later speech-language outcomes was not significantly attenuated by the addition of these hearing history variables. These findings suggest that speech and language development during the preschool years is predictive of long-term speech and language functioning in early-implanted, prelingually deaf children. As a result, measures of speech-language functioning at preschool ages can be used to identify and adjust interventions for very young CI users who may be at long-term risk for suboptimal speech and language outcomes.

  10. Long-term outcomes of minor troponin elevations in the intensive care unit.

    Science.gov (United States)

    Velasquez, A; Ghassemi, M; Szolovits, P; Park, S; Osorio, J; Dejam, A; Celi, L

    2014-05-01

    The aim of our study is to determine the short-term and long-term outcomes of intensive care unit (ICU) patients with minor troponin elevations. The retrospective study compared ICU patients with peak troponin elevation less than 0.1 ng/ml to those with only negative tests during their hospital stay. Data were gathered from ICUs at Beth Israel Deaconess Medical Center between 2001 and 2008. A total of 4224 patients (2547 controls and 1677 positives) were analysed. The primary outcome was mortality at one year. Secondary outcomes were 30-day mortality and hospital and ICU lengths of stay. After adjusting for age, sex, Simplified Acute Physiology Score, Sequential Organ Failure Assessment and combined Elixhauser score, we found that minor troponin elevations (peak troponin elevation between 0.01 and 0.09 ng/ml) were associated with a higher one-year mortality (Hazard Ratio 1.22, P troponin presence; Hazard Ratio 1.03, P troponin increment). This relationship held for the subgroup of seven-day post-discharge survivors (Hazard Ratio 1.26, P troponin also significantly increased the net reclassification index over traditional risk markers for mortality prediction (net reclassification score 0.12, P troponin elevation was also associated with 30-day mortality (odds ratio 1.33, P=0.003). Importantly, troponin testing did not increase the adjusted mortality odds (P=0.9). Minor elevations in troponin substantially increase one-year, all-cause mortality in a stepwise fashion; it was also independently associated with 30-day mortality. We propose that minor elevations in troponin should not be regarded as clinically unimportant, but rather be included as a prognostic element if measured. We recommend prospective ICU studies to assess prognostic value of routine troponin determination.

  11. Long-term outcomes of a pediatric HIV treatment program in Maputo, Mozambique: a cohort study

    Directory of Open Access Journals (Sweden)

    Jan Walter

    2015-08-01

    Full Text Available Objective: To describe long-term treatment outcomes of a pediatric HIV cohort in Mozambique. Design: Retrospective analysis of routine monitoring data. Setting: Secondary health care facilities in the Chamanculo Health District of Maputo. Subjects: A total of 1,335 antiretroviral treatment (ART naïve children <15 years of age enrolled in HIV care between 2002 and 2010. Intervention: HIV care, ART (since 2003, task shifting to lower cadre nurses, counseling by lay counselors, active patient tracing, nutritional support, support by a psychologist, targeted viral load testing, and switch to second-line treatment. Main outcome measures: Kaplan–Meier estimates for retention in care (RIC, CD4 cell percentage, body mass index for age z-score, and adjusted incidence rate ratios for attrition (death or loss to follow-up as calculated by Poisson regression. Results: The RIC at 6 years in the pre-ART cohort was 44% (95% confidence interval: 38–49, and the one at 8 years in the ART cohort was 70% (64–75. Risk factors for attrition included young age, low CD4 percentage, underweight, active tuberculosis, and enrollment/treatment initiation after 2006. The mean CD4 percentage increased strongly at 1 year on treatment and remained high thereafter. The body mass index for age z-score sharply increased at 1 year after treatment initiation before stabilizing at pre-ART levels thereafter. Conclusions: Good clinical and immunological treatment outcomes up to 8 years of follow-up on ART can be achieved in a context of shortage of health workers and a high level of task-shifting approach.

  12. Early predictors of long-term cognitive, emotional and behavioural outcome in children with ESES: A retrospective study

    NARCIS (Netherlands)

    Weijenberg, A.; Vlaskamp, D.R.M.; Elting, J.W.; Veenstra, W.S.; Gutter, T.; Geerts, Y.; Brouwer, O.F.; Callenbach, P.M.C.; de Walle, Hermien

    2013-01-01

    Objectives: Long-term outcome of Electrical Status Epilepticus during Sleep (ESES) is generally unfavourable but hard to predict in individual children. Longer duration of ESES and younger age at onset of ESES have been reported to be predictors of poor outcome, whereas any treatment response is ass

  13. Long-Term Outcomes for the Promoting CARE Suicide Prevention Program

    Science.gov (United States)

    Hooven, Carole; Herting, Jerald R.; Snedker, Karen A.

    2010-01-01

    Objectives: To provide a long-term look at suicide risk from adolescence to young adulthood for former participants in Promoting CARE, an indicated suicide prevention program. Methods: Five hundred ninety-three suicide-vulnerable high school youth were involved in a long-term follow-up study. Latent class growth models identify patterns of change…

  14. Long-term neurodevelopmental outcome of monochorionic and matched dichorionic twins.

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    Karien E A Hack

    Full Text Available BACKGROUND: Monochorionic (MC twins are at increased risk for perinatal mortality and serious morbidity due to the presence of placental vascular anastomoses. Cerebral injury can be secondary to haemodynamic and hematological disorders during pregnancy (especially twin-to-twin transfusion syndrome (TTTS or intrauterine co-twin death or from postnatal injury associated with prematurity and low birth weight, common complications in twin pregnancies. We investigated neurodevelopmental outcome in MC and dichorionic (DC twins at the age of two years. METHODS: This was a prospective cohort study. Cerebral palsy (CP was studied in 182 MC infants and 189 DC infants matched for weight and age at delivery, gender, ethnicity of the mother and study center. After losses to follow-up, 282 of the 366 infants without CP were available to be tested with the Griffiths Mental Developmental Scales at 22 months corrected age, all born between January 2005 and January 2006 in nine perinatal centers in The Netherlands. Due to phenotypic (unalikeness in mono-or dizygosity, the principal investigator was not blinded to chorionic status; perinatal outcome, with exception of co-twin death, was not known to the examiner. FINDINGS: Four out of 182 MC infants had CP (2.2% - two of the four CP-cases were due to complications specific to MC twin pregnancies (TTTS and co-twin death and the other two cases of CP were the result of cystic PVL after preterm birth - compared to one sibling of a DC twin (0.5%; OR 4.2, 95% CI 0.5-38.2 of unknown origin. Follow-up rate of neurodevelopmental outcome by Griffith's test was 76%. The majority of 2-year-old twins had normal developmental status. There were no significant differences between MC and DC twins. One MC infant (0.7% had a developmental delay compared to 6 DC infants (4.2%; OR 0.2, 95% 0.0-1.4. Birth weight discordancy did not influence long-term outcome, though the smaller twin had slightly lower developmental scores than its

  15. Long-term seizure and psychosocial outcomes of vagus nerve stimulation for intractable epilepsy.

    Science.gov (United States)

    Wasade, Vibhangini S; Schultz, Lonni; Mohanarangan, Karthik; Gaddam, Aryamaan; Schwalb, Jason M; Spanaki-Varelas, Marianna

    2015-12-01

    Vagus nerve stimulation (VNS) is a widely used adjunctive treatment option for intractable epilepsy. Most studies have demonstrated short-term seizure outcomes, usually for up to 5 years, and thus far, none have reported psychosocial outcomes in adults. We aimed to assess long-term seizure and psychosocial outcomes in patients with intractable epilepsy on VNS therapy for more than 15 years. We identified patients who had VNS implantation for treatment of intractable epilepsy from 1997 to 2013 at our Comprehensive Epilepsy Program and gathered demographics including age at epilepsy onset and VNS implantation, epilepsy type, number of antiepilepsy drugs (AEDs) and seizure frequency before VNS implantation and at the last clinic visit, and the most recent stimulation parameters from electronic medical records (EMR). Phone surveys were conducted by research assistants from May to November 2014 to determine patients' current seizure frequency and psychosocial metrics, including driving, employment status, and use of antidepressants. Seizure outcomes were based on modified Engel classification (I: seizure-free/rare simple partial seizures; II: >90% seizure reduction (SR), III: 50-90% SR, IV: 50% SR)=favorable outcome). A total of 207 patients underwent VNS implantation, 15 of whom were deceased at the time of the phone survey, and 40 had incomplete data for medical abstraction. Of the remaining 152, 90 (59%) were contacted and completed the survey. Of these, 51% were male, with the mean age at epilepsy onset of 9.4 years (range: birth to 60 years). There were 35 (39%) patients with extratemporal epilepsy, 19 (21%) with temporal, 18 (20%) with symptomatic generalized, 5 (6%) with idiopathic generalized, and 13 (14%) with multiple types. Final VNS settings showed 16 (18%) patients with an output current >2 mA and 14 (16%) with rapid cycling. Of the 80 patients with seizure frequency information, 16 (20%) had a modified Engel class I outcome, 14 (18%) had class II, 24 (30

  16. Long-term outcome of correction of tetralogy of Fallot in 56 adult patients

    Institute of Scientific and Technical Information of China (English)

    ZHENG Da-wei; SHAO Guo-feng; FENG Qiang; NI Yi-ming

    2013-01-01

    Background Although most patients with tetralogy of Fallot undergo radical repair during infancy and childhood,patients that remain undiagnosed and untreated until adulthood can still be treated.This study aimed to evaluate longterm outcomes of adult patients with tetralogy of Fallot who were treated surgically,and to determine the predictors of postoperative pulmonary regurgitation.Methods Fifty-six adult patients underwent complete surgical repair.Forty-three patients (76.8%) required a transannular patch.Systolic,diastolic,and mean pressure in the main pulmonary artery were measured after repair.Results The early mortality rate was 3.6%.The 16-year survival rate was (84.4±11.5)%.Late echocardiography revealed 41 patients with transannular patch who had pulmonary regurgitation,consisting of mild pulmonary regurgitation in 28 patients,moderate in eight,and severe regurgitation in five patients.In addition,there was right ventricular outflow tract stenosis in nine patients,moderate/severe tricuspid valve regurgitation in seven,and residual ventricular septal defect in five.Logistic regression analysis demonstrated that the mean pulmonary pressure measured just after repair predicted late pulmonary regurgitation.Conclusions The long-term survival of surgically treated adult patients with tetralogy of Fallot is acceptable.The mean pressure >20 mmHg in the main pulmonary artery measured right after surgical repair may be a feasible reference to time the reconstruction of the pulmonary valve.

  17. Long-term outcomes of surgery and radiotherapy for secreting and non-secreting pituitary adenoma

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    Kim, Mi Young; Kim, Jin Hee; Oh, Young Kee; Kim, El [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2016-06-15

    To investigate treatment outcome and long term complication after surgery and radiotherapy (RT) for pituitary adenoma. From 1990 to 2009, 73 patients with surgery and RT for pituitary adenoma were analyzed in this study. Median age was 51 years (range, 25 to 71 years). Median tumor size was 3 cm (range, 1 to 5 cm) with suprasellar (n = 21), cavernous sinus extension (n = 14) or both (n = 5). Hormone secreting tumor was diagnosed in 29 patients; 16 patients with prolactin, 12 patients with growth hormone, and 1 patient with adrenocorticotrophic hormone. Impairment of visual acuity or visual field was presented in 33 patients at first diagnosis. Most patients (n = 64) received RT as postoperative adjuvant setting. Median RT dose was 45 Gy (range, 45 to 59.4 Gy). Median follow-up duration was 8 years (range, 3 to 22 years). In secreting tumors, hormone normalization rate was 55% (16 of 29 patients). For 25 patients with evaluable visual field and visual acuity test, 21 patients (84%) showed improvement of visual disturbance after treatment. The 10-year tumor control rate for non-secreting and secreting adenoma was 100% and 58%, respectively (p < 0.001). Progression free survival rate at 10 years was 98%. Only 1 patient experienced endocrinological recurrence. Following surgery, 60% (n = 44) suffered from pituitary function deficit. Late complication associated with RT was only 1 patient, who developed cataract. Surgery and RT are very effective and safe in hormonal and tumor growth control for secreting and non-secreting pituitary adenoma.

  18. Long-term outcome of acupuncture in women with frequency, urgency and dysuria.

    Science.gov (United States)

    Chang, P L; Wu, C J; Huang, M H

    1993-01-01

    Urodynamic measurements including cystometry, anal sphincter electromyography, urethral pressure profilometry and uroflowmetry were carried out on 21 female patients before acupuncture and at 1 and 3 years during follow-up. Follow-up ranged from 60 to 72 months (average 66.2 months). There was no significant difference in all urodynamic measurements before acupuncture and at the 1 year or 3 years follow-up. During follow-up, acupuncture at the Sp-6 point was performed in patients who had recurrence of symptoms of frequency, urgency and dysuria. The number of acupuncture treatments ranged from 2 to 8 times, with an average number of 4.8 times. A decrease of acupuncture treatments after 30 months was noted on 8 patients, but it was not statistically significant. We concluded that the long-term outcome of acupuncture at the Sp-6 point for women with frequency, urgency and dysuria was positive, but that the effect was temporary and repeated acupuncture was necessary to maintain beneficial effects.

  19. Long-term outcome of intensive initial immunosuppression protocol in pediatric deceased donor renal transplantation.

    LENUS (Irish Health Repository)

    Olaitan, Oyedolamu K

    2010-02-01

    To report the long-term outcome of deceased donor kidney transplantation in children with emphasis on the use of an intensive initial immunosuppression protocol using R-ATG as antibody induction. Between January 1991 and December 1997, 82 deceased donor kidney transplantations were performed in 75 pediatric recipients. Mean recipient age at transplantation was 12.9 yr and the mean follow-up period was 12.6 yr. All patients received quadruple immunosuppression with steroid, cyclosporine, azathioprine, and antibody induction using R-ATG-Fresenius. Actual one, five, and 10 yr patient survival rates were 99%, 97%, and 94%, respectively; only one patient (1.2%) developed PTLD. Actual one, five, and 10 yr overall graft survival rates were 84%, 71%, and 50%, respectively; there were five cases (6%) of graft thrombosis and the actual immunological graft survival rates were 91%, 78%, and 63% at one, five, and 10 yr, respectively. The use of an intensive initial immunosuppression protocol with R-ATG as antibody induction is safe and effective in pediatric recipients of deceased donor kidneys with excellent immunological graft survival without an increase in PTLD or other neoplasms over a minimum 10-yr follow up.

  20. LONG-TERM OUTCOMES OF RETINAL DEGENERATIVE DISORDER TREATMENT WITH PEPTIDE BIOREGULATORS

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    M. I. Razumovskiy

    2015-01-01

    Full Text Available Aim. To analyze long-term outcomes and efficacy of retinal degeneration treatment with Retinalamin.Patients and methods. Group I included 20 patients (40 eyes with pigmentary retinal dystrophy (15 patients, 30 eyes and retinal abiotrophy (5 patients, 10 eyes who received treatment with Retinalamin for 5‑7 years. Group II included 11 patients (22 eyes with pigmentary retinal dystrophy (9 patients, 18 eyes and retinal abiotrophy (2 patients, 4 eyes who received treatment with Retinalamin for 23‑25 years. Group III (controls included 15 patients (30 eyes with pigmentary retinal dystrophy (11 patients, 22 eyes and retinal abiotrophy (4 patients, 8 eyes who received traditional treatment (vasodilators, angioprotectors, antisclerotic agents, vitamins for 25 years. Standard ophthalmological examination, i.e., visual acuity measurement, visual field test, refractometry, biomicroscopy, ophthalmoscopy, was performed.Results. First course of treatment with Retinalamin improved vision in 58.1 % of retinal degeneration patients. Visual fields improved in 64.5 % of cases. Repeated treatment courses (1‑2 times a year for 23‑25 years preserved residual vision in 55.6 % of patients and object vision in 11.1 % of cases. In retinal abiotrophy patients, residual vision preserved in 100 % of cases.Conclusions. In retinal degenerations, Retinalamin improves vision and visual fields and decreases total area of absolute scotomas even after the first treatment course as well as preserves vision in prolonged use. 

  1. STUDY OF LONG TERM FUNCTIONAL OUTCOME AFTER REPAIRED VOLAR CUT WRIST

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    Lokesh Chowdary

    2015-01-01

    Full Text Available BACKGROUND: C ut wrist repair is commonest procedure done in Hand surgery , inspite of that there is dearth of literature on long term functional outcome & social rehabilitation of such patients , so we decided to study our patients retrospectively with self - devised scale which not only incorporated the combined assessment of nerve & tendon but also the patients self - assessment of his status of recovery. MATERIAL AND METHODS: W e retrospect ively studied a cohort of 32 patients by searching through hospital records from 2010 to 2013 . RESULTS: Most common age group 21 - 30 yrs , M:F=9:1 , glass cut most common injury , sensation improved with time but return of sensation not seen in period of obser vation , MN has better recovery than UN , except 2 patients significant 2PD was not observed. C old intolerance/paraesthesia is a common problem in patients & persists for long , tendon function recovery is good to excellent at wrist level , majority of our pat ients were satisfied & were able to return to their original vocation within 1 yr.

  2. Long-term motor and sensory outcomes after surgery for infantile esotropia

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    Altınsoy Halil Ibrahim

    2016-01-01

    Full Text Available Background/Aim. Infantile esotropia (ET, entitled as congenital ET, is defined as an alternating, cross-fixational ET that occurs within the first 6 months of life. The aim of this study was to determine the long-term motor and sensory outcomes after surgical correction of patients with infantile ET. Methods. Medical records of 108 consecutive children who had bimedial rectus recession (BMR initially for ET were reviewed retrospectively. The patients were divided into 3 groups: the group I, surgery before one-year old; the group II, surgery between one and two-year old; the group III, surgery after two-year old. Results. No significant differences were determined among the groups for preoperative mean angle of deviation and refractive error (p > 0.05, for both. Development rate of dissociated vertical deviation (DVD was greater (40% in the group I, and the relationship between the rate of DVD and the timing of the initial surgery was statistically significant (p = 0.03. Risk for additional surgery was significantly greater in patients with a younger mean age at initial surgery (p = 0.01. Although measurable stereopsis rate was higher in the group I (35%, 32.4%, 27.8%, respectively the difference among the groups was insignificant (p = 0.80. Conclusion. Patients with ET have limited potential of high grade stereoacuity despite the early alignment of eyes. Early surgery also has potential effects for the development of both inferior oblique overaction and DVD earlier.

  3. Long-term outcomes of allograft reconstruction of the anterior cruciate ligament.

    Science.gov (United States)

    Lenehan, Eric A; Payne, W Barrett; Askam, Brad M; Grana, William A; Farrow, Lutul D

    2015-05-01

    Recent studies have found higher rates of failed reconstruction of the anterior cruciate ligament (ACL) with use of allograft when compared with autograft reconstruction. To evaluate the long-term outcomes of allograft ACL reconstruction, we retrospectively reviewed the cases of all patients who underwent allograft (n=99) or autograft (n=24) ACL reconstruction by 2 senior surgeons at a single institution over an 8-year period. Seventeen (17%) of the 99 allograft reconstructions required additional surgery. Reoperation and revision ACL reconstruction rates (30.8% and 20.5%, respectively) were much higher for patients 25 years of age or younger than for patients older than 25 years. In our cohort of NCAA (National Collegiate Athletic Association) Division I athletes, the revision ACL reconstruction rate was 62% for allograft ACL reconstruction and 0% for autograft reconstruction. Our study found that reoperation and revision rates for irradiated soft-tissue allograft ACL reconstruction were higher than generally quoted for autograft reconstruction. Given the extremely high graft failure rates in patients younger than 25 years, we recommend against routine use of irradiated soft-tissue allograft for ACL reconstruction in younger patients.

  4. Long-term neurodevelopmental outcomes of infants born late preterm: a systematic review

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    Tripathi T

    2015-11-01

    Full Text Available Tanya Tripathi,1 Stacey C Dusing2,3 1Rehabilitation and Movement Science Program, Department of Physical Therapy, 2Department of Physical Therapy, 3Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA Purpose: Late preterm (LPT births constitute a large proportion of the preterm births in the USA. Over the last few decades, there has been an increase in research focusing on the neurodevelopment of infants born LPT. The purpose of this research was to systematically review the long-term neurodevelopmental outcomes in LPT infants. Materials and methods: We identified studies by using PubMed, ERIC, CINAHL, and PsycINFO databases. The references of included papers were reviewed for additional papers that met the inclusion criteria. Included papers compared motor, cognitive, language development, or academic performance outcomes between individuals born LPT and a term control group assessed between 12 months and 18 years of age. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards for systematic reviews were utilized including a two-step, two-investigator review process. Results: Of the 4,720 studies found in the initial search, 20 studies met the inclusion criteria. Approximately 75% of the 16 studies that assessed cognitive outcomes reported cognitive delay in the LPT group when compared to their full-term counterparts. More than 50% of the seven studies that assessed motor outcomes suggested a delay in motor development in the LPT group in comparison to full-term. Fewer papers assessed academic performance and language in children born LPT; however, the majority identified borderline differences when LPT infants were compared to those born full-term. Conclusion: Evidence suggests that infants born LPT are at an increased risk of neurodevelopmental delay between 1 and 18 years of life when compared to those born at term. The delay is most evident in the cognitive

  5. Causes, epidemiology, and long-term outcome of traumatic cataracts in children in rural India

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    Parikshit Gogate

    2012-01-01

    Full Text Available Purpose : To describe preoperative factors, long-term (>3 years postoperative outcome and cost of traumatic cataracts in children in predominantly rural districts of western India. Subjects : Eighty-two traumatic cataracts in 81 children in a pediatric ophthalmology department of a tertiary eye-care center. Materials and Methods : Traumatic cataracts operated in 2004-2008 were reexamined prospectively in 2010-2011 using standardized technique. Cause and type of trauma, demographic factors, surgical intervention, complications, and visual acuity was recorded. Statistical Analysis : Data analysis done by using SPSS (Statistical package for social sciences version 17.0 We have used Chi-square test, Fisher′s exact test, paired t-test to find the association between the final vision and various parameters at 5% level of significance; binary logistic regression was performed for visual outcome ≥6/18 and ≥6/60. Results : The children were examined in a 3-7 year follow-up (4.35 ± 1.54. Average age at time of surgery was 10.4 ± 4.43 years (1.03 to 18. Fifty (61.7% were boys. Forty (48.8% were blunt and 32 (39% were sharp trauma. The most common cause was wooden stick 23 (28.0% and sharp thorn 14 (17.1%. Delay between trauma and presentation to hospital ranged from same day to 12 years after the injury with median of 4 days. The mean preoperative visual acuity by decimal notation was 0.059 ± 0.073 and mean postoperative visual acuity was 0.483 ± 0.417 (P < 0.001. Thirty-eight (46.3% had best corrected visual acuity (BCVA ≥6/18 and 51 (62.2% had BCVA ≥ 6/60. In univariable analysis, visual outcome (≥6/18 depended on type of surgery (P = 0.002, gender (P = 0.028, and type of injury (P = 0.07-sharp trauma and open globe injury had poorer outcomes; but not on age of child, preoperative vision, and type of surgeon. On multivariable binary logistic regression, only gender was significant variable. Of the 82 eyes, 18 (22% needed more than one

  6. Dexamethasone and Long-Term Outcome of Tuberculous Meningitis in Vietnamese Adults and Adolescents

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    Török, M. Estée; Bang, Nguyen Duc; Chau, Tran Thi Hong; Yen, Nguyen Thi Bich; Thwaites, Guy E.; Thi Quy, Hoang; Dung, Nguyen Huy; Hien, Tran Tinh; Chinh, Nguyen Tran; Thi Thanh Hoang, Hoang; Wolbers, Marcel; Farrar, Jeremy J.

    2011-01-01

    Background Dexamethasone has been shown to reduce mortality in patients with tuberculous meningitis but the long-term outcome of the disease is unknown. Methods Vietnamese adults and adolescents with tuberculous meningitis recruited to a randomised, double-blind, placebo-controlled trial of adjunctive dexamethasone were followed-up at five years, to determine the effect of dexamethasone on long-term survival and neurological disability. Results 545 patients were randomised to receive either dexamethasone (274 patients) or placebo (271 patients). 50 patients (9.2%) were lost to follow-up at five years. In all patients two-year survival, probabilities tended to be higher in the dexamethasone arm (0.63 versus 0.55; p = 0.07) but five-year survival rates were similar (0.54 versus 0.51, p = 0.51) in both groups. In patients with grade 1 TBM, but not with grade 2 or grade 3 TBM, the benefit of dexamethasone treatment tended to persist over time (five-year survival probabilities 0.69 versus 0.55, p = 0.07) but there was no conclusive evidence of treatment effect heterogeneity by TBM grade (p = 0.36). The dexamethasone group had a similar proportion of severely disabled patients among survivors at five years as the placebo group (17/128, 13.2% vs. 17/116, 14.7%) and there was no significant association between dexamethasone treatment and disability status at five years (p = 0.32). Conclusions Adjunctive dexamethasone appears to improve the probability of survival in patients with TBM, until at least two years of follow-up. We could not demonstrate a five-year survival benefit of dexamethasone treatment which may be confined to patients with grade 1 TBM. Trial Registration ClinicalTrials.gov NCT01317654 NCT01317654?term = tuberculous+meningitis&rank = 3 PMID:22174748

  7. Long-Term Outcomes After High-Dose Postprostatectomy Salvage Radiation Treatment

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    Goenka, Anuj; Magsanoc, Juan Martin; Pei Xin; Schechter, Michael; Kollmeier, Marisa; Cox, Brett [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Scardino, Peter T.; Eastham, James A. [Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-09-01

    Purpose: To review the impact of high-dose radiotherapy (RT) in the postprostatectomy salvage setting on long-term biochemical control and distant metastases-free survival, and to identify clinical and pathologic predictors of outcomes. Methods and Materials: During 1988-2007, 285 consecutive patients were treated with salvage RT (SRT) after radical prostatectomy. All patients were treated with either three-dimensional conformal RT or intensity-modulated RT. Two hundred seventy patients (95%) were treated to a dose {>=}66 Gy, of whom 205 (72%) received doses {>=}70 Gy. Eighty-seven patients (31%) received androgen-deprivation therapy as a component of their salvage treatment. All clinical and pathologic records were reviewed to identify treatment risk factors and response. Results: The median follow-up time after SRT was 60 months. Seven-year actuarial prostate-specific antigen (PSA) relapse-free survival and distant metastases-free survival were 37% and 77%, respectively. Independent predictors of biochemical recurrence were vascular invasion (p < 0.01), negative surgical margins (p < 0.01), presalvage PSA level >0.4 ng/mL (p < 0.01), androgen-deprivation therapy (p = 0.03), Gleason score {>=}7 (p = 0.02), and seminal vesicle involvement (p = 0.05). Salvage RT dose {>=}70 Gy was not associated with improvement in biochemical control. A doubling time <3 months was the only independent predictor of metastatic disease (p < 0.01). There was a trend suggesting benefit of SRT dose {>=}70 Gy in preventing clinical local failure in patients with radiographically visible local disease at time of SRT (7 years: 90% vs. 79.1%, p = 0.07). Conclusion: Salvage RT provides effective long-term biochemical control and freedom from metastasis in selected patients presenting with detectable PSA after prostatectomy. Androgen-deprivation therapy was associated with improvement in biochemical progression-free survival. Clinical local failures were rare but occurred most commonly in

  8. Mid- to Long-term Clinical Outcomes of Hancock II Bioprosthesis in Chinese Population

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    Yin Wang

    2015-01-01

    Full Text Available Background: Compared to the Western countries, Chinese patients present a special primary disease spectrum, diverse valvular pathogenesis, and different postoperational anticoagulation strategy. This research aimed to evaluate the mid- to long-term clinical performance of Hancock II bioprosthesis in the Chinese population. Methods: This study retrospectively reviewed all patients who received surgical treatments with at least one Hancock II bioprosthesis implantation from January 2004 to December 2013 at a single center in China. Totally 647 patients were included in the clinical evaluation, and 629 patients were successfully discharge, among whom 605 patients were completely followed-up. The follow-up rate was 96.2%. The mean and median follow-up time was 62.0 ± 59.0 and 56.0 months, respectively. Postoperative outcomes of survival rates, reoperations and valve related morbidities were assessed. Continuous and categorical variables were compared using the t -test and Chi-square test, respectively. Survival and freedom from adverse events were calculated by using a Kaplan-Meier method. Results: The overall in-hospital mortality was 2.8% (18/647 while there were 34 deaths (5.6%, 34/605 in the follow-up stage after discharge. The overall survival rate was 94.6% and 82.7% at 5 years and 10 years, respectively. The cumulative survival rate of 10 years was 82.8% in AVR group, 84.4% in MVR group, and 78.4% in DVR group. The overall rate of freedom from reoperations was 95.5% at 5 years and 86.8% at 10 years. The freedom from reoperation at 10 years was 87.0%, 88.1%, and 84.0% in AVR, MVR, and DVR group, respectively. The freedom from morbidities at 10 years was: 90.3% for thromboembolism, 95.2% for hemorrhage, 97.5% for prosthesis endocarditis, 95.9% for paravalvular leak, and 94.6% for structural valve deterioration, respectively. Conclusions: Hancock II bioprosthesis exhibited a satisfactory mid- to long-term durability and promising clinical

  9. Mid-to Long-term Clinical Outcomes of Hancock Ⅱ Bioprosthesis in Chinese Population

    Institute of Scientific and Technical Information of China (English)

    Yin Wang; Si Chen; Xing-Jian Hu; Jia-Wei Shi; Nian-Guo Dong

    2015-01-01

    Background: Compared to the Western countries, Chinese patients present a special primary disease spectrum, diverse valvular pathogenesis, and different postoperational anticoagulation strategy.This research aimed to evaluate the mid-to long-term clinical performance of Hancock Ⅱ bioprosthesis in the Chinese population.Methods: This study retrospectively reviewed all patients who received surgical treatments with at least one Hancock Ⅱ bioprosthesis implantation from January 2004 to December 2013 at a single center in China.Totally 647 patients were included in the clinical evaluation, and 629 patients were successfully discharge, among whom 605 patients were completely followed-up.The follow-up rate was 96.2%.The mean and median follow-up time was 62.0 ± 59.0 and 56.0 months, respectively Postoperative outcomes of survival rates, reoperations and valve related morbidities were assessed.Continuous and categorical variables were compared using the t-test and Chi-square test, respectively.Survival and freedom from adverse events were calculated by using a Kaplan-Meier method.Results: The overall in-hospital mortality was 2.8% (18/647) while there were 34 deaths (5.6%, 34/605) in the follow-up stage after discharge.The overall survival rate was 94.6% and 82.7% at 5 years and 10 years, respectively The cumulative survival rate of 10 years was 82.8% in AVR group, 84.4% in MVR group, and 78.4% in DVR group.The overall rate of freedom from reoperations was 95.5% at 5 years and 86.8% at 10 years.The freedom from reoperation at 10 years was 87.0%, 88.1%, and 84.0% in AVR, MVR, and DVR group, respectively.The freedom from morbidities at 10 years was: 90.3% for thromboembolism, 95.2% for hemorrhage, 97.5% for prosthesis endocarditis, 95.9% for paravalvular leak, and 94.6% for structural valve deterioration, respectively.Conclusions: Hancock Ⅱ bioprosthesis exhibited a satisfactory mid-to long-term durability and promising clinical

  10. Long-term functional outcome in adult prison inmates with ADHD receiving OROS-methylphenidate.

    Science.gov (United States)

    Ginsberg, Ylva; Hirvikoski, Tatja; Grann, Martin; Lindefors, Nils

    2012-12-01

    In a recent randomized, double-blind, placebo-controlled trial, we established a robust efficacy (Cohen's d = 2.17) of osmotic release oral system-methylphenidate (OROS-methylphenidate) delivered 72 mg daily for 5 weeks versus placebo on attention deficit hyperactivity disorder (ADHD) symptoms, global severity and global functioning in 30 adult male prison inmates with ADHD and coexisting disorders. Outcomes continued to improve during the subsequent 47-week open-label extension with OROS-methylphenidate delivered at a flexible daily dosage of up to 1.3 mg/kg body weight. In the present study, we evaluated long-term effectiveness and maintenance of improvement over the cumulated 52-week trial on cognition, motor activity, institutional behaviour and quality of life. Post hoc, we explored the associations between investigators' and self-ratings of ADHD symptoms and between ratings of symptoms and functioning, respectively. Outcomes, calculated by repeated measures ANOVA, improved from baseline until week 16, with maintenance or further improvement until week 52. Both verbal and visuospatial working memory, and abstract verbal reasoning improved significantly over time, as well as several cognition-related measures and motor activity. No substance abuse was detected and a majority of participants took part in psychosocial treatment programmes. The quality of life domains of Learning, and Goals and values improved over time; the latter domain was at open-label endpoint significantly related to improvements in attention. Investigators' and self-ratings of ADHD symptoms, as well as global symptom severity related most significantly to global functioning at week 52. Finally, investigators' and self-ratings of ADHD symptoms associated significantly at baseline with increasing convergence over time.

  11. Long term outcomes in 46, XX adult patients with congenital adrenal hyperplasia reared as males.

    Science.gov (United States)

    Khattab, A; Yau, M; Qamar, A; Gangishetti, P; Barhen, A; Al-Malki, S; Mistry, H; Anthony, W; Toralles, M B; New, Maria I

    2017-01-01

    Patients with Congenital Adrenal Hyperplasia (CAH) owing to 21-hydroxylase deficiency and whose karyotype is 46, XX are usually assigned to the female gender. Reported herein are the long term outcomes in three patients with CAH whose karyotype is 46, XX and who were reared as males. A retrospective review of three CAH patients with a 46, XX karyotype who were reared as males was conducted. Gender assignment, clinical and biochemical data, pre and post-genitoplasty genital examinations were reviewed. Gender identity was tested by an extensive questionnaire. Gender role, sexual preference, marital status and sexual satisfaction were evaluated by interview. The three patients were genotyped for the CYP21A2 gene confirming the diagnosis of CAH. Owing to genital virilization, cultural preferences for male gender and the lack of newborn screening programs the three patients reported herein were assigned to the male gender at birth before the diagnosis of CAH was established. In adulthood the patients remained significantly virilized. Thorough psychosexual assessments in adulthood revealed well established male gender identities compatible with their male gender assignments at birth. In all three patients, gender role and behavior were consistent with male gender identity including sexual intercourse with female partners. The three patients reported herein revealed that male gender assignment to CAH patients with a 46, XX karyotype may have a successful outcome providing there is strong parental support and expert endocrine care. No standard guidelines have been published for the gender assignment of CAH patients with a 46, XX karyotype and genital ambiguity. More studies concerning gender assignment in CAH patients with a 46, XX karyotype reared as males are needed.

  12. Sex differences in long-term outcomes of patients with percutaneous coronary intervention: the Armenian experience

    Directory of Open Access Journals (Sweden)

    Yeva Sahakyan

    2013-09-01

    Full Text Available The present study aimed at assessing sex differences in perioperative characteristics and 3-year event-free survival from major adverse cardiac and cerebrovascular events (MACCE in patients with percutaneous coronary intervention (PCI in Armenia. The study utilized an observational, retrospective cohort design enrolling patients who underwent PCI from 2006 to 2008 at a single center in Yerevan, Armenia. Major adverse cardiac and cerebrovascular events included all-cause mortality, myocardial infarction (MI, repeat revascularization, or stroke/transient ischemic attack. Among 485 participants included in the analysis, 419 (86% were men. Women were older, more hypertensive, more obese, and had significantly higher rates of diabetes. At the end of follow-up, the incidence of MACCE was 37% for men and 33% for women (P=0.9. Based on the results from the adjusted Cox proportional hazards model, the independent predictors of MACCE included acute MI [hazard ratio (HR=1.43, 95% confidence interval (CI: 1.02-2.00], arrhythmia (HR=1.64, 95% CI: 1.07-2.50, sex (HR=2.46, 95% CI: 1.08- 5.61, diabetes (HR=5.65, 95% CI: 2.14-14.95, and the interaction between sex and diabetes (HR=0.16; 95% CI: 0.05-0.47. Among diabetic patients, men had better event-free survival from MACCE (HR=0.40, 95% CI: 0.19-0.85 than women, whereas in patients without diabetes men had worse outcomes than women (95% CI: 1.08-5.62. In Armenia, the baseline profile of women undergoing PCI differed considerably from that of men. In patients with diabetes, women had worse outcomes at long-term follow-up, while the opposite was noted in patients without diabetes.

  13. Long-Term Outcome of Definitive Radiotherapy for Early Glottic Cancer: Prognostic Factors and Patterns of Local Failure

    OpenAIRE

    Lim, Yu Jin; Wu, Hong-Gyun; Kwon, Tack-Kyun; Hah, J. Hun; Sung, Myung-Whun; Kim, Kwang Hyun; Park, Charn Il

    2015-01-01

    Purpose This study evaluates the long-term results of definitive radiotherapy (RT) for early glottic cancer. Clinical and treatment factors related to local control and patterns of failure are analyzed. Materials and Methods We retrospectively reviewed 222 patients with T1-2N0 squamous cell carcinoma of the glottic larynx treated with definitive RT from 1981 to 2010. None of the patients received elective nodal RT or combined chemotherapy. The median total RT dose was 66 Gy. The daily fractio...

  14. Intelligence as a predictor of outcome in short- and long-term psychotherapy.

    Science.gov (United States)

    Knekt, Paul; Saari, Taru; Lindfors, Olavi

    2014-12-30

    Intelligence has been suggested as a suitability factor for short-term therapy whereas its possible effect on short-term versus long-term therapy still is unknown. The aim of this study was to compare the prediction of intelligence on the level of psychiatric symptoms and psychosocial functioning in psychotherapies of different lengths. A total of 251 outpatients from the Helsinki Psychotherapy Study, aged 20–46 years, and suffering from mood or anxiety disorders were allocated to two long-term and two short-term therapies. Intelligence was assessed at baseline with the Wechsler Adult Intelligence Scale (WAIS-R). Psychiatric symptoms and psychosocial functioning were assessed 5–10 times during a 5-year follow-up using two primary symptom measures (HDRS and HARS) and one primary measure of psychosocial functioning (GAF). Short-term therapy was more effective than long-term therapy during the first year of follow-up. During the second to fourth follow-up year no differences between short- and long-term therapies or the intelligence groups were found. At the fifth follow-up year, however, long-term psychotherapy showed a statistically significantly larger change in all three primary measures compared to short-term therapy among those with higher intelligence. No differences between therapy groups were noted in those with lower intelligence. People with higher intelligence may benefit more from long-term than from short-term psychotherapy. These findings should be confirmed.

  15. U0126 attenuates cerebral vasoconstriction and improves long-term neurologic outcome after stroke in female rats

    DEFF Research Database (Denmark)

    Ahnstedt, Hilda; Mostajeran, Maryam; Blixt, Frank W;

    2015-01-01

    , responses to this treatment in females and long-term effects on outcome are not known. Initial experiments used in vitro organ culture of cerebral arteries, confirming ERK1/2 activation and increased ETB receptor-mediated vasoconstriction in female cerebral arteries. Transient middle cerebral artery......-mediated contraction was studied with myograph and protein expression with immunohistochemistry. In vitro organ culture and tMCAO resulted in vascular ETB receptor upregulation and activation of ERK1/2 that was prevented by U0126. Although no effect on infarct size, U0126 improved the long-term neurologic function...... after experimental stroke in female rats. In conclusion, early prevention of the ERK1/2 activation and ETB receptor-mediated vasoconstriction in the cerebral vasculature after ischemic stroke in female rats improves the long-term neurologic outcome....

  16. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease

    Science.gov (United States)

    Banerji, Deepu; Das, Nitu K.; Sharma, Siddhiraj; Jindal, Yogesh; Jain, Vijendra K.; Behari, Sanjay

    2016-01-01

    Context: Functional growth hormone producing adenomas have long-term deleterious effects on the visual apparatus, the cardiovascular and musculoskeletal systems, and often predispose to malignancies. Since persistence of acromegaly affects outcome and quality of life, therapeutic interventions become mandatory. Aim: This study represents an analysis of long-term clinical and endocrinal outcome of 115 patients of acromegaly after surgical management. Setting and Design: Tertiary care retrospective study. Materials and Methods: One hundred and fifteen patients (male:female ratio: 1:1.09) with acromegalic features were studied. Apart from acromegalic features, their main clinical presentation also included headache, diminution of vision, field defects, ptosis, irregular menstruation, diabetes insipidus, diabetes mellitus and hypertension. Six of them presented with apoplexy. Their preoperative endocrinal evaluation included basal and suppressed growth hormone (GH), prolactin and thyroid levels. On the basis of axial and coronal CT scan or multiplanar MR imaging or both, the tumors were classified according to their suprasellar and parasellar extension (Hardy's grade). Transnasal trans-sphenoidal surgery (TSS) (n = 37) and sublabial, rhinoseptal TSS (n = 72) were the preferred approaches. Six patients with significant parasellar extensions underwent trans-cranial explorations. The patients were followed up at 6 and 12 weeks and then at 6 monthly intervals. Hormonal and CT/MR evaluation were also done. Attainment of random GH value less than 2.5 µg/L, and the nadir GH value after oral glucose tolerance test (OGTT) less than 1 µg/L were used as the criteria of cure. Findings: The patients were preoperatively in Hardy's tumor grade 0 (29), A (21), A+E (3), B (21), B+E (5), C (9), C+E (10), D (1) D+E (11), E (5), respectively. One hundred and one patients were available for follow-up (FU; median FU duration: 84 months; range: 6 to 132 months). Surgical cure was achieved

  17. Long-Term Outcomes of Sacrococcygeal Germ Cell Tumors in Infancy and Childhood

    Directory of Open Access Journals (Sweden)

    Rangsan Niramis

    2015-01-01

    Full Text Available Purpose. The aim of this study was to evaluate long-term outcomes of sacrococcygeal germ cell tumors (SC-GCTs over a 15-year period. Materials and Methods. A retrospective review was conducted of all pediatric patients treated for SC-GCTs at our hospital from 1998 to 2012. Results. Fifty-seven patients were treated for SC-GCTs with the most common in Altman’s classification type I. Age at surgery ranged from one day to 5.6 years. Tumor resection and coccygectomy were primarily performed in about 84% of the cases. Pathology revealed mature, immature, malignant sacrococcygeal teratomas (SCTs, and endodermal sinus tumors (ESTs in 41 (72%, 4 (77%, 6 (10.5%, and 6 (10.5%, respectively. Recurrence of discase occurred in 3 of 41 patients with mature teratomas (7.3%; 2 recurrences with mature teratomas and one recurrence with EST. Five of 6 malignant SCTs and 3 of 6 ESTs responded well to the treatment. Alpha-fetoprotein (AFP level was elevated in both malignant teratomas and ESTs. No immediate patient death was noted in any of the 57 cases, but 4 patients with malignant tumors and distant metastasis succumbed at home within 2 years of the initial treatment. Conclusion. Benign SCTs have a significant recurrence rate of approximately 7%. Close follow-up with serial AFP level monitoring should be done for 5 years after initial tumor resection and coccygectomy. The survival rate for malignant SC-GCTs with distant metastasis was unfavorable in the present study.

  18. Immediate and long-term clinical outcome after spinal cord stimulation for refractory stable angina pectoris.

    Science.gov (United States)

    Di Pede, Francesco; Lanza, Gaetano Antonio; Zuin, Guerrino; Alfieri, Ottavio; Rapati, Massimo; Romanò, Massimo; Circo, Antonio; Cardano, Paola; Bellocci, Fulvio; Santini, Massimo; Maseri, Attilio

    2003-04-15

    The treatment of patients with angina pectoris refractory to medical therapy and unsuitable for revascularization procedures has yet not been well standardized. Previous retrospective studies and small prospective studies have suggested beneficial effects of spinal cord stimulation (SCS) in these patients. We created a Prospective Italian Registry of SCS to evaluate the short- and long-term clinical outcome of patients who underwent SCS device implantation because of severe refractory angina pectoris. Overall, 104 patients were enrolled in the registry (70 men, aged 68 +/- 17 years), most of whom (83%) had severe coronary artery disease. Average follow-up was 13.2 +/- 8 months. Overall, 17 patients (16%) died, 8 (8%) due to cardiac death. Among clinical variables, only age was found to be significantly associated both with total mortality (p = 0.04) and cardiac mortality (p = 0.02) on Cox regression analysis. A significant improvement of anginal symptoms (> or =50% reduction of weekly anginal episodes, compared with baseline) occurred in 73% of patients, and Canadian Cardiovascular Society angina class improved by > or =1 class in 80% and by > or =2 classes in 42% of patients, with a relevant reduction in the rate of hospital admission and days spent in the hospital because of angina (p <0.0001 for both). No life-threatening or clinically serious complications were observed. The most frequent side effect consisted of superficial infections, either at the site of puncture of electrode insertion or of the abdominal pocket, which occurred in 6 patients. In conclusion, our prospective data point out that SCS can be performed safely and is associated with a sustained improvement of anginal symptoms in a relevant number of patients with refractory stable angina pectoris.

  19. Serum uric acid levels and long-term outcomes in chronic kidney disease.

    Science.gov (United States)

    Miyaoka, Tokiko; Mochizuki, Toshio; Takei, Takashi; Tsuchiya, Ken; Nitta, Kosaku

    2014-07-01

    Hyperuricemia is common in chronic kidney disease (CKD), but data regarding the relationship between serum uric acid levels and the long-term outcomes of CKD patients have been limited. The present study evaluated the associations between baseline serum uric acid levels with mortality and end-stage renal disease (ESRD). The subjects of this study were 551 stage 2-4 CKD patients. Cox proportional hazards models were used to evaluate the relationship between serum uric acid tertiles and all-cause mortality, cardiovascular disease (CVD) mortality, 50 % reduction in estimated glomerular filtration rate (eGFR), and development of ESRD, initially without adjustment, and then after adjusting for several groups of covariates. The mean age of the study subjects was 58.5 years, 59.3 % were men, and 10.0 % had diabetes. The mean eGFR was 42.02 ± 18.52 ml/min/1.73 m(2). In all subjects, the mean serum uric acid level was 6.57 ± 1.35 mg/dl, and 52.2 % of study subjects were on hypouricemic therapy (allopurinol; 48.3 %) at baseline. Thirty-one patients (6.1 %) died during a follow-up period of approximately 6 years. There was no significant association between serum uric acid level and all-cause mortality, CVD mortality, development of ESRD and 50 % reduction in eGFR in the unadjusted Cox models. In the adjusted models, hyperuricemia was found to be associated with all-cause mortality and CVD mortality after adjustment with CVD risk factors, kidney disease factors, and allopurinol, but not associated with development of ESRD and 50 % reduction in eGFR. The results of this study showed that hyperuricemia but not serum uric acid levels were associated with all-cause mortality, CVD mortality after adjustments with CVD risk factors, kidney disease factors, and allopurinol in stage 2-4 CKD patients.

  20. Long-Term Clinical Outcome of Internal Globus Pallidus Deep Brain Stimulation for Dystonia.

    Directory of Open Access Journals (Sweden)

    Hye Ran Park

    Full Text Available GPi (Internal globus pallidus DBS (deep brain stimulation is recognized as a safe, reliable, reversible and adjustable treatment in patients with medically refractory dystonia.This report describes the long-term clinical outcome of 36 patients implanted with GPi DBS at the Neurosurgery Department of Seoul National University Hospital.Nine patients with a known genetic cause, 12 patients with acquired dystonia, and 15 patients with isolated dystonia without a known genetic cause were included. When categorized by phenomenology, 29 patients had generalized, 5 patients had segmental, and 2 patients had multifocal dystonia. Patients were assessed preoperatively and at defined follow-up examinations postoperatively, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS for movement and functional disability assessment. The mean follow-up duration was 47 months (range, 12-84.The mean movement scores significantly decreased from 44.88 points preoperatively to 26.45 points at 60-month follow up (N = 19, P = 0.006. The mean disability score was also decreased over time, from 11.54 points preoperatively to 8.26 points at 60-month follow up, despite no statistical significance (N = 19, P = 0.073. When analyzed the movement and disability improvement rates at 12-month follow up point, no significant difference was noted according to etiology, disease duration, age at surgery, age of onset, and phenomenology. However, the patients with DYT-1 dystonia and isolated dystonia without a known genetic cause showed marked improvement.GPi DBS is a safe and efficient therapeutic method for treatment of dystonia patients to improve both movement and disability. However, this study has some limitations caused by the retrospective design with small sample size in a single-center.

  1. Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    Andreas Weber; Christian Prinz; Sonja Landrock; Jochen Schneider; Manfred Stangl; Bruno Neu; Peter Born; Meinhard Classen; Thomas R(o)sch; Roland M Schmid

    2007-01-01

    AIM: To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma.METHODS: Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during 1995-2005. Of the 96 patients, 20 were initially treated with surgery (n = 2 R0 / n = 18 R1). In non-operated patients, data analysis was performed retrospectively.RESULTS: Among the 96 patients, 76 were treated with endoscopic transpapillary (ERC, n = 45) and/or percutaneous transhepatic biliary drainage (PTBD, n= 31). The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 + 296 d. The mean survival time of patients with initial bilirubin levels > 10 mg/dL was significantly lower (P < 0.001) than patients with bilirubin levels < 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ (n = 8), Ⅲ (n = 28) and Ⅳ (n =40) was 496 + 300 d, 441 + 385 d and 274 ± 218 d,respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant beneficial effect on the mean survival time (ERC vs PTBD, P = 0.806).CONCLUSION: Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast,age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.

  2. Long-Term Outcomes and Complications in Patients With Craniopharyngioma: The British Columbia Cancer Agency Experience

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Andrea C., E-mail: andrealo@gmail.com [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Howard, A. Fuchsia [School of Population and Public Health, University of British Columbia, Vancouver, British Columbia (Canada); Nichol, Alan; Sidhu, Keerat; Abdulsatar, Farah [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada); Hasan, Haroon [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Goddard, Karen [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, University of British Columbia, Vancouver, British Columbia (Canada)

    2014-04-01

    Purpose: We report long-term outcomes and complications of craniopharyngioma patients referred to our institution. Methods and Materials: Between 1971 and 2010, 123 consecutive patients received primary treatment for craniopharyngioma in British Columbia and were referred to our institution. The median age was 30 years (range, 2-80 years). Thirty-nine percent of patients were treated primarily with subtotal resection (STR) and radiation therapy (RT), 28% with STR alone, 15% with gross total resection, 11% with cyst drainage (CD) alone, 5% with CD+RT, and 2% with RT alone. Eight percent of patients received intracystic bleomycin (ICB) therapy. Results: Median follow-up was 8.9 years, and study endpoints were reported at 10 years. Ten-year Kaplan-Meier progression-free survival (PFS) was 46%. Patients treated with STR+RT or CD+RT had the highest PFS (82% and 83%, respectively). There were no significant differences between PFS after adjuvant versus salvage RT (84% vs 74%, respectively; P=.6). Disease-specific survival (DSS) was 88%, and overall survival (OS) was 80%. Primary treatment modality did not affect DSS or OS, while older age was a negative prognostic factor for OS but not DSS. Kaplan-Meier rates for visual deterioration, anterior pituitary hormone deficiency, diabetes insipidus, seizure disorder, and cerebrovascular events (CVE) due to treatment, not tumor progression, were 27%, 76%, 45%, 16%, and 11%, respectively. The CVE rate was 29% in patients who received ICB compared to 10% in those who did not (P=.07). Conclusions: We report favorable PFS in patients with craniopharyngioma, especially in those who received RT after surgery. DSS and OS rates were excellent regardless of primary treatment modality. We observed a high incidence of hypopituitarism, visual deterioration, and seizure disorder. Eleven percent of patients experienced CVEs after treatment. There was a suggestion of increased CVE risk in patients treated with ICB.

  3. Long-term outcome of Chinese patients with membranous lupus nephropathy.

    Science.gov (United States)

    Sun, H O; Hu, W X; Xie, H L; Zhang, H T; Chen, H P; Zeng, C H; Liu, Z H; Li, L S

    2008-01-01

    A retrospective analysis of the long-term outcome of patients with membranous lupus nephropathy (MLN) was conducted. One hundred Chinese patients, 90 females and 10 males with a mean age of 32+/-9 years, with systemic lupus erythematosus and biopsy-proven MLN (ISN/RPS2003 classification criteria) were enrolled in this study. The patient and renal survivals were estimated by the Kaplan-Meier method and the risk factors associated with end-stage renal failure (ESRF) were assessed by the Cox proportional hazards regression analysis. The mean follow-up of all patients was 77.6+/-56 months. During follow-up, two patients died. Patient survival at 5 and 10 years was 98%. Renal survival at 5 and 10 years was 96.1% and 92.7%, respectively. Severe tubular-intersticial lesion (HR 66.514), nephrotic range proteinuria (HR 19.159) and refractoriness to treatments (HR 9.834) were independent risk factors for developing ESRF. Three of the six patients with ESRF had severe tubular-interstitial lesions on initial biopsy. Twenty-one patients underwent a repeat biopsy after 33months' (median time) follow-up, eight (38.1%) of these (class V superimposed class IV in 5, class V superimposed class III in 2 and class VI in 1) had transformed and three (37.5%) of them progressed to ESRF. Complications included infection (13%), thrombosis (3%), avascular necrosis (3%), diabetes mellitus (4%) and skin cancer (1%). The rate of patient and renal survival was high in this group of patients with MLN.

  4. Neuromagnetic index of hemispheric asymmetry predicting long-term outcome in sudden hearing loss.

    Science.gov (United States)

    Li, Lieber Po-Hung; Chen, Kuang-Chao; Lee, Po-Lei; Niddam, David M; Cheng, Chou-Ming; Chou, Chih-Cher; Hsieh, Jen-Chuen; Shiao, An-Suey

    2013-01-01

    The neuromagnetic index of hemispheric asymmetry in terms of ipsilateral/contralateral ratio at acute stage was previously revealed to prognosticate the 1-month hearing outcome of acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL), showing a dynamic relationship between top- and down-levels of auditory pathway. However, the prognostic effect of reorganization pattern for the long-term results remained elusive. This study aimed to probe the prognosticating relevance of hemispheric asymmetry to the hearing at chronic stage of ISSNHL. Using magnetoencephalography (MEG), inter-hemispheric differences in peak dipole of N100m responses to monaural tones were evaluated in 21 controls and 21 ISSNHL patients at initial and final (12 months later) stages. Predictive value of hemispheric asymmetry was assessed by correlating hearing level and ipsilateral/contralateral ratio (I/C) of N100m latency and amplitude. Healthy-side dominance of N100m was observed in ISSNHL initially, and remained in three final prognostic subgroups (complete, partial, and no recovery) of ISSNHL. The initial I/C(amplitude) on affected-ear stimulation strongly correlated with the hearing level of final stage in ISSNHL. However, there was no prognostic effect of hemispheric asymmetry pattern for the 12-month hearing improvement. The heterogeneity between neuromagnetic index and hearing levels possibly echoed different pathogeneses of ISSNHL. Since a restored hearing status did not necessarily lead toward a normal functional organization, the dynamics of hemispheric asymmetry could actually index a central resilient reorganization in the brain for sound processing in ISSNHL. Our finding showed not only a clinically relevant measure to predict final hearing of ISSNHL, but also a linkage between central plasticity and cochlear lesion. This finding suggests a new perspective, and perhaps new interventions, to diagnose and treat unilateral ISSNHL.

  5. Long-term outcome of benign fibroadenomas treated by ultrasound-guided percutaneous excision.

    Science.gov (United States)

    Grady, Ian; Gorsuch, Heidi; Wilburn-Bailey, Shelly

    2008-01-01

    Surgical as well as conservative treatment has been described for fibroadenomas. Both have disadvantages. A minimally invasive treatment, ultrasound-guided, vacuum-assisted percutaneous excision has been shown to facilitate the removal of all imaged evidence of benign breast lesions, including fibroadenomas up to 3 cm in diameter. This study is performed to assess the long-term outcome of ultrasound-guided percutaneous excision as a minimally invasive treatment for fibroadenomas. A retrospective review of 69 consecutive fibroadenomas treated with ultrasound-guided percutaneous excision between May, 2001 and December, 2005 was carried out. All these lesions underwent percutaneous excision of all imaged lesion evidence. Clinical and sonographic follow-up was recommended for all patients every 6 months. Initial size, location, and patient age were recorded for each treated lesion. Of 69 lesions treated, 52 were available for follow-up. The median follow-up period was 22 months, with a range of 7 to 59 months. At 6 months, there were no fibroadenoma recurrences. Follow-up sonography demonstrated recurrences in 13 lesions distributed across eight patients. The overall recurrence rate was 15% (8/52) with an actuarial recurrence rate of 33% at 59 months. All of the recurrences were in lesions which were larger than 2 cm in size at initial presentation. Our data suggest that the mechanism of recurrence is the regrowth of retained lesion fragments too small to be detected by ultrasound--not the incomplete excision of all imaged lesion evidence. Despite successful percutaneous excision, fibroadenomas do recur. Lesions smaller than 2 cm in size, so treated, do not need additional therapy or surveillance. Fibroadenomas larger than 2 cm are prone to recurrence and require additional treatment.

  6. Long-Term Outcome of A Large Series of Gastric Cancer Patients in China

    Institute of Scientific and Technical Information of China (English)

    Ai-wen Wu; Zhao-de Bu; Ji Zhang; Xiang-qian Su; Yi Wang; Guang-wei Xu; Jia-fu Ji; Hong Yang; Yan-ning Li; Shuang-xi Li; Lian-hai Zhang; Zi-yu Li; Xiao-jiang Wu; Xiang-long Zong

    2010-01-01

    Objective:The outcome of gastric cancer treatment in China is relatively poor compared with those in Japan and Korea.Relevant factors are not quite clear till now.The aim of this study is to present data on gastric cancer patients from a single high volume cancer center of China and to illuminate relevant factors regarding unsatisfactory outcome.Methods:A total of 2312 consecutive pathologically proven gastric carcinoma patients were treated in Beijing Cancer Hospital from January 1995 to December 2005.Clinical information including demographic information,tumor characteristics,therapeutic experience and survival was retrieved from the Database specially designed for Gastric Cancer Collaborative Group,Beijing Cancer Hospital.Results:There were 1633 males and 679 females with a median age of 58.8 years(range 19-89).Merely 181 patients were in the early stage(7.8%).Curative resection was performed in less than 72% of the patients.The number of lymph nodes harvested varied from 0 to 71(average 9)while the median number of positive lymph node was 2(0-37).Only in 650patients the number of lymph nodes harvested was more than 14.At the end of follow-up,874 patients were still alive while1132 died.The 1,2,5,10-year overall survival were 68.50%,51.88%,36.83%,and 30.49%,respectively.Multivariate analysis demonstrated that TNM stage,tumor location,tumor size,surgery,and vascular invasion were independent prognostic factors.Conclusion:The outcome of gastric cancer in China is not as good as expected.Early detection and standardized curative resection should be prompted at present to improve the outcome.

  7. Long-term outcomes of gene therapy for the treatment of Leber's hereditary optic neuropathy

    Directory of Open Access Journals (Sweden)

    Shuo Yang

    2016-08-01

    Full Text Available Leber's hereditary optic neuropathy (LHON is a disease that leads to blindness. Gene therapy has been investigated with some success, and could lead to important advancements in treating LHON. This was a prospective, open-label trial involving 9 LHON patients at Tongji Hospital, Wuhan, China, from August 2011 to December 2015. The purpose of this study was to evaluate the long-term outcomes of gene therapy for LHON. Nine LHON patients voluntarily received an intravitreal injection of rAAV2-ND4. Systemic examinations and visual function tests were performed during the 36-month follow-up period to determine the safety and efficacy of this gene therapy. Based on successful experiments in an animal model of LHON, 1 subject also received an rAAV2-ND4 injection in the second eye 12 months after gene therapy was administered in the first eye. Recovery of visual acuity was defined as the primary outcome of this study. Changes in the visual field, visual evoked potential (VEP, optical coherence tomography findings, liver and kidney function, and antibodies against AAV2 were defined as secondary endpoints. Eight patients (Patients 2–9 received unilateral gene therapy and visual function improvement was observed in both treated eyes (Patients 4, 6, 7, and 8 and untreated eyes (Patients 2, 3, 4, 6 and 8. Visual regression fluctuations, defined as changes in visual acuity greater than or equal to 0.3 logMAR, were observed in Patients 2 and 9. Age at disease onset, disease duration, and the amount of remaining optic nerve fibers did not have a significant effect on the visual function improvement. The visual field and pattern reversal VEP also improved. The patient (Patient 1 who received gene therapy in both eyes had improved visual acuity in the injected eye after the first treatment. Unfortunately, visual acuity in this eye decreased 3 months after he received gene therapy in the second eye. Animal experiments suggested that ND4 expression remains

  8. Radioembolization for Neuroendocrine Liver Metastases: Safety, Imaging, and Long-Term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Memon, Khairuddin; Lewandowski, Robert J. [Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States); Mulcahy, Mary F. [Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States); Riaz, Ahsun; Ryu, Robert K.; Sato, Kent T.; Gupta, Ramona; Nikolaidis, Paul; Miller, Frank H.; Yaghmai, Vahid; Gates, Vanessa L.; Atassi, Bassel [Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States); Newman, Steven [Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States); Omary, Reed A. [Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States); Benson, Al B. [Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States); Salem, Riad, E-mail: r-salem@northwestern.edu [Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States); Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (United States)

    2012-07-01

    Purpose: To present long-term outcomes on the safety and efficacy of Yttrium-90 radioembolization in the treatment of unresectable hepatic neuroendocrine metastases refractory to standard-of-care therapy. Methods and Materials: This study was approved by our institutional review board and was compliant with the Health Insurance Portability and Accountability Act. Forty patients with hepatic neuroendocrine metastases were treated with {sup 90}Y radioembolization at a single center. Toxicity was assessed using National Cancer Institute Common Terminology Criteria v3.0. Response to therapy was assessed by World Health Organization (WHO) guidelines for size and European Association for the Study of the Liver disease (EASL) guidelines for necrosis. Time to response and overall survival were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed. Results: The median dose was 113 Gy (29-299 Gy). Clinical toxicities included fatigue (63%), nausea/vomiting (40%), abdominal pain (18%), fever (8%), diarrhea and weight loss (5%); Grade 3 and 4 bilirubin toxicities were experienced by 2 patients and 1 patient, respectively. Different responses were noted by WHO (complete response, 1.2%; partial response, 62.7%) and EASL (complete response, 20.5%; partial response, 43.4%). Median time to response was 4 and 4.9 months by lesion and patient, respectively. The 1-, 2-, and 3-year overall survival rates were 72.5%, 62.5%, and 45%, respectively. Eastern Cooperative Oncology Group (ECOG) performance score 0 (p < 0.0001), tumor burden {<=}25% (p = 0.0019), albumin {>=}3.5 g/dL (p = 0.017), and bilirubin {<=}1.2 mg/dL (p = 0.002) prognosticated survival on univariate analysis; only ECOG performance score 0 and bilirubin {<=}1.2 mg/dL prognosticated better survival outcome on multivariate analysis (p = 0.0001 and p = 0.02). Conclusion: Yttrium-90 therapy for hepatic neuroendocrine metastases leads to satisfactory tumor response and patient survival

  9. Long-term outcomes of gene therapy for the treatment of Leber's hereditary optic neuropathy.

    Science.gov (United States)

    Yang, Shuo; Ma, Si-Qi; Wan, Xing; He, Heng; Pei, Han; Zhao, Min-Jian; Chen, Chen; Wang, Dao-Wen; Dong, Xiao-Yan; Yuan, Jia-Jia; Li, Bin

    2016-08-01

    Leber's hereditary optic neuropathy (LHON) is a disease that leads to blindness. Gene therapy has been investigated with some success, and could lead to important advancements in treating LHON. This was a prospective, open-label trial involving 9 LHON patients at Tongji Hospital, Wuhan, China, from August 2011 to December 2015. The purpose of this study was to evaluate the long-term outcomes of gene therapy for LHON. Nine LHON patients voluntarily received an intravitreal injection of rAAV2-ND4. Systemic examinations and visual function tests were performed during the 36-month follow-up period to determine the safety and efficacy of this gene therapy. Based on successful experiments in an animal model of LHON, 1 subject also received an rAAV2-ND4 injection in the second eye 12months after gene therapy was administered in the first eye. Recovery of visual acuity was defined as the primary outcome of this study. Changes in the visual field, visual evoked potential (VEP), optical coherence tomography findings, liver and kidney function, and antibodies against AAV2 were defined as secondary endpoints. Eight patients (Patients 2-9) received unilateral gene therapy and visual function improvement was observed in both treated eyes (Patients 4, 6, 7, and 8) and untreated eyes (Patients 2, 3, 4, 6 and 8). Visual regression fluctuations, defined as changes in visual acuity greater than or equal to 0.3 logMAR, were observed in Patients 2 and 9. Age at disease onset, disease duration, and the amount of remaining optic nerve fibers did not have a significant effect on the visual function improvement. The visual field and pattern reversal VEP also improved. The patient (Patient 1) who received gene therapy in both eyes had improved visual acuity in the injected eye after the first treatment. Unfortunately, visual acuity in this eye decreased 3months after he received gene therapy in the second eye. Animal experiments suggested that ND4 expression remains stable in the

  10. The Influence of the Metabolic Syndrome on the Short- and Long-Term Outcome After Carotid Endarterectomy

    NARCIS (Netherlands)

    Visser, Linda; Wallis de Vries, Bas M; Mulder, Douwe J; Uyttenboogaart, Maarten; van der Veen, Sterre; Zeebregts, Clark J; Pol, Robert A

    2016-01-01

    The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease. The aim of this study is to determine the influence of MetS on short- and long-term outcome and survival after carotid endarterectomy (CEA). Between January 2005 and December 2014, data from all patients undergoin

  11. Stenting for symptomatic vertebral artery stenosis associated with bilateral carotid rate mirabile: The long-term clinical and angiographic outcome

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Jang Hyun; Kim, Byung Moon [Dept. of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    Symptomatic vertebral artery (VA) stenosis associated with bilateral carotid rate mirabile (CRM) has not been reported. We report the long-term clinical and angiographic outcome after stenting for symptomatic VA stenosis in the patient with bilateral CRM. This report is the first case that symptomatic VA stenosis associated with bilateral CRM was treated with stenting.

  12. Long-Term Outcomes of War-Related Death of Family Members in Kosovar Civilian War Survivors

    Science.gov (United States)

    Morina, Nexhmedin; Reschke, Konrad; Hofmann, Stefan G.

    2011-01-01

    Exposure to war-related experiences can comprise a broad variety of experiences and the very nature of certain war-related events has generally been neglected. To examine the long-term outcomes of war-related death of family members, the authors investigated the prevalence rates of major depressive episode (MDE), anxiety disorders, and quality of…

  13. Long-term outcomes of war-related death of family members in Kosovar civilian war survivors

    NARCIS (Netherlands)

    Morina, N.; Reschke, K.; Hofmann, S.G.

    2011-01-01

    Exposure to war-related experiences can comprise a broad variety of experiences and the very nature of certain war-related events has generally been neglected. To examine the long-term outcomes of war-related death of family members, the authors investigated the prevalence rates of major depressive

  14. Long-Term Outcomes of Cognitive-Behavioral Treatments for Posttraumatic Stress Disorder among Female Rape Survivors

    Science.gov (United States)

    Resick, Patricia A.; Williams, Lauren F.; Suvak, Michael K.; Monson, Candice M.; Gradus, Jaimie L.

    2012-01-01

    Objective: We conducted a long-term follow-up (LTFU) assessment of participants from a randomized controlled trial comparing cognitive processing therapy (CPT) with prolonged exposure (PE) for posttraumatic stress disorder (PTSD). Competing hypotheses for positive outcomes (i.e., additional therapy, medication) were examined. Method:…

  15. Long-term follow-up of Class II adults treated with orthodontic camouflage: A comparison with orthognathic surgery outcomes

    Science.gov (United States)

    Mihalik, Colin A.; Proffit, William R.; Phillips, Ceib

    2013-01-01

    Thirty-one adults who had been treated with orthodontics alone for Class II malocclusions were recalled at least 5 years posttreatment to evaluate cephalometric and occlusal stability and also their satisfaction with treatment outcomes. The data were compared with similar data for long-term outcomes in patients with more severe Class II problems who had surgical correction with mandibular advancement, maxillary impaction, or a combination of those. In the camouflage patients, small mean changes in skeletal landmark positions occurred in the long term, but the changes were generally much smaller than in the surgery patients. The percentages of patients with a long-term increase in overbite were almost identical in the orthodontic and surgery groups, but the surgery patients were nearly twice as likely to have a long-term increase in overjet. The patients’ perceptions of outcomes were highly positive in both the orthodontic and the surgical groups. The orthodontics-only (camouflage) patients reported fewer functional or temporomandibular joint problems than did the surgery patients and had similar reports of overall satisfaction with treatment, but patients who had their mandibles advanced were significantly more positive about their dentofacial images. PMID:12637899

  16. Long-term visual outcomes after Crystalens® HD intraocular lens implantation

    Directory of Open Access Journals (Sweden)

    Karavitaki AE

    2014-05-01

    Full Text Available Alexandra E Karavitaki, Ioannis G Pallikaris, Sophia I Panagopoulou, George A Kounis, George Kontadakis, George D KymionisInstitute of Vision and Optics, University of Crete, Crete, GreecePurpose: Our purpose was to evaluate the long-term visual outcomes after bilateral implantation of Crystalens® HD (Bausch and Lomb, Inc. accommodative intraocular lenses.Methods: In this study, 25 patients (50 eyes who underwent cataract surgery and bilateral Crystalens HD accommodative intraocular lens implantation were included. The Crystalens HD lens was implanted in the bag in both eyes, without any intra- or postoperative complications. The visual parameters measured before and after surgery were: uncorrected distance visual acuity, corrected distance visual acuity (CDVA (using the Early Diabetic Retinopathy Study [EDTRS] logMAR charts, uncorrected intermediate visual acuity, and uncorrected near visual acuity using a Birkhäuser reading chart, at a distance of 66 cm and 33 cm for intermediate and near vision, respectively, directly illuminated by a lamp of 60 watts. After surgery, the patients were evaluated at 1, 3, 6, 12, 24, and 36 months.Results: The mean age was 68.70±7.1 (range: 54 to 83 years. The mean follow-up was 42.72±0.49 (range: 42.33 to 43.27 months. The uncorrected distance visual acuity improved from 0.56±0.41 (range: 0 to 2 preoperatively to 0.19±0.13 (range: 0 to 0.38 (logMAR scale at the last follow-up visit, and the CDVA improved from 0.17±0.18 (range: 0 to 0.7 preoperatively to 0.05±0.05 (range: −0.02 to 0.22 at the last follow-up visit. No eyes lost lines of CDVA during the follow-up period, while 54% of patients gained one or more lines of CDVA. The uncorrected intermediate and near visual acuity was J2 or better in 71% and 69% of our patients, respectively.Conclusion: Crystalens HD implantation seems to provide an improvement in visual acuity for far, intermediate, and near distances.Keywords: presbyopia, accommodation

  17. Long-term outcome and structural integrity following open repair of massive rotator cuff tears

    Directory of Open Access Journals (Sweden)

    Christoph Bartl

    2012-01-01

    Full Text Available Background: Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit. Materials and Methods: During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST and a pain visual analog scale (VAS. At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol. Results: The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05. Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs. Conclusions: Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did

  18. Long term outcomes of cardiac transplant for immunoglobulin light chain amyloidosis: The Mayo Clinic experience

    Science.gov (United States)

    Grogan, Martha; Gertz, Morie; McCurdy, Arleigh; Roeker, Lindsey; Kyle, Robert; Kushwaha, Sudhir; Daly, Richard; Dearani, Joseph; Rodeheffer, Richard; Frantz, Robert; Lacy, Martha; Hayman, Suzanne; McGregor, Christopher; Edwards, Brooks; Dispenzieri, Angela

    2016-01-01

    rejection at a median of 1.8 mo post OHT (range 0.4 to 4.9 mo); only one patient died of rejection. Median survival of seven patients who achieved a complete hematologic response to either chemotherapy or autologous hematopoietic stem cell transplantation was 10.8 years. CONCLUSION: Our data demonstrate that long term survival after heart transplant is feasible in AL patients with limited extra-cardiac involvement who achieve complete hematologic response. PMID:27358783

  19. Long-term Follow-up and Outcome of Phenylketonuria Patients on Sapropterin : A Retrospective Study

    NARCIS (Netherlands)

    Keil, Stefanie; Anjema, Karen; van Spronsen, Francjan J.; Lambruschini, Nilo; Burlina, Alberto; Belanger-Quintana, Amaya; Couce, Maria L.; Feillet, Francois; Cerone, Roberto; Lotz-Havla, Amelie S.; Muntau, Ania C.; Bosch, Annet M.; Meli, Concetta A. P.; de Villemeur, Thierry Billette; Kern, Ilse; Riva, Enrica; Giovannini, Marcello; Damaj, Lena; Leuzzi, Vincenzo; Blau, Nenad

    2013-01-01

    OBJECTIVE: Sapropterin dihydrochloride, the synthetic form of 6R-tetrahydrobiopterin (BH4), is an approved drug for the treatment of patients with BH4-responsive phenylketonuria (PKU). The purpose of this study was to assess genotypes and data on the long-term effects of BH4/sapropterin on metabolic

  20. The Effect of Long-Term Outcome Studies on the Therapy of Schizophrenia.

    Science.gov (United States)

    Haley, Jay

    1989-01-01

    Claims since schizophrenia is reversible, professions involved in social control and those doing therapy face new responsibilities. Notes therapists can approach psychotic symptoms expecting the person to become normal. Describes goal as being to help people past periods of acute disturbance without doing them long-term harm. (Author/ABL)

  1. Long-term outcomes in patients with rheumatologic disorders undergoing percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Nochioka, Kotaro; Biering-Sørensen, Tor; Hansen, Kim Wadt;

    2017-01-01

    AIMS: Rheumatologic disorders are characterised by inflammation and an increased risk of coronary artery disease (CAD). However, the association between rheumatologic disorders and long-term prognosis in CAD patients undergoing percutaneous coronary intervention (PCI) is unknown. Thus, we aimed t...

  2. An Early Childhood Intervention Programme and the Long-Term Outcomes for Students

    Science.gov (United States)

    Martin, Shirley

    2010-01-01

    Early childhood education has increasingly been identified as a mechanism to alleviate educational disadvantage in areas of social exclusion. This study aims to add to the understanding of the nature and distribution of long-term benefits from early childhood intervention programmes and provides a detailed analysis of both the cognitive and…

  3. Long-term cognitive outcome of ischaemic stroke in young adults

    NARCIS (Netherlands)

    Bruijn, M.A. de; Synhaeve, N.E.; Rijsbergen, M.W. van; Leeuw, F.E. de; Jansen, B.P.; Kort, P.L.M. de

    2014-01-01

    BACKGROUND: Long-term prognosis in terms of cognition in young stroke patients is very important because these patients usually still have a long life expectancy and rather extensive daily life demands. However, little is known on cognitive deficits in these patients. We aimed to evaluate cognitive

  4. The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma

    NARCIS (Netherlands)

    van Gestel, Aukje; Webers, Carroll A.; Severens, Johan L.; Beckers, Henny J.; Jansonius, Nomdo M.; Hendrikse, Fred; Schouten, Jan S.

    2012-01-01

    Purpose: To evaluate the long-term effects and costs of four treatment strategies for primary open-angle glaucoma compared to usual care. Methods: Cost-effectiveness analyses with a lifelong horizon were made from a societal perspective. Data were generated with a patient-level model based on discre

  5. Short- and Long-term Outcomes in Patients with Connective Tissue Diseases Undergoing Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Li Zhou

    2016-01-01

    Conclusions: Patients with CTD and CAD may have severe coronary lesions. PCI in these patients tends to result in an increased rate of stent thrombosis and TVR during long-term follow-up, which may be influenced by traditional and nontraditional risk factors.

  6. Hepatocellular carcinoma: Advances in diagnosis,management, and long term outcome

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Hepatocellular carcinoma (HCC) remains a common andlethal malignancy worldwide and arises in the setting ofa host of diseases. The incidence continues to increasedespite multiple vaccines and therapies for viruses suchas the hepatitis B and C viruses. In addition, due to thegrowing incidence of obesity in Western society, thereis anticipation that there will be a growing populationwith HCC due to non-alcoholic fatty liver disease. Dueto the growing frequency of this disease, screening isrecommended using ultrasound with further imagingusing magnetic resonance imaging and multi-detectorcomputed tomography used for further characterizationof masses. Great advances have been made to help withthe early diagnosis of small lesions leading to potentialcurative resection or transplantation. Resection andtransplantation maybe used in a variety of patients thatare carefully selected based on underlying liver disease.Using certain guidelines and clinical acumen patientsmay have good outcomes with either resection ortransplantation however many patients are inoperableat time of presentation. Fortunately, the use of newlocoregional therapies has made down staging patientsa potential option making them potential surgicalcandidates. Despite a growing population with HCC,new advances in viral therapies, chemotherapeutics,and an expanding population of surgical and transplantcandidates might all contribute to improved long-termsurvival of these patients.

  7. Short and long term outcomes of primary angioplasty in patients aged 75 years and over

    Directory of Open Access Journals (Sweden)

    Turgay Işık

    2011-06-01

    Full Text Available The treatment of elderly patients with ST segment elevated myocardial infarction (STEMI remains controversial. This study aimed to investigate the effects of primary angioplasty in elderly patients on in-hospital and long term major adverse cardiac events (MACE.Materials and methods: From October 2003 to March 2008, we retrospectively enrolled 220 patients aged 75 years and over with STEMI who underwent primary angioplasty. Patients’ characteristics, in-hospital and long term events were recorded.Results: Male/Female ratio of patients was 129/91 and mean age was 78.7 ± 3.6 (range, 75-97 years, and 58.6% of male. Of these patients 29.2% were diabetics, 69.8% were hypertensive, 34.4% were smoker and 43.5% were anemic at admission. Anterior myocardial infarction was diagnosed in 52.3% of patients. Mean pain-balloon time was 222 ± 116 minutes. Eighty two (38.2% of these 220 patients had three-vessel disease and 12 (5.7% were diagnosed as cardiogenic shock. Procedural success was observed in 79.6% of patients. Heart failure was observed 27.7% in hospital and intra aortic pump was used in 14.5% of patients. There was no significant difference between age groups in long term major cardiac events and in hospital mortality. Diabetes, leukocyte count at admission and in hospital heart failure were independent predictors of short term MACE and low hemoglobin level at admission and peak CKMB levels were independent predictors of long term MACE.Conclusions: Primary angioplasty in patients aged 75 years and over seems to be associated with low procedural complication, high procedural success, improved short and long term survival.

  8. Long-term outcome of surgical Class III correction as a function of age at surgery

    Science.gov (United States)

    Bailey, L'Tanya J.; Phillips, Ceib; Proffit, William R.

    2009-01-01

    Introduction In this study, we assessed whether the likelihood of a positive overjet 5 to 10 years after Class III surgery was affected by age at the surgery or the type of surgery and evaluated the amount and pattern of postsurgical growth. Methods Cephalometric measurements including overjet were evaluated from immediately postsurgery and long-term recall cephalograms of 104 patients who had had surgical Class III correction and at least 5-year recalls. The patients were classified as younger (Long-term changes in overjet and other cephalometric characteristics in the younger and the older patients were similar. No patients in the sample had negative overjet in the long term, but zero overjet (<1 mm) was observed in some patients in all groups. Patients who had mandibular setback at any age were 2.6 times more likely to have zero overjet in the long term (P = .003) than those with maxillary surgery alone. For the younger patients, the likelihood of zero overjet in the long term was not significantly different from patients who were treated later (P = .87), with or without mandibular surgery. Conclusions The data support the use of serial cephalometric radiographs, with surgery deferred until little or no mandibular growth is observed, to determine the timing of Class III surgery in younger patients. PMID:18331934

  9. Factors associated with a positive occupational outcome during long-term central stimulant treatment in adult ADHD.

    Science.gov (United States)

    Torgersen, Terje; Krokstad, Steinar; Vaaler, Arne E

    2014-12-01

    There is a lack of long-term studies of central stimulant (CS) treatment in adult attention-deficit/hyperactivity disorder (ADHD), and studies on functional outcomes like occupational status are rare. The current study investigated occupational status in adult ADHD patients before and after long-term CS treatment (median duration of treatment 33 months) and aimed to identify variables associated with improvement in occupational status. The collection of data was based on a naturalistic, retrospective approach using the medical records of a sample of all 117 adult ADHD patients consecutively starting treatment with CS in a specific catchment area in Norway in the period 1997 to May 2005. Most patients did not improve in occupational status during long-term CS treatment. The improved group had significantly higher baseline ADHD symptoms as measured by the general adult ADD symptom checklist (83.7 vs. 76.2, p=0.024) and had a significantly shorter period from the first contact with adult psychiatry until they got the ADHD diagnosis (11.7 vs. 50.9 months, p=0.001). The results indicate that long-term CS treatment itself may have limited effect on occupational status in functionally impaired and highly comorbid patients with adult ADHD. A high baseline ADHD symptom level may be related to a superior outcome in occupational status.

  10. The squamous cell carcinoma case that received long-term COPD treatment

    Directory of Open Access Journals (Sweden)

    Figen Türk

    2013-03-01

    Full Text Available Primary tracheal tumors are rare, and composed of variousbenign and malignant pathologies. They often cansimulate obstructive pulmonary diseases, such as asthmaand chronic obstructive pulmonary disease, and patientswith malign tracheal tumors sometimes undergolong-term treatment for such diseases, without any improvement.Therefore, these tumors should be includedin the differential diagnosis in patients presenting tracheobronchialtree obstruction. We present a squamous cellendotracheal carcinoma case that had received treatmentwith a diagnosis of chronic obstructive pulmonarydisease for a long time. The recent increase in symptomshad been thought to be due to an exacerbation of the disorderbut the bronchoscopy performed after 3 months ofno improvement revealed an endotracheal mass lesion.Full recovery was obtained with bronchoscopic resectionof the tumor.Key words: Endotracheal tumor, chronic obstructive pulmonary disease, squamous cell carcinoma

  11. Does long-term medication use improve the academic outcomes of youth with attention-deficit/hyperactivity disorder?

    Science.gov (United States)

    Langberg, Joshua M; Becker, Stephen P

    2012-09-01

    Youth with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently experience academic impairment, including lower grades than their peers and elevated risk for grade retention and school dropout. Medication is the most commonly used treatment for youth with ADHD, and it is therefore essential to understand the extent to which medication use improves long-term academic functioning. This paper reviews the literature on the relation between long-term medication use and the academic outcomes of youth with ADHD. A systematic literature search was conducted to identify pertinent studies published since 2000 that followed youth with ADHD for 3 or more years. Academic outcomes of interest included school grades, achievement test scores, and grade retention. Nine studies were identified reporting on eight distinct longitudinal samples (N across studies = 8,721). These studies demonstrate that long-term medication use is associated with improvements in standardized achievement scores. However, the magnitude of these improvements is small and the clinical or educational significance is questionable. Evidence for long-term improvements in school grades and grade retention is less compelling. This review highlights methodological considerations in providing directions for future research. The importance of using multiple sources to gather information about medication adherence is discussed, including use of methodologies such as electronic monitors, rather than relying solely on parent report or chart review. Future research should also examine a range of medication adherence definitions in order to determine whether age of onset, duration of use, dose, and/or consistency of use moderates the relation between long-term medication use and academic outcomes.

  12. Hepatocellular Carcinoma in a Noncirrhotic Liver after Long-Term Use of Danazol for Hereditary Angioedema

    Directory of Open Access Journals (Sweden)

    Soraya Rahal

    2014-12-01

    Full Text Available We report a 57-year-old male who was treated with high-dose danazol for hereditary angioedema for more than 30 years; he developed hepatocellular carcinoma in the absence of cirrhosis. Despite surgical resection, he had a recurrence and received sorafenib, but had a poor skin tolerance. Such tumors arising after danazol are infrequent, and this case is highly unique due to the minor lesions found on the liver.

  13. Analysis of the Long-term Effect of Intraoperative Radiotherapy (IORT) for Non-Small Cell Lung Carcinoma (NSCLC)

    Institute of Scientific and Technical Information of China (English)

    Guxia Zhou; Tiwen Zeng; Lianyuan Wang; Lin Ma

    2007-01-01

    OBJECTIVE To analyze the long-term effects of treatment with an operation+postoperative irradiation (A group) and an operation+intraoperative radiotherapy+postoperative irradiation (B group) in non-small cell lung cancer patients.METHODS Through a prospective randomized clinical trial,a total of 154 patients with non-small cell lung carcinoma were divided into two groups of 77 cases.Among the 154 cases,there were 134 squamous carcinomas,17 adenocarcinomas and 3 adeno-squamous carcinomas.TNM staging:there were 17 in Stage Ⅰ.76 in Stage Ⅱ and 61 in Stage Ⅲ.Adosage of 15~25 Gy IORT,energy 9~16 MeV electrons,was delivered to the fumors.The doses given were 40~60 Gy postoperation.RESULTS The local control rates in A and B groups were 49.4% and 62.3% respectively (P<0.05).The survivals at 3,5 and 7 years for group A were 40.3%,27.3%,and 5.2% and for group B 44.2%,28.6% and 6.5% (P>0.05).There were 16 deaths from radiotherapy complications,with 2 cases in group A and 14 in group B.CONCLUSION IORT+postoperative irradiation can enhance the local control rate of non-small cell lung cancer patients and reduce the recurrentrates.but it can not improve long-term survival.KEYWORDS:lung neoplasms/surgery,lung neoplasms/radiotherapy,radiotherapy intraoperative,prognosis.

  14. Echocardiographic Assessment of Ischaemic Mitral Regurgitation, Mechanism, Severity, Impact on Treatment Strategy and Long Term Outcome

    Science.gov (United States)

    Naser, Nabil; Dzubur, Alen; Kusljugic, Zumreta; Kovacevic, Katarina; Kulic, Mehmed; Sokolovic, Sekib; Terzic, Ibrahim; Haxihibeqiri-Karabdic, Ilirijana; Hondo, Zorica; Brdzanovic, Snjezana; Miseljic, Sanja

    2016-01-01

    Introduction: The commonest mitral regurgitation etiologies are degenerative (60%), rheumatic post-inflammatory, 12%) and functional (25%). Due to the large number of patients with acute MI, the incidence of ischaemic MR is also high. Ischaemic mitral regurgitation is a complex multifactorial disease that involves left ventricular geometry, the mitral annulus, and the valvular/subvalvular apparatus. Ischaemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Research Objectives: The objective of this study is to determine the role of echocardiography in detecting and assessment of mitral regurgitation mechanism, severity, impact on treatment strategy and long term outcome in patients with myocardial infarction during the follow up period of 5 years. Also one of objectives to determine if the absence or presence of ischaemic MR is associated with increased morbidity and mortality in patients with myocardial infarction. Patients and methods: The study covered 138 adult patients. All patients were subjected to echocardiography evaluation after acute myocardial infarction during the period of follow up for 5 years. The patients were examined on an ultrasound machine Philips iE 33 xMatrix, Philips HD 11 XE, and GE Vivid 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated mechanisms and severity of mitral regurgitation which includes the regurgitant volume (RV), effective regurgitant orifice area (EROA), the regurgitant fraction (RF), Jet/LA area, also we measured the of vena contracta width (VC width cm) for assessment of IMR severity, papillary muscles anatomy and displacement, LV systolic function ± dilation, LV regional wall motion abnormality WMA, LV WMI, Left ventricle LV remodeling, impact on treatment strategy and long term mortality. Results: We analyzed and follow up 138 patients with previous (>16 days) Q-wave myocardial infarction by ECG who underwent TTE and TEE

  15. Genetic variation at the BDNF locus: evidence for association with long-term outcome after ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Tara M Stanne

    Full Text Available Rates and extent of recovery after stroke vary considerably between individuals and genetic factors are thought to contribute to post-stroke outcome. Brain-derived neurotrophic factor (BDNF plays important roles in brain plasticity and repair and has been shown to be involved in stroke severity, recovery, and outcome in animal models. Few clinical studies on BDNF genotypes in relation to ischemic stroke have been performed. The aims of the present study are therefore to investigate whether genetic variation at the BDNF locus is associated with initial stroke severity, recovery and/or short-term and long-term functional outcome after ischemic stroke.Four BDNF tagSNPs were analyzed in the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS; 600 patients and 600 controls, all aged 18-70 years. Stroke severity was assessed using the NIH Stroke Scale (NIHSS. Stroke recovery was defined as the change in NIHSS over a 3-month period. Short- and long-term functional outcome post-stroke was assessed using the modified Rankin Scale at 3 months and at 2 and 7 years after stroke, respectively.No SNP was associated with stroke severity or recovery at 3 months and no SNP had an impact on short-term outcome. However, rs11030119 was independently associated with poor functional outcome 7-years after stroke (OR 0.66, 95% CI 0.46-0.92; P =  0.006.BDNF gene variants were not major contributors to ischemic stroke severity, recovery, or short-term functional outcome. However, this study suggests that variants in the BDNF gene may contribute to poor long-term functional outcome after ischemic stroke.

  16. Prestroke physical activity is associated with severity and long-term outcome from first-ever stroke

    DEFF Research Database (Denmark)

    Krarup, L.H.; Truelsen, T.; Gluud, C.;

    2008-01-01

    (PASE) questionnaire. The PASE questionnaire quantifies the amount of physical activity done during a 7-day period. In this prospectively collected patient population initial stroke severity was measured using the Scandinavian Stroke Scale and long-term outcome was assessed after 2 years using......OBJECTIVE: To determine whether prestroke level of physical activity influenced stroke severity and long-term outcome. METHODS: Patients included into the present analyses represent a subset of patients with first-ever stroke enrolled into the ExStroke Pilot Trial. Patients with ischemic stroke...... were randomized in the ExStroke Pilot Trial to an intervention of repeated instructions and encouragement to increase the level of physical activity or to a control group. Prestroke level of physical activity was assessed retrospectively by interview using the Physical Activity Scale for the Elderly...

  17. Long-term survival following two recurrences and re-irradiation courses for a nasopharyngeal carcinoma: a case report

    Directory of Open Access Journals (Sweden)

    Haddad P

    2010-10-01

    Full Text Available "nBackground: Local recurrence in Nasopharyngeal Carcinoma (NPC presents is a major challenge. Patients experience substantial morbidity as well as poor survival if no further treatment is offered. Residual or recurrent nasopharyngeal carcinoma is usually managed by chemotherapy, stereotactic radiosurgery, external beam radiation therapy (EBRT, interstitial, and intracavitary brachytherapy or salvage surgery. This case presents the treatment of two consecutive localized recurrences of NPC."n "nCase presentation: The patient was a 59-year-old man who underwent a course of radical external-beam radiotherapy for a primary NPC in 1999, then another course of external radiation in 2004 for his first recurrence, and finally a course of brachytherapy for the second recurrence in 2005. The patient is well now in 2010, with no signs of disease five years after the third radiotherapy."n "nConclusion: Our experience of re-irradiation for this twice recurrent nasopharyngeal carcinoma has been promising with encouraging tumor control and acceptable treatment-related toxicity profile. This case indicates the efficacy of definitive re-irradiation for regional recurrence and the necessity for long-term observation for the salvageable early-stage local failure.

  18. [A case of mucinous carcinoma treated by local excision after long-term serial observations].

    Science.gov (United States)

    Yamamuro, Minori; Enomoto, Katsuhisa; Sakurai, Kenichi; Amano, Sadao

    2013-11-01

    We report a case of a 45-year-old woman in whom an abnormality was identified by an examination when she was 42 years old. Breast ultrasonography revealed a cyst in the C area of the left breast. Ultrasonography performed 3 years later showed a mass lesion, 1 cm in diameter, in the C area of the left breast. Contrast-enhanced magnetic resonance imaging (MRI) showed a mass shadow. Core needle biopsy was performed, and the pathological diagnosis was mucinous carcinoma. Partial excision of the breast and sentinel lymph node biopsy were performed. The final histopathological diagnosis was mucinous carcinoma( pure type, estrogen receptor[ ER][ +], progesterone receptor[ PgR][ +], human epidermal growth factor receptor-2[ HER2][ 0], Ki67[ 10%], T1N0M0, stage I). One year after the operation, no signs of recurrence or metastasis have been observed. It was difficult to ascertain the presence of a lesion as the patient experienced pregnancy and childbirth during serial observations. An early diagnosis was made by imaging techniques such as consecutive ultrasonography, owing to which we were able to treat the patient early. The findings of this case emphasize the need for serial imaging studies.

  19. Long-term follow-up of in situ carcinoma of the breast.

    Science.gov (United States)

    Eusebi, V; Feudale, E; Foschini, M P; Micheli, A; Conti, A; Riva, C; Di Palma, S; Rilke, F

    1994-08-01

    Eighty cases of duct carcinoma in situ (DCIS) of the breast have been investigated by a cohort-retrospective study. These consisted of 8.5 per 1,000 of 9,446 breast biopsies originally diagnosed as benign, between 1964 and 1976, with a mean follow-up of 17.5 years. There were forty-one cases (51%) of DCIS of clinging type (CC); 30 cases (37.%) of CC associated with other types of DCIS; nine cases of DCIS other than CC two of which were DCIS of comedo-type. Invasive duct carcinoma (IDC) subsequently developed in 11 patients (14%), whereas DCIS recurred in 5 (6%). The recurrence was ipsilateral in 12 of these 16 patients. IDC appeared more frequently, with high statistical significance, when the lesion present in the original biopsy showed pleomorphic (P) nuclei (ie, poorly differentiated cyto-nuclear morphology). The Standardized Morbidity Ratio (SMR) was 8.0 (95% CI; 2.9-17.5) with the general population as reference. IDC that developed following a lesion displaying P nuclei also showed a statistically significantly more aggressive behavior. It is suggested that when cases of DCIS are followed-up for a considerable length of time, a two-wave pattern of aggressiveness becomes apparent. IDC that develops after a poorly differentiated DCIS leads to death more precociously than that appearing after other types of DCIS, especially those showing more bland nuclear cytology.

  20. Smoking and Histological Factors Influencing Long-term Survival of Gastric Carcinoma in Consecutive Patient Series

    Directory of Open Access Journals (Sweden)

    Ali Delpisheh

    2014-06-01

    Full Text Available Background: There is little information about the possible influence of lifestyle and etiologic risk factors on survival amongst patients with gastric cancer. Methods: We recruited a consecutive series of 249 patients with definite diagnosis of gastric cancer who had been hospitalized in Towhid Hospital, Sanandaj, Kurdistan Province in Western Iran during a five-year period from 2006 until 2011. Survival rate was calculated according to the Kaplan-Meier and log rank statistical methods. Cox hazard regression was used to investigate the effect of the variables and adjust for the effect of age. Results: According to univariate analysis, related variables that included age, gender, Residence, histology grade, histology type, familial history of gastrointestinal cancer and mental illness during the disease had no significant effects on survival rate variation. Significant independent factors on survival included past medical history of gastrointestinal diseases (P-value = 0.010, tobacco smoking (P-value = 0.012, and early diagnosis (P-value = 0.008. Cox-regression analysis of demographic, lifestyle and histological factors with >45 years of age as the reference revealed that patients 46-65 years of age at diagnosis (HR=0.602; 95% CI=0.250-1.44; P=0.256 and those >66 years of age (HR=1.07, 95% CI=0.46-2.50, P≤0.001 had an increased risk for disease progression and death. Conclusions: Past medical history of gastrointestinal diseases, tobacco smoking and early stage diagnosis might influence the long-term survival of patients with gastric cancer.

  1. Long-term Outcomes of the ATHENA (Athletes Targeting Healthy Exercise & Nutrition Alternatives) Program for Female High School Athletes

    OpenAIRE

    Elliot, Diane L.; Goldberg, Linn; Moe, Esther L; DeFrancesco, Carol A.; Durham, Melissa B.; McGinnis, Wendy; Lockwood, Chondra

    2008-01-01

    Adolescence and emerging adulthood are critical windows for establishing life-long behaviors. We assessed long-term outcomes of a prospective randomized harm reduction/health promotion program for female high school athletes. The intervention’s immediate beneficial effects on diet pill use and unhealthy eating behaviors have been reported; however, tobacco, alcohol and marijuana use were not immediately altered (Elliot et al, 2004). One to three years following graduation, positive benefits i...

  2. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes

    OpenAIRE

    Bamigboye, Anthony A; Hofmeyr, G Justus

    2014-01-01

    Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the ...

  3. Treatment and long-term outcome of chronic radiation esophagitis after radiation therapy for head and neck tumors: A report of 13 cases

    Energy Technology Data Exchange (ETDEWEB)

    Silvain, C.; Barrioz, T.; Besson, I.; Babin, P.; Fontanel, J.P.; Daban, A.; Matuchansky, C.; Beauchant, M. (CHU J Bernard, Poitiers (France))

    1993-05-01

    The natural history of chronic radiation esophagitis occurring in previously normal esophagus is still unknown. The authors describe here the long-term outcome of chronic esophagitis arising after neck irradiation for oropharynx and larynx carcinomas in 13 consecutive adult patients. The first clinical signs of radiation esophagitis were dysphagia or impossibility of oral intake, which appeared within 26 months (range 2--120 months) after the end of radiation for pyriform fossae carcinoma (N = 5), tonsil carcinoma (N = 2), larynx carcinoma (N = 2), pharynx carcinoma (N = 2), base of the tongue (N = 1), and thyroid carcinomas (N = 1). During upper endoscopy, an esophageal stenosis was found in 11 cases and was associated with ulceration in three cases. An isolated esophageal ulceration was present in only two cases. Chronic radiation esophagitis diagnosis was confirmed by histology and surgery in seven cases. In the last six cases, diagnosis was supported by the absence of first cancer relapses within a median follow-up of two years (16 months to nine years) and by endoscopic findings. Seven patients received parenteral or enteral nutrition. Ten patients were treated by peroral dilatations. These treatments allowed nearly normal oral diet in 11/13 patients. Only one patient was lost of follow-up after 20 months. Four patients died from chronic radiation esophagitis. One of these patients died from massive hemorrhage after peroral dilatation. Four patients died of a second carcinoma with no first cancer recurrence. Four patients were alive after six months to nine years of follow-up. Moderate dysphagia was still present, allowing nearly normal oral feeding. In conclusion, chronic radiation esophagitis is a severe disease with an underestimated frequency. In this study, peroral dilatations appeared to be necessary and were not associated with an increased morbidity. 21 refs., 1 tab.

  4. Long-term outcome of patients with acromegaly and congestive heart failure.

    Science.gov (United States)

    Bihan, Hélène; Espinosa, Consuelo; Valdes-Socin, Hernan; Salenave, Sylvie; Young, Jacques; Levasseur, Suzanne; Assayag, Patrick; Beckers, Albert; Chanson, Philippe

    2004-11-01

    Cardiovascular complications are a major cause of morbidity and mortality in patients with acromegaly. Normalization of GH secretion is associated with an improvement in structural and functional cardiac abnormalities. However, the long-term cardiac effects of treatment for acromegaly have not been studied in patients who have already developed chronic congestive heart failure (CHF). We reviewed the charts of 330 consecutive patients with acromegaly treated in two French and Belgian centers since 1985. Ten patients with both acromegaly and CHF (eight men, two women, mean age 49.7 yr) were studied retrospectively. One of them was excluded because CHF was due to severe aortic stenosis.CHF (New York Heart Association stages III-IV and echocardiography showing dilated hypokinetic cardiomyopathy with left ventricular systolic dysfunction and a left ventricular ejection fraction less than 45%) was diagnosed before, concomitantly, or after acromegaly in, respectively, two, five, and two patients. Three patients were referred with terminal heart failure requiring transplantation.One patient had transient CHF associated with a hypertensive crisis. The other eight patients had symptomatic chronic CHF. Control of GH hypersecretion failed, totally or partially, in three patients: one had a long-term survival, and the two others died at 1 and 5 yr. Good GH control was achieved in five patients: four of these are still alive 2-16 yr after diagnosis of CHF, their clinical status is stable or improved, and their quality of life is good. Overall, the 1- and 5-yr mortality (or transplantation) rates for patients with chronic symptomatic CHF were 25% (2 of 8 patients) and 37.5% (3 of 8 patients), respectively. In conclusion, less than 3% of acromegalic patients developed CHF in this study. Although effective treatment of acromegaly improved short-term cardiovascular status, its impact on long-term survival is questionable.

  5. Long term outcome of acquired food allergy in pediatric liver recipients: a single center experience

    Directory of Open Access Journals (Sweden)

    Antigoni Mavroudi

    2012-01-01

    Full Text Available Food induced sensitization has been reported in pediatric liver recipients. However long term follow up has not been established so far. We report here our experience regarding 3 pediatric patients who developed acquired food allergy after liver transplantation. The first patient suffered from persistent diarrhea and eczema. The second one presented with abdominal pain with no signs of rejection, abdominal discomfort, vomiting when ingesting milk proteins and responded well to the elimination diet. The third patient presented with facial angioedema and hoarseness of voice. She had multiple food allergies and reacted to milk, egg and sesame. All the patients had elevated total Immunoglobulin E (IgE and elevated specific IgE antibodies to the implicated food allergens. The first patient presented clinical manifestations of allergy when she was 19 months old. The second patient became allergic at the age of 16 and the third patient at the age of 3. The symptoms of food allergy persisted for 8 years in the first case and for 2 years in the other two cases. Low levels of specific IgE antibodies to the implicated food allergens and an enhanced T-helper 1 cell immune response toward interferon-gamma production were markers of tolerance acquisition. The long term prognosis in our cases was excellent. Food allergy resolved in all the patients. The long term prognosis of acquired food allergy after liver transplantation is currently obscure. More studies would be needed including greater number of patients to determine whether acquired food allergy is transient in pediatric liver recipients.

  6. Neonatal Magnesium Levels Correlate with Motor Outcomes in Premature Infants: a Long-Term Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Elizabeth eDoll

    2014-11-01

    Full Text Available ObjectiveChronic neurological deficits are a significant complication of preterm birth. Magnesium supplementation has been suggested to have neuroprotective function in the developing brain. Our objective was to determine whether higher neonatal serum magnesium levels were associated with better long-term neurodevelopmental outcomes in very low birth weight infants.Study DesignA retrospective cohort of 75 preterm infants (<1500 g, gestational age <27 weeks had follow-up for the outcomes of abnormal motor exam and for epilepsy. Average total serum magnesium level in the neonate during the period of prematurity was the main independent variable assessed, tested using a Wilcoxon rank-sum test. ResultsHigher average serum magnesium level was associated with a statistically significant decreased risk for abnormal motor exam (p 0.037. A lower risk for epilepsy in the group with higher magnesium level did not reach statistical significance (p 0.06. ConclusionThis study demonstrates a correlation between higher neonatal magnesium levels and decreased risk for long-term abnormal motor exam. Larger studies are needed to evaluate the hypothesis that higher neonatal magnesium levels can improve long-term neurodevelopmental outcomes.

  7. Long-term asymmetric hearing affects cochlear implantation outcomes differently in adults with pre- and postlingual hearing loss.

    Science.gov (United States)

    Boisvert, Isabelle; McMahon, Catherine M; Dowell, Richard C; Lyxell, Björn

    2015-01-01

    In many countries, a single cochlear implant is offered as a treatment for a bilateral hearing loss. In cases where there is asymmetry in the amount of sound deprivation between the ears, there is a dilemma in choosing which ear should be implanted. In many clinics, the choice of ear has been guided by an assumption that the reorganisation of the auditory pathways caused by longer duration of deafness in one ear is associated with poorer implantation outcomes for that ear. This assumption, however, is mainly derived from studies of early childhood deafness. This study compared outcomes following implantation of the better or poorer ear in cases of long-term hearing asymmetries. Audiological records of 146 adults with bilateral hearing loss using a single hearing aid were reviewed. The unaided ear had 15 to 72 years of unaided severe to profound hearing loss before unilateral cochlear implantation. 98 received the implant in their long-term sound-deprived ear. A multiple regression analysis was conducted to assess the relative contribution of potential predictors to speech recognition performance after implantation. Duration of bilateral significant hearing loss and the presence of a prelingual hearing loss explained the majority of variance in speech recognition performance following cochlear implantation. For participants with postlingual hearing loss, similar outcomes were obtained by implanting either ear. With prelingual hearing loss, poorer outcomes were obtained when implanting the long-term sound-deprived ear, but the duration of the sound deprivation in the implanted ear did not reliably predict outcomes. Contrary to an apparent clinical consensus, duration of sound deprivation in one ear has limited value in predicting speech recognition outcomes of cochlear implantation in that ear. Outcomes of cochlear implantation are more closely related to the period of time for which the brain is deprived of auditory stimulation from both ears.

  8. Long-term outcome of lung transplantation in previous intravenous drug users with talc lung granulomatosis.

    Science.gov (United States)

    Weinkauf, J G; Puttagunta, L; Nador, R; Jackson, K; LaBranche, K; Kapasi, A; Mullen, J; Modry, D L; Stewart, K C; Thakrar, M; Doucette, K; Lien, D C

    2013-01-01

    Talc lung granulomatosis results from the intravenous use of medication intended for oral use. Talc (magnesium silicate) acts as filler in some oral medications; when injected intravenously, it deposits in the lungs leading to airflow obstruction and impaired gas exchange. Allocation of donor lungs to previous intravenous drug users is controversial. After a careful selection process, 19 patients with talc lung granulomatosis have received lung allografts in our program. Long-term survival for these patients is excellent and our results suggest the previous use of intravenous drugs should not necessarily preclude lung transplantation.

  9. [A patient with invasive carcinoma derived from IPMN who achieved long-term survival despite lymph node metastasis].

    Science.gov (United States)

    Ueda, Nobuhiko; Kaida, Daisuke; Tomita, Yasuto; Ohnishi, Toshio; Funaki, Hiroshi; Fujita, Hideto; Kinami, Shinichi; Nakano, Yasuharu; Kosaka, Takeo

    2014-11-01

    A woman in her 70s was referred for examination of liver dysfunction. A cystic lesion with irregular contrast was observed at the pancreas head. The bile and pancreatic ducts were obstructed by the lesion. Part of the branch of the pancreatic duct at the pancreas head, continuous with the main pancreatic duct, was observed to be extended by using pancreatography. Pancreaticoduodenectomy was performed, and a diagnosis of invasive carcinoma from an intraductal papillary-mucinous neoplasm (IPMN) was made. Postoperative pathological diagnosis showed 16b1 inter-node metastasis. Liver and lung metastases were also detected after surgery; nevertheless, long-term survival was achieved for 5 years and 2 months by using various treatment modalities.

  10. Effect of propofol in the immature rat brain on short- and long-term neurodevelopmental outcome.

    Directory of Open Access Journals (Sweden)

    Tanja Karen

    Full Text Available BACKGROUND: Propofol is commonly used as sedative in newborns and children. Recent experimental studies led to contradictory results, revealing neurodegenerative or neuroprotective properties of propofol on the developing brain. We investigated neurodevelopmental short- and long-term effects of neonatal propofol treatment. METHODS: 6-day-old Wistar rats (P6, randomised in two groups, received repeated intraperitoneal injections (0, 90, 180 min of 30 mg/kg propofol or normal saline and sacrificed 6, 12 and 24 hrs following the first injection. Cortical and thalamic areas were analysed by Western blot and quantitative real-time PCR (qRT-PCR for expression of apoptotic and neurotrophin-dependent signalling pathways. Long-term effects were assessed by Open-field and Novel-Object-Recognition at P30 and P120. RESULTS: Western blot analyses revealed a transient increase of activated caspase-3 in cortical, and a reduction of active mitogen-activated protein kinases (ERK1/2, AKT in cortical and thalamic areas. qRT-PCR analyses showed a down-regulation of neurotrophic factors (BDNF, NGF, NT-3 in cortical and thalamic regions. Minor impairment in locomotive activity was observed in propofol treated adolescent animals at P30. Memory or anxiety were not impaired at any time point. CONCLUSION: Exposing the neonatal rat brain to propofol induces acute neurotrophic imbalance and neuroapoptosis in a region- and time-specific manner and minor behavioural changes in adolescent animals.

  11. Resilience and rejection sensitivity mediate long-term outcomes of parental divorce.

    Science.gov (United States)

    Schaan, Violetta K; Vögele, Claus

    2016-11-01

    Increasing divorce rates leave more and more children to deal with the separation of their parents. Recent research suggests that children of divorced parents more often experience psychological and physical symptoms than children of non-divorced parents. The processes that mediate the relationship between parental divorce and ill-health, however, are still elusive. This study investigated the mediating role of psychological factors such as resilience and rejection sensitivity on the long-term consequences of parental divorce in young adults. One hundred and ninety-nine participants (mean age 22.3 years) completed an online survey, including measures of mental health, childhood trauma, resilience, and rejection sensitivity. Participants with divorced parents (33 %) reported increased levels of psychological symptoms, childhood trauma, rejection sensitivity, and lower levels of resilience. The association between parental divorce and mental health was fully mediated by resilience, rejection sensitivity, and childhood trauma. The mediation model explained up to 44 % of the total variance in mental health symptoms. Resilience and rejection sensitivity are crucial factors for successful coping with the experience of parental separation. Prevention programs that help to boost children's resilience might help to reduce the long-term effects of parental divorce on their attachment style (e.g., rejection sensitivity), thereby improving their mental health on the long run. Furthermore, the results call for parental awareness and counseling to target and reduce the observed increased level of childhood trauma. Limitations concern the cross-sectional and retrospective design of the study.

  12. Evans syndrome in children. Long-term outcome in a prospective French national observational cohort.

    Directory of Open Access Journals (Sweden)

    Nathalie eAladjidi

    2015-09-01

    Full Text Available Evans syndrome (ES is a rare autoimmune disorder whose long-term follow-up characteristics are unknown. Patients under 18 at the time of diagnosis of a first autoimmune cytopenia have been included since 2004 in a national prospective observational cohort. In 2014, 156 children diagnosed between 1981 and 2014 with ES, were analyzed. The median age at initial cytopenia was 5.4 (0.2-17.2 years old. For 85 sequential cases, the median delay between the episodes of AIHA and ITP was 2.4 years (0.1–16.3. The median follow-up since ES diagnosis was 6.5 years (0.1-28.8. ES revealed underlying diseases in 10% of children; in 60% of patients, various associated immune manifestations were observed, and ES remained primary in 30%. Five-year ITP and AIHA relapse-free survival were respectively 25% and 61%. In all, 69% of children required one or more than one second-line immune treatment and 15 patients (10% died at a median age of 14.3 years (1.7-28.1.This national work provides the first consistent clinical description for ES and underscores the high percentage of associated immune manifestations, the long-term complications, and treatment toxicities. Current challenges include the identification of underlying genetic immune dysregulations and better characterization of subgroups of patients and of second-line therapy strategies.

  13. Long-term outcome in renal transplantation with terminal cutaneous ureterostomy.

    Science.gov (United States)

    Prieto, M; Sierra, M; de Francisco, A L; Zubimendi, J A; Montesinos, M G; de la Torriente, J; Arias, M

    1993-12-01

    We have reviewed the complications and follow-up in 6 patients who underwent kidney transplantation with cutaneous ureterostomy. Four patients had tuberculosis, 1 myelomeningocele and another congenital stenosis of the posterior urethra. Cutaneous ureterostomy was performed by suturing the edges of the distal end of the ureter to the skin. The mean follow-up was 40.6 months (range 2-105). The patient and graft survival rates were 83.3% and 66.6% respectively during the 249 months of total follow-up. Significant bacteriuria and leukocyturia were constantly present and the incidence of urinary infection was 3.1 episodes/patient/year. The early complications of the stoma were partial necrosis in 1 case and haematoma in another. The most frequent late complication was stomal stenosis requiring periodic dilatation. A plasma creatinine of 61.88 to 114.92 mumol/l reflected good long-term graft function in the remaining patients. Terminal cutaneous ureterostomy is a simple technique with good long-term results.

  14. Soft tissue profile changes following mandibular advancement surgery: predictability and long-term outcome.

    Science.gov (United States)

    Mobarak, K A; Espeland, L; Krogstad, O; Lyberg, T

    2001-04-01

    The objectives of this cephalometric study were to assess long-term changes in the soft tissue profile following mandibular advancement surgery and to investigate the relationship between soft tissue and hard tissue movements. The sample consisted of 61 patients treated consecutively for mandibular retrognathism with orthodontic therapy combined with bilateral sagittal split osteotomy and rigid fixation. Lateral cephalograms were taken on 6 occasions: immediately before surgery, immediately after surgery, 2 and 6 months after surgery, and 1 and 3 years after surgery. Postsurgical changes in the upper and the lower lips and the mentolabial fold were more pronounced among low-angle cases compared with high-angle cases. In accordance with other studies, the soft tissue chin and the mentolabial fold were generally found to follow their underlying skeletal structures in a 1:1 ratio. Because of the strong influence skeletal relapse has on soft tissue profile changes, alternative ratios of soft tissue-to-hard tissue movement that accounted for mean relapse were also generated. It is suggested that if a more realistic long-term prediction of the postsurgical soft tissue profile is desirable, then ratios incorporating mean relapse should be used rather than estimates based on a 1:1 relationship.

  15. The long term outcome of feminizing genital surgery for congenital adrenal hyperplasia: anatomical, functional and cosmetic outcomes, psychosexual development, and satisfaction in adult female patients.

    NARCIS (Netherlands)

    Stikkelbroeck, M.M.L.; Beerendonk, C.C.M.; Willemsen, W.N.P.; Schreuders-Bais, C.; Feitz, W.F.J.; Rieu, P.N.M.A.; Hermus, A.R.M.M.; Otten, B.J.

    2003-01-01

    BACKGROUND: There are only a few reports analyzing the long term outcome of feminizing surgery in females with congenital adrenal hyperplasia (CAH). Such analysis is crucial to evaluate the treatment and to make necessary adjustments. STUDY OBJECTIVES: To evaluate the adult outcome after feminizing

  16. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma - A systematic review

    NARCIS (Netherlands)

    Clement, S. C.; Peeters, R. P.; Ronckers, C. M.; Links, T. P.; van den Heuvel-Eibrink, M. M.; van Dijkum, E. J. M. Nieveen; van Rijn, R. R.; van der Pal, H. J. H.; Neggers, S. J.; Kremer, L. C. M.; van Eck-Smit, B. L. F.; van Santen, H. M.

    2015-01-01

    Background: Treatment of differentiated thyroid carcinoma (DTC) often involves administration of radioactive iodine (I-131) for remnant ablation or adjuvant therapy. As DTC has favorable outcome and the incidence is increasing, concerns have been raised about the possible adverse effects of I-131 th

  17. Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma - A systematic review

    NARCIS (Netherlands)

    Clement, S C; Peeters, R P; Ronckers, C M; Links, T P; van den Heuvel-Eibrink, M M; Nieveen van Dijkum, E J M; van Rijn, R R; van der Pal, H J H; Neggers, S J; Kremer, L C M; van Eck-Smit, B L F; van Santen, H M

    2015-01-01

    BACKGROUND: Treatment of differentiated thyroid carcinoma (DTC) often involves administration of radioactive iodine (I-131) for remnant ablation or adjuvant therapy. As DTC has favorable outcome and the incidence is increasing, concerns have been raised about the possible adverse effects of I-131 th

  18. Circulating DNG level is negatively associated with the long-term survival of hepatocellular carcinoma patients

    Institute of Scientific and Technical Information of China (English)

    Ning Ren; Qing-Hai Ye; Lun-Xiu Qin; Bo-Heng Zhang; Yin-Kun Liu; Zhao-You Tang

    2006-01-01

    AIM: To quantify the circulating DNA in plasma from patients with hepatocellular carcinoma (HCC) and to evaluate its prognostic value.METHODS: Blood samples were collected from 79patients with HCC before operation, 20 patients with liver cirrhosis, and 20 healthy volunteers. Circulating DNA was extracted from plasma and quantified. The association between circulating DNA level and prognosis of HCC patients was evaluated.RESULTS: Compared with the healthy volunteers (17.6± 9.5 ng/mL), a significant higher circulating DNA level was found in the patients with HCC (47.1±43.7 ng/mL, P = 0.000) or with liver cirrhosis (30.0 ± 13.3 ng/mL, P = 0.002). The circulating DNA level was closely associated with tumor size (P = 0.008) and TNM stage (P = 0.040), negatively associated with the 3-year diseasefree survival (DFS) (P = 0.017) and overall survival (OS) (P = 0.001).CONCLUSION: Large or invasive tumor may release more circulating DNA, and higher level of circulating DNA may be associated with poor prognosis of HCC patients.

  19. Impact of Right-Sided Nephrectomy on Long-Term Outcomes in Retroperitoneoscopic Live Donor Nephrectomy at Single Center

    Directory of Open Access Journals (Sweden)

    Kazuya Omoto

    2013-01-01

    Full Text Available Objective. To assess the long-term graft survival of right-sided retroperitoneoscopic live donor nephrectomy (RPLDN, we compared the outcomes of right- and left-sided RPLDN. Methods. Five hundred and thirty-three patients underwent live donor renal transplantation with allografts procured by RPLDN from July 2001 to August 2010 at our institute. Of these, 24 (4.5% cases were selected for right-sided RPLDN (R-RPLDN according to our criteria for donor kidney selection. Study variables included peri- and postoperative clinical data. Results. No significant differences were found in the recipients' postoperative graft function and incidence of slow graft function. Despite significant increased warm ischemic time (WIT: mean 5.9 min versus 4.7 min, in R-RPLDN compared to that in L-RPLDN, there was no significant difference between the two groups regarding long-term patient and graft survival. The complication rate in R-RPLDN was not significantly different compared to that in L-RPLDN (17% versus 6.5%, . No renal vein thrombosis was experienced in either groups. Conclusions. Although our study was retrospective and there was only a small number of R-RPLDN patients, R-RPLDN could be an option for laparoscopic live donor nephrectomy because of similar results, with the sole exception of WIT, in L-RPLDN, and its excellent long-term graft outcomes.

  20. Long-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia.

    LENUS (Irish Health Repository)

    Doodnath, Reshma

    2012-02-01

    BACKGROUND: Internal anal sphincter achalasia (IASA) is a condition with presentation similar to Hirschsprung\\'s disease (HD), but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made on anorectal manometry (ARM) by the absence of the rectosphincteric reflex on rectal balloon inflation. Internal sphincter myectomy (ISM) is the treatment of choice for patients with IASA. Recently, botulinum toxin has been used to treat IASA patients. The purpose of this study was to assess the long-term bowel function in patients with IASA following ISM. METHODS: The medical records of 24 patients with IASA managed by ISM during 1993-2005 were examined. There were 18 boys and 6 girls, aged 2-12 years. All patients presented with intractable constipation with or without soiling. The diagnosis was made by the demonstration of the absence of the rectosphincteric reflex on ARM. HD was excluded by the presence of ganglion cells and normal acetylcholinesterase activity in RSB. Patients were followed 4-14 years later. RESULTS: Fifteen (62.5%) patients at the time of follow-up had regular bowel motions without the use of laxatives. Six (25%) patients had regular bowel motions, but remained on small doses of laxatives. Two (8.3%) patients who suffered from constipation and soiling required twice weekly enemas to remain clean. One (4.2%) patient required resection of dilated rectosigmoid colon 3 years after myectomy, remains on laxatives, but has normal bowel control. No patients had faecal incontinence following ISM. CONCLUSION: This long-term follow-up study shows that the vast majority of IASA patients have normal bowel control following ISM.

  1. Islet transplantation in type 1 diabetes: ongoing challenges, refined procedures, and long-term outcome.

    Science.gov (United States)

    Shapiro, A M James

    2012-01-01

    Remarkable progress has been made in islet transplantation over a span of 40 years. Once just an experimental curiosity in mice, this therapy has moved forward, and can now provide robust therapy for highly selected patients with type 1 diabetes (T1D), refractory to stabilization by other means. This progress could not have occurred without extensive dynamic international collaboration. Currently, 1,085 patients have undergone islet transplantation at 40 international sites since the Edmonton Protocol was reported in 2000 (752 allografts, 333 autografts), according to the Collaborative Islet Transplant Registry. The long-term results of islet transplantation in selected centers now match registry data of pancreas-alone transplantation, with 6 sites reporting five-year insulin independence rates ≥50%. Islet transplantation has been criticized for the use of multiple donor pancreas organs, but progress has also occurred in single-donor success, with 10 sites reporting increased single-donor engraftment. The next wave of innovative clinical trial interventions will address instant blood-mediated inflammatory reaction (IBMIR), apoptosis, and inflammation, and will translate into further marked improvements in single-donor success. Effective control of auto- and alloimmunity is the key to long-term islet function, and high-resolution cellular and antibody-based assays will add considerable precision to this process. Advances in immunosuppression, with new antibody-based targeting of costimulatory blockade and other T-B cellular signaling, will have further profound impact on the safety record of immunotherapy. Clinical trials will move forward shortly to test out new human stem cell derived islets, and in parallel trials will move forward, testing pig islets for compatibility in patients. Induction of immunological tolerance to self-islet antigens and to allografts is a difficult challenge, but potentially within our grasp.

  2. Long-term outcome of anti-glomerular basement membrane antibody disease treated with immunoadsorption.

    Directory of Open Access Journals (Sweden)

    Peter Biesenbach

    Full Text Available Anti-glomerular basement membrane (GBM antibody disease may lead to acute crescentic glomerulonephritis with poor renal prognosis. Current therapy favours plasma exchange (PE for removal of pathogenic antibodies. Immunoadsorption (IAS is superior to PE regarding efficiency of antibody-removal and safety. Apart from anecdotal data, there is no systemic analysis of the long-term effects of IAS on anti-GBM-disease and antibody kinetics.To examine the long-term effect of high-frequency IAS combined with standard immunosuppression on patient and renal survival in patients with anti-GBM-disease and to quantify antibody removal and kinetics through IAS.Retrospective review of patients treated with IAS for anti-GBM-antibody disease confirmed by biopsy and/or anti-GBM-antibodies.University Hospital of Vienna, Austria.10 patients with anti-GBM-disease treated with IAS.Patient and renal survival, renal histology, anti-GBM-antibodies.Anti-GBM-antibodies were reduced by the first 9 IAS treatments (mean number of 23 to negative levels in all patients. Renal survival was 40% at diagnosis, 70% after the end of IAS, 63% after one year and 50% at the end of observation (mean 84 months, range 9 to 186. Dialysis dependency was successfully reversed in three of six patients. Patient survival was 90% at the end of observation.IAS efficiently eliminates anti-GBM-antibodies suggesting non-inferiority to PE with regard to renal and patient survival. Hence IAS should be considered as a valuable treatment option for anti-GBM-disease, especially in patients presenting with a high percentage of crescents and dialysis dependency due to an unusual high proportion of responders.

  3. Protein Carbamylation in Chronic Systolic Heart Failure: Relation to Renal Impairment and Adverse Long-Term Outcomes

    Science.gov (United States)

    Wilson Tang, W. H.; Shrestha, Kevin; Wang, Zeneng; Borowski, Allen G.; Troughton, Richard W.; Klein, Allan L.; Hazen, Stanley L.

    2013-01-01

    Background Protein carbamylation, a post-translational modification promoted during uremia and catalyzed by myeloperoxidase (MPO) at sites of inflammation, is linked to altered protein structure, vascular dysfunction, and poor prognosis. We examine the relationship between plasma protein-bound homocitrulline (PBHCit) levels, a marker of protein lysine residue carbamylation, with cardio-renal function and long-term outcomes in chronic systolic heart failure. Methods and Results In 115 patients with chronic systolic HF (LVEF≤35%), we measured plasma PBHCit by quantitative mass spectrometry and performed comprehensive echocardiography with assessment of cardiac structure and performance. Adverse long-term events (death, cardiac transplant) were tracked for 5 years. In our study cohort, the median PBHCit level was 87 [IQR: 59, 128] μmol/mol Lysine. Higher plasma PBHcit levels were associated with poorer renal function (eGFR Spearman’s r= −0.37, p0.10 for each). Furthermore, elevated plasma PBHCit levels were not related to indices of cardiac structure or function (p>0.10 for all examined) except modestly with increased right atrial volume index (RAVi; r=0.31, p=0.002). PBHCit levels predicted adverse long-term events (Hazard ratio [HR]: 1.8, 95% CI 1.3– 2.6, p<0.001), including following adjustment for age, eGFR, MPO and NT-proBNP (HR: 1.9, 95% CI: 1.2–3.1, p=0.006). Conclusions In chronic systolic HF, protein carbamylation is associated with poorer renal but not cardiac function, and portends poorer long-term adverse clinical outcomes even when adjusted for cardio-renal indices of adverse prognosis. PMID:23582087

  4. Predictors of long-term clinical outcome of patients with acute massive pulmonary embolism after thrombolytic therapy

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective To assess the in-hospital clinical course and the long-term evolution of acute massive pulmonary embolism after thrombolytic therapy and to identify predictors of adverse clinical outcome.Methods A total of 260 patients hospitalized from January 1989 to October 1998 were retrospectively reviewed and followed up for 3.9 to 8.4 years. Baseline characteristics and variables pre- and post-thrombolysis were identified. Particular attention was paid to the clinical events, including death, recurrent thromboembolism, chronic thromboembolic pulmonary hypertension, and major bleeding attributable to the use of anticoagulants. Kaplan-Meier event-free survival curves were generated. Univariate analysis by means of the log-rank test was used to test each candidate variable for association with clinical outcome. Multivariate analysis with the Cox proportional hazard model was used to determine independent predictors of the long-term outcome.Results The in-hospital mortality rate was 8.5%, with 68.2% due to pulmonary embolism itself, and the follow-up mortality rate was 31.7%, with 29.2% due to recurrent embolism. Factors associated with an adverse outcome in univariate analysis were: (1) prior thromboembolic diseases; (2) duration of anticoagulant therapy 50 mmHg after thrombolysis; and (6) greater than 30% obstruction of pulmonary vasculature identified by pulmonary ventilation/perfusion scintigraphy before hospital discharge. Multivariate analysis identified three independent predictors of poor long-term outcome for patients with acute massive pulmonary embolism after thrombolysis; which were: (1) Doppler recording of pulmonary artery systolic pressure >50 mmHg, with relative risk of 3.78 and a 95% confidence interval of 2.70 to 4.86; (2) echocardiographic evidence of right ventricular dysfunction/dilatation (relative risk: 2.18; 95% confidence interval: 1.48 to 2.88); and (3) greater than 30% obstruction of pulmonary vasculature documented by lung scan (relative

  5. Does gender influence the long-term outcome of single-event multilevel surgery in spastic cerebral palsy?

    Science.gov (United States)

    Zwick, Ernst B; Svehlík, Martin; Kraus, Tanja; Steinwender, Gerhard; Linhart, Wolfgang E

    2012-09-01

    This study compared the long-term outcome of single-event multilevel surgery in spastic diplegic cerebral palsy (CP) on the basis of sex. We hypothesized that boys would have a worse outcome than girls. Thirty-four children (19 boys and 15 girls) with diplegic spastic CP and a minimal follow-up of 10 years were included. The Gillette Gait Index was the main outcome measure. We found no differences in surgical treatment, and both groups initially benefited from the surgery. However, although girls maintained the enhanced level of walking, walking ability in boys deteriorated constantly. Such a finding suggests that sex might have an important influence on treatment outcomes in children with CP.

  6. Hypothesis of Long-Term Outcome after Coronary Revascularization in Japanese Patients Compared to Multiethnic Groups in the US.

    Directory of Open Access Journals (Sweden)

    Taku Inohara

    Full Text Available Ethnicity has a significant impact on coronary artery disease (CAD. This study investigated the long-term outcomes of Japanese patients undergoing revascularization compared with US patients belonging to multiple ethnic groups.We evaluated clinical outcomes, based on ethnicity, of patients included in the Coronary Revascularization Demonstrating Outcome (CREDO-Kyoto and the Texas (US Heart Institute Research Database (THIRDBase registries. For the analysis, we included 8871 patients from the CREDO-Kyoto registry (median follow-up period [FU], 3.5 years; interquartile range [IQR], 2.6-4.3 and 6717 patients from the THIRDBase registry (FU, 5.2 years; IQR, 3.8-6.5 who underwent percutaneous coronary intervention or bypass surgery. Cox proportional hazard models were constructed to compare the adjusted long-term outcomes for each ethnic group. A total of 8871 Japanese, 5170 Caucasians, 648 African-Americans, 817 Hispanics, and 82 Asian-Americans were identified. When adjusted, Japanese patients had significantly better outcomes than US patients, classified by ethnicity (Caucasians: hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.35-1.79; Hispanics: HR, 1.53; 95% CI, 1.22-1.93; African-Americans: HR, 2.03; 95% CI, 1.62-2.56, except for Asian-Americans (HR, 0.84; 95% CI. 0.38-1.89 who had outcomes similar to Japanese patients.Our findings indicate better survival outcomes in re-vascularized Japanese CAD patients compared to major ethnic groups in the US, including Caucasian, Hispanic, and African-American CAD patients. The characteristics and outcomes of Japanese CAD patients were similar to those of Asian-Americans, despite the sample size limitations in the US dataset.

  7. Resultados a longo prazo da cirurgia da otosclerose Long term outcome of otosclerosis surgery

    Directory of Open Access Journals (Sweden)

    Maria Teresa Bernardo

    2012-08-01

    Full Text Available O tratamento da otosclerose é preferencialmente cirúrgico e consiste na estapedotomia/estapedectomia, cujos bons resultados imediatos estão bem documentados. OBJETIVOS: Avaliar os resultados audiométricos da cirurgia da otosclerose a longo prazo. Desenho: Estudo retrospectivo. MATERIAL E MÉTODOS: Incluíram-se os doentes submetidos à estapedotomia/estapedectomia parcial no nosso Serviço e melhoria da audição pós-operatória comprovada. Convocaram-se os doentes para reavaliação audiométrica e compareceram 41 (47 ouvidos. Compararam-se os valores obtidos com os prévios à cirurgia e do pós-operatório imediato. RESULTADOS: A mediana do seguimento tardio foi de 11 anos. Nesta data, 49% dos doentes tinham audição normal ou um grau de hipoacusia ligeira. Os valores médios dos PTA (Pure Tone Average aéreo e ósseo, pré, pós e pós-operatório tardio foram 64,4 e 27,0 dB, 35,6 e 22,3 dB e 44,1 e 29,5 dB, respectivamente. CONCLUSÃO: A cirurgia da otosclerose tem bons resultados a longo prazo porque, apesar do agravamento dos limiares, o grau de hipoacusia, 10 anos depois, é inferior ao pré-operatório.The treatment of otosclerosis is eminently surgical. Good immediate results have been well documented when stapedotomy or stapedectomy are chosen. OBJECTIVES: This study aims to assess long term audiometric performance after otosclerosis surgery. MATERIALS AND METHODS: this retrospective study enrolled stapedotomy and partial stapedectomy patients seen at our service with proven hearing improvement after surgery. Forty-one patients (47 ears accepted the invitation to be reassessed. Audiometry results before and immediately after surgery were compared. RESULTS: the median late follow-up was 11 years. To this date, 49% of the patients had normal hearing or mild dysacusis. Preoperative, postoperative, and late postoperative bone and air pure tone averages were 64.4 and 27.0 dB, 35.6 and 22.3 dB, and 44.1 and 29.5 dB respectively

  8. Long-term treatment outcome of two patients with pyridoxine-dependent epilepsy caused by ALDH7A1 mutations: normal neurocognitive outcome.

    Science.gov (United States)

    Nasr, Enas; Mamak, Eva; Feigenbaum, Anette; Donner, Elizabeth J; Mercimek-Mahmutoglu, Saadet

    2015-04-01

    Pyridoxine-dependent epilepsy is an autosomal recessively inherited disorder of lysine catabolism caused by mutations in the ALDH7A1 gene. We report 2 patients with normal neurocognitive outcome (full-scale IQ of 108 and 74) and their more than 10 years' treatment outcome on pyridoxine monotherapy. Both patients had specific borderline impairments in visual processing speed. More long-term treatment outcome reports will increase our knowledge about the natural history of the disease.

  9. Polyvascular Disease and Long-term Cardiovascular Outcomes in Older Patients with Non–ST-segment Elevation Myocardial Infarction

    Science.gov (United States)

    Subherwal, Sumeet; Bhatt, Deepak L.; Li, Shuang; Tracy Y., Wang; Thomas, Laine; Alexander, Karen P.; Patel, Manesh R.; Ohman, E. Magnus; Gibler, W. Brian; Peterson, Eric D.; Roe, Matthew T.

    2013-01-01

    Background The impact of polyvascular disease (peripheral arterial disease [PAD] and/or cerebrovascular disease [CVD]) on long-term cardiovascular outcomes among older patients with acute myocardial infarction (MI) has not been well studied. Methods Non–ST-elevation MI (NSTEMI) patients aged ≥65 years from the CRUSADE registry who survived to hospital discharge were linked to longitudinal data from the Centers for Medicare and Medicaid Services (n=34,205). All patients were presumed to have coronary artery disease (CAD) and were classified into 4 groups: 10.7% had prior CVD (CAD+CVD group); 11.5% had prior PAD (CAD+PAD); 3.1% had prior PAD and CVD (CAD+PAD+CVD); and 74.7% had no polyvascular disease (CAD alone). Cox proportional hazard modeling was used to examine the hazard of long-term mortality and the composite of death, readmission for MI, or readmission for stroke (median follow-up 35 months, IQR 17–49) among the 4 groups. Results Compared with the CAD-alone group, patients with polyvascular disease had a greater comorbidity burden, were less likely to undergo revascularization, and less often received recommended discharge interventions. Three-year mortality rates increased with a greater number of arterial beds involved: 33% for CAD alone, 49% for CAD+PAD, 52% for CAD+CVD, and 59% for CAD+PAD+CVD. Relative to the CAD-alone group, patients with all 3 arterial beds involved had the highest risk of long-term mortality (adjusted HR [95% CI]: 1.49 [1.38–1.61], with a lower risk for those with CAD+CVD, 1.38 [1.31–1.44], and those with CAD+PAD, 1.29 [1.23–1.35]). Similarly, the adjusted risk of long-term composite ischemic events was highest among the CAD+PAD+CVD group. Conclusions Older NSTEMI patients with polyvascular disease have substantially higher long-term risk, such that the 3-year mortality rate is >50%. Future studies targeting greater adherance to secondary prevention strategies and novel therapies are needed to help reduce long-term

  10. Immediate, intermediate and long term clinical outcomes of percutaneous transvenous mitral commissurotomy

    Directory of Open Access Journals (Sweden)

    Satya Narayana Murthy Jayanthi Sriram

    2015-03-01

    Conclusions: MV score, Mitral valve area, mitral gradient and pulmonary artery pressures appeared to influence the outcome of PTMC. A clear-cut prospective assessment of individual components of the mitral valve apparatus using 3-D echocardiographic images may provide a more precise prediction of the PTMC outcome based on its morphological abnormalities.

  11. Long-Term Outcome for People with Severe Intellectual Disabilities: Impact of Social Impairment

    Science.gov (United States)

    Beadle-Brown, Julie; Murphy, Glynis; Wing, Lorna

    2005-01-01

    Results from a 25-year follow-up study of the Camberwell Cohort (L. Wing & Gould, 1978, 1979) were presented. Ninety-one people, ranging in age from 27 to 41 years, were traced, and an outcome measure was developed incorporating independent functioning, residential placement, employment, and quality of life. Outcome was rated as either poor…

  12. Long term outcome of an attachment-based program for conduct disorder.

    Science.gov (United States)

    Moretti, M M; Holland, R; Peterson, S

    1994-08-01

    There is increasing concern among professionals and the public about the level of violence and antisocial behaviour among our youth. This has been coupled with confusion and a sense of helplessness about which types of interventions are most effective in responding to these difficulties. Some professionals and advocacy groups are calling for tougher disciplinary responses to violence and antisocial behaviour, including changes in the Young Offenders Act. Yet, such interventions are rarely effective in producing the desired reductions in these behaviours. Other professionals have called for better forms of treatment. However, few treatments have been shown to be effective in bringing about long term reductions either in aggressive behaviour or in the concomitant psychological difficulties experienced by these youths. In this paper, a description is presented of an approach to understanding conduct disorder that focuses on attachment as an organizing principle of behaviour and affect. Also, a description is presented of a community-oriented program that is based on attachment theory, as well as the results of the program evaluation at six, 12 and 18 months following discharge. The findings replicate and extend earlier findings reported by Holland et al (1) on the effectiveness of this approach.

  13. Treatment of central precocious puberty by GnRH analogs:long-term outcome in men

    Institute of Scientific and Technical Information of China (English)

    Silvano Bertelloni; Dick Mul

    2008-01-01

    In boys, central precocious puberty (CPP) is the appearance of secondary sex characteristics driven by pituitary gonadotropin secretion before the age of 9 years. In the last years, relevant improvements in the treatment of CPP have been achieved. Because CPP is rare in boys, the majority of papers on this issue focus on girls and do not address specific features of male patients regarding end results and safety. In the present paper, recent advances of CPP management with GnRH analogs in men are summarized. End results in untreated and treated patients are also reviewed by an analysis of the recently published literature on treatment of CPP in men. The available data indicate that therapy with GnRH analogs can improve final height into the range of target height without significant adverse short-term and long-term effects, but longer follow-up of larger series of patients is still required to draw definitive conclusions. (Asian J Androl 2008 Jul; 10: 525-534)

  14. Successful outcomes of cochlear implantation in long-term unilateral deafness: brain plasticity?

    Science.gov (United States)

    Távora-Vieira, Dayse; Boisvert, Isabelle; McMahon, Catherine M; Maric, Vesna; Rajan, Gunesh P

    2013-09-11

    To investigate the implications of duration of deafness in the rehabilitation of unilateral deafness utilizing cochlear implantation. From the ongoing prospective cochlear implantation in unilateral deafness study, we looked at five adults who received a cochlear implant for long-term unilateral deafness. Speech perception in noise and subjective evaluation of the benefits of cochlear implantation were measured at 3, 6, and 12 months after implantation. The results were analyzed and compared with published data from normal hearing individuals and adults using cochlear implants bilaterally. Analysis of speech perception in noise showed significant improvement for three spatial configurations: speech and noise from the front (S0/N0; P=0.003), speech from the front and noise from the normal hearing ear (S0/NHE; P=0.001), speech from the implanted ear, and noise from the normal hearing ear (SCI/NHE; Pdeafness obtained scores in speech perception testing and in subjective evaluation that are similar to those attained by individuals with normal hearing and/or those with bilateral cochlear implants. Therefore, patients with postlingual unilateral deafness should not be excluded as cochlear implant candidates on the basis of a long duration of deafness.

  15. Steatosis influences the clinical profiles and long-term outcomes of interferon-treated chronic hepatitis C and liver cirrhosis patients

    Science.gov (United States)

    Nirei, Kazushige; Matsumura, Hiroshi; Kumakawa, Mariko; Matsumoto, Naoki; Nakamura, Hitomi; Yamagami, Hiroaki; Matsuoka, Shunichi; Moriyama, Mitsuhiko

    2017-01-01

    Objective: This study aimed to assess the relationship between steatosis and long-term outcomes of patients with chronic hepatitis C (CH) and liver cirrhosis (LC). Patients and methods: The study population included 282 subjects with CH or LC who underwent liver biopsy at our institute. All patients achieved a sustained virological response (SVR) to interferon (IFN). Clinical characteristics, including age, gender and body mass index (BMI), were compared. The liver biopsy specimens of all patients were examined and scores were assigned to indicate the severity of each of the following features: inflammatory cell infiltration in the periportal, parenchymal and portal areas; F (fibrosis) stage; portal sclerotic change; perivenular fibrosis; pericellular fibrosis; bile duct damage; hepatic steatosis. Results: Of the 282 patients, 112 (39.7%) were free of steatosis. The other 170 patients (60.3%) had steatosis. The blood biochemical parameters of the patients with hepatic steatosis were significantly poorer than those of patients free of steatosis. Inflammatory cell infiltration and F stage were both significantly more severe in patients with than in those without steatosis. The incidences of hepatocellular carcinoma differed significantly between the two groups. However, the incidences of hepatocellular carcinoma did not differ significantly between the groups with BMI above and below 25. Conclusion: We consider hepatic steatosis to potentially affect the blood biochemical parameters and clinical profiles of Japanese patients with CH due to hepatitis virus type C. Patients with this form of CH showed favorable clinical responses to IFN. Furthermore, fibrosis and steatosis appear to affect the long-term outcomes of these patients. However, BMI alone cannot be used to predict HCC development. PMID:28138308

  16. Clinical Long-Term Outcome and Reinterventional Rate After Uterine Fibroid Embolization with Nonspherical Versus Spherical Polyvinyl Alcohol Particles

    Energy Technology Data Exchange (ETDEWEB)

    Duvnjak, Stevo, E-mail: stevo.duvnjak@rsyd.dk [Odense University Hospital, Department of Radiology (Denmark); Ravn, Pernille [Odense University Hospital, Department of Gynecology (Denmark); Green, Anders [Odense University Hospital, Odense Patient Data Explorative Network (Denmark); Andersen, Poul Erik [Odense University Hospital, Department of Radiology (Denmark)

    2016-02-15

    PurposeThis study was designed to evaluate the long-term clinical outcome and frequency of reinterventions in patients with uterine fibroids treated with embolization at a single center using polyvinyl alcohol microparticles.MethodsThe study included all patients with symptomatic uterine fibroids treated with uterine fibroid embolization (UFE) with spherical (s-PVA) and nonspherical (ns-PVA) polyvinyl alcohol microparticles during the period January 2001 to January 2011. Clinical success and secondary interventions were examined. Hospital records were reviewed during follow-up, and symptom-specific questionnaires were sent to all patients.ResultsIn total, 515 patients were treated with UFE and 350 patients (67 %) were available for long-term clinical follow-up. Median time of follow-up was 93 (range 76–120.2) months. Eighty-five patients (72 %) had no reinterventions during follow-up in the group embolized with ns-PVA compared with 134 patients (58 %) treated with s-PVA. Thirty-three patients (28 %) underwent secondary interventions in the ns-PVA group compared with 98 patients (42 %) in s-PVA group (χ{sup 2} test, p < 0.01).ConclusionsSpherical PVA particles 500–700 µm showed high reintervention rate at long-term follow-up, and almost one quarter of the patients underwent secondary interventions, suggesting that this type of particle is inappropriate for UFE.

  17. The Value of Median Nerve Sonography as a Predictor for Short- and Long-Term Clinical Outcomes in Patients with Carpal Tunnel Syndrome: A Prospective Long-Term Follow-Up Study

    Science.gov (United States)

    Marschall, Alexander; Ficjian, Anja; Husic, Rusmir; Zauner, Dorothea; Seel, Werner; Simmet, Nicole E.; Klammer, Alexander; Heizer, Petra; Brickmann, Kerstin; Gretler, Judith; Fürst-Moazedi, Florentine C.; Thonhofer, Rene; Hermann, Josef; Graninger, Winfried B.; Quasthoff, Stefan; Dejaco, Christian

    2016-01-01

    Objectives To investigate the prognostic value of B-mode and Power Doppler (PD) ultrasound of the median nerve for the short- and long-term clinical outcomes of patients with carpal tunnel syndrome (CTS). Methods Prospective study of 135 patients with suspected CTS seen 3 times: at baseline, then at short-term (3 months) and long-term (15–36 months) follow-up. At baseline, the cross-sectional area (CSA) of the median nerve was measured with ultrasound at 4 levels on the forearm and wrist. PD signals were graded semi-quantitatively (0–3). Clinical outcomes were evaluated at each visit with the Boston Questionnaire (BQ) and the DASH Questionnaire, as well as visual analogue scales for the patient’s assessment of pain (painVAS) and physician’s global assessment (physVAS). The predictive values of baseline CSA and PD for clinical outcomes were determined with multivariate logistic regression models. Results Short-term and long-term follow-up data were available for 111 (82.2%) and 105 (77.8%) patients, respectively. There was a final diagnosis of CTS in 84 patients (125 wrists). Regression analysis revealed that the CSA, measured at the carpal tunnel inlet, predicted short-term clinical improvement according to BQ in CTS patients undergoing carpal tunnel surgery (OR 1.8, p = 0.05), but not in patients treated conservatively. Neither CSA nor PD assessments predicted short-term improvement of painVAS, physVAS or DASH, nor was any of the ultrasound parameters useful for the prediction of long-term clinical outcomes. Conclusions Ultrasound assessment of the median nerve at the carpal tunnel inlet may predict short-term clinical improvement in CTS patients undergoing carpal tunnel release, but long-term outcomes are unrelated to ultrasound findings. PMID:27662617

  18. Long-term outcomes in idiopathic membranous nephropathy using a restrictive treatment strategy

    NARCIS (Netherlands)

    Brand, J. van den; Dijk, P.R. van; Hofstra, J.M.; Wetzels, J.F.M.

    2014-01-01

    Recently published Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend limiting the use of immunosuppressive drugs in idiopathic membranous nephropathy to patients at the highest risk of kidney failure. However, recommendations are based on natural history rather than direct assess

  19. Reconstructive surgery for hypospadias: A systematic review of long-term patient satisfaction with cosmetic outcomes

    Directory of Open Access Journals (Sweden)

    Julie Adams

    2016-01-01

    Conclusions: Protocols for clinical postpuberty follow-up and methodologically sound studies, using validated assessment tools, are required for the accurate assessment of cosmetic and psychological outcomes of hypospadias surgery.

  20. Functional, psychosocial and professional outcomes in long-term survivors of lower-extremity osteosarcomas: amputation versus limb salvage.

    Science.gov (United States)

    Ottaviani, Giulia; Robert, Rhonda S; Huh, Winston W; Jaffe, Norman

    2009-01-01

    As the number of osteosarcoma survivors increases, the impact of quality of life and function needs to be addressed. Limb salvage is the preferred treatment when patients have treatment options; yet, the questionable long-term durability and complications of prostheses, combined with ambiguous function, leave some doubt regarding the best clinical and surgical options. Comparisons between limb salvage patients, amputees and controls also require further investigation. Amputation would leave the patients with a lifelong requirement for an external prosthetic leg associated with an overall limited walking distance. While artificial limbs are much more sophisticated than those used in the past, phantom limb sensations remain a substantial and unpredictable problem in the amputee. Complications such as stump overgrowth, bleeding, and infection, also require further elucidation. Limb salvage surgery using endoprosthesis, allografts or reconstruction is performed in approximately 85% of patients affected by osteosarcoma located in the middle and/or distal femur. One drawback in limb-salvage surgery in the long-term survivor is that endoprostheses have a limited life span with long-term prosthetic failure. The inherent high rate of reoperation remains a serious problem. Replacing a damaged, infected or severely worn-out arthroplastic joint or its intramedullary stem is difficult, especially in the long-stem cemented endoprostheses used in the 1980s. Limb lengthening procedures in patients who have not reached maturity must also be addressed. Periprosthetic infections, compared to other indications for joint reconstruction, were found to be more frequent in patients treated for neoplastic conditions and their outcome can be devastating, resulting in total loss of joint function, amputation, and systemic complications. Quality of life in terms of function, psychological outcome and endpoint achievements such as marriage and employment apparently do not differ significantly

  1. Long-term outcome in patients treated with sirolimus-eluting stents in complex coronary artery lesions

    DEFF Research Database (Denmark)

    Kelbaek, Henning; Kløvgaard, Lene; Helqvist, Steffen;

    2008-01-01

    data of the long-term outcome of patients with complex coronary artery lesions. METHODS: We randomly assigned 322 patients with total coronary occlusions or lesions located in bifurcations, ostial, or angulated segments of the coronary arteries to have SES or BMS implanted. RESULTS: At 3 years, major...... benefit was observed up to 3 years after implantation of SES in patients with complex coronary artery lesions. The rate of late adverse events was similar in the 2 groups, and stent thromboses occurred rarely after 1 year. (Sirolimus Eluting Stents in Complex Coronary Lesions [SCANDSTENT]; NCT00151658)...

  2. Long-term outcomes of peroral endoscopic myotomy for patients with achalasia: a retrospective single-center study.

    Science.gov (United States)

    Guo, H; Yang, H; Zhang, X; Wang, L; Lv, Y; Zou, X; Ling, T

    2017-05-01

    Peroral endoscopic myotomy (POEM) has been widely applied to the treatment of achalasia. The aim of this study is to retrospectively investigate the long-term outcome of POEM in patients with achalasia. Patients undergoing POEM at our center with a minimum follow-up of 3 years were enrolled in this study. Relief of patients' symptom was defined as the primary outcome. Secondary outcomes included lower esophageal sphincter pressure, esophageal emptying, symptoms relapse, and clinical reflux adverse events. The Chi-square test was performed to determine the potential predictors of surgical failure. Sixty-seven patients (aged 40.7 ± 15.3 years) were recruited in the study, with a mean follow-up period of 40.1 ± 2.8 months. At the final follow-up, the median Eckardt score reduced from 7.6 ± 2.3 preoperatively to 1.9 ± 1.7 (P POEM was a promising treatment for patients with achalasia, which can yield a long-term relief of the symptom and a low rate of clinical reflux adverse events.

  3. Long term outcomes in children with steroid resistant nephrotic syndrome treated with calcineurin inhibitors

    Directory of Open Access Journals (Sweden)

    Nathan T Beins

    2015-11-01

    Full Text Available Background: Steroid resistant nephrotic syndrome (SRNS is an important cause of chronic kidney disease (CKD in children that often progresses to end-stage renal disease (ESRD. Calcineurin inhibitors (CNIs have been shown to be effective in inducing short-term remission in some patients with SRNS. However, there are little data examining their long-term impact on ESRD progression rates.Methods: We performed a retrospective chart review of all patients treated for SRNS with CNIs at our institution from 1995-2013. Data collected including demographics, initial response to medical therapy, number of relapses, progression to ESRD, and treatment complications.Results: A total of 16 patients met inclusion criteria with a mean follow-up of 6.6 years (range 0.6-17.6 years. Histopathological diagnoses were focal segmental glomerulosclerosis (8, mesangial proliferative glomerulonephritis (4, IgM nephropathy (3, and minimal change disease (1. Three patients (18.8% were unresponsive to CNIs while the remaining 13 (81.2% achieved remission with CNI therapy. Six patients (37.5% progressed to ESRD during the study period, three of whom did so after initially responding to CNI therapy. Renal survival rates were 87%, 71%, and 57% at 2 years, 5 years, and 10 years respectively. Non-Caucasian ethnicity was associated with progression to ESRD. Finally, a higher number of acute kidney injury episodes was associated with a lower final estimated glomerular filtration rate.Discussion: Despite the majority of SRNS patients initially responding to CNI therapy, a significant percentage still progressed to ESRD despite achieving short-term remission. Recurrent episodes of AKI may be associated with progression of CKD in SRNS patients with.

  4. Potential role of plasma myeloperoxidase level in predicting long-term outcome of acute myocardial infarction.

    Science.gov (United States)

    Kaya, Mehmet Gungor; Yalcin, Ridvan; Okyay, Kaan; Poyraz, Fatih; Bayraktar, Nilufer; Pasaoglu, Hatice; Boyaci, Bulent; Cengel, Atiye

    2012-01-01

    We investigated the prognostic importance of plasma myeloperoxidase levels in patients with ST-elevation myocardial infarction (STEMI) at long-term follow-up, and we analyzed the correlations between plasma myeloperoxidase levels and other biochemical values. We evaluated 73 consecutive patients (56 men; mean age, 56 ± 11 yr) diagnosed with acute STEMI and 46 age- and sex-matched healthy control participants. Patients were divided into 2 groups according to the median myeloperoxidase level (Group 1: plasma myeloperoxidase ≤ 68 ng/mL; and Group 2: plasma myeloperoxidase > 68 ng/mL). Patients were monitored for the occurrence of major adverse cardiovascular events (MACE), which were defined as cardiac death; reinfarction; new hospital admission for angina; heart failure; and revascularization procedures. The mean follow-up period was 25 ± 16 months. Plasma myeloperoxidase levels were higher in STEMI patients than in control participants (82 ± 34 vs 20 ± 12 ng/mL; P = 0.001). Composite MACE occurred in 12 patients with high myeloperoxidase levels (33%) and in 4 patients with low myeloperoxidase levels (11%) (P = 0.02). The incidences of nonfatal recurrent myocardial infarction and verified cardiac death were higher in the high-myeloperoxidase group. In multivariate analysis, high plasma myeloperoxidase levels were independent predictors of MACE (odds ratio = 3.843; <95% confidence interval, 1.625-6.563; P = 0.003). High plasma myeloperoxidase levels identify patients with a worse prognosis after acute STEMI at 2-year follow-up. Evaluation of plasma myeloperoxidase levels might be useful in determining patients at high risk of death and MACE who can benefit from further aggressive treatment and closer follow-up.

  5. Leisure time physical activity and long-term cardiovascular and cancer outcomes: the Busselton Health Study.

    Science.gov (United States)

    Gunnell, Anthony S; Knuiman, Matthew W; Divitini, Mark L; Cormie, Prue

    2014-11-01

    The study aimed to investigate whether meeting leisure time physical activity recommendations was associated with reduced incident and fatal cancer or cardiovascular disease (CVD) in a community-based cohort of middle- to late-aged adults with long-term follow-up. At baseline, 2,320 individuals were assessed on a large number of lifestyle and clinical parameters including their level of physical activity per week, other risk factors (e.g. smoking and alcohol use) various anthropometric measures, blood tests and medical history. Individuals were linked to hospital and mortality registry data to identify future cancer and cardiovascular events (fatal and non-fatal) out to 15 years of follow-up. Cox regression analyses adjusted for relevant confounders identified a priori were used to estimate risk for all-cause, cancer-specific and CVD-specific mortality. In the full cohort an estimated 21 % decreased risk for all-cause mortality (HR 0.79; 95 % CI 0.66-0.96) and 22 % decreased risk for fatal/non-fatal CVD events (HR 0.78; 95 % CI 0.66-0.92) was associated with baseline self-reported physical activity levels of 150 min or more. After exclusion of those with chronic co-morbidities (CVD, cancer, diabetes, chronic obstructive pulmonary disease, hypertension treatment) at baseline, lower risk for fatal/non-fatal CVD events remained significantly associated with 150 min or more of physical activity (HR 0.77; 95 % CI 0.62-0.96). Results from this well established prospective community-based cohort study support the role of leisure time physical activity in reducing all-cause mortality and CVD events (fatal/nonfatal) in the broader population studied. The data also suggest that physical activity associated reductions in risk for CVD events (fatal/nonfatal) were not overly impacted by prevalent key non-communicable diseases.

  6. The Impact of Hepatitis B Infection on Outcome of Kidney Transplantation: A Long-Term Study

    Science.gov (United States)

    Einollahi, B.; Alavian, S. M.; Lessan-Pezeshki, M.; Simforoosh, N.; Nourbala, M. H.; Rostami, Z.; Pourfarziani, V.; Nemati, E.; Sharafi, M.; Nafar, M.; Pour-Reza Gholi, F.; Firoozan, A.

    2010-01-01

    Background: With the success of kidney transplantation, liver disease has emerged as an important cause of morbidity and mortality in kidney recipients. Objective: To determine the impact of hepatitis B virus (HBV) infection on patients and graft survival in both short- and long-terms. Methods: 99 renal transplant patients infected with HBV on follow-up in two major transplant centers were included in a retrospective study. These patients were grafted between 1986 and 2005 and divided into two groups: (1) those only positive for hepatitis B surface antigen (HBsAg) and (2) those who were also positive for hepatitis C virus antibodies (HCV Ab). Results: There were 88 patients with HBsAg+ and 11 with both HBsAg+ and HCV Ab+. The mean±SD age of patients was 38.8±13.2 years, and the median follow-up after transplantation was 19 months. Although not significant, the allograft survival rate in the first group (HBV+) was better compared to that in the second group (HBV+ and HCV+); 1, 5 and 10 years graft survival rates were 91, 77 and 62 in the first group and 70, 56 and 28 in the second group, respectively (P=0.07). The overall mortality was 5% (4 of 88) in the first and 27% (3 of 11) in the second group (P=0.02). Conclusion: Renal allograft recipients with HBV and HCV infections has a poor survival rate compared to patients with only HBV infection. However, there is no significant difference in terms of renal graft survival between the two groups. PMID:25013571

  7. Long-term outcomes after first-generation autologous chondrocyte implantation for cartilage defects of the knee

    DEFF Research Database (Denmark)

    Niemeyer, Philipp; Porichis, Stella; Steinwachs, Matthias

    2014-01-01

    decreased from 7.2 ± 1.9 preoperatively to 2.1 ± 2.1 postoperatively. The mean MOCART score was 44.9 ± 23.6. Defect-associated bone marrow edema was found in 78% of the cases. Nevertheless, no correlation between the MOCART score and clinical outcome (IKDC score) could be found (Pearson coefficient, r = 0...... score seems moderate, this could not be correlated with long-term clinical outcomes.......) score. Clinical function at follow-up was assessed by means of the Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Knee injury and Osteoarthritis Outcome Score (KOOS). Patient activity was assessed by the Tegner score. In addition, pain on a visual analog scale (VAS...

  8. Long-term Administration of Angiotension-Converting Enzyme Inhibitor Improves the Outcome of Chronic Heart Failure in Senile Patients

    Institute of Scientific and Technical Information of China (English)

    陈学林; 张劲农; 柯琴梅; 张银环; 刘承云

    2002-01-01

    Summary: One hundred and sixteen senile patients (older than 65 years) with chronic heart failure (CHF) were analyzed retrospectively in order to verify if old patients with CHF would benefit from long-term (one year) angiotension-converting enzyme inhibitor (ACEI) treatment. The frequency of drugs (including ACEI, digitalis and diuretic) used was stratified into four degrees accordingly. Development of the CHF was scored with regard to relapse rate and severity of this disease. Stepwise regression analysis was applied to explore the relationship between the scored outcome of CHF and the frequency of individual drug administra tion. A significant relationship of the scored outcome of CHF to the frequency of ACEI usage but not to digitalis nor to diuretics was found (partial coefficient of the correlation r=0. 42, P=0. 002). It was concluded that the longterm administration of ACEI improves the outcome of CHF in senile patients.

  9. Evaluating a theory of stress and adjustment when predicting long-term psychosocial outcome after brain injury.

    Science.gov (United States)

    Rutterford, Neil A; Wood, Rodger L

    2006-05-01

    Kendall and Terry (1996) include many psychosocial predictors in their theoretical model that explains individual differences in psychosocial adjustment (Lazarus & Folkman, 1984). The model depicts appraisal and coping variables as mediating relationships between situation factors, environmental and personal resources, and multidimensional outcome. The aim of this study was to explore these theoretical relationships at very late stages of recovery from traumatic brain injury. A total of 131 participants who were more than 10 years post-injury (mean = 15.31 years) completed several psychosocial measures relating to outcome dimensions comprising employment, community integration, life satisfaction, quality of life (QoL), and emotion. There was no evidence that appraisal and coping variables mediated relationships between psychosocial and any of the outcome variables. However, when appraisal and coping variables were combined with psychosocial variables as direct predictors of outcome, every outcome except employment status was reliably predicted, accounting for between 31 and 46% of the variance. Personality significantly influenced all predicted outcomes. Self-efficacy contributed to the prediction of all outcomes except QoL. Data did not support for the theory of stress and adjustment as a framework for explaining the nature of predictive relationships between psychosocial variables and very long-term, multidimensional outcome after brain injury.

  10. Aetiology and long-term outcome of juvenile epilepsy in 136 dogs.

    Science.gov (United States)

    Arrol, L; Penderis, J; Garosi, L; Cripps, P; Gutierrez-Quintana, R; Gonçalves, R

    2012-03-01

    The aetiology and outcome of dogs with juvenile-onset seizures were investigated. One hundred and thirty-six dogs whose first seizure occurred before the age of one year were investigated. One hundred and two dogs were diagnosed with idiopathic epilepsy (IE), 23 with symptomatic epilepsy (SE), nine with reactive seizures (RS) and two with probable symptomatic epilepsy (pSE). The outcome was known in 114 dogs; 37 per cent died or were euthanased as a consequence of seizures. The mean survival time of this population of dogs was 7.1 years. Factors that were significantly associated with survival outcome included the diagnosis of SE and the number of antiepileptic drugs (AEDs) used before investigation. The use of one AED before investigation and a diagnosis of SE were associated with a negative outcome, whereas receiving no AED medications before referral was associated with a longer survival. For dogs with IE, survival time was shortened if the dog was a border collie or with a history of status epilepticus;receiving no AEDs before referral in the IE group was associated with a positive outcome. Seizure-free status was achieved in 22 per cent of dogs diagnosed with IE. While the survival times were longer than previously reported in canine epilepsy, similar remission rates to those reported in childhood epilepsy, where a 70 per cent remission rate is documented, were not seen in the canine juvenile population.

  11. Does a positive pretransplant crossmatch affect long-term outcome in liver transplantation?

    LENUS (Irish Health Repository)

    Al-Sibae, Mohamad R

    2012-02-01

    Despite the historical success of liver transplantation in the face of a positive lymphocytic crossmatch, increased incidence of acute cellular rejection and graft loss have been reported in this setting. Given the potential adverse effects of antirejection treatment, especially in hepatitis C virus-positive recipients, identification of predisposing factors could allow for better surveillance, avoidance of rejection, and potentially better graft outcomes.

  12. Transanal endoscopic microsurgery for advanced polyps and early cancers in the rectum-Long-term outcome

    DEFF Research Database (Denmark)

    Al-Najami, Issam; Rancinger, Carl Philip; Larsen, Morten Kobaek;

    2016-01-01

    Transanal endoscopic microsurgery (TEM) allows for the resection of large adenomas and early stage cancers in the rectum. The rate of complications and recurrence for malignant tumors compared with benign tumors has been questioned.The objective of our study was to analyze the outcome after TEM p...

  13. Predictors of short and long term outcome in patellofemoral pain syndrome: a prospective longitudinal study

    Directory of Open Access Journals (Sweden)

    Crossley Kay M

    2010-01-01

    Full Text Available Abstract Background Patellofemoral pain syndrome (PFP is a common musculoskeletal condition that has a tendency to become chronic and problematic in a proportion of affected individuals. The objective of this study was to identify prognostic factors that may have clinical utility in predicting poor outcome on measures of pain and function in individuals with PFP. Methods A prospective follow-up study was conducted of 179 participants in a randomised clinical trial. Nine baseline factors (age, gender, body mass index, arch height, duration of knee pain, worst pain visual analogue scale, Kujala Patellofemoral Score (KPS, functional index questionnaire (FIQ, step down repetitions were investigated for their prognostic ability on outcome assessed at six, 12 and 52 weeks (worst pain, KPS and FIQ. Factors with significant univariate associations were entered into multivariate linear regression models to identify a group of factors independently associated with poor outcome. Results Long symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (β-0.07, 95% confidence interval -0.1 to -0.03, p p Conclusions Patients presenting with PFP of long duration who score worse on the KPS have a poorer prognosis, irrespective of age, gender and morphometry. These results suggest that strategies aimed at preventing chronicity of more severe PFP may optimise prognosis.

  14. Effect of perioperative blood transfusions on long term graft outcomes in renal transplant patients.

    LENUS (Irish Health Repository)

    O'Brien, Frank J

    2012-06-01

    It is established that blood transfusions will promote sensitization to human leucocyte antigen (HLA) antigens, increase time spent waiting for transplantation and may lead to higher rates of rejection. Less is known about how perioperative blood transfusion influence patient and graft outcome. This study aims to establish if there is an association between perioperative blood transfusion and graft or patient survival.

  15. Long-Term Cognitive Outcomes of Infants Born Moderately and Late Preterm

    Science.gov (United States)

    Odd, David Edward; Emond, Alan; Whitelaw, Andrew

    2012-01-01

    Aim: To investigate whether infants born late preterm have poorer cognitive outcomes than term-born infants. Method: A cohort study based on the Avon Longitudinal Study of Parents and Children. Cognitive measures were assessed between the ages of 8 and 11 years. Exposure groups were defined as moderate/late preterm (32-36 weeks' gestation) or term…

  16. Long-Term Post-Intensive Behavioral Intervention Outcomes for Five Children with Autism Spectrum Disorder

    Science.gov (United States)

    O'Connor, Anne B.; Healy, Olive

    2010-01-01

    Research clearly indicates that early intensive behavioral intervention is an effective intervention for young children with Autism Spectrum Disorder (ASD). However little is known about the longitudinal development of these children. The purpose of this study was to examine the outcomes for a number of children with ASD following intensive…

  17. Long-term outcomes for women versus men with unstable angina/non-ST-segment elevation myocardial infarction managed medically without revascularization

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Roe, Matthew T.; Hochman, Judith S.;

    2015-01-01

    BACKGROUND: Women with acute coronary syndromes (ACS) are less likely to undergo invasive revascularization than men, but sex-specific differences in long-term outcomes and platelet reactivity among medically managed ACS patients remain uncertain. We examined sex-specific differences in long-term...

  18. Pancreatoduodenectomy for chronic pancreatitis: anatomic selection criteria and subsequent long-term outcome analysis.

    Science.gov (United States)

    Traverso, L W; Kozarek, R A

    1997-01-01

    OBJECTIVE: The authors sought to provide a framework through outcome analysis to evaluate operations directed toward the intractable abdominal pain of severe chronic pancreatitis centered in the pancreatic head. Pancreatoduodenectomy (PD) was used as an example. SUMMARY BACKGROUND DATA: Head resection for severe chronic pancreatitis is the treatment of choice for a ductal system in the head obliterated by severe disease when associated with intractable abdominal pain. To evaluate the effectiveness of promising head resection substitutes for PD, a framework is necessary to provide a reference standard (i.e., an outcome analysis) of PD. METHODS: Inclusion criteria were severe chronic pancreatitis centered in the pancreatic head, intractable abdominal pain, and a main pancreatic duct obstruction or stricture resulting in absent drainage into the duodenum from the uncinate process and adjacent pancreatic head areas or the entire gland. Since 1986, 57 consecutive cases with these criteria underwent PD (47 head only and 10 total pancreatectomy). Clinical and anatomic predictor variables were derived from the history, imaging studies, and pathologic examination. These variables then were tested for association with the following outcome events gathered during annual follow-up: pain relief, onset of diabetes, body weight maintenance, and peptic ulceration. RESULTS: Operative mortality was zero. In 57 patients with a mean follow-up of 42 months, the 5-year outcome event for survival was 93% and the onset of diabetes was 32%. All new cases of diabetes occurred more than 1 year after resection. In 43 cases > or =1 year postoperative with a mean follow-up of 55 months, all patients indicated significant pain relief and 76% were pain free. Pain relief was more common in patients with diabetes or in those patients with a pancreatic duct disruption. Death was more common in patients with diabetes. Weight maintenance was more common if preoperatively severe ductal changes were not

  19. Effects of long-term FK506 administration on functional and histopathological outcome after spinal cord injury in adult rat.

    Science.gov (United States)

    Saganová, Kamila; Orendácová, Judita; Sulla, Igor; Filipcík, Peter; Cízková, Dása; Vanický, Ivo

    2009-09-01

    FK506 (tacrolimus), a potent immunosuppressive drug primarily used for reduction of allograft rejection in organ transplantation, also offers neuroprotection after central nervous system injury. FK506-mediated immunosuppression and neuroprotection may occur through different mechanisms that could affect neurological recovery and the severity of spinal lesions where cells transplantation therapy is combined with FK506 application. We assessed effects of long-term FK506 administration using the same dose regiment (1 mg/kg/day for 6 weeks) as is used in spinal cord transplantation studies following a balloon-compression induced spinal cord injury (SCI). Body weight and locomotor recovery quantified by the BBB (Basso-Beattie-Bresnehan) locomotor rating scale were evaluated for up to 42 days post-injury. The area of the preserved spinal cord tissue within a 13 mm segment of the spinal cord (lesion epicenter and 6 mm rostral-caudal) was examined histologically. The results showed no significant effects of FK506 on spinal cord tissue sparing or improvement of locomotor recovery. However, body weight fell significantly (P < 0.05) with FK506 treatment when compared with placebo from day 7 until sacrifice. In our experimental design, long-term FK506 treatment did not affect the parameters of outcome following balloon-compression SCI in the rat; however, multiple effects of FK506 should be taken into account when evaluating the outcomes in transplantation studies.

  20. Comparison of Long-Term Outcomes of Postmastectomy Radiotherapy between Breast Cancer Patients with and without Immediate Flap Reconstruction.

    Directory of Open Access Journals (Sweden)

    Hsin-Hua Lee

    Full Text Available To compare the long-term clinical outcomes of postmastectomy radiotherapy (PMRT between breast cancer patients with and without immediate transverse rectus abdominis myocutaneous (TRAM flap reconstruction.The study included 492 patients with stage II or III breast cancer who underwent modified radical mastectomy (MRM and chemotherapy followed by PMRT between 1997 and 2011. Cox regression model and Kaplan-Meier curves were calculated, and the log-rank test was used to evaluate the differences between overall and disease-free survival rates in the 2 groups.Among 492 patients, 213 patients had immediate TRAM flap reconstruction. The mean follow-up was 7.2 years (range, 11-191 months. The 5-year and 10-year disease free survival rates were 81% and 76% for the TRAM flap group and 78% and 73% for the non-flap group. The 5-year and 10-year overall survival rates were 89% and 73% for the TRAM flap group and 83% and 74% for the non-flap group.There exists no statistically significant difference in the rates of local recurrence, distant metastasis, disease-free and overall survival when comparing immediate TRAM flap reconstruction with no reconstruction. Our results suggest that immediate TRAM flap reconstruction does not compromise long term clinical outcomes in breast cancer patients requiring PMRT.

  1. Transcatheter Mitral Valve Repair in Surgical High-Risk Patients: Gender-Specific Acute and Long-Term Outcomes

    Directory of Open Access Journals (Sweden)

    Eike Tigges

    2016-01-01

    Full Text Available Background. Analyses emphasizing gender-related differences in acute and long-term outcomes following MitraClip therapy for significant mitral regurgitation (MR are rare. Methods. 592 consecutive patients (75±8.7 years, 362 men, 230 women underwent clinical and echocardiographic follow-up for a median of 2.13 (0.99–4.02 years. Results. Significantly higher prevalence of cardiovascular comorbidities, renal failure, and adverse echocardiographic parameters in men resulted in longer device time (p=0.007 and higher numbers of implanted clips (p=0.0075, with equal procedural success (p=1.0. Rehospitalization for heart failure did not differ (p[logrank]=0.288 while survival was higher in women (p[logrank]=0.0317. Logarithmic increase of NT-proBNP was a common independent predictor of death. Hypercholesterolemia and peripheral artery disease were predictors of death only in men while ischemic and dilative cardiomyopathy (CM and age were predictors in women. Independent predictors of rehospitalization for heart failure were severely reduced ejection fraction and success in men while both ischemic and dilative CM, logistic EuroSCORE, and MR severity were predictive in women. Conclusions. Higher numbers of implanted clips and longer device time are likely related to more comorbidities in men. Procedural success and acute and mid-term clinical outcomes were equal. Superior survival for women in long-term analysis is presumably attributable to a comparatively better preprocedural health.

  2. A review of the long-term health outcomes associated with war-related amputation.

    Science.gov (United States)

    Robbins, Christopher B; Vreeman, Daniel J; Sothmann, Mark S; Wilson, Stephen L; Oldridge, Neil B

    2009-06-01

    The rate of war-related amputations in current U.S. military personnel is now twice that experienced by military personnel in previous wars. We reviewed the literature for health outcomes following war-related amputations and 17 studies were retrieved with evidence that (a) amputees are at a significant risk for developing cardiovascular disease; (b) insulin may play an important role in regulating blood pressure in maturity-onset obesity; (c) lower-extremity amputees are at risk for joint pain and osteoarthritis; (d) transfemoral amputees report a higher incidence of low back pain than transtibial amputees; and (e) 50 to 80% report phantom limb pain, with many amputees stating they were either told that their pain was imagined or their mental state was questioned. The consistency of the observations on health outcomes in these studies warrants careful examination for their implication in the contemporary treatment of war-related amputation.

  3. Predicting Adverse Health Outcomes in Long-Term Survivors of a Childhood Cancer

    Directory of Open Access Journals (Sweden)

    Chaya S. Moskowitz

    2014-07-01

    Full Text Available More than 80% of children and young adults diagnosed with invasive cancer will survive five or more years beyond their cancer diagnosis. This population has an increased risk for serious illness- and treatment-related morbidity and premature mortality. A number of these adverse health outcomes, such as cardiovascular disease and some second primary neoplasms, either have modifiable risk factors or can be successfully treated if detected early. Absolute risk models that project a personalized risk of developing a health outcome can be useful in patient counseling, in designing intervention studies, in forming prevention strategies, and in deciding upon surveillance programs. Here, we review existing absolute risk prediction models that are directly applicable to survivors of a childhood cancer, discuss the concepts and interpretation of absolute risk models, and examine ways in which these models can be used applied in clinical practice and public health.

  4. Prognosis in autism: do specialist treatments affect long-term outcome?

    Science.gov (United States)

    Howlin, P

    1997-06-01

    Many different treatments have been claimed to have a dramatic impact on children with autism. This paper reviews what is known about the outcome in adult life and examines the limitations and advantages of a variety of intervention approaches. It concludes that there is little evidence of any "cure" for autism, but appropriately structured programmes for education and management in the early years can play a significant role in enhancing functioning in later life.

  5. Concurrent coronary and carotid artery surgery: factors influencing perioperative outcome and long-term results

    OpenAIRE

    Kolh, Philippe; Comté, Laetitia; Tchana-Sato, Vincent; Honoré, Charles; Kerzmann, Arnaud; Mauer, M.; Limet, Raymond

    2006-01-01

    Aims To assess risk factors for early and late outcome after concurrent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG). Methods and results Records of all 311 consecutive patients having concurrent CEA and CABG from 1989 to 2002 were reviewed, and follow-up obtained (100% complete). In the group (mean age 67 years; 74% males), 62% had triple-vessel disease, 57% unstable angina, 31% left main coronary stenosis, 19% congestive heart failure, and 35% either a history of ...

  6. Long-term outcome of moderate hypofractionated stereotactic radiotherapy for meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    Maranzano, Ernesto; Draghini, Lorena; Casale, Michelina; Arcidiacono, Fabio; Anselmo, Paola; Trippa, Fabio; Giorgi, Cesare [Hospital, Radiotherapy Oncology Centre, Terni (Italy)

    2015-12-15

    The aim of this work was to evaluate long-term results of moderate hypofractionated stereotactic radiotherapy (hFSRT) for intracranial meningiomas. In all, 77 consecutive patients with 80 lesions were included. Median age was 65 years (range 23-82 years), male/female ratio was 21/56, and the median Karnofsky performance status was 90 (range 60-100). In 31 lesions (39 %), diagnosis was based upon clinical and radiological data; 37 lesions were histologically proven as World Health Organization (WHO) grade I and 12 grade II meningiomas. Median treatment volume was 23 cc. Prescribed doses were 45 Gy in 15 fractions of 3 Gy (15 x 3 Gy) or 42 Gy in 14 fractions of 3 Gy (14 x 3 Gy). After a median follow-up of 56 months, 49 (61 %) lesions received 14 x 3 Gy and 31 (39 %) 15 x 3 Gy. Local control (LC) rate remained unchanged at 84 % at 5 and 10 years. Overall survival and disease-specific survival (DSS) were 76 and 93 % at 5 years, 72 and 89 % at 10 years, respectively. With univariate analysis, previous surgery and WHO grade II tumor were negative prognostic factors for LC and DSS. With multivariate analysis only tumor grade was an independent prognostic factor for LC. No clinically significant acute and/or late toxicities were observed. Moderate hFSRT was effective and safe with an excellent tolerance profile. It can be an alternative treatment option for patients with recurrent or inoperable large meningiomas. The low number of fractions administered with hFSRT led to reduce treatment-related discomfort for patients. Grade II tumor and previous surgery were negative prognosis factors. (orig.) [German] Untersucht wurden die Langzeitergebnisse von moderater hypofraktionierter stereotaktischer Strahlentherapie (hFSRT) bei intrakraniellen Meningeomen. Es wurden 77 konsekutive Patienten mit 80 Laesionen ausgewaehlt. Das durchschnittliche Alter betrug 65 Jahre (Spanne 23-82 Jahre), das Verhaeltnis Maenner/Frauen lag bei 21/56, der mediane Karnofsky-Index betrug 90 (Spanne 60

  7. Long-term Outcomes of Parathyroidectomy in Kidney Transplant Recipients with Persistent Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Po-Yu Tseng

    2015-07-01

    Full Text Available Background/Aims: Hyperparathyroidism (HPT is a common complication of chronic kidney disease and contributes to hypertension and cardiovascular risks. Successful kidney transplantation corrects abnormal mineral metabolism, but persistent HPT is still observed in up to 25% of patients one year after transplantation despite renal function improvement. The purpose of this study was to examine the long-term effects of parathyroidectomy (PTX on blood pressure (BP and graft function in patients with persistent post-transplant HPT. Methods: This is a retrospective study of renal allograft recipients at a single institute. Records from all the patients who received kidney transplantation at the Taipei Veterans General Hospital between 2004 and 2012 were reviewed and enrolled 19 patients who underwent PTX for persistent post-transplant HPT. Preoperative and postoperative clinical and biochemical data were compared. Matched controls (n = 19 in the corresponding time span were enrolled for graft function comparisons. Results: The mean systolic BP (127.7 ± 14.3 to 119.5 ± 12.7 mmHg, p = 0.028, 1 year after PTX; 127.7 ± 14.3 to 117 ± 12.4 mmHg, p = 0.007, 2 years after PTX and pulse pressure (PP (51.3 ± 10.7 to 44.3 ± 11.6, p = 0.019 1 year after PTX; 51.3 ± 10.7 to 44.9 ± 12.5 mmHg, p = 0.028, 2 years after PTX reduced significantly at 1 year and 2 years of follow-up. However, no significant change of diastolic BP was observed. The improvement of SBP, DBP and PP was not correlated with the reduction of serum calcium level 1 year after PTX. The estimated glomerular filtration rate decreased significantly from 74.0 ± 20.5 mL/min/1.73m2 preoperatively to 68.2 ± 24.8 mL/min/1.73 m2 12 months after PTX but recovered at 15 months and lasted to 2 years after PTX. The all-cause hospitalization rate 1 year after PTX tended to be higher than that 1 year before PTX (105.3 versus 47.4 per 100 patient-years; RR, 2.22; 95 % CI: 0.97-5.54, but there was no

  8. Long-term clinical outcomes following the use of synthetic hydroxyapatite and bone graft in impaction in revision hip arthroplasty.

    Science.gov (United States)

    Aulakh, Tajeshwar S; Jayasekera, Narlaka; Kuiper, Jan-Herman; Richardson, James B

    2009-03-01

    Impaction grafting using morsellised allograft bone restores bone stock, but carries the potential for transmission of infection. Synthetic bone graft substitutes can eliminate this risk but may, however, influence outcome. In this study we tested the hypothesis that a 50/50 mix of hydroxyapatite and allograft does not affect long-term function, survival or radiological outcome. Sixty-five patients had revision hip arthroplasty using impaction grafting with either pure allograft (42 patients) or a 50/50 mixture of allograft and solid particulate hydroxyapatite. Harris hip scores were assessed pre-operatively and annual intervals thereafter. Function was analyzed using multilevel modeling, the Kaplan-Meier method used for survival analysis and graft incorporation was assessed radiologically. The hip score improved in both groups but showed a small annual decline (average 1.2/year, plong-term prosthesis survival and function following revision arthroplasty with a 50/50 mixture of allograft and hydroxyapatite are comparable to allograft alone.

  9. The prevalence of uncontrolled pain in long-term care: a pilot study examining outcomes of pain management processes.

    Science.gov (United States)

    Good, Heidi; Riley-Doucet, Cheryl K; Dunn, Karen S

    2015-02-01

    Pain in long-term care (LTC) is common among older residents despite the vast options available for optimal pain management. Inadequate pain management affects individual health care outcomes. Researcher evidence has shown that nurse practitioners (NPs) improve the quality of care in LTC but are challenged by multiple barriers that inhibit optimal pain control. The purpose of the current pilot study was to explore both the pain management processes used by nurses in LTC and the documented patient outcomes that come from these processes. In addition, factors were identified that may impact the NP role in providing adequate pain control in LTC. This descriptive study used a retrospective, case-controlled research design that incorporated reviewing 55 LTC resident medical records. Results show how the process of pain management in LTC can be improved by expanding the professional role of the NP.

  10. Decreased muscle strength is associated with impaired long-term functional outcome after intramedullary nailing of femoral shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Graven-Nielsen, Thomas;

    2015-01-01

    -up with clinical examination of 48 patients treated with intramedullary nailing after femoral shaft fracture between 2007 and 2010. The patients underwent a clinical examination and assessment of walking ability, maximal muscle strength during knee flexion and extension and hip abduction. Hip disability...... strength of knee flexion with the injured leg (226.0 N) was significantly lower then knee flexion with the non-injured leg (259.5 N, P abduction (129.2 vs 156.0 N, P ... in the difference in muscle strength were observed as well as between worse HOOS outcome and increasing body mass index. CONCLUSION:This study showed that decreased muscle strength for knee flexion, knee extension and hip abduction was associated with worse long-term functional outcome measured with a disease...

  11. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment

    Directory of Open Access Journals (Sweden)

    Shaw Monica

    2012-09-01

    Full Text Available Abstract Background In childhood, attention deficit/hyperactivity disorder (ADHD is characterized by age-inappropriate levels of inattentiveness/disorganization, hyperactivity/impulsiveness, or a combination thereof. Although the criteria for ADHD are well defined, the long-term consequences in adults and children need to be more comprehensively understood and quantified. We conducted a systematic review evaluating the long-term outcomes (defined as 2 years or more of ADHD with the goal of identifying long-term outcomes and the impact that any treatment (pharmacological, non-pharmacological, or multimodal has on ADHD long-term outcomes. Methods Studies were identified using predefined search criteria and 12 databases. Studies included were peer-reviewed, primary studies of ADHD long-term outcomes published between January 1980 to December 2010. Inclusion was agreed on by two independent researchers on review of abstracts or full text. Published statistical comparison of outcome results were summarized as poorer than, similar to, or improved versus comparators, and quantified as percentage comparisons of these categories. Results Outcomes from 351 studies were grouped into 9 major categories: academic, antisocial behavior, driving, non-medicinal drug use/addictive behavior, obesity, occupation, services use, self-esteem, and social function outcomes. The following broad trends emerged: (1 without treatment, people with ADHD had poorer long-term outcomes in all categories compared with people without ADHD, and (2 treatment for ADHD improved long-term outcomes compared with untreated ADHD, although not usually to normal levels. Only English-language papers were searched and databases may have omitted relevant studies. Conclusions This systematic review provides a synthesis of studies of ADHD long-term outcomes. Current treatments may reduce the negative impact that untreated ADHD has on life functioning, but does not usually 'normalize' the

  12. Long-term outcome of endoscopic metallic stenting for benign biliary stenosis associated with chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Taketo Yamaguchi; Takeshi Ishihara; Katsutoshi Seza; Akihiko Nakagawa; Kentarou Sudo; Katsuyuki Tawada; Teruo Kouzu; Hiromitsu Saisho

    2006-01-01

    AIM: Endoscopic metal stenting (EMS) offers good results in short to medium term follow-up for bile duct stenosis associated with chronic pancreatitis (CP);however, longer follow-up is needed to determine if EMS has the potential to become the treatment of first choice.METHODS: EMS was performed in eight patients with severe common bile duct stenosis due to CR After the resolution of cholestasis by endoscopic naso-biliary drainage three patients were subjected to EMS while,the other five underwent EMS following plastic tube stenting. The patients were followed up for more than5 years through periodical laboratory tests and imaging techniques.RESULTS: EMS was successfully performed in all the patients. Two patients died due to causes unrelated to the procedure: one with an acute myocardial infarction and the other with maxillary carcinoma at 2.8 and 5.5years after EMS, respectively. One patient died with cholangitis because of EMS clogging 3.6 years after EMS.None of these three patients had showed symptoms of cholestasis during the follow-up period. Two patients developed choledocholithiasis and two suffered from duodenal ulcers due to dislodgement of the stent between 4.8 and 7.3 years after stenting; however, they were successfully treated endoscopically. Thus, five of eight patients are alive at present after a mean follow-up period of 7.4 years.CONCLUSION: EMS is evidently one of the very promising treatment options for bile duct stenosis associated with CP, provided the patients are closely followed up; thus setting a system for their prompt management on emergency is desirable.

  13. Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis

    Directory of Open Access Journals (Sweden)

    Almeida DRP

    2015-07-01

    Full Text Available David RP Almeida,1 Eric K Chin,1 Ryan M Tarantola,1 Elizabeth O Tegins,1 Christopher A Lopez,1 Herbert Culver Boldt,1 Karen M Gehrs,1 Elliott H Sohn,1 Stephen R Russell,1 James C Folk,1 Vinit B Mahajan1,2 1Department of Ophthalmology and Visual Sciences, 2Omics Laboratory, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Purpose: To determine the outcomes in patients with rhegmatogenous retinal detachment (RRD secondary to viral retinitis. Patients and methods: This was a retrospective, consecutive, noncomparative, interventional case series of 12 eyes in ten patients with RRD secondary to viral retinitis. Results of vitreous or aqueous biopsy, effect of antiviral therapeutics, time to retinal detachment, course of visual acuity, and anatomic and surgical outcomes were investigated. Results: There were 1,259 cases of RRD during the study period, with 12 cases of RRD secondary to viral retinitis (prevalence of 0.95%. Follow-up was available for a mean period of 4.4 years. Varicella zoster virus was detected in six eyes, herpes simplex virus in two eyes, and cytomegalovirus in two eyes. Eight patients were treated with oral valacyclovir and two patients with intravenous acyclovir. Lack of optic nerve involvement correlated with improved final visual acuity of 20/100 or greater. Pars plana vitrectomy (n=12, silicone-oil tamponade (n=11, and scleral buckling (n=10 provided successful anatomic retinal reattachment in all cases, with no recurrent retinal detachment and no cases of hypotony during the follow-up period. Conclusion: Varicella zoster virus was the most frequent cause of viral retinitis, and lack of optic nerve involvement was predictive of a favorable visual acuity prognosis. Vitrectomy with silicone-oil tamponade and scleral buckle placement provided stable anatomical outcomes. Keywords: viral retinitis, acute retinal necrosis, herpetic retinitis, vitrectomy, retinal detachment 

  14. Long-term follow-up of cognitive outcome after breech presentation at birth

    DEFF Research Database (Denmark)

    Sørensen, Henrik Toft; Steffensen, Flemming Hald; Olsen, Jørn;

    1999-01-01

    with the Boerge Prien IQ test. A total of 164 conscripts were born in breech presentation and 70 (42.7%) of these were delivered after Caesarean section. The mean Boerge Prien test score was 43.2 among men born in cephalic presentation and 39.9 among those born in breech presentation for a difference of 3.3 (95......% confidence interval = 1.8-4.7). The negative association between breech presentation and cognitive outcome persisted after stratifying by Caesarean section and after adjustment for confounders. It also persisted when we restricted the analyses to term singleton pregnancies....

  15. Effects of maternal obesity on early and long-term outcomes for offspring

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    Stirrat LI

    2014-03-01

    Full Text Available Laura I Stirrat,1,2 Rebecca M Reynolds2,3 1Medical Research Council Centre for Reproductive Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK; 2Tommy's Centre for Maternal and Fetal Health, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK; 3Endocrinology Unit, University/British Heart Foundation Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK Abstract: The prevalence of maternal obesity has increased significantly in recent years, and obesity is currently the most common comorbidity of pregnancy. Pregnancies of obese women are often defined as "high-risk" for the purposes of clinical care, with many well documented risks to the mother and developing baby. Maternal physiology and metabolism is dysregulated in the context of obesity, which may contribute to some of the adverse outcomes during pregnancy. Furthermore, maternal obesity has been hypothesized to cause harmful effects for the developing baby through "early life programming." This review will examine evidence from human studies for outcomes of offspring from obese women during pregnancy, during labor, during the neonatal period, and later in life. Keywords: pregnancy, short-term, physiology, metabolism, early life programming, neonatal complications, adverse intrauterine environment

  16. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence

    Directory of Open Access Journals (Sweden)

    Papalia R

    2015-02-01

    Full Text Available Rocco Papalia,1 Guglielmo Torre,1 Sebastiano Vasta,1 Biagio Zampogna,1 Douglas R Pedersen,2,3 Vincenzo Denaro,1 Annunziato Amendola3 1Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy; 2Department of Biomedical Engineering, 3Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA Background: Bone bruises are frequently associated with anterior cruciate ligament (ACL tears as a result of trauma or direct shear stress of the bone. Purpose: To review the evidence regarding the characteristics of the bone bruise associated with ACL tears, its relevance on clinical outcomes, and its progression over time. In particular, the long-term effects of the bone bruise on the knee osteochondral architecture and joint function were evaluated. Study design: Review; level of evidence: 4. Methods: An electronic search was performed on PubMed. Combinations of keywords included: “bone bruise AND knee”; “bone bruise AND anterior cruciate ligament”; “bone bruise AND osteo-chondral defects”. Any level of evidence studies concerning bone bruises in patients with partial or complete ACL tears were retrieved. Results: A total of 25 studies were included; three of them investigated biomechanical parameters, seven were concerned with clinical outcomes, and 15 were radiological studies. Evaluation of the bone bruise is best performed using a fat-saturated T2-weighted fast spin echo exam or a short tau inversion recovery sequence where fat saturation is challenging. The location of the injury has been demonstrated to be more frequent in the lateral compartment of the joint (lateral femoral condyle and lateral tibial plateau. It is associated with ACL tears in approximately 70% of cases, often with collateral ligament or meniscal tears. Mid- and long-term outcomes demonstrated a complete healing of the marrow lesions at magnetic ρresonance imaging, but chondral defects detected with T1

  17. Short- and long-term subjective medical treatment outcome of trauma surgery patients: the importance of physician empathy

    Directory of Open Access Journals (Sweden)

    Steinhausen S

    2014-09-01

    Full Text Available Simone Steinhausen,1 Oliver Ommen,2 Sunya-Lee Antoine,1 Thorsten Koehler,3 Holger Pfaff,4 Edmund Neugebauer11Institute for Research in Operative Medicine (IFOM, Witten/Herdecke University, Campus Cologne-Merheim, Germany; 2Federal Centre for Health Education (BZgA, Cologne, Germany; 3Institute for Applied Social Sciences (infas, Bonn, Germany; 4Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR, Faculty of Human Science and Faculty of Medicine, University of Cologne, Germany Purpose: To investigate accident casualties’ long-term subjective evaluation of treatment outcome 6 weeks and 12 months after discharge and its relation to the experienced surgeon’s empathy during hospital treatment after trauma in consideration of patient-, injury-, and health-related factors. The long-term results are compared to the 6-week follow-up outcomes.Patients and methods: Two hundred and seventeen surgery patients were surveyed at 6 weeks, and 206 patients at 12 months after discharge from the trauma surgical general ward. The subjective evaluation of medical treatment outcome was measured 6 weeks and 12 months after discharge with the respective scale from the Cologne Patient Questionnaire. Physician Empathy was assessed with the Consultation and Relational Empathy Measure. The correlation between physician empathy and control variables with the subjective evaluation of medical treatment outcome 12 months after discharge was identified by means of logistic regression analysis under control of sociodemographic and injury-related factors.Results: One hundred and thirty-six patients were included within the logistic regression analysis at the 12-month follow-up. Compared to the 6-week follow-up, the level of subjective evaluation of medical treatment outcome was slightly lower and the association with physician empathy was weaker. Compared to patients who rated the empathy of their surgeon lower than 31 points, patients

  18. Update on prostate brachytherapy: long-term outcomes and treatment-related morbidity.

    Science.gov (United States)

    Kao, Johnny; Cesaretti, Jamie A; Stone, Nelson N; Stock, Richard G

    2011-06-01

    Current research in prostate brachytherapy focuses on five key concepts covered in this review. Transrectal ultrasound-guided prostate brachytherapy assisted by intraoperative treatment planning is the most advanced form of image-guided radiation delivery. Prostate brachytherapy alone for low-risk prostate cancer achieves lower prostate-specific antigen (PSA) nadirs than intensity-modulated radiotherapy (IMRT) or protons while maintaining durable biochemical control in about 90% of patients without late failures seen in surgically treated patients. As an organ-conserving treatment option, seed implant results in a lower rate of erectile dysfunction and urinary incontinence than surgery that has been validated in several recent prospective studies. Combined IMRT and seed implant has emerged as a rational and highly effective approach to radiation-dose escalation for intermediate- and high-risk prostate cancer. Preliminary results suggest that seed implantation may play a role in improving outcomes for historically poor-prognosis locally advanced and recurrent prostate cancers.

  19. Long-term graft outcome of pediatric liver transplantation in Copenhagen

    DEFF Research Database (Denmark)

    Yamauchi, Yasushi; Yamashita, Yuichi; Wettergren, Andre

    2006-01-01

    status of the recipients (hospitalization or intensive care unit care before surgery), a retransplanted graft, and a reduced-size graft were independent risk factors for graft failure. With experience, overall graft survival has improved significantly and the differences in graft survival between graft......BACKGROUND: Graft loss after liver transplantation remains a significant problem, especially in pediatric patients. The aim of this study was to assess our initial series of pediatric liver transplantation and to identify the risk factors that influence graft outcome. METHODS: The first 51...... types have disappeared. CONCLUSIONS: To improve graft survival after pediatric liver transplantation, the timely referral of potential recipients to the transplant team and employing a meticulous technique during the operation, particularly for the technical-variant graft, are required....

  20. Characteristics and Long-Term Outcome of Patients with Systemic Immunoglobulin Light-Chain Amyloidosis

    DEFF Research Database (Denmark)

    Nelson, Lærke Marie; Gustafsson, Finn; Gimsing, Peter

    2014-01-01

    and predominantly originate from highly selected centers. We aimed to evaluate patient characteristics and outcomes in a cohort treated at a single center. Methods: This is a single-center retrospective study of 63 consecutive patients diagnosed with AL amyloidosis between January 2000 and December 2012. Patients......Background/Aims: Immunoglobulin light-chain (AL) amyloidosis is a systemic disorder that causes progressive organ dysfunction. The optimal treatment strategy requires accurate patient stratification with an emphasis on the extent of cardiac involvement. Reports on its prognosis are sparse...... were evaluated by treatment strategy and cardiac involvement. Results: The mean age at diagnosis was 61.4 years (±8.9), and 39 patients (62%) were male. Thirty-two (51%) patients presented with cardiac amyloid involvement (CA) and the remaining 31 (49%) had noncardiac amyloidosis (NCA). The median...

  1. Chemoradiotherapy with or without consolidation chemotherapy using cisplatin and 5-fluorouracil in anal squamous cell carcinoma: long-term results in 31 patients

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    Roh Jae

    2008-01-01

    Full Text Available Abstract Background The objectives of this study were to evaluate long-term results of concurrent chemoradiotherapy (CRT with 5-fluorouracil and cisplatin and the potential benefit of consolidation chemotherapy in patients with anal squamous cell carcinoma (ASCC. Methods Between January 1995 and February 2006, 31 patients with ASCC were treated with CRT. Radiotherapy was administered at 45 Gy over 5 weeks, followed by a boost of 9 Gy to complete or partial responders. Chemotherapy consisted of 5-fluorouracil (750 or 1,000 mg/m2 daily on days 1 to 5 and days 29 to 33; and, cisplatin (75 or 100 mg/m2 on day 2 and day 30. Twelve patients had T3–4 disease, whereas 18 patients presented with lymphadenopathy. Twenty-one (67.7% received consolidation chemotherapy with the same doses of 5-fluorouracil and cisplatin, repeated every 4 weeks for maximum 4 cycles. Results Nineteen patients (90.5% completed all four courses of consolidation chemotherapy. After CRT, 28 patients showed complete responses, while 3 showed partial responses. After a median follow-up period of 72 months, the 5-year overall, disease-free, and colostomy-free survival rates were 84.7%, 82.9% and 96.6%, demonstrating that CRT with 5-fluorouracil and cisplatin yields a good outcome in terms of survival and sphincter preservation. No differences in 5-year OS and DFS rates between patients treated with CRT alone and CRT with consolidation chemotherapy was observed. Conclusion our study shows that CRT with 5-FU and cisplatin, with or without consolidation chemotherapy, was well tolerated and proved highly encouraging in terms of long-term survival and the preservation of anal function in ASCC. Further trials with a larger patient population are warranted in order to evaluate the potential role of consolidation chemotherapy.

  2. Orthodontic treatment outcomes in the long term: findings from a longitudinal study of New Zealanders.

    Science.gov (United States)

    Thomson, W M

    2002-10-01

    The aim of this study was to use a health services research (HSR) approach to examine the longer-term outcomes of orthodontic treatment. Participants in a longstanding population-based New Zealand cohort study (the Dunedin Multidisciplinary Health and Development Study) were allocated to one of four malocclusion severity categories on the basis of orthodontic data collected at age 12. The outcome of that care by age 26 was evaluated using the key indicators of equity (was it fair?); efficacy (did it work?); effectiveness (did it work in the longer term?); and safety (was it associated with a greater subsequent experience of caries, periodontal disease, or tooth loss?). Data were available for 452 Study members, of whom 56.2% were in the minor/none category, 29.0% were in the definite category, 10.2% were in the severe category, and 4.6% were in the handicapping treatment-need category. No clear differences in treatment uptake by socioeconomic status were apparent, and the proportion treated increased across the malocclusion severity categories, as did the proportion that showed an improvement following treatment. By age 26 a difference between those who had and those who had not been treated was evident, with the percentage of those rating their dental appearance as above average increasing with increasing severity of the age-12 orthodontic treatment need. This was also true for the percentage that considered their orthodontic treatment to have been successful. There were no significant differences in caries experience, periodontal disease occurrence, or tooth loss between those who had and had not been treated by age 26. This study has found the equity, efficacy, effectiveness, and safety of orthodontic treatment in the Dunedin cohort to be acceptable.

  3. Spanking, corporal punishment and negative long-term outcomes: a meta-analytic review of longitudinal studies.

    Science.gov (United States)

    Ferguson, Christopher J

    2013-02-01

    Social scientists continue to debate the impact of spanking and corporal punishment (CP) on negative child outcomes including externalizing and internalizing behavior problems and cognitive performance. Previous meta-analytic reviews have mixed long- and short-term studies and relied on bivariate r, which may inflate effect sizes. The current meta-analysis focused on longitudinal studies, and compared effects using bivariate r and better controlled partial r coefficients controlling for time-1 outcome variables. Consistent with previous findings, results based on bivariate r found small but non-trivial long-term relationships between spanking/CP use and negative outcomes. Spanking and CP correlated .14 and .18 respectively with externalizing problems, .12 and .21 with internalizing problems and -.09 and -.18 with cognitive performance. However, when better controlled partial r coefficients (pr) were examined, results were statistically significant but trivial (at or below pr = .10) for externalizing (.07 for spanking, .08 for CP) and internalizing behaviors (.10 for spanking, insufficient studies for CP) and near the threshold of trivial for cognitive performance (-.11 for CP, insufficient studies for spanking). It is concluded that the impact of spanking and CP on the negative outcomes evaluated here (externalizing, internalizing behaviors and low cognitive performance) are minimal. It is advised that psychologists take a more nuanced approach in discussing the effects of spanking/CP with the general public, consistent with the size as well as the significance of their longitudinal associations with adverse outcomes.

  4. D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale.

    Science.gov (United States)

    Kim, Young Dae; Song, Dongbeom; Nam, Hyo Suk; Lee, Kijeong; Yoo, Joonsang; Hong, Geu-Ru; Lee, Hye Sun; Nam, Chung Mo; Heo, Ji Hoe

    2015-08-31

    Patent foramen ovale (PFO) is a potential cause of cryptogenic stroke, given the possibility of paradoxical embolism from venous to systemic circulation. D-dimer level is used to screen venous thrombosis. We investigated the risk of embolism and mortality according to the presence of PFO and D-dimer levels in cryptogenic stroke patients. A total of 570 first-ever cryptogenic stroke patients who underwent transesophageal echocardiography were included in this study. D-dimer was assessed using latex agglutination assay during admission. The association of long-term outcomes with the presence of PFO and D-dimer levels was investigated. PFO was detected in 241 patients (42.3 %). During a mean 34.0 ± 22.8 months of follow-up, all-cause death occurred in 58 (10.2 %) patients, ischaemic stroke in 33 (5.8 %), and pulmonary thromboembolism in 6 (1.1 %). Multivariate Cox regression analysis showed that a D-dimer level of > 1,000 ng/ml was an independent predictor for recurrent ischaemic stroke in patients with PFO (hazard ratio 5.341, 95 % confidence interval 1.648-17.309, p=0.005), but not in those without PFO. However, in patients without PFO, a D-dimer level of > 1,000 ng/ml was independently related with all-cause mortality. The risk of pulmonary thromboembolism tended to be high in patients with high D-dimer levels, regardless of PFO. Elevated D-dimer levels in cryptogenic stroke were predictive of the long-term outcome, which differed according to the presence of PFO. The coexistence of PFO and a high D-dimer level increased the risk of recurrent ischaemic stroke. The D-dimer test in cryptogenic stroke patients may be useful for predicting outcomes and deciding treatment strategy.

  5. Long-term tolerance and outcomes for dose escalation in early salvage post-prostatectomy radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Safdieh, Joseph; Schwartz, David; Weiner, Joseph; Weiss, Jeffrey P.; Madeb, Isaac; Rotman, Marvin; Schreiber, David [Dept.of Veteran Affairs, New York Harbor Healthcare System, Brooklyn (United States); Rineer, Justin [University of Florida Health Cancer Center, Orlando (United States)

    2014-09-15

    To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting. The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes. The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%). In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.

  6. Acute upper gastrointestinal bleeding in patients on long-term oral anticoagulation therapy: Endoscopic findings, clinical management and outcome

    Institute of Scientific and Technical Information of China (English)

    Konstantinos C Thomopoulos; Konstantinos P Mimidis; George J Theocharis; Anthie G Gatopoulou; Georgios N Kartalis; Vassiliki N Nikolopoulou

    2005-01-01

    AIM: Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy.The purpose of this study was to describe the causes and clinical outcome of these patients.METHODS: From January 1999 to October 2003, 111patients with acute upper gastrointestinal bleeding (AUGIB)were hospitalized while on oral anticoagulants. The causes and clinical outcome of these patients were compared with those of 604 patients hospitalized during 2000-2001with AUGIB who were not taking warfarin.RESULTS: The most common cause of bleeding was peptic ulcer in 51 patients (45%) receiving anticoagulants compared to 359/604 (59.4%) patients not receiving warfarin (P<0.05). No identifiable source of bleeding could be found in 33 patients (29.7%) compared to 31/604(5.1%) patients not receiving anticoagulants (P= 0.0001).The majority of patients with concurrent use of non-steroidal anti-inflammatory drugs (NSATDs) (26/35, 74.3%) had a peptic ulcer as a cause of bleeding while 32/76 (40.8%)patients not taking a great dose of NSATDs had a negative upper and lower gastrointestinal endoscopy. Endoscopic hemostasis was applied and no complication was reported.Six patients (5.4%) were operated due to continuing or recurrent hemorrhage, compared to 23/604 (3.8%) patients not receiving anticoagulants. Four patients died, the overall mortality was 3.6% in patients with AUGIB due to anticoagulants, which was not different from that in patients not receiving anticoagulant therapy.CONCLUSION: Patients with AUGIB while on long-term anticoagulant therapy had a clinical outcome, which is not different from that of patients not taking anticoagulants.Early endoscopy is important for the management of these patients and endoscopic hemostasis can be safely applied.

  7. Mid- to long-term outcome of 96 corrective hindfoot fusions in 84 patients with rigid flatfoot deformity.

    Science.gov (United States)

    Röhm, J; Zwicky, L; Horn Lang, T; Salentiny, Y; Hintermann, B; Knupp, M

    2015-05-01

    Talonavicular and subtalar joint fusion through a medial incision (modified triple arthrodesis) has become an increasingly popular technique for treating symptomatic flatfoot deformity caused by posterior tibial tendon dysfunction. The purpose of this study was to look at its clinical and radiological mid- to long-term outcomes, including the rates of recurrent flatfoot deformity, nonunion and avascular necrosis of the dome of the talus. A total of 84 patients (96 feet) with a symptomatic rigid flatfoot deformity caused by posterior tibial tendon dysfunction were treated using a modified triple arthrodesis. The mean age of the patients was 66 years (35 to 85) and the mean follow-up was 4.7 years (1 to 8.3). Both clinical and radiological outcomes were analysed retrospectively. In 86 of the 95 feet (90.5%) for which radiographs were available, there was no loss of correction at final follow-up. In all, 14 feet (14.7%) needed secondary surgery, six for nonunion, two for avascular necrosis, five for progression of the flatfoot deformity and tibiotalar arthritis and one because of symptomatic overcorrection. The mean American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS score) at final follow-up was 67 (between 16 and 100) and the mean visual analogue score for pain 2.4 points (between 0 and 10). In conclusion, modified triple arthrodesis provides reliable correction of deformity and a good clinical outcome at mid- to long-term follow-up, with nonunion as the most frequent complication. Avascular necrosis of the talus is a rare but serious complication of this technique.

  8. Improving long term outcomes in urea cycle disorders-report from the Urea Cycle Disorders Consortium.

    Science.gov (United States)

    Waisbren, Susan E; Gropman, Andrea L; Batshaw, Mark L

    2016-07-01

    The Urea Cycle Disorders Consortium (UCDC) has conducted, beginning in 2006, a longitudinal study (LS) of eight enzyme deficiencies/transporter defects associated with the urea cycle. These include N-acetylglutamate synthase deficiency (NAGSD); Carbamyl phosphate synthetase 1 deficiency (CPS1D); Ornithine transcarbamylase deficiency (OTCD); Argininosuccinate synthetase deficiency (ASSD) (Citrullinemia); Argininosuccinate lyase deficiency (ASLD) (Argininosuccinic aciduria); Arginase deficiency (ARGD, Argininemia); Hyperornithinemia, hyperammonemia, homocitrullinuria (HHH) syndrome (or mitochondrial ornithine transporter 1 deficiency [ORNT1D]); and Citrullinemia type II (mitochondrial aspartate/glutamate carrier deficiency [CITRIN]). There were 678 UCD patients enrolled in 14 sites in the U.S., Canada, and Europe at the writing of this paper. This review summarizes findings of the consortium related to outcome, focusing primarily on neuroimaging findings and neurocognitive function. Neuroimaging studies in late onset OTCD offered evidence that brain injury caused by biochemical dysregulation may impact functional neuroanatomy serving working memory processes, an important component of executive function and regulation. Additionally, there were alteration in white mater microstructure and functional connectivity at rest. Intellectual deficits in OTCD and other urea cycle disorders (UCD) vary. However, when neuropsychological deficits occur, they tend to be more prominent in motor/performance areas on both intelligence tests and other measures. In some disorders, adults performed significantly less well than younger patients. Further longitudinal follow-up will reveal whether this is due to declines throughout life or to improvements in diagnostics (especially newborn screening) and treatments in the younger generation of patients.

  9. Long-term outcome on kidney retransplantation: a review of 100 cases from a single center.

    Science.gov (United States)

    Barocci, S; Valente, U; Fontana, I; Tagliamacco, A; Santori, G; Mossa, M; Ferrari, E; Trovatello, G; Centore, C; Lorenzi, S; Rolla, D; Nocera, A

    2009-05-01

    Renal transplantation has become an effective form of treatment for end-stage renal failure. Unfortunately, as a consequence of immunological and nonimmunological pathogenic mechanisms, chronic allograft nephropathy is responsible for the loss of a large proportion of kidney grafts after several years and return to dialysis. We have reported herein our 24 years of experience with second kidney transplantations. Of 1,302 kidney transplantations between January 1983 and June 2007 performed in our transplantation center, 100 were second transplantations. Kidney retransplantation was performed in 74 men and 26 women of overall mean age of 35.4 +/- 12.6 years. Cadaveric donor grafts were transplanted in 92 patients, whereas the remaining 8 were living-related donor kidneys. At 1, 5, and 10 years after kidney transplantation, patient survival rates were 100%, 96%, and 92%, respectively, whereas graft survival rates were 85%, 72%, and 53%, respectively. Immunosuppressive therapy included induction therapy with polyclonal anti-lymphocyte antibodies (ALG/ATG) or (starting from 1999) monoclonal anti CD 25 antibody. Our results demonstrated good outcomes for kidney retransplantations with allocation based on anti- HLA antibody identification together with induction immunosuppression.

  10. Total pancreatectomy: Short- and long-term outcomes at a high-volume pancreas center

    Science.gov (United States)

    Zakaria, Hazem M; Stauffer, John A; Raimondo, Massimo; Woodward, Timothy A; Wallace, Michael B; Asbun, Horacio J

    2016-01-01

    AIM To identify the current indications and outcomes of total pancreatectomy at a high-volume center. METHODS A single institutional retrospective study of patients undergoing total pancreatectomy from 1995 to 2014 was performed. RESULTS One hundred and three patients underwent total pancreatectomy for indications including: Pancreatic ductal adenocarcinoma (n = 42, 40.8%), intraductal papillary mucinous neoplasms (n = 40, 38.8%), chronic pancreatitis (n = 8, 7.8%), pancreatic neuroendocrine tumors (n = 7, 6.8%), and miscellaneous (n = 6, 5.8%). The mean age was 66.2 years, and 59 (57.3%) were female. Twenty-four patients (23.3%) underwent a laparoscopic total pancreatectomy. Splenic preservation and portal vein resection and reconstruction were performed in 24 (23.3%) and 18 patients (17.5%), respectively. The 90 d major complications, readmission, and mortality rates were 32%, 17.5%, and 6.8% respectively. The 1-, 3-, 5-, and 7-year survival for patients with benign indications were 84%, 82%, 79.5%, and 75.9%, and for malignant indications were 64%, 40.4%, 34.7% and 30.9%, respectively. CONCLUSION Total pancreatectomy, including laparoscopic total pancreatectomy, appears to be an appropriate option for selected patients when treated at a high-volume pancreatic center and through a multispecialty approach. PMID:27721927

  11. Long-term clinical outcomes of war-related bilateral lower extremities amputations.

    Science.gov (United States)

    Ebrahimzadeh, Mohammad Hosein; Moradi, Ali; Khorasani, Mohammad Reza; Hallaj-Moghaddam, Mohammad; Kachooei, Amir Reza

    2015-02-01

    In a cross-sectional study, 291 out of 500 veterans with war-related bilateral lower limb amputations from Iran-Iraq war (1980-1988) accepted to participate in our study. Information related to amputees and amputated limbs were gathered and a Persian version of the Medical Outcomes Study Short Form 36 (SF-36) was filled. To evaluate the effect of amputation level on health related quality of life, we classified patients to seven types according to the functional remainder of major joints (ankles, knees, hips). 97% of patients were male and the average age at the time of injury was 20 years. The major cause of war injury was shells in 50. 54% of amputees were involved in sport activities. The most common amputation level was transtibial (48%).The major stump complaint was muscle spasm. History of being hospitalized for a psychiatric disorder was reported in 5.6%. The average SF-36 score in type 2 to type 6 were 68, 60, 60, 56, and 62, respectively. Except Energy/Fatigue domain, all the other domains were different from normal population. There was not any significant statistical correlation between amputation type and any domain of the SF-36. Type 6 amputees showed an increase in physical health domains compared with former types.

  12. Long-term neuropsychological, neuroanatomical, and life outcome in hippocampal amnesia

    Science.gov (United States)

    Warren, David E.; Duff, Melissa C.; Magnotta, Vincent; Capizzano, Aristides A; Cassell, Martin D.; Tranel, Daniel

    2012-01-01

    Focal bilateral hippocampal damage typically causes severe and selective amnesia for new declarative information (facts and events), a cognitive deficit that greatly impacts the ability to live a normal, fully-independent life. We describe the case of 1846, a 48-year-old woman with profound hippocampal amnesia following status epilepticus and an associated anoxic episode at age 30. 1846 has undergone extensive neuropsychological testing on many occasions over the 18 years since her injury, and we present data indicating that her memory impairment has remained severe and stable during that time. New, high-resolution structural MRI studies of 1846's brain reveal substantial bilateral hippocampal atrophy resembling that of other well-known amnesic patients. In spite of severe amnesia, 1846 lives a full and mostly independent adult life, facilitated by an extensive social support network of family and friends. Her case provides an example of a rare and unlikely positive outcome in the face of severe memory problems. PMID:22401298

  13. Long-term follow-up outcomes of perinatally HIV-infected adolescents: infection control but school failure.

    Science.gov (United States)

    Souza, Edvaldo; Santos, Nicole; Valentini, Sophia; Silva, Gerlane; Falbo, Ana

    2010-12-01

    Perinatally human immunodeficiency virus (HIV)-infected children are fighting acquired immune deficiency syndrome (AIDS) and becoming adolescents. The objective of this study was to examine long-term outcomes among perinatally HIV-1-infected adolescents. Cross-sectional clinical and laboratory data were collected for 49 perinatally HIV-infected adolescents followed at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP's) Hospital from 1987 to 2007. The mean age of these adolescents was 12.5 years, the majority were female (73.5%) with a mean follow-up duration of 9.0 years, 71.4% of adolescents had no signs of HIV infection, 81.6% had normal CD4(+) lymphocyte count, and 53.1% had undetectable HIV viral load. HIV disclosure to the adolescent was reported in 31 (63.3%) participants. The majority were in school (89.8%) but failure and drop-out were reported by 51% and 28.6% of the subjects, respectively. All five domains of quality of life (QOL) measured revealed high scores. The majority of long-term adolescent survivors showed HIV-infection control and high scores of QOL, but with problems in schooling functioning that need early detection and intervention.

  14. initial angiotensin receptor blockade-induced decrease in albuminuria is associated with long-term renal outcome in type 2 diabetic patients with microalbuminuria

    DEFF Research Database (Denmark)

    Hellemons, Merel E; Persson, Frederik; Bakker, Stephan J L;

    2011-01-01

    We aimed to investigate the individual impact of initial responses in urinary albumin excretion (UAE) and systolic blood pressure (SBP) to angiotensin II receptor blocker (ARB) treatment on long-term renal outcome in patients with type 2 diabetes and microalbuminuria.......We aimed to investigate the individual impact of initial responses in urinary albumin excretion (UAE) and systolic blood pressure (SBP) to angiotensin II receptor blocker (ARB) treatment on long-term renal outcome in patients with type 2 diabetes and microalbuminuria....

  15. Dermatofibrosarcoma Protuberans: Long-term Outcomes of 53 Patients Treated With Conservative Surgery and Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Castle, Katherine O. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Guadagnolo, B. Ashleigh, E-mail: aguadagn@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tsai, C. Jillian [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Feig, Barry W. [Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Zagars, Gunar K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2013-07-01

    Purpose: To evaluate outcomes of conservative surgery and radiation therapy (RT) treatment in patients with dermatofibrosarcoma protuberans. Methods and Materials: We retrospectively reviewed the medical records of 53 consecutive dermatofibrosarcoma protuberans patients treated with surgery and preoperative or postoperative radiation therapy between 1972 and 2010. Median tumor size was 4 cm (range, 1-25 cm). Seven patients (13%) were treated with preoperative RT (50-50.4 Gy) and 46 patients (87%) with postoperative RT (60-66 Gy). Of the 46 patients receiving postoperative radiation, 3 (7%) had gross disease, 14 (30%) positive margins, 26 (57%) negative margins, and 3 (7%) uncertain margin status. Radiation dose ranged from 50 to 66 Gy (median dose, 60 Gy). Results: At a median follow-up time of 6.5 years (range, 0.5 months-23.5 years), 2 patients (4%) had disease recurrence, and 3 patients (6%) had died. Actuarial overall survival was 98% at both 5 and 10 years. Local control was 98% and 93% at 5 and 10 years, respectively. Disease-free survival was 98% and 93% at 5 and 10 years, respectively. The presence of fibrosarcomatous change was not associated with increased risk of local or distant relapse (P=.43). One of the patients with a local recurrence had gross residual disease at the time of RT and despite RT to 65 Gy developed both an in-field recurrence and a nodal and distant recurrence 3 months after RT. The other patient with local recurrence was found to have in-field recurrence 10 years after initial treatment. Thirteen percent of patients had an RT complication at 5 and 10 years, and 9% had a moderate or severe complication at 5 and 10 years. Conclusions: Dermatofibrosarcoma protuberans is a radioresponsive disease with excellent local control after conservative surgery and radiation therapy. Adjuvant RT should be considered for patients with large or recurrent tumors or when attempts at wide surgical margins would result in significant morbidity.

  16. Maternal Iron Status in Pregnancy and Long-Term Health Outcomes in the Offspring

    Science.gov (United States)

    Alwan, Nisreen A.; Hamamy, Hanan

    2015-01-01

    Iron is an essential micronutrient and is important not only in carrying oxygen but also to the catalytic activity of a variety of enzymes. In the fetus, it is vital to the synthesis of hemoglobin and in brain development. Iron deficiency (ID) anemia in pregnancy is a common problem, even in high-income country settings. Around 50% of pregnant women worldwide are anemic, with at least half of this burden due to ID. Iron supplements are widely recommended and used during pregnancy globally. However, the evidence on the extent of benefit they contribute to the offspring's health is not well established, and their routine use has its side effects and drawbacks. Dietary iron intake is difficult to assess accurately and it is unlikely to be sufficient to meet the demands of pregnancy if women start with inadequate body iron stores at conception. Evidence from experimental animal models suggests that maternal ID during pregnancy is associated with fetal growth restriction, as well as offspring obesity and high blood pressure later in life. The possible biological mechanisms for this observed association may be due to ID-induced changes in placental structure and function, enzyme expression, nutrient absorption, and fetal organ development. However, such evidence is limited in human studies. Prenatal ID in experimental animal models also adversely affected the developing brain structures, neurotransmitter systems, and myelination resulting in acute brain dysfunction during the period of deficiency and persistence of various postnatal neurobehavioral abnormalities as well as persistent dysregulation of some genes into adult life after iron repletion pointing to the possibility of gene expression changes. The evidence from human population studies is limited and heterogeneous and more research is needed in the future, investigating the effects of ID in pregnancy on future offspring health outcomes. PMID:27617121

  17. Maternal Iron Status in Pregnancy and Long-Term Health Outcomes in the Offspring.

    Science.gov (United States)

    Alwan, Nisreen A; Hamamy, Hanan

    2015-06-01

    Iron is an essential micronutrient and is important not only in carrying oxygen but also to the catalytic activity of a variety of enzymes. In the fetus, it is vital to the synthesis of hemoglobin and in brain development. Iron deficiency (ID) anemia in pregnancy is a common problem, even in high-income country settings. Around 50% of pregnant women worldwide are anemic, with at least half of this burden due to ID. Iron supplements are widely recommended and used during pregnancy globally. However, the evidence on the extent of benefit they contribute to the offspring's health is not well established, and their routine use has its side effects and drawbacks. Dietary iron intake is difficult to assess accurately and it is unlikely to be sufficient to meet the demands of pregnancy if women start with inadequate body iron stores at conception. Evidence from experimental animal models suggests that maternal ID during pregnancy is associated with fetal growth restriction, as well as offspring obesity and high blood pressure later in life. The possible biological mechanisms for this observed association may be due to ID-induced changes in placental structure and function, enzyme expression, nutrient absorption, and fetal organ development. However, such evidence is limited in human studies. Prenatal ID in experimental animal models also adversely affected the developing brain structures, neurotransmitter systems, and myelination resulting in acute brain dysfunction during the period of deficiency and persistence of various postnatal neurobehavioral abnormalities as well as persistent dysregulation of some genes into adult life after iron repletion pointing to the possibility of gene expression changes. The evidence from human population studies is limited and heterogeneous and more research is needed in the future, investigating the effects of ID in pregnancy on future offspring health outcomes.

  18. Neopterin plasma concentrations in patients with aneurysmal subarachnoid hemorrhage: correlation with infection and long-term outcome.

    Science.gov (United States)

    Azurmendi, Leire; Degos, Vincent; Tiberti, Natalia; Kapandji, Natacha; Sanchez-Peña, Paola; Sarrafzadeh, Asita; Puybasset, Louis; Turck, Natacha; Sanchez, Jean-Charles

    2016-05-01

    OBJECT Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of mortality and morbidity. The main predictor for the poor outcome is the World Federation of Neurosurgical Societies (WFNS) scale. However, this scale does not take into account proinflammatory events, such as infection occurring after the aSAH, which could modify the long-term status of patients. The aim of this study was to evaluate neopterin as an inflammatory biomarker for outcome and infection prediction in aSAH patients. METHODS Plasma concentrations of neopterin were measured in 61 aSAH patients (22 male and 39 female; mean age [± SD] 52.8 ± 11.8 years) using a commercial ELISA kit. Samples were collected daily for 10 days. Outcome at 12 months was determined using the Glasgow Outcome Scale (GOS) and dichotomized as poor (GOS score 1, 2, or 3) or good (GOS score 4 or 5). Infection was determined by the presence of a positive bacterial culture. RESULTS Patients with poor outcome at 12 months had higher concentrations of neopterin than patients with good outcome. In the same way, patients who had an infection during the hospitalization had significantly higher concentrations of neopterin than patients without infection (p = 0.001). Moreover, neopterin concentrations were significantly (p < 0.008) elevated in infected patients 2 days before infection detection and antibiotic therapy. CONCLUSIONS Neopterin is an efficient outcome predictor after aSAH. Furthermore, it is able to differentiate between infected and uninfected patients as early as 2 days before clinical signs of infection, facilitating earlier antibiotic therapy and better management.

  19. Chinese L1 children's English L2 verb morphology over time: individual variation in long-term outcomes.

    Science.gov (United States)

    Paradis, Johanne; Tulpar, Yasemin; Arppe, Antti

    2016-05-01

    This study examined accuracy in production and grammaticality judgements of verb morphology by eighteen Chinese-speaking children learning English as a second language (L2) followed longitudinally from four to six years of exposure to English, and who began to learn English at age 4;2. Children's growth in accuracy with verb morphology reached a plateau by six years, where 11/18 children did not display native-speaker levels of accuracy for one or more morphemes. Variation in children's accuracy with verb morphology was predicted by their English vocabulary size and verbal short-term memories primarily, and quality and quantity of English input at home secondarily. This study shows that even very young L2 learners might not all catch up to native speakers in this time frame and that non-age factors play a role in determining individual variation in child L2 learners' long-term outcomes with English morphology.

  20. Rape-related symptoms in adolescents: short- and long-term outcome after cognitive behavior group therapy

    Directory of Open Access Journals (Sweden)

    Iva Bicanic

    2014-06-01

    Full Text Available Background: Efficacy studies on treatment in adolescent victims of single rape are lacking, even though sexual victimization is most likely to occur during adolescence and despite the fact that adolescents are at risk to develop subsequent posttraumatic stress disorder. Aim: The aim of this prospective observational study was to evaluate the short- and long-term outcomes of a nine-session cognitive behavior group therapy (STEPS, including a parallel six-session parents’ group on rape-related symptomatology in female adolescents (13–18 years. STEPS includes psychoeducation, exposure in sensu as well as in vivo, cognitive restructuring, and relapse prevention. Methods: Fifty-five female adolescents with mental health problems due to single rape, but without prior sexual trauma, received STEPS while their parents participated in a support group. Subjects were assessed on posttraumatic stress (PTS and comorbid symptoms using self-report questionnaires prior to and directly after treatment, and at 6 and 12 months follow-up. Results: Repeated measures analysis showed a significant and large decrease in symptoms of PTS, anxiety, depression, anger, dissociation, sexual concerns, and behavior problems directly after treatment, which maintained at 12 months follow-up. Time since trauma did not influence the results. Dropout during STEPS was 1.8%. Conclusions: The results potentially suggest that the positive treatment outcomes at short- and long-term may be caused by STEPS. The encouraging findings need confirmation in future controlled studies on the effectiveness of STEPS because it may be possible that the treatment works especially well for more chronic symptoms, while the less chronic part of the sample showed considerable improvement on its own.

  1. FDG PET scan strategies and long-term outcomes after first-line therapy in Hodgkin's Disease

    Energy Technology Data Exchange (ETDEWEB)

    Poulou, Loukia S. [Department of Computed Tomography, ' Sotiria' General Hospital for Chest Diseases, Athens (Greece); Karianakis, George [Bone Marrow Transplantation Unit, ' Hygeia' Diagnostic and Therapeutic Centre, 4 Erythrou Stavrou Street, 151 23 Athens (Greece); Ziakas, Panayiotis D. [Bone Marrow Transplantation Unit, ' Hygeia' Diagnostic and Therapeutic Centre, 4 Erythrou Stavrou Street, 151 23 Athens (Greece)], E-mail: zpanos@otenet.gr

    2009-06-15

    Background: The use of positron emission tomography with fluoro-deoxy-glucose (FDG PET) in Hodgkin's disease (HD) is continuing to expand worldwide, with response assessment after completion of therapy being its most widely utilized application. A positive scan has been associated with high relapse rates and disease progression. Methods: A decision analysis was performed to determine the long-term impact of FDG PET restaging both with and without computed tomography (CT) in terms of the 5-year progression-free survival (5yrPFS). Outcomes and utilities were based on published data. The first strategy involved CT restaging after first-line therapy, with or without subsequent FDG PET, while Second strategy used FDG PET scan alone. All positive test required histological examination. Upon histological confirmation of active lymphoma, patients were considered candidates for autologous transplantation and long-term outcomes were retrieved. The expected clinical benefit of the two strategies was calculated and depicted, along with the mean costs. One-way and two-way sensitivity analyses were performed to ensure the validity of the results. Results: CT restaging plus FDG PET when residual mass is detected, results in a 2% benefit at 5yrPFS at baseline compared to FDG PET-alone restaging and remains positive for a wide range of probabilities. This strategy reduces the average cost by Euro 1863 per patient, including costs of biopsy and autologous transplantation. Conclusion: A more conservative approach that includes CT restaging after first-line therapy and FDG PET scan only on residual mass, is the preferred strategy in HD. Furthermore it appears to confer the maximal diagnostic yield along with a substantial reduction in the mean cost.

  2. Aneurysmal subarachnoid hemorrhage in elderly patients: long-term outcome and prognostic factors in an interdisciplinary treatment approach.

    Science.gov (United States)

    Schöller, Karsten; Massmann, Maike; Markl, Gertraud; Kunz, Mathias; Fesl, Gunther; Brückmann, Hartmut; Pfefferkorn, Thomas; Tonn, Jörg-Christian; Schichor, Christian

    2013-04-01

    The number of elderly patients with aneurysmal subarachnoid hemorrhage (SAH) is increasing with the aging of the population. However, management recommendations based on long-term outcome data and analyses of prognostic factors are scarce. Our study focused exclusively on elderly patients aged ≥ 60 years at the onset of SAH. Patients were selected from an in-house database and compared in cohorts of age 60-69, 70-79, and ≥ 80, regarding pre-existing medical conditions, treatment, clinical course including complications, and outcome. A multivariate analysis was conducted to identify prognostic factors for death and disability. A total of 256 patients (138 aged 60-69, 93 aged 70-79, 25 aged ≥ 80) with putative aneurysmal SAH who had been admitted to our hospital between January 1, 1996 and June 30, 2007 were extracted. The median follow-up of our total cohort was 35.5 months (range <1-154 months). Endovascular or conservative aneurysm treatment was applied more often with increasing age (p < 0.006). The 1-year survival rate was 78, 65, and 38 % in the three age groups, respectively (p = 0.0002); most of the patients died from the initial hemorrhage or from medical complications. Patients aged <70 with an initial World Federation of Neurosurgical Societies (WFNS) score of I-III showed the best clinical recovery. WFNS score, age, and clipping/coiling were extracted as prognostic factors from the Cox model. Elderly patients who get admitted with a good WFNS score (I-III) seem to benefit from aggressive treatment whereas caution seems to be warranted particularly in patients ≥ 70 years of age who get admitted in a WFNS score of IV and V because of their limited short- and long-term prognosis.

  3. Hyperhomocysteinemia is an independent predictor of long-term clinical outcomes in Chinese octogenarians with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Fu Z

    2015-09-01

    Full Text Available Zhenhong Fu,1,* Geng Qian,1,* Hao Xue,1,* Jun Guo,1 Lian Chen,1 Xia Yang,1 Mingzhi Shen,2 Wei Dong,1 Yundai Chen11Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China; 2Department of Cardiology, Hainai Branch of Chinese People’s Liberation Army General Hospital, Sanya, Hainan, People’s Republic of China*These authors contributed equally to this workObjective: To evaluate the prognostic value of homocysteine (Hcy in Chinese acute coronary syndrome (ACS octogenarians.Methods: The study cohort comprised 660 consecutive ACS octogenarians who underwent coronary angiography. We classified the patients into three groups according to Hcy tertiles. Kaplan–Meier method was performed for survival and major adverse cardiac events (MACE rates. Multivariate Cox regression was performed to identify mortality predictors. Receiver operating characteristic curve analysis was performed to predict the cutoff value of Hcy for all-cause mortality.Results: The follow-up period was 28 (inter-quartile range: 16–38 months. Diastolic blood pressure, ratios of male, renal failure and old myocardial infarction in high plasma level Hcy (H-Hcy group were higher than those in low (L-Hcy and middle (M-Hcy plasma level of Hcy groups (P<0.05. The Hcy level was positively correlated with uric acid level (r=0.211, P=0.001 and Cystatin C (Cys C level (r=0.212, P=0.001 and negatively correlated with estimated glomerular filtration rate (r=−0.148, P=0.018. For the long-term outcomes, the cumulative survival rate of H-Hcy group was significantly lower than that of L-Hcy and M-Hcy groups (P=0.006. All-cause mortality and MACE of H-Hcy group were higher than those of L-Hcy and M-Hcy group (P=0.0001, P=0.0008. Hcy is an independent predictor for long-term all-cause mortality (odds ratio =2.26, 95% CI=1.23–4.16, P=0.023 and MACE (odds ratio =1.91, 95% CI=1.03–3.51, P=0.039. Receiver operating characteristic

  4. Long-term outcomes of palliative colonic stenting versus emergency surgery for acute proximal malignant colonic obstruction: a multicenter trial

    Science.gov (United States)

    Siddiqui, Ali; Cosgrove, Natalie; Yan, Linda H.; Brandt, Daniel; Janowski, Raymond; Kalra, Ankush; Zhan, Tingting; Baron, Todd H.; Repici, Allesandro; Taylor, Linda Jo; Adler, Douglas. G.

    2017-01-01

    Background and study aims Long-term data are limited regarding clinical outcomes of self-expanding metal stents as an alternative for surgery in the treatment of acute proximal MBO. The aim of this study was to compare the long-term outcomes of stenting to surgery for palliation in patients with incurable obstructive CRC for lesions proximal to the splenic flexure. Patients and methods Retrospective multicenter cohort study of obstructing proximal CRC patients with who underwent insertion of a SEMS (n = 69) or surgery (n = 36) from 1999 to 2014. The primary endpoint was relief of obstruction. Secondary endpoints included technical success, duration of hospital stay, early and late adverse events (AEs) and survival. Results Technical success was achieved in 62/69 (89.8 %) patients in the SEMS group and in 36 /36 (100 %) patients who underwent surgery (P = 0.09). In the SEMS group, 10 patients underwent stenting as a bridge to surgery and 59 underwent stent placement for palliation. Clinical relief was achieved in 78 % of patients with stenting and in 100 % of patients who underwent surgery (P group (7.2 % vs. 30.5 %, P = 0.003). Hospital mortality for the SEMS group was 0 % compared to 5.6 % in the surgery group (P = 0.11). Patients in the SEMS group had a significantly shorter median hospital stay (4 days) as compared to the surgery group (8 days) (P group (73.9 %) than the surgery group (97.3 %; P = 0.003). SEMS placement was associated with higher long-term complication rates compared to surgery (21 % and 11 % P = 0.27). Late SEMS AEs included occlusion (10 %), migration (5 %), and colonic ulcer (6 %). At 120 weeks, survival in the SEMS group was 5.6 % vs. 0 % in the surgery group (P = 0.8). Conclusions Technical and clinical success associated with proximal colonic obstruction are higher with surgery when compared to SEMS, but surgery is associated with longer hospital stays and more

  5. Impact of nutritional status on long-term functional outcomes of post-acute stroke patients in Taiwan.

    Science.gov (United States)

    Shen, Hsiu-Chu; Chen, Hsueh-Fen; Peng, Li-Ning; Lin, Ming-Hsien; Chen, Liang-Kung; Liang, Chih-Kuang; Lo, Yuk-Keung; Hwang, Shinn-Jang

    2011-01-01

    Nutritional status is important in stroke care, but little is known regarding to the prognostic role of nutritional status on long-term functional outcomes among stroke survivors. The main purpose of this study was to evaluate to the prognostic role of nutritional status on long-term functional outcomes among stroke survivors. Data of acute stroke registry in Kaohsiung Veterans General Hospital were retrieved for analysis. Overall, 483 patients (mean age = 70.7 ± 10.3 years) with first-ever stroke were found. Among them, 95 patients (19.7%) were malnourished at admission, 310 (mean age = 70.4 ± 10.1 years, 63.5% males) survived for 6 months, and 244 (78.7%) had good functional outcomes. Subjects with poor functional outcomes were older (74.7 ± 8.9 vs. 69.0 ± 10.1 years, p pneumonia upon admission (23.3% vs. 12.7%, p = 0.027), had a longer hospital stay (23.5 ± 13.9 vs. 12.5 ± 8.2 days, p < 0.001), had a higher National Institutes of Health Stroke Scale (NIHSS) score (12.9 ± 9.3 vs. 4.9 ± 4.3, p < 0.001), poorer stroke recovery (NIHSS improvement: 6.9% vs. 27.4%, p = 0.005), and poorer functional improvement (Barthel index = BI improvement in the first month: 31.4% vs. 138%, p < 0.001). Older age (odds ratio = OR) = 1.07, 95% confidence interval (CI = 1.03-1.11, p<0.001), baseline NIHSS score (OR = 1.23, 95%CI = 1.15-1.31, p < 0.001) and malnutrition at acute stroke (OR = 2.57, 95%CI: 1.29-5.13, p<0.001) were all independent risk factors for poorer functional outcomes. In conclusion, as a potentially modifiable factor, more attentions should be paid to malnutrition to promote quality of stroke care since the acute stage.

  6. Outcome of Long-Term Bisphosphonate Therapy in McCune-Albright Syndrome and Polyostotic Fibrous Dysplasia.

    Science.gov (United States)

    Majoor, Bas Cj; Appelman-Dijkstra, Natasha M; Fiocco, Martha; van de Sande, Michiel Aj; Dijkstra, Pd Sander; Hamdy, Neveen At

    2017-02-01

    McCune-Albright syndrome (MAS) is a rare bone disorder characterized by fibrous dysplasia (FD), endocrinopathies, and café-au-lait patches. FD patients have been shown to respond favorably to treatment with bisphosphonates, but data are scarce in the more severe polyostotic form (PFD), including MAS, and factors determining treatment outcome are not known, particularly in the long-term. We evaluated the biochemical (bone turnover markers [BTMs]) and clinical (pain reduction) outcome of bisphosphonate therapy in 11 patients with MAS and 30 patients with PFD: median duration of treatment 6 years (range, 2 to 25 years). Prognostic factors for treatment outcome were identified in both groups. Patients with MAS were younger at diagnosis (p = 0.001), all had precocious puberty, and four (36%) had additional growth hormone (GH) excess associated with severe craniofacial FD. Extent of skeletal disease was more severe in MAS compared to PFD. MAS patients had higher serum alkaline phosphatase (ALP) concentrations (p = 0.005), higher skeletal burden scores (p < 0.001), and more fractures (p = 0.021). MAS patients had also higher levels of FGF-23 (p = 0.008) and higher prevalence of hypophosphatemia (p = 0.013). Twenty-four of 30 PFD patients (80%) demonstrated a complete clinical and biochemical response within a year of starting treatment (p = 0.015), compared to only four of 11 MAS patients (36%). There were no nonresponders. In the whole group, FGF-23, total ALP, P1NP, and CTX positively correlated with skeletal burden scores (all p ≤ 0.001), which was the only significant risk factor for an incomplete response to bisphosphonate therapy (p < 0.01). Our data suggest a beneficial and safe outcome of long-term bisphosphonate therapy in the majority of patients with PFD, although response to therapy was limited by the higher skeletal disease burden in MAS patients. In the PFD/MAS population studied, the only identified prognostic factor

  7. Long-term outcomes associated to video-assisted thoracic sympathotomy for palmar-axillar subtype of the hyperhidrosis

    Directory of Open Access Journals (Sweden)

    Leandro Pretto Flores

    2012-06-01

    Full Text Available OBJECTIVE: Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS of T2, T3 and T4 ganglia for these cases. METHODS: Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS. All subjects were followed-up for 36 months. RESULTS: Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423, respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031 still noticed it at the end of the follow-up period. CONCLUSIONS: VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however it is usually self-limited.

  8. Long-Term Survival and Outcome in Children Admitted to Kilifi District Hospital with Convulsive Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Agnes Prins

    2014-01-01

    Full Text Available Objectives. The incidence of convulsive status epilepticus (CSE is high in Africa but the long-term outcome is unknown. We examined the neurocognitive outcome and survival of children treated for CSE in a Kenyan hospital 3 to 4 years after discharge. Methods. The frequency and nature of neurological deficits among this group of children were determined and compared to a control group. The children were screened with the Ten Questions Questionnaire for neurodevelopmental impairment if alive and those that screened positive were invited for further assessment to determine the pattern and extent of their impairment. A verbal autopsy was performed to determine the cause of death in those that died. Results. In the 119 cases followed-up, 9 (8% died after discharge, with the majority having seizures during their fatal illness. The 110 survivors (median age 5 years had significantly more neurological impairments on the screening compared to 282 controls (34/110 (30.9% versus 11/282 (3.9%, OR = 11.0, 95% CI 5.3–22.8. Fifteen percent of the cases had active epilepsy. Conclusions. This study demonstrates the considerable burden of CSE in African children. Strategies to manage children with CSE that are acceptable to the community need to be explored to improve the longer-term outcome.

  9. Long-Term Outcomes of Fractionated Stereotactic Radiation Therapy for Pituitary Adenomas at the BC Cancer Agency

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Julian O.; Ma, Roy [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver (Canada); Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver (Canada); Akagami, Ryojo [Division of Neurosurgery, University of British Columbia, Vancouver (Canada); McKenzie, Michael [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver (Canada); Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver (Canada); Johnson, Michelle [Division of Endocrinology, University of British Columbia, Vancouver (Canada); Gete, Ermias [Department of Medical Physics, British Columbia Cancer Agency, Vancouver (Canada); Nichol, Alan, E-mail: anichol@bccancer.bc.ca [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver (Canada); Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver (Canada)

    2013-11-01

    Purpose: To assess the long-term disease control and toxicity outcomes of fractionated stereotactic radiation therapy (FSRT) in patients with pituitary adenomas treated at the BC Cancer Agency. Methods and Materials: To ensure a minimum of 5 years of clinical follow-up, this study identified a cohort of 76 patients treated consecutively with FSRT between 1998 and 2007 for pituitary adenomas: 71% (54/76) had nonfunctioning and 29% (22/76) had functioning adenomas (15 adrenocorticotrophic hormone-secreting, 5 growth hormone-secreting, and 2 prolactin-secreting). Surgery was used before FSRT in 96% (73/76) of patients. A median isocenter dose of 50.4 Gy was delivered in 28 fractions, with 100% of the planning target volume covered by the 90% isodose. Patients were followed up clinically by endocrinologists, ophthalmologists, and radiation oncologists. Serial magnetic resonance imaging was used to assess tumor response. Results: With a median follow-up time of 6.8 years (range, 0.6 - 13.1 years), the 7-year progression-free survival was 97.1% and disease-specific survival was 100%. Of the 2 patients with tumor progression, both had disease control after salvage surgery. Of the 22 patients with functioning adenomas, 50% (11/22) had complete and 9% (2/22) had partial responses after FSRT. Of the patients with normal pituitary function at baseline, 48% (14/29) experienced 1 or more hormone deficiencies after FSRT. Although 79% (60/76) of optic chiasms were at least partially within the planning target volumes, no patient experienced radiation-induced optic neuropathy. No patient experienced radionecrosis. No secondary malignancy occurred during follow-up. Conclusion: In this study of long-term follow-up of patients treated for pituitary adenomas, FSRT was safe and effective.

  10. Long-term outcome of free fibula osteocutaneous flap and massive allograft in the reconstruction of long bone defect.

    Science.gov (United States)

    Halim, Ahmad Sukari; Chai, Siew Cheng; Wan Ismail, Wan Faisham; Wan Azman, Wan Sulaiman; Mat Saad, Arman Zaharil; Wan, Zulmi

    2015-12-01

    Reconstruction of massive bone defects in bone tumors with allografts has been shown to have significant complications including infection, delayed or nonunion of allograft, and allograft fracture. Resection compounded with soft tissue defects requires skin coverage. A composite osteocutaneous free fibula offers an optimal solution where the allografts can be augmented mechanically and achieve biological incorporation. Following resection, the cutaneous component of the free osteocutaneous fibula flaps covers the massive soft tissue defect. In this retrospective study, the long-term outcome of 12 patients, who underwent single-stage limb reconstruction with massive allograft and free fibula osteocutaneous flaps instead of free fibula osteal flaps only, was evaluated. This study included 12 consecutive patients who had primary bone tumors and had follow-up for a minimum of 24 months. The mean age at the time of surgery was 19.8 years. A total of eight patients had primary malignant bone tumors (five osteosarcomas, two chondrosarcomas and one synovial sarcoma), and four patients had benign bone tumors (two giant-cell tumors, one aneurysmal bone cyst, and one neurofibromatosis). The mean follow-up for the 12 patients was 63 months (range 24-124 months). Out of the 10 patients, nine underwent lower-limb reconstruction and ambulated with partial weight bearing and full weight bearing at an average of 4.2 months and 8.2 months, respectively. In conclusion, augmentation of a massive allograft with free fibula osteocutaneous flap is an excellent alternative for reducing the long-term complication of massive allograft and concurrently addresses the soft tissue coverage.

  11. Long-term survival outcomes of reduced-intensity allogeneic or autologous transplantation in relapsed grade 3 follicular lymphoma

    Science.gov (United States)

    Klyuchnikov, Evgeny; Bacher, Ulrike; Ahn, Kwang Woo; Carreras, Jeanette; Kröger, Nicolaus M.; Hari, Parameswaran N.; Ku, Grace H.; Ayala, Ernesto; Chen, Andy I.; Chen, Yi-Bin; Cohen, Jonathon B.; Freytes, César O.; Gale, Robert Peter; Kamble, Rammurti T.; Kharfan-Dabaja, Mohamed A.; Lazarus, Hillard M.; Martino, Rodrigo; Mussetti, Alberto; Savani, Bipin N.; Schouten, Harry C.; Usmani, Saad Z.; Wiernik, Peter H.; Wirk, Baldeep; Smith, Sonali M.; Sureda, Anna; Hamadani, Mehdi

    2015-01-01

    Grade-3 follicular lymphoma (FL) has aggressive clinical behavior. To evaluate the optimal first transplantation approach in relapsed/refractory grade-3 FL patients, we compared the long-term outcomes after allogeneic (allo-) vs. autologous hematopoietic cell transplantation (auto-HCT) in the rituximab-era. A total of 197 patients undergoing first RIC allo-HCT or first auto-HCT during 2000-2012 were included. Rituximab-naïve patients were excluded. Allo-HCT recipients were younger; more heavily pretreated, and had a longer interval between diagnosis and HCT. The 5-year probabilities of non-relapse mortality (NRM), relapse/progression, progression-free survival (PFS) and overall survival (OS) for auto-HCT vs. allo-HCT groups were 4% vs. 27% (p<0.001); 61% vs. 20% (p<0.001); 36% vs. 51% (p=0.07) and 59% vs. 54% (p=0.7), respectively. On multivariate analysis auto-HCT was associated with reduced risk of NRM (RR=0.20; p=0.001). Within the first 11months post-HCT auto- and allo-HCT had similar risks of relapse/progression and PFS. Beyond 11months, auto-HCT was associated with higher risk of relapse/progression (RR=21.3; p=0.003) and inferior PFS (RR=3.2; p=0.005). In the first 24 months post-HCT, auto-HCT was associated with improved OS (RR=0.42; p=0.005), but in long-time survivors (beyond 24 months) it was associated with inferior OS (RR=3.6; p=0.04). RIC allo-HCT as the first transplant approach can provide improved PFS and OS, in long-term survivors. PMID:26437062

  12. Long-term Outcome of Peripherally Implanted Venous Access Ports in the Forearm in Female Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Klösges, Laura, E-mail: l.kloesges@uni-bonn.de; Meyer, Carsten, E-mail: carsten.meyer@ukb.uni-bonn.de; Boschewitz, Jack, E-mail: jack.boschewitz@ukb.uni-bonn.de; Andersson, Magnus, E-mail: magnus.andersson@ukb.uni-bonn.de [Universitätsklinikum Bonn, Department of Radiology (Germany); Rudlowski, Christian, E-mail: c.rudlowski@evk.de [Evangelisches Krankenhaus Bergisch Gladbach, Department of Gynecology (Germany); Schild, Hans H., E-mail: hans.schild@ukb.uni-bonn.de [Universitätsklinikum Bonn, Department of Radiology (Germany); Wilhelm, Kai, E-mail: kai.wilhelm@ek-bonn.de [Ev. Kliniken Bonn, Johanniter-Krankenhaus, Department of Radiology (Germany)

    2015-06-15

    PurposeThe aim of this retrospective study was to analyze the long-term outcome of peripherally implanted venous access ports in the forearm at our institution in a female patient collective.MethodsBetween June 2002 and May 2011, a total of 293 female patients with an underlying malignancy had 299 forearm ports implanted in our interventional radiology suite. The mean age of the cohort was 55 ± 12 years (range 26–81 years). The majority of women suffered from breast (59.5 %) or ovarian cancer (28.1 %). Complications were classified as infectious complications, thrombotic and nonthrombotic catheter dysfunction (dislocation of the catheter or port chamber, fracture with/without embolization or kinking of the catheter, port occlusion), and others.ResultsWe analyzed a total of 90,276 catheter days in 248 port systems (47 patients were lost to follow-up). The mean device service interval was 364 days per catheter (range 8–2,132, median 223 days, CI 311–415, SD 404). Sixty-seven early (≤30 days from implantation) or late complications (>30 days) occurred during the observation period (0.74/1,000 catheter days). Common complications were port infection (0.18/1,000 days), thrombotic dysfunction (0.12/1,000 days), and skin dehiscence (0.12/1,000 days). Nonthrombotic dysfunction occurred in a total of 21 cases (0.23/1,000 days) and seemed to cumulate on the venous catheter entry site on the distal upper arm.ConclusionPeripherally implanted venous access ports in the forearm are a safe alternative to chest or upper-arm ports in female oncology patients. Special attention should be paid to signs of skin dehiscence and nonthrombotic dysfunction, especially when used for long-term treatment.

  13. Marginal pulmonary function is associated with poor short- and long-term outcomes in lung cancer surgery

    Science.gov (United States)

    Ozeki, Naoki; Kawaguchi, Koji; Okasaka, Toshiki; Fukui, Takayuki; Fukumoto, Koichi; Nakamura, Shota; Hakiri, Shuhei; Yokoi, Kohei

    2017-01-01

    ABSTRACT We sought to determine the short- and long-term prognoses among ‘marginal-risk’ non-small cell lung cancer patients who have a predicted postoperative- (ppo) forced expiratory volume in the first second (FEV1) of 30–60% and/or a ppo-diffusing capacity of the lung for carbon monoxide (DLCO) of 30–60%. The present study included 73 ‘marginal-risk’ and 318 ‘normal-risk’ patients who underwent anatomical resection for clinical stage I lung cancer between 2008 and 2012. The rates of postoperative morbidity, prolonged hospital stay, and overall survival were assessed. Postoperative morbidity occurred in 35 (48%) ‘marginal-risk’ patients and 66 (21%) ‘normal-risk’ patients, and 17 (23%) ‘marginal-risk’ patients and 20 (6%) ‘normal-risk’ patients required a prolonged hospital stay. The three- and five-year survival rates were 79% and 64% in the ‘marginal-risk’ patients and 93% and 87% in the ‘normal-risk’ patients, respectively. A ‘marginal-risk’ status was a significant factor in the prediction of postoperative morbidity (odds ratio [OR] 2.97, p < 0.001), the rate of prolonged hospital stay (OR 3.83, p < 0.001), and overall survival (hazard ratio 2.07, p = 0.028). In conclusion, ‘Marginal-risk’ patients, who are assessed based on ppo-values, comprise a subgroup of patients with poorer short- and long-term postoperative outcomes.

  14. Long-term Behavior of Serous Borderline Tumors Subdivided Into Atypical Proliferative Tumors and Noninvasive Low-grade Carcinomas

    DEFF Research Database (Denmark)

    Vang, Russell; Hannibal, Charlotte Gerd; Junge, Jette

    2017-01-01

    Ovarian serous borderline tumors (SBTs) have been the subject of considerable controversy, particularly with regard to terminology and behavior. It has been proposed that they constitute a heterogenous group of tumors composed, for the most part, of typical SBTs that are benign and designated...... "atypical proliferative serous tumor (APST)" and a small subset of SBTs with micropapillary architecture that have a poor outcome and are designated "noninvasive low-grade serous carcinoma (niLGSC)". It also has been argued that the difference in behavior between the 2 groups is not due to the subtype...... of the primary tumor but rather the presence of extraovarian disease, specifically invasive implants. According to the terminology of the 2014 WHO Classification, typical SBTs are equivalent to APSTs and SBTs displaying micropapillary architecture are synonymous with niLGSC. In addition, "invasive implants" were...

  15. The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury.

    Directory of Open Access Journals (Sweden)

    Gilles Clermont

    Full Text Available BACKGROUND: The pulmonary artery catheter (PAC remains widely used in acute lung injury (ALI despite known complications and little evidence of improved short-term mortality. Concurrent with NHLBI ARDS Clinical Trials Network Fluid and Catheters Treatment Trial (FACTT, we conducted a prospectively-defined comparison of healthcare costs and long-term outcomes for care with a PAC vs. central venous catheter (CVC. We explored if use of the PAC in ALI is justified by a beneficial cost-effectiveness profile. METHODS: We obtained detailed bills for the initial hospitalization. We interviewed survivors using the Health Utilities Index Mark 2 questionnaire at 2, 6, 9 and 12 m to determine quality of life (QOL and post-discharge resource use. Outcomes beyond 12 m were estimated from federal databases. Incremental costs and outcomes were generated using MonteCarlo simulation. RESULTS: Of 1001 subjects enrolled in FACTT, 774 (86% were eligible for long-term follow-up and 655 (85% consented. Hospital costs were similar for the PAC and CVC groups ($96.8k vs. $89.2k, p = 0.38. Post-discharge to 12 m costs were higher for PAC subjects ($61.1k vs. 45.4k, p = 0.03. One-year mortality and QOL among survivors were similar in PAC and CVC groups (mortality: 35.6% vs. 31.9%, p = 0.33; QOL [scale: 0-1]: 0.61 vs. 0.66, p = 0.49. MonteCarlo simulation showed PAC use had a 75.2% probability of being more expensive and less effective (mean cost increase of $14.4k and mean loss of 0.3 quality-adjusted life years (QALYs and a 94.2% probability of being higher than the $100k/QALY willingness-to-pay threshold. CONCLUSION: PAC use increased costs with no patient benefit and thus appears unjustified for routine use in ALI. TRIAL REGISTRATION: www.clinicaltrials.gov NCT00234767.

  16. Long term follow up of clinical outcome between patellar resurfacing and nonresurfacing in total knee arthroplasty: Chinese experience

    Institute of Scientific and Technical Information of China (English)

    Feng Bin; Weng Xisheng; Lin Jin; Jin Jin; Qian Wenwei; Wang Wei; Qiu Guixing

    2014-01-01

    Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.Methods From January 1993 to December 2002,265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery,Peking Union Medical College Hospital.Among them,226 patients (246 knees) were successfully followed up,with 176 knees for patellar resurfacing and 70 knees for nonresurfacing.The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score (HSS),patellar score,patellar related complication and radiological results were studied at the latest follow-up.Results The HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up.Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group.There was no statistically significant difference for both HSS score,patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group.Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation.Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis.The 10-year survival rate was not statistically significant different between the two groups (P=0.12).Conclusions There was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing.Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis.Selective patellar resurfacing for patients with rheumatoid arthritis can achieve

  17. Long term Outcome of Non-Ablative Booster Bone Marrow Transplantation in Patients with Severe Combined Immunodeficiency

    Science.gov (United States)

    Teigland, Claire L.; Parrott, Roberta E.; Buckley, Rebecca H.

    2013-01-01

    Severe combined immunodeficiency (SCID) is a fatal syndrome caused by mutations in at least 13 different genes. It is characterized by the absence of T-cells. Immune reconstitution can be achieved through non-ablative related donor bone marrow transplantation. However, the first transplant may not provide sufficient immunity. In these cases, booster transplants may be helpful. A prospective/retrospective study was conducted of 49 SCID patients (28.7 percent of 171 SCIDs transplanted over 30 years) who had received booster transplants to define the long term outcome, factors contributing to a need for a booster and factors that predicted success. Of the 49 patients, 31 (63 percent) are alive for up to 28 years. Age at initial transplantation was found to have a significant effect on outcome (mean of 194 days old for patients currently alive, versus a mean of 273 days old for those now deceased, p=0.0401). Persistent viral infection was present in most deceased booster patients. In several patients, the use of two parents as sequential donors resulted in striking T and B cell immune reconstitution. A majority of the patients alive today have normal or adequate T-cell function and are healthy. Non-ablative booster bone marrow transplantation can be life-saving for SCID. PMID:23396406

  18. Long-term renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis.

    Science.gov (United States)

    Yang, J; Liang, D; Zhang, H; Liu, Z; Le, W; Zhou, M; Hu, W; Zeng, C; Liu, Z

    2015-12-01

    In the present study, we observed the renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis (LN) and evaluated the risk factors associated with poor renal prognosis. The 5 -, 10 -, 15 - and 20-year renal survival rates were 93.1%, 87.9%, 81.0% and 68.3%, respectively. Gender, LN duration, mean arterial pressure (MAP), proteinuria, serum creatinine, haemoglobin and pathological classification at the time of biopsy were independent risk factors for end-stage renal disease (ESRD). The long-term renal outcomes of patients with class II LN were unfavorable as opposed to those with class V. Additionally, the time-average proteinuria (TA-Pro) and the time-average mean arterial pressure (TA-MAP) during the follow-up were important risk factors for ESRD, with better predictive values than the baseline proteinuria and MAP. The results underscore the need for proteinuria and blood pressure control during follow-up in patients with LN; proteinuria levels should be controlled at least to < 1.0 g/24 h, and optimally to < 0.5 g/24 h; MAP should not exceed 96.5 mmHg. More attention should be paid to class II LN and emphasis should be placed on recurrence prevention of class II LN.

  19. The long-term outcome of patients treated operatively and non-operatively for scoliosis deformity secondary to spina bifida.

    Science.gov (United States)

    Khoshbin, A; Vivas, L; Law, P W; Stephens, D; Davis, A M; Howard, A; Jarvis, J G; Wright, J G

    2014-09-01

    The purpose of this study was to evaluate the long-term outcome of adults with spina bifida cystica (SBC) who had been treated either operatively or non-operatively for scoliosis during childhood. We reviewed 45 patients with a SBC scoliosis (Cobb angle ≥ 50º) who had been treated at one of two children's hospitals between 1991 and 2007. Of these, 34 (75.6%) had been treated operatively and 11 (24.4%) non-operatively. After a mean follow-up of 14.1 years (standard deviation (sd) 4.3) clinical, radiological and health-related quality of life (HRQOL) outcomes were evaluated using the Spina Bifida Spine Questionnaire (SBSQ) and the 36-Item Short Form Health Survey (SF-36). Although patients in the two groups were demographically similar, those who had undergone surgery had a larger mean Cobb angle (88.0º (sd 20.5; 50.0 to 122.0) ; : versus 65.7º (sd 22.0; 51.0 to 115.0); p scoliosis corrects coronal deformity and stops progression of the curve but has no clear effect on HRQOL.

  20. Long-term renal outcomes in patients with traumatic brain injury: A nationwide population-based cohort study

    Science.gov (United States)

    Kor, Chew-Teng; Chiu, Ping-Fang; Tsai, Chun-Chieh; Lian, Ie-Bin; Yang, Tao-Hsiang; Tarng, Der-Cherng; Chang, Chia-Chu

    2017-01-01

    Background Traumatic brain injury (TBI) is an important cause of death and disability worldwide. The relationship between TBI and kidney diseases is largely unknown. Methods We aimed to determine whether TBI is associated with long-term adverse renal outcomes. We performed a nationwide, population-based, propensity score-matched cohort study of 32,152 TBI patients and 128,608 propensity score-matched controls. Data were collected by the National Health Insurance Research Database of Taiwan from 2000 to 2012. Our clinical outcomes were chronic kidney disease (CKD), end-stage renal disease (ESRD) and the composite endpoint of ESRD or all-cause mortality. Results The incidence rate of CKD was higher in the TBI than in the control cohort (8.99 vs. 7.4 per 1000 person-years). The TBI patients also showed higher risks of CKD (adjusted hazard ratio [aHR] 1.14, 95% confidence interval [CI] 1.08–1.20; P < 0.001) and composite endpoints (aHR 1.08, 95% CI 1.01–1.15; P = 0.022) than the control groups, but the ESRD was not significantly different between the groups. In subgroup analyses, the risks of incident CKD and composite endpoints were significantly raised in TBI patients aged < 65 years and/or without comorbidities. However, the risks of both CKD and composite outcome were little affected by the severity of TBI. Conclusions TBI has a modest but significant effect on incident CKD and composite endpoint, but not on ESRD alone. TBI patients under 65 are at greater risk of CKD and composite outcome than their older counterparts. PMID:28196132

  1. Establishing long-term efficacy in chronic disease: use of recursive partitioning and propensity score adjustment to estimate outcome in MS.

    Directory of Open Access Journals (Sweden)

    Douglas S Goodin

    Full Text Available CONTEXT: Establishing the long-term benefit of therapy in chronic diseases has been challenging. Long-term studies require non-randomized designs and, thus, are often confounded by biases. For example, although disease-modifying therapy in MS has a convincing benefit on several short-term outcome-measures in randomized trials, its impact on long-term function remains uncertain. OBJECTIVE: Data from the 16-year Long-Term Follow-up study of interferon-beta-1b is used to assess the relationship between drug-exposure and long-term disability in MS patients. DESIGN/SETTING: To mitigate the bias of outcome-dependent exposure variation in non-randomized long-term studies, drug-exposure was measured as the medication-possession-ratio, adjusted up or down according to multiple different weighting-schemes based on MS severity and MS duration at treatment initiation. A recursive-partitioning algorithm assessed whether exposure (using any weighing scheme affected long-term outcome. The optimal cut-point that was used to define "high" or "low" exposure-groups was chosen by the algorithm. Subsequent to verification of an exposure-impact that included all predictor variables, the two groups were compared using a weighted propensity-stratified analysis in order to mitigate any treatment-selection bias that may have been present. Finally, multiple sensitivity-analyses were undertaken using different definitions of long-term outcome and different assumptions about the data. MAIN OUTCOME MEASURE: Long-Term Disability. RESULTS: In these analyses, the same weighting-scheme was consistently selected by the recursive-partitioning algorithm. This scheme reduced (down-weighted the effectiveness of drug exposure as either disease duration or disability at treatment-onset increased. Applying this scheme and using propensity-stratification to further mitigate bias, high-exposure had a consistently better clinical outcome compared to low-exposure (Cox proportional hazard

  2. Durable intermediate- to long-term outcomes after minimally invasive transiliac sacroiliac joint fusion using triangular titanium implants

    Directory of Open Access Journals (Sweden)

    Sachs D

    2016-07-01

    Full Text Available Donald Sachs,1 Don Kovalsky,2 Andy Redmond,3 Robert Limoni,4 S Craig Meyer,5 Charles Harvey,6 Dimitriy Kondrashov7 1Center for Spinal Stenosis and Neurologic Care, Lakeland, FL, 2Orthopaedic Center of Southern Illinois, Mount Vernon, IL, 3Precision Spine Care, Tyler, TX, 4BayCare Clinic, Green Bay, WI, 5Columbia Orthopaedic Group, Columbia, MO, 6Riverside Medical Center, Kankakee, IL, 7SF Spine Group at St Mary’s Spine Center, San Francisco, CA, USA Background: Sacroiliac joint (SIJ fusion (SIJF, first performed 95 years ago, has become an increasingly accepted surgical option for chronic SIJ dysfunction. Few studies have reported intermediate- or long-term outcomes after SIJF.Objective: The objective of this study is to determine patient-based outcomes after SIJF for chronic SIJ dysfunction due to degenerative sacroiliitis or SIJ disruption at ≥3 years of follow-up.Methods: Consecutive patients who underwent SIJF prior to December 2012 were contacted over phone or through email. Participants completed questionnaires in clinic, over phone or by email, regarding SIJ pain, activities related to SIJ dysfunction, and the Oswestry Disability Index. Charts were reviewed to extract baseline parameters and the clinical course of follow-up.Results: One hundred seven patients were eligible and participated in this study. Mean (standard deviation preoperative SIJ pain score was 7.5 (1.7. At mean follow-up of 3.7 years, the mean SIJ pain score was 2.6 (representing a 4.8-point improvement from baseline, P<0.0001 and the mean Oswestry Disability Index was 28.2. The ability to perform activities commonly impaired by SIJ dysfunction showed positive improvements in most patients. SIJ revision surgery was uncommon (five patients, 4.7%. Fourteen patients (13.1% underwent contralateral SIJF during follow-up, 25.2% of patients had additional non-SIJ-related lumbar spine or hip surgeries during follow-up.Conclusion: In intermediate- to long-term follow

  3. Long-term sexual outcomes after holmium laser enucleation of the prostate: which patients could benefit the most?

    Science.gov (United States)

    Capogrosso, P; Ventimiglia, E; Ferrari, M; Serino, A; Boeri, L; Capitanio, U; Briganti, A; Damiano, R; Montorsi, F; Salonia, A

    2016-09-01

    Assess rate and predictors of erectile function (EF) outcomes at long-term follow-up (FU) after holmium laser enucleation of the prostate (HoLEP). Cross-sectional analyses were performed on 135 patients with a mean FU of 12 years post HoLEP. Patients completed both a baseline and a FU International Index of Erectile Function (IIEF)-EF domain and the International Prostatic Symptoms Score (IPSS). Postoperative EF outcomes, including rate and predictors of EF improvement considering minimal clinically important differences (MCIDs) criteria, were assessed. Logistic regression models tested the association between predictors and EF. At a mean (median) FU of 152.1 (163) months, patients showed a significant decrease in the IIEF-EF score P<0.01) and significant IPSS improvement (P<0.01). Overall, 50 (37%) patients worsened by at least one IIEF-EF category. Conversel, 23 (17%) patients reported an improvement in postoperative IIEF-EF score; 75 (55.6%) and 10 (7.4%) patients maintained and eventually improved their IIEF-EF category, respectively. Patients reporting a decrease in the postoperative IIEF-EF score were significantly older (P=0.03) and showed a significantly longer mean FU (P<0.01) than those reporting postoperative improvements of IIEF-EF. Nine (6.7%) patients showed significant EF improvement according to MCIDs criteria. Both higher IPSS scores (odds ratio (OR): 1.12; P=0.02) and lower IIEF-EF (OR: 0.88; P<0.01) at baseline, emerged as independent predictors of postoperative EF improvement. HoLEP was associated with a decrease in EF and a persistent amelioration of BPH-related urinary symptoms at long-term FU. Almost one third of patients worsened by at least one IIEF-EF category. However, a clinically meaningful EF improvement was observed in roughly 7% of the individuals. Patients with more severe preoperative urinary symptoms and ED benefited more from HoLEP in terms of EF.

  4. Long-term outcomes of surgery alone versus surgery following preoperative chemoradiotherapy for early T3 rectal cancer

    Science.gov (United States)

    Cho, Seung Hyun; Choi, Gyu-Seog; Kim, Gab Chul; Seo, An Na; Kim, Hye Jung; Kim, Won Hwa; Shin, Kyung-Min; Lee, So Mi; Ryeom, Hunkyu; Kim, See Hyung

    2017-01-01

    Abstract Recently, a few studies have raised the question of whether preoperative chemoradiotherapy (PCRT) is essential for all T3 rectal cancers. This case-matched study aimed to compare the long-term outcomes of surgery alone with those of PCRT + surgery for magnetic resonance imaging (MRI)-assessed T3ab (extramural depth of invasion ≤5 mm) and absent mesorectal fascia invasion (clear MRF) in mid/lower rectal cancer patients. From January 2006 to November 2012, 203 patients who underwent curative surgery alone (n = 118) or PCRT + surgery (n = 85) were enrolled in this retrospective study. A 1:1 propensity score-matched analysis was performed to eliminate the inherent bias. Case-matching covariates included age, sex, body mass index, histologic grade, carcinoembryonic antigen, operation method, follow-up period, tumor height, and status of lymph node metastasis. The end-points were the 5-year local recurrence (LR) rate and disease-free-survival (DFS). After propensity score matching, 140 patients in 70 pairs were included. Neither the 5-year LR rate nor the DFS was significantly different between the 2 groups (the 5-year LR rate, P = 0.93; the 5-year DFS, P = 0.94). The 5-year LR rate of the surgery alone was 2% (95% confidence interval [CI] 0.2%–10.9%) versus 2% (95% CI 0.2%–10.1%) in the PCRT + surgery group. The 5-year DFS of the surgery alone was 87% (95% CI 74.6%–93.7%) versus 88% (95% CI 77.8%–93.9%) in the PCRT + surgery group. In patients with MRI-assessed T3ab and clear MRF mid/lower rectal cancer, the long-term outcomes of surgery alone were comparable with those of the PCRT + surgery. The suggested MRI-assessed T3ab and clear MRF can be used as a highly selective indication of surgery alone in mid/lower T3 rectal cancer. Additionally, in those patients, surgery alone can be tailored to the clinical situation. PMID:28328820

  5. Inflammatory abdominal aortic aneurysm:clinical features and long term outcome in comparison with atherosclerotic abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    YIN Ming-di; ZHANG Jian; WANG Shao-ye; DUAN Zhi-quan; XIN Shi-jie

    2010-01-01

    Background Inflammatory abdominal aortic aneurysms (IAAAs) are rare but distinct clinical entities of atherosclerotic abdominal aortic aneurysms (aAAAs).In this study we report a 20-year single institution experience for IAAA and analyze their clinical features and long term outcome in comparison with aAAA.Methods Between 1988 and 2008, 412 cases of abdominal aortic aneurysms (AAAs) underwent elective surgical operations, 11 (2.7%) of whom were diagnosed as IAAAs and 389 (94.4%) were diagnosed as aAAAs.The former group was matched in a case control fashion to a group of 33 patients with aAAAs having similar characteristics of age, gender, and preoperative risk factors.All available clinical, pathologic, and postoperative variables were retrospectively reviewed, and the two groups were compared.Results The two groups did not differ significantly in clinical characteristics and preoperative risk factors, although patients with IAAAs were significantly more symptomatic (100% vs.42.4%, P=0.001) and had larger aneurysms on admission ((7.4±0.7) cm vs.(6.3±0.9) cm, P=0.006).In IAAAs, the preoperative erythrocyte sedimentation rate was found to be significantly elevated compared to aAAA group ((44.5±9.1) mm/h vs.(11.4±5.4) mm/h, P <0.05).Surgical morbidity and mortality rates did not differ between the two groups.The operation time for patients with IAAAs was significantly longer than that for patients with aAAAs ((308±36) minutes vs.(224±46) minutes, P <0.05), but the cross-clamp time was similar in both groups ((41.5±6.2) minutes vs.(41.8±6.2) minutes, P=0.92).A five-year survival rate analysis showed no significant difference between the two groups (P=0.711).Conclusions Despite having more symptoms, larger size and longer operation time, patients with IAAA can now be treated with approaches that cause Iow morbidity and mortality, similar to patients with aAAA.Long term outcome of IAAA patients is of no difference from aAAA patients.

  6. Reduced Irregularity of Ventricular Response During Atrial Fibrillation and Long-term Outcome in Patients With Heart Failure.

    Science.gov (United States)

    Cygankiewicz, Iwona; Corino, Valentina; Vazquez, Rafael; Bayes-Genis, Antoni; Mainardi, Luca; Zareba, Wojciech; de Luna, Antoni Bayes; Platonov, Pyotr G

    2015-10-01

    Reduced heart rate variability (HRV) is associated with poor outcome in patients with heart failure (HF). However, the data on predictive value of RR variability during atrial fibrillation (AF) are limited. Therefore, the aim of this study was to evaluate the association between ventricular response characteristics and long-term clinical outcome in the population of ambulatory patients with mild-to-moderate HF and AF at baseline. The study included 155 patients (mean age 69 ± 10 years) with AF at 20-minute Holter electrocardiographic (ECG) recordings at enrollment. HRV analysis included SDNN, rMSSD, and pNN50, whereas irregularity indexes included 2 nonlinear parameters: approximate entropy (ApEn) and Shannon entropy. After median 41 months of follow-up, 54 patients died, including 21 HF related and 16 sudden deaths. Patients with ApEn ≤1.68 (lower tertile) had 40% mortality versus 12% in others (p <0.001) at 2 years of follow-up. Only nonlinear HRV parameters (irregularity but not variability indexes) identified patients at higher risk during follow-up. Decreased ApEn ≤1.68 was an independent predictor of total mortality (hazard ratio [HR] 2.81, 95% confidence interval [CI] 1.61 to 4.89, p <0.001), sudden cardiac death (HR 3.83, 95% CI 1.31 to 11.25, p = 0.014), and HF death (HR 3.45, 95% CI 1.42 to 8.38, p = 0.006) in a multivariate Cox analysis. In conclusion, in a post hoc analysis of Muerte Subita en Insufficiencia Cardiaca study AF cohort, reduced irregularity of RR intervals during AF, likely caused by autonomic dysfunction, was an independent predictor of all-cause mortality and sudden death and HF progression in patients with mild-to-moderate HF, whereas traditional HRV indexes did not predict outcome.

  7. Matched unrelated donor allogeneic transplantation provides comparable long-term outcome to HLA-identical sibling transplantation in relapsed diffuse large B-cell lymphoma

    NARCIS (Netherlands)

    Avivi, I.; Canals, C.; Vernant, J.P.; Wulf, G.; Nagler, A.; Hermine, O.; Petersen, E.; Yakoub-Agha, I.; Craddock, C.; Schattenberg, A.V.; Niederwieser, D.; Thomson, K.; Blaise, D.; Attal, M.; Pfreundschuh, M.; Passweg, J.; Russell, N.; Dreger, P.; Sureda, A.

    2014-01-01

    The objective of this retrospective analysis was to compare outcomes of patients with diffuse large B-cell lymphoma (DLBCL) who received either a matched sibling (sib) or an unrelated donor (URD) allogeneic hematopoietic cell transplantation (allo-HCT). Long-term outcome of 172 DLBCL patients receiv

  8. Results of tricuspid valve surgery for functional tricuspid regurgitation: acute and long-term outcomes and predictors of failure.

    Science.gov (United States)

    Pozzoli, Alberto; Buzzatti, Nicola; Vicentini, Luca; De Bonis, Michele; Alfieri, Ottavio

    2017-02-15

    The assessment and management of tricuspid valve disease evolved significantly in the last decade. Tricuspid regurgitation is a frequent heart valve disease and it is most often secondary, due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery are several and mainly related to the underlying disease, to the severity of the regurgitation and to the right ventricular function. Moreover, surgical tricuspid repair has been avoided for years, because of the erroneous concept that tricuspid regurgitation should disappear once the primary pathology on the left heart has been resolved. Instead, during the last few years, many investigators have reported evidence in favour of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with annular dilatation and only moderate regurgitation (or less) at the time of surgery. This concept, along with the acute and long-term outcomes of tricuspid surgical repair techniques and tricuspid replacement are discussed in this review.

  9. Neoadjuvant Down-Sizing of Hilar Cholangiocarcinoma with Photodynamic Therapy—Long-Term Outcome of a Phase II Pilot Study

    Directory of Open Access Journals (Sweden)

    Andrej Wagner

    2015-11-01

    Full Text Available Hilar cholangiocarcinoma (CC is non-resectable in the majority of patients often due to intrahepatic extension along bile duct branches/segments, and even after complete resection (R0 recurrence can be as high as 70%. Photodynamic therapy (PDT is an established palliative local tumor ablative treatment for non-resectable hilar CC. We report the long-term outcome of curative resection (R0 performed after neoadjuvant PDT for downsizing of tumor margins in seven patients (median age 59 years with initially non-resectable hilar CC. Photofrin® was injected intravenously 24–48 h before laser light irradiation of the tumor stenoses and the adjacent bile duct segments. Major resective surgery was done with curative intention six weeks after PDT. All seven patients had been curatively (R0 resected and there were no undue early or late complications for the neoadjuvant PDT and surgery. Six of seven patients died from tumor recurrence at a median of 3.2 years after resection, the five-year survival rate was 43%. These results are comparable with published data for patients resected R0 without pre-treatment, indicating that neoadjuvant PDT is feasible and could improve overall survival of patients considered non-curatively resectable because of initial tumor extension in bile duct branches/segments—however, this concept needs to be validated in a larger trial.

  10. The long-term outcomes and unmet needs of a cohort of former long-stay patients in Melbourne, Australia.

    Science.gov (United States)

    Chopra, Prem; Herrman, Helen E

    2011-10-01

    Former long-stay patients with psychotic disorders have significant unmet needs. This study assessed the long-term outcomes for the original cohort of 18 residents of the Footbridge Community Care Unit (CCU), a residential psychiatric rehabilitation unit at St Vincent's Mental Health Melbourne. A review of case records and interviews were conducted for each member of the cohort 8 years after admission to the CCU. Members of the cohort were living in a variety of settings after discharge from the CCU. Despite significant gains during the period of residential rehabilitation in the CCU after hospital discharge, by the time of follow-up individuals were in general leading restricted lives characterised by a lack of stable residential and social supports. Most reported positively on the support provided in the CCU although later experiences of moving repeatedly from one setting to another were adverse. Five key unmet needs were identified: promotion of independence; stability in accommodation; stability in social networks; consistency of care; and addressing the theme of loss. A longitudinal perspective in management that focuses on stability in residential care is required for long-stay patients.

  11. Long-Term (Six Years) Clinical Outcome Discrimination of Patients in the Vegetative State Could be Achieved Based on the Operational Architectonics EEG Analysis: A Pilot Feasibility Study

    Science.gov (United States)

    Fingelkurts, Andrew A.; Fingelkurts, Alexander A.; Bagnato, Sergio; Boccagni, Cristina; Galardi, Giuseppe

    2016-01-01

    Electroencephalogram (EEG) recordings are increasingly used to evaluate patients with disorders of consciousness (DOC) or assess their prognosis outcome in the short-term perspective. However, there is a lack of information concerning the effectiveness of EEG in classifying long-term (many years) outcome in chronic DOC patients. Here we tested whether EEG operational architectonics parameters (geared towards consciousness phenomenon detection rather than neurophysiological processes) could be useful for distinguishing a very long-term (6 years) clinical outcome of DOC patients whose EEGs were registered within 3 months post-injury. The obtained results suggest that EEG recorded at third month after sustaining brain damage, may contain useful information on the long-term outcome of patients in vegetative state: it could discriminate patients who remain in a persistent vegetative state from patients who reach a minimally conscious state or even recover a full consciousness in a long-term perspective (6 years) post-injury. These findings, if confirmed in further studies, may be pivotal for long-term planning of clinical care, rehabilitative programs, medical-legal decisions concerning the patients, and policy makers. PMID:27347266

  12. Coronary stenting does not improve the long-term cardiovascular outcome of patients with mild to moderate renal insufficiency

    Institute of Scientific and Technical Information of China (English)

    XIE Di; HOU Yu-qing; HOU Fan-fan; ZHANG Wei-ru; LI Yong; GUO Zhi-gang; GUO Zhi-jian; ZHANG Xun

    2009-01-01

    Background Several studies have shown that coronary stenting reduces the frequency of clinical and angiographic restenosis in patients with mild to moderate renal insufficiency. However, less is known about the long-term benefits of stent use in this population. This study was aimed to determine the impact of coronary stenting on extended (5 years) long-term outcomes of patients with chronic renal insufficiency. Methods The study included 602 consecutive patients who underwent successful percutaneous coronary intervention with stenting. Renal insufficiency was defined as an estimated glomerular filtration rate <60 ml·min-1·1.73 m-2. The major adverse cardiac events were compared for patients with (n=160) and without (n=442) renal insufficiency. Results After the third year of follow-up, nonfatal myocardial infarction and revascularization rates were significantly increased in patients with renal insufficiency compared with those without renal dysfunction (16.9% vs 7.7%, P=0.001; 29.4% vs 15.8%, P <0.001). In patients who had recurrent cardiovascular events, a significantly higher rate of de novo stenosis revascularization was found in patients with renal insufficiency than without renal insufficiency (57.7% vs 22.7%, P <0.001), while there was no significant difference in target lesion revascularization between the groups (51.9% vs 43.6%, P=0.323). Multivariate analysis demonstrated an independent impact of the presence of renal insufficiency on the major adverse cardiac events (hazard ratio: 1.488, 95% confidence interval: 1.051-2.106, P=0.025) and de novo stenosis (hazard ratio: 5.505, 95% confidence interval: 2.151-14.090, P <0.001 ). Conclusions The late major adverse cardiac events, after successful coronary stenting, is increased in patients with an estimated glomerular filtration rate <60 ml·min-1·1.73 m2. This might be associated with increased risk of de novo stenosis in this population.

  13. Long-Term Outcomes of Systemic Lupus Erythematous Patients after Pregnancy: A Nationwide Population-Based Cohort Study

    Science.gov (United States)

    Chiu, Ting-Fang; Chuang, Ya-Wen; Lin, Cheng-Li; Yu, Tung-Min; Chung, Mu-Chi; Li, Chi-Yuan; Chung, Chi-Jung; Ho, Wen-Chao

    2016-01-01

    Background Data on long-term maternal outcomes in patients with systemic lupus erythematosus (SLE) are lacking. The study aimed to explore the relationships among SLE, pregnancy, outcomes of end-stage renal disease (ESRD), and overall mortality. Methods We established a retrospective cohort study consisting of four cohorts: pregnant (case cohort) and nonpregnant SLE patients, as well as pregnant and nonpregnant non-SLE patients. One case cohort and three comparison cohorts were matched by age at first pregnancy and index date of pregnancy by using the Taiwan National Health Insurance Research Dataset. All study subjects were selected based on the index date to the occurrence of ESRD or overall death. Cox proportional hazard regression models and Kaplan–Meier curves were used in the analysis. Results SLE pregnant patients exhibited significantly increased risk of ESRD after adjusting for other important confounders, including immunosuppressant and parity (HR = 3.19, 95% CI: 1.35–7.52 for pregnant non-SLE; and HR = 2.77, 95% CI: 1.24–6.15 for nonpregnant non-SLE patients). No significant differences in ESRD incidence were observed in pregnant and nonpregnant SLE patients. Pregnant SLE patients exhibited better clinical condition at the baseline and a significantly lower risk of overall mortality than nonpregnant SLE patients. Conclusions Our data support current recommendations for SLE patients to avoid pregnancy until disease activity is quiescent. Multicenter recruitment and clinical information can be used to further examine the association of SLE and ESRD (or mortality) after pregnancy. PMID:27992461

  14. The Modern Role of Radiation Therapy in Treating Advanced-Stage Retinoblastoma: Long-Term Outcomes and Racial Differences

    Energy Technology Data Exchange (ETDEWEB)

    Orman, Amber [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Koru-Sengul, Tulay [Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida (United States); Miao, Feng [Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (United States); Markoe, Arnold [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Panoff, Joseph E., E-mail: jpanoff@med.miami.edu [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States)

    2014-12-01

    Purpose/Objective(s): To evaluate the effects of various patient characteristics and radiation therapy treatment variables on outcomes in advanced-stage retinoblastoma. Methods and Materials: This was a retrospective review of 41 eyes of 30 patients treated with external beam radiation therapy between June 1, 1992, and March 31, 2012, with a median follow-up time of 133 months (11 years). Outcome measures included overall survival, progression-free survival, local control, eye preservation rate, and toxicity. Results: Over 90% of the eyes were stage V. Definitive external beam radiation therapy (EBRT) was delivered in 43.9% of eyes, adjuvant EBRT in 22% of eyes, and second-line/salvage EBRT in 34.1% of eyes. A relative lens sparing (RLS) technique was used in 68.3% of eyes and modified lens sparing (MLS) in 24.4% of eyes. Three eyes were treated with other techniques. Doses ≥45 Gy were used in 68.3% of eyes. Chemotherapy was a component of treatment in 53.7% of eyes. The 10-year overall survival was 87.7%, progression-free survival was 80.5%, and local control was 87.8%. White patients had significantly better overall survival than did African-American patients in univariate analysis (hazard ratio 0.09; 95% confidence interval 0.01-0.84; P=.035). Toxicity was seen in 68.3% of eyes, including 24.3% with isolated acute dermatitis. Conclusions: External beam radiation therapy continues to be an effective treatment modality for advanced retinoblastoma, achieving excellent long-term local control and survival with low rates of treatment-related toxicity and secondary malignancy.

  15. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer.

    Science.gov (United States)

    Kanda, Mitsuro; Mizuno, Akira; Tanaka, Chie; Kobayashi, Daisuke; Fujiwara, Michitaka; Iwata, Naoki; Hayashi, Masamichi; Yamada, Suguru; Nakayama, Goro; Fujii, Tsutomu; Sugimoto, Hiroyuki; Koike, Masahiko; Takami, Hideki; Niwa, Yukiko; Murotani, Kenta; Kodera, Yasuhiro

    2016-06-01

    Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC).This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm).The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy.Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC.

  16. Long term outcomes of bilateral congenital and developmental cataracts operated in Maharashtra, India. Miraj pediatric cataract study III

    Directory of Open Access Journals (Sweden)

    Parikshit M Gogate

    2014-01-01

    Full Text Available Aim : To study long term outcome of bilateral congenital and developmental cataract surgery. Subjects: 258 pediatric cataract operated eyes of 129 children. Materials and Methods: Children who underwent pediatric cataract surgery in 2004-8 were traced and examined prospectively in 2010-11. Demographic and clinical factors were noted from retrospective chart readings. All children underwent visual acuity estimation and comprehensive ocular examination in a standardized manner. L. V. Prasad Child Vision Function scores (LVP-CVF were noted for before and after surgery. Statistics: Statistical analysis was done with SPSS version 16 including multi-variate analysis. Results: Children aged 9.1 years (std dev 4.6, range 7 weeks-15 years at the time of surgery. 74/129 (57.4% were boys. The average duration of follow-up was 4.4 years (stddev 1.6, range 3-8 years. 177 (68.6% eyes had vision 6/18 and 157 (60.9% had BCVA >6/60 3-8 years after surgery. 48 (37.2% had binocular stereoacuity <480 sec of arc by TNO test. Visual outcome depended on type of cataract (P = 0.004, type of cataract surgery (P < 0.001, type of intra-ocular lens (P = 0.05, age at surgery (P = 0.004, absence of post-operative uveitis (P = 0.01 and pre-operative vision (P < 0.001, but did not depend on delay (0.612 between diagnosis and surgery. There was a statistically significant improvement for all the 20 questions of the LVP-CVF scale (P < 0.001. Conclusion : Pediatric cataract surgery improved the children′s visual acuity, stereo acuity and vision function. Developmental cataract, use of phacoemulsification, older children and those with better pre-operative vision had betterlong-termoutcomes.

  17. Long-term outcome of acute promyelocytic leukemia treated with all-trans-retinoic acid, arsenic trioxide, and gemtuzumab.

    Science.gov (United States)

    Abaza, Yasmin; Kantarjian, Hagop; Garcia-Manero, Guillermo; Estey, Elihu; Borthakur, Gautam; Jabbour, Elias; Faderl, Stefan; O'Brien, Susan; Wierda, William; Pierce, Sherry; Brandt, Mark; McCue, Deborah; Luthra, Rajyalakshmi; Patel, Keyur; Kornblau, Steven; Kadia, Tapan; Daver, Naval; DiNardo, Courtney; Jain, Nitin; Verstovsek, Srdan; Ferrajoli, Alessandra; Andreeff, Michael; Konopleva, Marina; Estrov, Zeev; Foudray, Maria; McCue, David; Cortes, Jorge; Ravandi, Farhad

    2017-03-09

    The combination of all-trans-retinoic acid (ATRA) plus arsenic trioxide (ATO) has been shown to be superior to ATRA plus chemotherapy in the treatment of standard-risk patients with newly diagnosed acute promyelocytic leukemia (APL). A recent study demonstrated the efficacy of this regimen with added gemtuzumab ozogamicin (GO) in high-risk patients. We examined the long-term outcome of patients with newly diagnosed APL treated at our institution on 3 consecutive prospective clinical trials, using the combination of ATRA and ATO, with or without GO. For induction, all patients received ATRA (45 mg/m(2) daily) and ATO (0.15 mg/kg daily) with a dose of GO (9 mg/m(2) on day 1) added to high-risk patients (white blood cell count, >10 × 10(9)/L), as well as low-risk patients who experienced leukocytosis during induction. Once in complete remission, patients received 4 cycles of ATRA plus ATO consolidation. One hundred eighty-seven patients, including 54 with high-risk and 133 with low-risk disease, have been treated. The complete remission rate was 96% (52 of 54 in high-risk and 127 of 133 in low-risk patients). Induction mortality was 4%, with only 7 relapses. Among low-risk patients, 60 patients (45%) required either GO or idarubicin for leukocytosis. Median duration of follow-up was 47.6 months. The 5-year event-free, disease-free, and overall survival rates are 85%, 96%, and 88%, respectively. Late hematological relapses beyond 1 year occurred in 3 patients. Fourteen deaths occurred beyond 1 year; 12 were related to other causes. This study confirms the durability of responses with this regimen.

  18. Short and long term outcomes of 200 patients supported by continuous-flow left ventricular assist devices

    Institute of Scientific and Technical Information of China (English)

    Athanasios; Tsiouris; Gaetano; Paone; Hassan; W; Nemeh; Jamil; Borgi; Celeste; T; Williams; David; E; Lanfear; Jeffrey; A; Morgan

    2015-01-01

    AIM: To study the institutional experience over 8 years with 200 continuous-flow(CF)- left ventricular assist devices(LVAD).METHODS: We evaluated our institution’s LVAD database and analyzed all patients who received a CF LVAD as a bridge to transplant(BTT) or destination therapy from March 2006 until June 2014. We identified 200 patients, of which 179 were implanted with a Heart Mate II device(Thoratec Corp., Pleasanton, CA) and 21 received a Heartware HVAD(Heart Ware Inc., Framingham, MA).RESULTS: The mean age of our LVAD recipients was 59.3 years(range 17-81), 76%(152/200) were males, and 49% were implanted for the indication of BTT. The survival rate for our LVAD patients at 30 d, 6 mo, 12 mo, 2 years, 3 years, and 4 years was 94%, 86%, 78%, 71%, 62% and 45% respectively. The mean duration of LVAD support was 581 d(range 2-2595 d). Gastrointestinal bleeding(was the most common adverse event(43/200, 21%), followed by right ventricular failure(38/200, 19%), stroke(31/200, 15%), re exploration for bleeding(31/200, 15%),ventilator dependent respiratory failure(19/200, 9%) and pneumonia(15/200, 7%). Our driveline infection rate was 7%. Pump thrombosis occurred in 6% of patients. Device exchanged was needed in 6% of patients. On multivariate analysis, preoperative liver dysfunction, ventilator dependent respiratory failure, tracheostomy and right ventricular failure requiring right ventricular assist device support were significant predictors of post LVAD survival.CONCLUSION: Short and long term survival for patients on LVAD support are excellent, although outcomes still remain inferior compared to heart transplantation. The incidence of driveline infections, pump thrombosis and pump exchange have declined significantly in recent years.

  19. The Outcome of a Long-Term Follow-up of Pancreatic Function after Recovery from Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Tomas Symersky

    2006-09-01

    Full Text Available Context: It is generally assumed that pancreatic function recovers completely after mild but not after severe acute pancreatitis. Objective :To evaluate both pancreatic function and quality of life in patients who had recovered from acute pancreatitis in a long-term follow-up study. Participants :Thirty-four patients (mean age: 56 years who had recovered from biliary (n=26 or post ERCP (n=8 acute pancreatitis. The mean time after the event was 4.6 years. Main outcome measures :Pancreatic function was evaluated by fecal fat excretion, urinary 4-aminobenzoic acid (PABA recovery, oral glucose tolerance test and pancreatic polypeptide (PP secretion. In addition, the quality of life was measured by the gastrointestinal quality of life index (GIQLI. Results :Of the 34 patients, 22 (65% had mild and 12 (35% had severe acute pancreatitis. Exocrine insufficiency (fecal fat greater than 7 g/24h and/or urinary PABA recovery less than 50% was present in 22 (65% patients: in 10 (83% after severe and in 12 (55% after mild acute pancreatitis, respectively (P=0.140. Endocrine insufficiency was present in 12 patients (35%: 7 (32% mild versus 5 (42% severe acute pancreatitis; P=0.711. the quality of life was significantly impaired after acute pancreatitis, (P=0.024. No significant relationship was found between the severity of the pancreatitis and impairment of the quality of life (P=0.604. Conclusion :In a significant proportion of patients who had recovered from acute pancreatitis, exocrine and endocrine functional impairment was found. This finding is not confined only to patients after severe acute pancreatitis. Routine evaluation of pancreatic function after acute pancreatitis should be considered.

  20. Management of post-biopsy renal allograft arteriovenous fistulas with selective arterial embolization: immediate and long-term outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Loffroy, R. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)], E-mail: loffroy.romaric@neuf.fr; Guiu, B.; Lambert, A. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Mousson, C.; Tanter, Y. [Department of Nephrology and Renal Transplantation (France); Martin, L. [Department of Pathology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France); Cercueil, J.-P.; Krause, D. [Department of Diagnostic and Interventional Radiology, University of Dijon School of Medicine, Bocage Teaching Hospital, Dijon (France)

    2008-06-15

    Aim: To evaluate the outcomes after transcatheter embolization of percutaneous biopsy-related arteriovenous fistulas in renal allografts. Materials and methods: All post-biopsy renal-transplant vascular injuries referred for embolization between June 1999 and October 2006 were reviewed retrospectively. There were six male and six female patients with a mean age of 49.8 years (range 25-67 years); nine patients were symptomatic, three asymptomatic. Colour Doppler ultrasound (CDUS) and angiography showed one intra-renal arteriovenous fistula in 10 patients and two in two patients, combined with a pseudoaneurysm in six patients. Superselective embolization using a single catheter or coaxial microcatheter was performed with 0.035'' coils or 0.018''microcoils, respectively, in all 12 cases. 24-h creatinine clearance values before (the day of biopsy) and after (7-14 days; 3 months) the procedure were compared using the Wilcoxon signed-rank test. Physical examination and CDUS were performed after 1, 6, and 12 months, and yearly thereafter. Mean follow-up was 33.6 months. Results: Complete definitive occlusion of the fistula was achieved consistently with a single procedure. No procedure-related complications occurred. Renal infarction was minor in all patients (0-10% in nine and 10-20% in three). Symptoms resolved completely. Creatinine clearance values obtained before and after embolization were not statistically different (p = 0.168;.889 respectively). No late recurrences were reported. Conclusion: Transcatheter embolization with coaxial or single-catheter techniques was effective and safe for treating post-biopsy arteriovenous fistulas in renal transplants. The loss of renal parenchyma was minimal and no mid-term deterioration of allograft function was noted. The long-term survival of the renal allograft seemed to be not affected by embolization.

  1. Long-Term Clinical Outcomes According to Previous Manifestations of Atherosclerotic Disease (from the FAST-MI 2010 Registry).

    Science.gov (United States)

    Puymirat, Etienne; Aissaoui, Nadia; Lemesle, Gilles; Cottin, Yves; Coste, Pierre; Schiele, François; Ferrières, Jean; Simon, Tabassome; Danchin, Nicolas

    2017-03-01

    The prognosis of patients with acute myocardial infarction (AMI) has notably improved in the past 20 years. Using the French Registry of ST-Elevation and Non-ST-elevation Myocardial Infarction (FAST-MI) 2010 registry, we investigated whether previous manifestations of atherosclerotic disease (i.e., previous MI, or a history of any form of atherosclerotic disease) are at truly increased risk compared with those in whom AMI is the first manifestation of the disease. FAST-MI 2010 is a nationwide French registry including 3,079 patients with AMI, among whom 1,062 patients had a history of cardiovascular atherosclerotic disease and 498 patients had a history of MI. Overall, patients with a history of atherosclerotic disease (or MI) were older compared with patients without known cardiovascular disease (71 ± 13 vs 63 ± 14 years) and had higher cardiovascular risk profiles and co-morbidities. Using fully adjusted Cox multivariate analysis, previous manifestations of atherosclerotic disease were associated with higher 3-year mortality (hazard ratio 1.80, 95% confidence interval 1.40 to 2.31; p <0.001) as history of previous MI alone (hazard ratio 1.32, 95% confidence interval 1.00 to 1.73; p = 0.048). Similar results were found in patients discharged alive. In conclusion, previous cardiovascular atherosclerotic disease represents 1/3 of patients with AMI and are strongly associated with worse long-term clinical outcomes. Intensive follow-up and therapy should be encouraged in this high-risk population.

  2. Association of Clinical Response and Long-term Outcome Among Patients With Biopsied Orbital Pseudotumor Receiving Modern Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Roshan S., E-mail: rprabhu@emory.edu [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Kandula, Shravan; Liebman, Lang [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Wojno, Ted H.; Hayek, Brent [Division of Oculoplastics, Orbital and Cosmetic Surgery, Emory University, Atlanta, Georgia (United States); Hall, William A.; Shu, Hui-Kuo; Crocker, Ian [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2013-03-01

    Purpose: To retrospectively evaluate institutional outcomes for patients treated with modern radiation therapy (RT) for biopsied orbital pseudotumor (OP). Methods and Materials: Twenty patients (26 affected orbits) with OP were treated with RT between January 2002 and December 2011. All patients underwent biopsy with histopathologic exclusion of other disease processes. Sixteen patients (80%) were treated with intensity modulated RT, 3 (15%) with opposed lateral beams, and 1 (5%) with electrons. Median RT dose was 27 Gy (range 25.2-30.6 Gy). Response to RT was evaluated at 4 months post-RT. Partial response (PR) was defined as improvement in orbital symptoms without an increase in steroid dose. Complete response (CR) 1 and CR 2 were defined as complete resolution of orbital symptoms with reduction in steroid dose (CR 1) or complete tapering of steroids (CR 2). The median follow-up period was 18.6 months (range 4-81.6 months). Results: Seventeen patients (85%) demonstrated response to RT, with 7 (35%), 1 (5%), and 9 (45%) achieving a PR, CR 1, and CR 2, respectively. Of the 17 patients who had ≥PR at 4 months post-RT, 6 (35%) experienced recurrence of symptoms. Age (>46 years vs ≤46 years, P=.04) and clinical response to RT (CR 2 vs CR 1/PR, P=.05) were significantly associated with pseudotumor recurrence. Long-term complications were seen in 7 patients (35%), including 4 with cataract formation, 1 with chronic dry eye, 1 with enophthalmos, and 1 with keratopathy. Conclusions: RT is an effective treatment for improving symptoms and tapering steroids in patients with a biopsy supported diagnosis of OP. Older age and complete response to RT were associated with a significantly reduced probability of symptom recurrence. The observed late complications may be related to RT, chronic use of steroids/immunosuppressants, medical comorbidities, or combination of factors.

  3. Surgical outcome of adenosquamous carcinoma of the pancreas

    Institute of Scientific and Technical Information of China (English)

    Takehiro Okabayashi; Kazuhiro Hanazaki

    2008-01-01

    Adenosquamous carcinoma is rare, accounting for 3%-4% of all pancreatic carcinoma cases. These tumors are characterized by the presence of variable proportions of mucin-producing glandular elements and squamous components, the latter of which should account for at least 30% of the tumor tissue. Recently, several reports have described cases of adenosquamous carcinoma of the pancreas. However, as the number of patients who undergo resection at a single institute is limited, large studies describing the clinicopathological features, therapeutic management, and surgical outcome for adenosquamous carcinoma of the pancreas are lacking. We performed a literature review of English articles retrieved from Medline using the keywords 'pancreas' and 'adenosquamous carcinoma'. Additional articles were obtained from references within the papers identified by the Medline search. Our subsequent review of the literature revealed that optimal adjuvant chemotherapy and/or radiotherapy regimens for adenosquamous carcinoma of the pancreas have not been established, and that curative surgical resection offers the only chance for long-term survival. Unfortunately, the prognosis of the 39 patients who underwent pancreatic resection for adenosquamous carcinoma was very poor, with a 3-year overall survival rate of 14.0% and a median survival time of 6.8 mo. Since the postoperative prognosis of adenosquamous carcinoma of the pancreas is currently worse than that of pancreatic adenocarcinoma, new adjuvant chemotherapies and/or radiation techniques should be investigated as they may prove indispensible to the improvement of surgical outcomes.

  4. Urinary and sexual outcomes in long-term (5+ years prostate cancer disease free survivors after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Ambruosi Carlo

    2009-11-01

    Full Text Available Abstract Background After long term disease free follow up (FUp patients reconsider quality of life (QOL outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP. Methods 367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA ≤ 0.2 ng/mL at the follow up ≥ 5 years were recruited. Urinary (UF and Sexual Function (SF, Urinary (UB and Sexual Bother (SB were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp, tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score, nerve sparing (NS procedure, and hormonal treatment (HT. We calculated the differences between 93 NS-RP without HT (group A and 274 non-NS-RP or NS-RP with HT (group B. We evaluated the correlation between function and bother in group A according to follow-up duration. Results Time since prostatectomy had a negative effect on SF and a positive effect SB (both p Higher stage PCa negatively affected UB, SF, and SB (all: p ≤ 0.05. NS was associated with better UB, SF and SB (all: p ≤ 0.05; conversely, HT was associated with worse UF, SF and SB (all: p ≤ 0.05. More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time. Conclusion Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders, subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother

  5. Long-Term Intellectual Functioning and School-Related Behavioural Outcomes in Children and Adolescents after Invasive Treatment for Congenital Heart Disease

    Science.gov (United States)

    Spijkerboer, A. W.; Utens, E. M. W. J.; Bogers, A. J. J. C.; Verhulst, F. C.; Helbing, W. A.

    2008-01-01

    In this study, long-term intellectual functioning and school-related behavioural outcomes were assessed in a patient sample that underwent invasive treatment for congenital heart disease (ConHD) between 1990 and 1995. The Wechsler Intelligence Scale for Children-Revised was used to measure intellectual functioning and the Teacher's Report Form to…

  6. Surviving meningococcal septic shock in childhood: Long-term overall outcome and the effect on health-related quality of life

    NARCIS (Netherlands)

    C.M.P. Buysse (Corinne); L.C.A.C. Vermunt (Lindy); H. Raat (Hein); J.A. Hazelzet (Jan); W.C.J. Hop (Wim); E.M.W.J. Utens (Elisabeth); K.F.M. Joosten (Koen)

    2010-01-01

    textabstractIntroduction: The purpose of this study was to evaluate associations between long-term physical and psychological outcome variables in patients who survived meningococcal septic shock (MSS) in childhood.Methods: The study population was made up of all MSS patients requiring intensive car

  7. Employment and insurance outcomes and factors associated with employment among long-term thyroid cancer survivors : a population-based study from the PROFILES registry

    NARCIS (Netherlands)

    Tamminga, S. J.; Bultmann, U.; Husson, O.; Kuijpens, J. L. P.; Frings-Dresen, M. H. W.; de Boer, Angela G. E. M.

    2016-01-01

    To obtain insight into employment and insurance outcomes of thyroid cancer survivors and to examine the association between not having employment and other factors including quality of life. In this cross-sectional population-based study, long-term thyroid cancer survivors from the Netherlands parti

  8. K-wire position in tension-band wiring technique affects stability of wires and long-term outcome in surgical treatment of olecranon fractures.

    NARCIS (Netherlands)

    Linden, S.C. van der; Kampen, A. van; Jaarsma, R.L.

    2012-01-01

    BACKGROUND: Tension-band wiring (TBW) has been accepted as the treatment of choice for displaced olecranon fractures. The aim of this study was to examine the effect of K-wire position on instability of the K-wires in relation to local complications and radiological and clinical long-term outcome. M

  9. Malignant tumors of the nasal cavity and paranasal sinuses: long-term outcome and morbidity with emphasis on hypothalamic-pituitary deficiency.

    NARCIS (Netherlands)

    Snyers, A.; Janssens, G.O.; Twickler, T.B.; Hermus, A.R.M.M.; Takes, R.P.; Kappelle, A.C.; Merkx, M.A.W.; Dirix, P.; Kaanders, J.H.A.M.

    2009-01-01

    PURPOSE: To evaluate the long-term outcome after surgery and radiotherapy for patients with sinonasal cancer and assess late toxicity, with special emphasis on hypothalamic-pituitary dysfunction. METHODS AND MATERIALS: A retrospective analysis of 168 patients treated for sinonasal cancer in a single

  10. Clinical Presentation, Long-Term Follow-Up, and Outcomes of 1001 Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Patients and Family Members

    NARCIS (Netherlands)

    Groeneweg, Judith A.; Bhonsale, Aditya; James, Cynthia A.; Te Riele, Anneline S.; Dooijes, Dennis; Tichnell, Crystal; Murray, Brittney; Wiesfeld, Ans C P; Sawant, Abhishek C.; Kassamali, Bina; Atsma, Douwe E.; Volders, Paul G.; De Groot, Natasja M.; De Boer, Karin; Zimmerman, Stefan L.; Kamel, Ihab R.; van der Heijden, JF; Russell, Stuart D.; Cramer, MJ; Tedford, Ryan J.; Doevendans, Pieter A.; van Veen, AAB; Tandri, Harikrishna; Wilde, Arthur A.; Judge, Daniel P.; Van Tintelen, J. Peter; Hauer, Richard N. W.; Calkins, Hugh

    2015-01-01

    Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a progressive cardiomyopathy. We aimed to define long-term outcome in a transatlantic cohort of 1001 individuals. Methods and Results Clinical and genetic characteristics and follow-up data of ARVD/C index-patients (n=4

  11. Long-Term Health and Work Outcomes of Renal Transplantation and Patterns of Work Status During the End-Stage Renal Disease Trajectory

    NARCIS (Netherlands)

    van der Mei, Sijrike F.; Kuiper, Daphne; Groothoff, Johan W.; van den Heuvel, Wim J. A.; van Son, Willem J.; Brouwer, Sandra

    2011-01-01

    Introduction The aim of this study was to examine the health-and work outcomes of renal transplant recipients long-term after transplantation as well as the pattern of work status, work ability and disability benefits during the end-stage renal disease (ESRD) trajectory that precedes transplantation

  12. Long-term outcome of mitomycin C- and 5-FU-based primary radiochemotherapy for esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wolf, Maria; Zehentmayr, Franz; Niyazi, Maximilian; Ganswindt, Ute; Haimerl, Wolfgang; Belka, Claus [Dept. of Radiation Oncology, Univ. Hospital Munich, LMU (Germany); Schmidt, Michael [Inst. for Biometry and Epidemiology, Univ. Hospital Munich, LMU (Germany); Hoelzel, Dieter [Tumor Registry Munich, Univ. Hospital Munich, LMU (Germany)

    2010-07-15

    Background and purpose: for definitive radiochemotherapy, 5-fluorouracil/cisplatin protocols have been considered the standard of care for esophageal carcinoma over the last 2 decades. By contrast, most patients treated at the University Hospital, LMU Munich, Germany, received 5-fluorouracil/mitomycin C. The objective of this retrospective analysis was to determine the value of 5-fluorouracil/mitomycin-C-based therapy. Patients and methods: tumor stage, treatment received, and outcome data of patients treated for esophageal cancer between 1982 and 2007 were collected; endpoint of the analysis was overall survival. Results: 298 patients with inoperable cancer of the esophagus were identified (16.8% adenocarcinoma, 77.5% squamous cell carcinoma). At diagnosis, 61.7% (184/298) had UICC stage III-IV, 54.4% (162/298) positive lymph nodes, and 26.5% (79/298) metastatic disease. 74.5% of all patients (222/298) received radiation doses between 55 and 65 Gy, 65.8% (196/298) were subjected to concomitant chemotherapy. The median follow-up period (patients alive) was 4.1 years. A significant increase of overall survival (p < 0.0001) in the radiochemotherapy versus the radiotherapy=alone group was observed. 52% (102/196) in the 5-fluorouracil/mitomycin C group had tumor stages comparable to the RTOG 85-01 study cohort (T1-3 N0-1 M0). The median survival in this subgroup was 18.2 months, 3- and 5-year survival rates were 22.7% (21/102) and 15.0% (13/102), respectively. Conclusion: despite being nominally inferior to platinum-based radiochemotherapy, the overall survival rates are in a similar range. Thus, the mitomycin-C-based radiochemotherapy approach may considered to be as effective as the standard therapy. However, there is no randomized trial available in order to prove the equality. (orig.)

  13. Long-term Outcome after Robotic-assisted Gastroplication in Adolescents: Hunger Hormone and Food Preference Changes Two Case Reports.

    Science.gov (United States)

    Calcaterra, Valeria; Cena, Hellas; Fonte, Maria Luisa; De Amici, Mara; Vandoni, Matteo; Albanesi, Michela; Pelizzo, Gloria

    2016-06-05

    Weight loss surgery (WLS) is efficacious for long-term weight reduction and decreases overall mortality in severely obese patients. The mechanisms implicated in long-term weight loss are not fully understood. Proposed mechanisms include changes in gut hormones and brain regulation of appetite and satiety. We aimed to investigate the long-term ghrelin and leptin profiles and changes in food preference and eating behavior after WLS in adolescent patients. Two obese females aged 15 years and 14 4/12 years, who did not respond to lifestyle changes, including dietary intervention and physical exercise in combination with medical therapy, underwent robotic-assisted gastroplication. Anthropometric measurements, food habits and eating behavior, as well as metabolic and hormonal changes during long-term post-surgical follow-up were monitored. Long-term weight reduction was obtained in both patients, with a significant decrease in waist circumference. Resting energy expenditure showed a decrease over time, with a respiratory quotient that increased showing a shift from oxidation of a high-fat diet before surgery to oxidation of a mixed diet two and three years later. Both subjects improved their eating habits and lifestyle. Co-morbidity resolution was also noted. Increased pre-prandial ghrelin levels as well as higher post-prandial ghrelin and a leptin drop compared with pre-surgery values were observed in both patients. Persistent weight loss after gastroplication is associated with a favorable change in gut hormones and food preferences. The role of hormonal and sensory components in long-term results seems crucial. Particularly in adolescent patients, a multidisciplinary approach and continuous nutritional care is mandatory for weight maintenance and consolidation of changes.

  14. Acute and long-term outcomes in a Drosophila melanogaster model of classic galactosemia occur independently of galactose-1-phosphate accumulation

    Directory of Open Access Journals (Sweden)

    Jennifer M. I. Daenzer

    2016-11-01

    Full Text Available Classic galactosemia (CG is a potentially lethal inborn error of metabolism that results from the profound loss of galactose-1-phosphate uridylyltransferase (GALT, the second enzyme in the Leloir pathway of galactose metabolism. Neonatal detection and dietary restriction of galactose minimizes or resolves the acute sequelae of CG, but fails to prevent the long-term complications experienced by a majority of patients. One of the substrates of GALT, galactose-1-phosphate (Gal-1P, accumulates to high levels in affected infants, especially following milk exposure, and has been proposed as the key mediator of acute and long-term pathophysiology in CG. However, studies of treated patients demonstrate no association between red blood cell Gal-1P level and long-term outcome severity. Here, we used genetic, epigenetic and environmental manipulations of a Drosophila melanogaster model of CG to test the role of Gal-1P as a candidate mediator of outcome in GALT deficiency. Specifically, we both deleted and knocked down the gene encoding galactokinase (GALK in control and GALT-null Drosophila, and assessed the acute and long-term outcomes of the resulting animals in the presence and absence of dietary galactose. GALK is the first enzyme in the Leloir pathway of galactose metabolism and is responsible for generating Gal-1P in humans and Drosophila. Our data confirmed that, as expected, loss of GALK lowered or eliminated Gal-1P accumulation in GALT-null animals. However, we saw no concomitant rescue of larval survival or adult climbing or fecundity phenotypes. Instead, we saw that loss of GALK itself was not benign and in some cases phenocopied or exacerbated the outcome seen in GALT-null animals. These findings strongly contradict the long-standing hypothesis that Gal-1P alone underlies pathophysiology of acute and long-term outcomes in GALT-null Drosophila and suggests that other metabolite(s of galactose, and/or other pathogenic factors, might be involved.

  15. Acute and long-term outcomes in a Drosophila melanogaster model of classic galactosemia occur independently of galactose-1-phosphate accumulation

    Science.gov (United States)

    Daenzer, Jennifer M. I.; Jumbo-Lucioni, Patricia P.; Ryan, Emily L.

    2016-01-01

    ABSTRACT Classic galactosemia (CG) is a potentially lethal inborn error of metabolism that results from the profound loss of galactose-1-phosphate uridylyltransferase (GALT), the second enzyme in the Leloir pathway of galactose metabolism. Neonatal detection and dietary restriction of galactose minimizes or resolves the acute sequelae of CG, but fails to prevent the long-term complications experienced by a majority of patients. One of the substrates of GALT, galactose-1-phosphate (Gal-1P), accumulates to high levels in affected infants, especially following milk exposure, and has been proposed as the key mediator of acute and long-term pathophysiology in CG. However, studies of treated patients demonstrate no association between red blood cell Gal-1P level and long-term outcome severity. Here, we used genetic, epigenetic and environmental manipulations of a Drosophila melanogaster model of CG to test the role of Gal-1P as a candidate mediator of outcome in GALT deficiency. Specifically, we both deleted and knocked down the gene encoding galactokinase (GALK) in control and GALT-null Drosophila, and assessed the acute and long-term outcomes of the resulting animals in the presence and absence of dietary galactose. GALK is the first enzyme in the Leloir pathway of galactose metabolism and is responsible for generating Gal-1P in humans and Drosophila. Our data confirmed that, as expected, loss of GALK lowered or eliminated Gal-1P accumulation in GALT-null animals. However, we saw no concomitant rescue of larval survival or adult climbing or fecundity phenotypes. Instead, we saw that loss of GALK itself was not benign and in some cases phenocopied or exacerbated the outcome seen in GALT-null animals. These findings strongly contradict the long-standing hypothesis that Gal-1P alone underlies pathophysiology of acute and long-term outcomes in GALT-null Drosophila and suggests that other metabolite(s) of galactose, and/or other pathogenic factors, might be involved. PMID

  16. Acute and long-term outcomes in a Drosophila melanogaster model of classic galactosemia occur independently of galactose-1-phosphate accumulation.

    Science.gov (United States)

    Daenzer, Jennifer M I; Jumbo-Lucioni, Patricia P; Hopson, Marquise L; Garza, Kerry R; Ryan, Emily L; Fridovich-Keil, Judith L

    2016-11-01

    Classic galactosemia (CG) is a potentially lethal inborn error of metabolism that results from the profound loss of galactose-1-phosphate uridylyltransferase (GALT), the second enzyme in the Leloir pathway of galactose metabolism. Neonatal detection and dietary restriction of galactose minimizes or resolves the acute sequelae of CG, but fails to prevent the long-term complications experienced by a majority of patients. One of the substrates of GALT, galactose-1-phosphate (Gal-1P), accumulates to high levels in affected infants, especially following milk exposure, and has been proposed as the key mediator of acute and long-term pathophysiology in CG. However, studies of treated patients demonstrate no association between red blood cell Gal-1P level and long-term outcome severity. Here, we used genetic, epigenetic and environmental manipulations of a Drosophila melanogaster model of CG to test the role of Gal-1P as a candidate mediator of outcome in GALT deficiency. Specifically, we both deleted and knocked down the gene encoding galactokinase (GALK) in control and GALT-null Drosophila, and assessed the acute and long-term outcomes of the resulting animals in the presence and absence of dietary galactose. GALK is the first enzyme in the Leloir pathway of galactose metabolism and is responsible for generating Gal-1P in humans and Drosophila Our data confirmed that, as expected, loss of GALK lowered or eliminated Gal-1P accumulation in GALT-null animals. However, we saw no concomitant rescue of larval survival or adult climbing or fecundity phenotypes. Instead, we saw that loss of GALK itself was not benign and in some cases phenocopied or exacerbated the outcome seen in GALT-null animals. These findings strongly contradict the long-standing hypothesis that Gal-1P alone underlies pathophysiology of acute and long-term outcomes in GALT-null Drosophila and suggests that other metabolite(s) of galactose, and/or other pathogenic factors, might be involved.

  17. Long-term survival results of a randomized phase III trial of vinflunine plus best supportive care versus best supportive care alone in advanced urothelial carcinoma patients after failure of platinum-based chemotherapy

    DEFF Research Database (Denmark)

    Bellmunt, J; Fougeray, R; Rosenberg, J E;

    2013-01-01

    To compare long-term, updated overall survival (OS) of patients with advanced transitional cell carcinoma of the urothelium (TCCU) treated with vinflunine plus best supportive care (BSC) or BSC alone, after failure of platinum-based chemotherapy.......To compare long-term, updated overall survival (OS) of patients with advanced transitional cell carcinoma of the urothelium (TCCU) treated with vinflunine plus best supportive care (BSC) or BSC alone, after failure of platinum-based chemotherapy....

  18. Maternal Diabetes in Pregnancy: Early and Long-Term Outcomes on the Offspring and the Concept of “Metabolic Memory”

    OpenAIRE

    Akadiri Yessoufou; Kabirou Moutairou

    2011-01-01

    The adverse outcomes on the offspring from maternal diabetes in pregnancy are substantially documented. In this paper, we report main knowledge on impacts of maternal diabetes on early and long-term health of the offspring, with specific comments on maternal obesity. The main adverse outcome on progenies from pregnancy complicated with maternal diabetes appears to be macrosomia, as it is commonly known that intrauterine exposure to hyperglycemia increases the risk and programs the offspring t...

  19. Long-term outcomes in adults with leukemia treated with transplantation of two unrelated umbilical cord blood units

    Institute of Scientific and Technical Information of China (English)

    YIN Yue; LI Yuan; DONG Yu-jun; REN Han-yun; CEN Xin-an; QIU Zhi-xiang; OU Jin-ping; WANG Wen-sheng; WANG Mang-ju; XU Wei-lin; WANG Li-hong

    2011-01-01

    Background Wide application of umbilical cord blood transplantation (UCBT) in adult patients is limited by low cell-dose available in one umbilical cord blood (UCB) unit. The aim of this study was to investigate the safety and long-term outcomes of UCBT from unrelated donors in adult and adolescent patients with leukemia.Methods Thirteen patients with leukemia received double-unit UCBT with human leukocyte antigen (HLA) mismatched at 0-2 loci. We analyzed the engraftment, graft-versus-host disease (GVHD) and survival.Results Twelve evaluable patients (92.3%) had neutrophil and platelet engraftment at a median of 21 days (range,16-38 days) and 34 days (range, 25-51 days), respectively. At day 30, engraftment was derived from one donor in 8patients (66.7%, 95% CI40.0%-93.4%), and from both donors in 4 patients (33.3%, 95% CI 6.7%-60.0%) with 1 unit predominated. Unit with larger nucleated cell (NC) dose would predominate in engraftment (P=0.039), whereas CD34+ cell dose or HLA-match failed to demonstrate any relationship with unit predominance. Only one patient developed grade Ⅱ acute graft-versus-host disease (aGVHD). Chronic GVHD (cGVHD) was observed in 2 of 11 patients who survived more than 100 days, and both were limited. The median follow-up after transplantation for the 13 patients was 45 months (range 1.5-121.0 months) and 72 months (range 41.0-121.0 months) for the 8 alive and with full donor chimerism. The 5-year cumulative disease free survival (DFS) was (61.5±13.5)%. Of the 13 patients, 5 patients died in 1 year and 1-year transplantation related mortality (TRM) was 23.1% (95% CI 0.2%-46.0%).Conclusion Double-unit UCBT from unrelated donors with HLA-mismatched at 0-2 loci may overcome the cell-dose barrier and be feasible for adults and adolescents with leukemia.

  20. Perioperative and long-term outcome of thymectomy for myasthenia gravis: comparison of surgical approaches and prognostic analysis

    Institute of Scientific and Technical Information of China (English)

    LIU Cheng-wu; LUO Meng; MEI Jian-dong; ZHU Yun-ke; PU Qiang; MA Lin; CHE Guo-wei

    2013-01-01

    Background Thymectomy is an established treatment for myasthenia gravis (MG),and video-assisted thoracoscopic surgery (VATS) thymectomy has become an acceptable surgical procedure.This study aimed to compare the results of VATS thymectomy and open thymectomy and to identify the prognostic factors after thymectomy.Methods The clinical data of 187 consecutive thymectomies performed between July 2000 and December 2009 were retrospectively reviewed; 75 open thymectomies and 112 VATS thymectomies.Clinical efficacy and variables influencing outcome were assessed by Kaplan-Meier survival curves and Cox proportional hazards regression analysis.Results The operative blood loss in the VATS group was significantly less than that in the open group ((62.14±55.43)ml vs.(137.87±165.25) ml,P <0.05).The postoperative crisis rate increased with the severity of preoperative MG and the prescription dose of anticholinesterase.Complete follow-up information of patients more than 12 months after the thymectomy was obtained on 151 cases,89 cases from the VATS group and 62 cases from the open group,with a mean follow-up period of 59.3 months,range from 12 to 117 months.Complete stable remission (CSR) was the end point for evaluation of the treatment results.The overall five-year CSR rate was 57.5% Two good prognostic factors were identified; preoperative prescription of anticholinesterase alone (P=0.035) and non-thymomatous MG (P=0.003).The five-year CSR rate of the ocular type of MG reached a high level of 67.4%.Conclusions Thymectomy can achieve good long-term CSR in MG,and VATS is an ideal alternative method.High-dose prescription of anticholinesterase and the advanced stage by Myasthenia Gravis Foundation of America (MGFA) classification have higher risks of postoperative crisis.Preoperative prescription of anticholinesterase alone and non-thymomatous MG are good prognostic factors.Thymectomy should also be considered for the ocular type of MG.

  1. Active middle ear implantation for patients with sensorineural hearing loss and external otitis: long-term outcome in patient satisfaction

    NARCIS (Netherlands)

    Zwartenkot, J.W.; Hashemi, J.; Cremers, C.W.R.J.; Mulder, J.J.S.; Snik, A.F.M.

    2013-01-01

    OBJECTIVE: To study long-term subjective benefit of patients with sensorineural hearing loss and chronic external otitis who use active middle ear implants. DESIGN: Single-subject repeated measures in a preintervention and postintervention design with multiple postintervention measurements (question

  2. Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands

    NARCIS (Netherlands)

    P. Blanken; V.M. Hendriks; J.M. van Ree; W. van den Brink

    2010-01-01

    Aims To describe 4-year treatment retention and treatment response among chronic, treatment-resistant heroin-dependent patients offered long-term heroin-assisted treatment (HAT) in the Netherlands. Design Observational cohort study. Setting and intervention Out-patient treatment in specialized heroi

  3. Long-term outcome in patients treated with combined heart and liver transplantation for familial amyloidotic cardiomyopathy

    DEFF Research Database (Denmark)

    Nelson, Laerke M; Penninga, Luit; Sander, Kaare

    2013-01-01

    allograft vasculopathy or neuropathy after transplantation. No recurrence of cardiac amyloid was found. CONCLUSIONS: CHLTx in selected patients with FAC due to Leu111Met mutation offers acceptable long-term survival, almost comparable with isolated cardiac transplantation. Allograft rejection was rare....

  4. Birthing positions during second stage of labor and long-term psychological outcomes in low-risk women

    NARCIS (Netherlands)

    Jonge, A. de; Rijnders, M.E.B.; Diem, M.T. van; Scheepers, P.L.H.; Lagro-Janssen, A.L.M.

    2011-01-01

    PURPOSE: To examine the long-term influence of birthing positions during the second stage of labor, as well as other factors, on birth satisfaction, self-esteem (based on the Rosenberg Self-esteem Scale [RSE]) and emotional well-being (based on the Edinburgh Postnatal Depression Scale [EPDS]). STUDY

  5. A case of endometrial carcinoma in a long-term Levonorgestrel Intrauterine System (LNG 52 mg-IUS) user.

    Science.gov (United States)

    Thomas, Melisa; Briggs, Paula

    2017-03-01

    This report describes a 50-year-old woman who presented to a community gynaecology clinic complaining of persistent heavy vaginal bleeding with an LNG 52 mg-IUS in situ. She was subsequently found to have stage 1 grade 1a endometrioid carcinoma. From the literature, we have identified five similar cases. This case highlights the possibility of endometrial carcinoma despite treatment with an LNG 52 mg-IUS and reinforces the importance of investigating women who present with unusual persistent or heavy vaginal bleeding.

  6. Short-term and long-term efficacy of 7 targeted therapies for the treatment of advanced hepatocellular carcinoma: a network meta-analysis

    Science.gov (United States)

    Niu, Meng; Hong, Duo; Ma, Teng-Chuang; Chen, Xiao-Wei; Han, Jin-Hang; Sun, Jun; Xu, Ke

    2016-01-01

    Abstract Background: A variety of targeted drug therapies in clinical trials have been proven to be effective for the treatment of hepatocellular carcinoma (HCC). Our study aims to compare the short-term and long-term efficacies of different targeted drugs in advanced hepatocellular carcinoma (AHCC) treatment using a network meta-analysis approach. Methods: PubMed, Embase, Ovid, EBSCO, and Cochrane central register of controlled trials were searched for randomized controlled trials (RCTs) of different targeted therapies implemented to patients with AHCC. And the retrieval resulted in 7 targeted drugs, namely, sorafenib, ramucirumab, everolimus, brivanib, tivantinib, sunitinib, and sorafenib+erlotinib. Direct and indirect evidence were combined to evaluate stable disease (SD), progressive disease (PD), complete response (CR), partial response (PR), disease control rate (DCR), overall response ratio (ORR), overall survival (OS), and surface under the cumulative ranking curve (SUCRA) of patients with AHCC. Results: A total of 11 RCTs were incorporated into our analysis, including 6594 patients with AHCC, among which 1619 patients received placebo treatment and 4975 cases had targeted therapies. The results revealed that in comparison with placebo, sorafenib, and ramucirumab displayed better short-term efficacy in terms of PR and ORR, and brivanib was better in ORR. Regarding long-term efficacy, sorafenib and sorafenib+erlotinib treatments exhibited longer OS. The data of cluster analysis showed that ramucirumab or sorafenib+erlotinib presented relatively better short-term efficacy for the treatment of AHCC. Conclusion: This network meta-analysis shows that ramucirumab and sorafenib+erlotinib may be the better targeted drugs for AHCC patients, and sorafenib+erlotinib achieved a better long-term efficacy. PMID:27930578

  7. Long-term outcome of sporadic and FAP-associated desmoid tumors treated with high-dose selective estrogen receptor modulators and sulindac: a single-center long-term observational study in 134 patients.

    Science.gov (United States)

    Quast, Daniel Robert; Schneider, Ralph; Burdzik, Emanuel; Hoppe, Steffen; Möslein, Gabriela

    2016-01-01

    Aim of this study is to evaluate the outcome of long-term conservative treatment with sulindac and high-dose selective estrogen receptor modulators (SERMs) for sporadic and FAP-associated desmoid tumors. Desmoids are very rare tumors in the general population but occur frequently in FAP patients, being encountered in 23-38 %. Treatment of desmoids is still most controversial since response cannot be predicted and they are prone to develop recurrence. This study included all desmoid patients that were treated and followed at our institution and had completed at least 1 year of treatment. Response was defined as stable size or regression of desmoid size between two CT or MRI scans. A total of 134 patients were included. 64 (47.8 %) patients had a confirmed diagnosis of FAP, 69 (51.5 %) patients were sporadic. Overall 114 (85.1 %) patients showed regressive or stable desmoid size. Patients with previous history of multiple desmoid-related surgeries showed less-favorable response. The mean time to reach at least stable size was 14.9 (±9.1) months. After regression or stabilization, medication was tapered in 69 (60.5 %) of the treated patients with only one long-term recurrence after >10 years. The results of this study fortify the role of sulindac and high-dose SERMs as an effective and safe treatment for both, sporadic and FAP-associated desmoid tumors. While invasive treatment frequently results in high recurrence rates, high morbidity and high mortality, this conservative treatment is successful in most patients. The recurrence rate is negligible with no desmoid-related mortality in this large series. Therefore surgical resection, especially for mesenteric desmoids, should be deferred favoring this convincingly effective, well tolerated regimen.

  8. Neurocognitive and clinical predictors of long-term outcome in adolescents at ultra-high risk for psychosis: a 6-year follow-up.

    Directory of Open Access Journals (Sweden)

    Tim Ziermans

    Full Text Available BACKGROUND: Most studies aiming to predict transition to psychosis for individuals at ultra-high risk (UHR have focused on either neurocognitive or clinical variables and have made little effort to combine the two. Furthermore, most have focused on a dichotomous measure of transition to psychosis rather than a continuous measure of functional outcome. We aimed to investigate the relative value of neurocognitive and clinical variables for predicting both transition to psychosis and functional outcome. METHODS: Forty-three UHR individuals and 47 controls completed an extensive clinical and neurocognitive assessment at baseline and participated in long-term follow-up approximately six years later. UHR adolescents who had converted to psychosis (UHR-P; n = 10 were compared to individuals who had not (UHR-NP; n = 33 and controls on clinical and neurocognitive variables. Regression analyses were performed to determine which baseline measures best predicted transition to psychosis and long-term functional outcome for UHR individuals. RESULTS: Low IQ was the single neurocognitive parameter that discriminated UHR-P individuals from UHR-NP individuals and controls. The severity of attenuated positive symptoms was the only significant predictor of a transition to psychosis and disorganized symptoms were highly predictive of functional outcome. CONCLUSIONS: Clinical measures are currently the most important vulnerability markers for long-term outcome in adolescents at imminent risk of psychosis.

  9. No increased risk of hepatocellular carcinoma in cirrhosis due to Wilson disease during long-term follow-up

    NARCIS (Netherlands)

    Meer, S. Winters-Van Der; Man, R.A. de; Berg, A.P. van den; Houwen, R.H.; Linn, F.H.; Oijen, M.G. van; Siersema, P.D.; Erpecum, K.J. van

    2015-01-01

    BACKGROUND AND AIMS: Data on risk of hepatocellular carcinoma (HCC) in patients with Wilson disease are scarce. We determine HCC risk in a well-defined cohort of Wilson patients. METHODS: All patients with a confirmed diagnosis of Wilson disease (Leipzig score >/= 4) in three Dutch university ref

  10. No increased risk of hepatocellular carcinoma in cirrhosis due to Wilson disease during long-term follow-up

    NARCIS (Netherlands)

    van Meer, Suzanne; de Man, Robert A.; van den Berg, Aad P.; Houwen, Roderick H. J.; Linn, Francisca H. H.; van Oijen, Martijn G. H.; Siersema, Peter D.; van Erpecum, Karel J.

    2015-01-01

    Background and AimsData on risk of hepatocellular carcinoma (HCC) in patients with Wilson disease are scarce. We determine HCC risk in a well-defined cohort of Wilson patients. MethodsAll patients with a confirmed diagnosis of Wilson disease (Leipzig score4) in three Dutch university referral hospit

  11. Social support as a predictor of the outcome of depressive and anxiety disorder in short-term and long-term psychotherapy.

    Science.gov (United States)

    Lindfors, Olavi; Ojanen, Sakari; Jääskeläinen, Tuija; Knekt, Paul

    2014-04-30

    Social support is known to be important for well-being of individuals, but it is not clear how it predicts psychotherapy outcome in patients suffering from depressive or anxiety disorders. The aim of the present study was to study the prediction of social support on the outcome of short-term and long-term psychotherapy. In the Helsinki Psychotherapy Study, 326 psychiatric outpatients, aged 20-46 years, and suffering from depressive or anxiety disorders, were randomly assigned to short-term psychotherapy (short-term psychodynamic or solution-focused) or long-term psychodynamic psychotherapy. The level of social support at baseline was assessed using the Brief Inventory of Social Support and Integration (BISSI). Psychiatric symptoms were assessed with the Symptom Check List, Global Severity Index (SCL-90-GSI) at baseline and four times during a 3-year follow-up. Patients with a high level of social support before treatment benefitted more from long-term than short-term therapy at the 3-year follow-up, whereas patients with a low level of social support experienced no such benefit. Pretreatment social support seems to predict differentially short- and long-term psychotherapy and thus needs to be acknowledged when evaluating patient's resources and treatment options. More research is needed to verify these findings.

  12. Significance of preoperative C-reactive protein as a parameter of the perioperative course and long-term prognosis in squamous cell carcinoma and adenocarcinoma of the oesophagus

    Institute of Scientific and Technical Information of China (English)

    Ines Gockel; Kathrin Dirksen; Claudia M Messow; Theodor Junginger

    2006-01-01

    AIM: C-reactive protein (CRP) is an acute-phase reactant and a known indicator of the malignant potential of the tumour. The aim of this study was to investigate the significance of preoperative CRP as a parameter of the perioperative course and long-term prognosis in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.METHODS: Serum CRP was determined preoperatively in 291 of 371 patients undergoing oesophagectomy for cancer from December 1989 to March 2004. Median patient age was 59 (28-79) year,82.5% of patients were males. Squamous cell carcinoma was diagnosed in 151(51.9%) and adenocarcinoma in 122 patients. Transhiatal oesophagectomy was done in 151 (51.9%) patients and 134 (46.0%) patients underwent the abdominothoracic procedure.RESULTS: In 127 (43.6%) patients the preoperative serum CRP concentration was within the normal range (<5 mg/dL), elevated CRP levels were measured in 164 (56.4%) patients. Tumour extension (P<0.0005)and the number of lymph nodes affected by metastatic spread (P=0.015) were significantly increased in the group with elevated CRP levels. Among the perioperative parameters both the number of blood transfusions (P =0.006) and the general complication rate (P=0.002)were higher in patients with elevated preoperative CRP levels. The long-term survival rate of 13.6 (0-109.8)mo was poorer in the group with elevated CRP levels compared to 18.9 (0-155.4) mo in the group with normal CRP levels (log-rank test:P=0.107). Multivariate analysis with backward variables selection identified preoperative CRP as an independent prognostic factor of the long-term prognosis in patients with oesophageal carcinoma, with a hazard ratio of 1.182 (95% confidence interval: 1.030-1.356).CONCLUSION: The preoperative serum CRP-level is an easily determined independent prognostic marker in patients with squamous cell carcinoma and adenocarcinoma of the oesophagus.

  13. Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years

    Directory of Open Access Journals (Sweden)

    Engblom Erik

    2008-04-01

    Full Text Available Abstract Background Only a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE. Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery. Methods A total of 326 episodes of IE in 303 patients were treated during 1980–2004 in the Turku University Hospital. We evaluated the long-term outcome and requirement for late valve surgery for 243 of these episodes in 226 patients who survived longer than 1 year after the initial admission. Factors associated with recurrences were analysed both for the 1-year survivors and for all 303 patients. Results The mean (SD follow-up time for the 1-year survivors was 11.5 (7.3 years (range 25 days to 25.5 years. The overall survival was 95%, 82%, 66%, 51% and 45% at 2, 5, 10, 15 and 20 years. In age and sex adjusted multivariate analyses, significant predictors for long-term overall mortality were heart failure within 3 months of admission (HR 1.97, 95% CI 1.27 to 3.06; p = 0.003 and collagen disease (HR 2.54, 95% CI 1.25 to 5.19; p = 0.010 or alcohol abuse (HR 2.39, 95% CI 1.30 to 4.40; p = 0.005 as underlying conditions, while early surgery was significantly associated with lower overall mortality rates (HR 0.31, 95% CI 0.17 to 0.58; p Conclusion Heart failure during the index episode of IE was the complication, which significantly predicted a poor long-term outcome. Patients who underwent surgery during the initial hospitalisation for IE faired significantly better than those who did not.

  14. The Effect of Positive Adolescent Life Skills Training on Long Term Outcomes for High-Risk Teens

    OpenAIRE

    Campbell-Heider, Nancy; Tuttle, Jane; Thomas R. Knapp

    2009-01-01

    This paper reports on long term follow-up data—12 months post intervention—from a clinical trial of an intervention designed to enhance teen resilience by supporting the development of social skills needed to make positive connections and overcome the influence of negative environmental influences. Sixteen adolescents aged 12 to 16 (10 boys and 6 girls) attending an inner city urban secondary school participated in a 32 week intervention study. Subjects were randomly assigned within sex to Te...

  15. Long-term outcome in patients receiving permanent pacemaker implantation for atrioventricular block: Comparison of VDD and DDD pacing.

    Science.gov (United States)

    Liao, Jo-Nan; Chao, Tze-Fan; Tuan, Ta-Chuan; Kong, Chi-Woon; Chen, Shih-Ann

    2016-08-01

    A permanent pacemaker (PPM) with dual chamber pacing (DDD) offers atrioventricular synchronization for patients with atrioventricular block (AVB). Single lead atrial synchronous ventricular pacing mode (VDD) is an alternative, but there are concerns about its efficacy and risk of atrial undersensing. Whether VDD can be a good alternative in patients with AVB remains unknown. The aim of the present study was to compare the long-term risk of mortality of VDD with DDD pacing.A total of 207 patients undergoing PPM implantations for AVB with VDD mode were enrolled from 2000 to 2013. Another 828 age- and sex-matched patients undergoing DDD implantations during the same period of time were selected as the control group in a 1 to 4 ratio. The study endpoint was mortality.A total of 1035 patients (64.3% male) were followed up for 46.5 ± 43.2 months. The mean ages were 75.0 years for VDD, and 74.9 years for DDD. The Kaplan-Meier survival analysis showed no significant difference in long-term survival between the VDD and DDD groups (log-rank P = 0.313). After adjustment for baseline characteristics, the VDD and DDD groups had a similar long-term prognosis with an adjusted hazard ratio of 0.875 (P = 0.445). Further analyses for the risk of cardiovascular and noncardiovascular deaths also showed no significant differences between the 2 groups.The long-term prognosis of VDD mode is comparable to that of DDD mode. Single lead VDD can be considered as an alternative choice in patients with AVB without sinus nodal dysfunction.

  16. Neurocognitive Outcomes in Long-term Survivors of Childhood Acute Lymphoblastic Leukemia Treated on Contemporary Treatment Protocols: A Systematic Review

    Science.gov (United States)

    Cheung, Yin Ting; Krull, Kevin R.

    2015-01-01

    The intensified administration of chemotherapeutic drugs has gradually replaced cranial radiation therapy (CRT) for the treatment of childhood acute lymphoblastic leukemia (ALL). While CRT is often implicated in neurocognitive impairment in ALL survivors, there is a paucity of literature that evaluates the persistence of neurocognitive deficits in long-term survivors of pediatric ALL who were treated with contemporary chemotherapy-only protocols. Results from this systematic review concurred to the probable cognitive-sparing effect of chemotherapy-based protocols over CRT in long-term survivors. However, coupled with multiple intrinsic and extrinsic factors, survivors who received chemotherapy treatment still suffered from apparent cognitive impairment, particularly in the attention and executive function domains. Notably, there is evidence to suggest that the late neurotoxic effect of methotrexate on survivors’ neurocognitive performance may be dose-related. This review also recommends future pharmacokinetic, neuroimaging and genetic studies to illuminate the multifactorial nature of this subject matter and discusses the potential value of neurochemical, physiological, inflammatory and genetic markers for the prediction of susceptibility to neurocognitive impairment in long-term survivors of childhood ALL. PMID:25857254

  17. Predicting long-term outcomes for children affected by HIV and AIDS: perspectives from the scientific study of children's development.

    Science.gov (United States)

    Stein, Alan; Desmond, Christopher; Garbarino, James; Van IJzendoorn, Marinus H; Barbarin, Oscar; Black, Maureen M; Stein, Aryeh D; Hillis, Susan D; Kalichman, Seth C; Mercy, James A; Bakermans-Kranenburg, Marian J; Rapa, Elizabeth; Saul, Janet R; Dobrova-Krol, Natasha A; Richter, Linda M

    2014-07-01

    The immediate and short-term consequences of adult HIV for affected children are well documented. Little research has examined the long-term implications of childhood adversity stemming from caregiver HIV infection. Through overviews provided by experts in the field, together with an iterative process of consultation and refinement, we have extracted insights from the broader field of child development of relevance to predicting the long-term consequences to children affected by HIV and AIDS. We focus on what is known about the impact of adversities similar to those experienced by HIV-affected children, and for which there is longitudinal evidence. Cautioning that findings are not directly transferable across children or contexts, we examine findings from the study of parental death, divorce, poor parental mental health, institutionalization, undernutrition, and exposure to violence. Regardless of the type of adversity, the majority of children manifest resilience and do not experience any long-term negative consequences. However, a significant minority do and these children experience not one, but multiple problems, which frequently endure over time in the absence of support and opportunities for recovery. As a result, they are highly likely to suffer numerous and enduring impacts. These insights suggest a new strategic approach to interventions for children affected by HIV and AIDS, one that effectively combines a universal lattice of protection with intensive intervention targeted to selected children and families.

  18. Prognostic value of intra-operative abnormal muscle response monitoring during microvascular decompression for long-term outcome of hemifacial spasm.

    Science.gov (United States)

    Li, Jiping; Zhang, Yuqing; Zhu, Hongwei; Li, Yongjie

    2012-01-01

    The reliability of intra-operative abnormal muscle response (AMR) monitoring as an indicator of post-operative outcome in patients with hemifacial spasm (HFS) is under debate. The primary aim of this study was to evaluate the correlation between intra-operative AMR changes and long-term post-operative outcome. We monitored intra-operative AMR during microvascular decompression (MVD) in consecutive patients with HFS (n = 104). Patients in this study were divided into two groups based on whether their AMR disappeared or persisted following MVD. Ninety patients were followed-up, and the mean duration from surgery to final follow-up examination was 3.7 years. Fourteen patients were lost to follow-up. AMR disappeared during surgery for 80 patients; of these, 74 achieved complete resolution of HFS, five had persistent HFS, and one patient developed a recurrence of HFS. Of the 10 patients with persistent AMR despite effective MVD, eight patients achieved complete resolution, one patient had persistent HFS, and one developed recurrent HFS. The long-term clinical outcome of HFS after MVD did not significantly correlate with intra-operative AMR changes (p = 0.791). Therefore, we suggest that intra-operative AMR monitoring may not be a reliable indicator of long-term post-operative outcome for HFS.

  19. Relation between strain dyssynchrony index determined by comprehensive assessment using speckle-tracking imaging and long-term outcome after cardiac resynchronization therapy for patients with heart failure.

    Science.gov (United States)

    Tatsumi, Kazuhiro; Tanaka, Hidekazu; Matsumoto, Kensuke; Kaneko, Akihiro; Tsuji, Takayuki; Ryo, Keiko; Fukuda, Yuko; Norisada, Kazuko; Onishi, Tetsuari; Yoshida, Akihiro; Kawai, Hiroya; Hirata, Ken-Ichi

    2012-04-15

    Strain dyssynchrony index (SDI), which was a marker of dyssynchrony and residual myocardial contractility, can predict left ventricular reverse remodeling short-term after cardiac resynchronization therapy (CRT). We investigated SDI-predicted long-term outcome after CRT in patients with heart failure (HF). We studied 74 patients with HF who underwent CRT. SDI was calculated as the average difference between peak and end-systolic strain from 6 segments for radial and circumferential SDIs and 18 segments for longitudinal SDI using 2-dimensional speckle-tracking strain. Based on our previous findings, the predefined cutoff for significant dyssynchrony and residual myocardial contractility was a radial SDI ≥6.5%, a circumferential SDI ≥3.2%, and a longitudinal SDI ≥3.6%. The predefined principal outcome variable was the combined end point of death or hospitalization owing to deteriorating HF. Long-term follow-up after CRT was tracked over 4 years. The primary end point of prespecified events occurred in 14 patients (19%). An association with a favorable long-term outcome after CRT was observed in patients with significant radial, circumferential, and longitudinal SDIs (p SDIs, respectively). Furthermore, cardiovascular event-free rate after CRT in patients with positivity of 3 for the 3 SDIs was 100% better than that in patients with positivity of 1 (52%, p SDIs. In conclusion, SDIs can successfully predict long-term outcome after CRT in patients with HF. Moreover, the approach combining the 3 types of SDI leads to a more accurate prediction than the use of individual parameters. These findings may have clinical implications in patients with CRT.

  20. Evaluation of long-term clinical and health service outcomes following coronary artery revascularisation in Western Australia (WACARP): a population-based cohort study protocol

    OpenAIRE

    Gardner, C; Rankin, J. M.; Geelhoed, E.; Nguyen, M; Newman, M.; Cutlip, D; Knuiman, M W; Briffa, T G; Hobbs, M S T; Sanfilippo, F M

    2014-01-01

    Introduction: Coronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) are procedures commonly performed on patients with significant obstructive coronary artery disease to relieve symptoms of ischaemia, improve survival or both. Although the efficacy of both procedures at the individual level has been established, the impact of advances in coronary artery revascularisation procedures (CARP) on long-term outcomes and cost-effectiveness at the population level are y...

  1. Association between arthritis score at the onset of the disease and long-term locomotor outcome in adjuvant-induced arthritis in rats

    OpenAIRE

    Mossiat, Claude; Laroche, Davy; Prati, Clément; Pozzo, Thierry; Demougeot, Céline; Marie, Christine

    2015-01-01

    Introduction To investigate the connection between the intensity of initial symptoms of inflammation and locomotor outcome in rheumatoid arthritis, we examined the relationship between long-term locomotor abnormalities and signs of inflammation at the onset of the disease in adjuvant-induced arthritis (AIA) in rats. Methods The arthritis score and hind-paw diameter were followed from immunization to day 195 (~7 months). At this time, locomotion was recorded during forced treadmill walking usi...

  2. Characterization of chemically induced ovarian carcinomas in an ethanol-preferring rat model: influence of long-term melatonin treatment.

    Directory of Open Access Journals (Sweden)

    Luiz Gustavo A Chuffa

    Full Text Available Ovarian cancer is the fourth most common cause of cancer deaths among women, and chronic alcoholism may exert co-carcinogenic effects. Because melatonin (mel has oncostatic properties, we aimed to investigate and characterize the chemical induction of ovarian tumors in a model of ethanol-preferring rats and to verify the influence of mel treatment on the overall features of these tumors. After rats were selected to receive ethanol (EtOH, they were surgically injected with 100 µg of 7,12-dimethyl-benz[a]anthracene (DMBA plus sesame oil directly under the left ovarian bursa. At 260 days old, half of the animals received i.p. injections of 200 µg mel/100 g b.w. for 60 days. Four experimental groups were established: Group C, rats bearing ovarian carcinomas (OC; Group C+EtOH, rats voluntarily consuming 10% (v/v EtOH and bearing OC; Group C+M, rats bearing OC and receiving mel; and Group C+EtOH+M, rats with OC consuming EtOH and receiving mel. Estrous cycle and nutritional parameters were evaluated, and anatomopathological analyses of the ovarian tumors were conducted. The incidence of ovarian tumors was higher in EtOH drinking animals 120 days post-DMBA administration, and mel efficiently reduced the prevalence of some aggressive tumors. Although mel promoted high EtOH consumption, it was effective in synchronizing the estrous cycle and reducing ovarian tumor mass by 20%. While rats in the C group displayed cysts containing serous fluid, C+EtOH rats showed solid tumor masses. After mel treatment, the ovaries of these rats presented as soft and mobile tissues. EtOH consumption increased the incidence of serous papillary carcinomas and sarcomas but not clear cell carcinomas. In contrast, mel reduced the incidence of sarcomas, endometrioid carcinomas and cystic teratomas. Combination of DMBA with EtOH intake potentiated the incidence of OC with malignant histologic subtypes. We concluded that mel reduces ovarian masses and the incidence of

  3. Characterization of Chemically Induced Ovarian Carcinomas in an Ethanol-Preferring Rat Model: Influence of Long-Term Melatonin Treatment

    Science.gov (United States)

    Chuffa, Luiz Gustavo A.; Fioruci-Fontanelli, Beatriz A.; Mendes, Leonardo O.; Fávaro, Wagner J.; Pinheiro, Patricia Fernanda F.; Martinez, Marcelo; Martinez, Francisco Eduardo

    2013-01-01

    Ovarian cancer is the fourth most common cause of cancer deaths among women, and chronic alcoholism may exert co-carcinogenic effects. Because melatonin (mel) has oncostatic properties, we aimed to investigate and characterize the chemical induction of ovarian tumors in a model of ethanol-preferring rats and to verify the influence of mel treatment on the overall features of these tumors. After rats were selected to receive ethanol (EtOH), they were surgically injected with 100 µg of 7,12-dimethyl-benz[a]anthracene (DMBA) plus sesame oil directly under the left ovarian bursa. At 260 days old, half of the animals received i.p. injections of 200 µg mel/100 g b.w. for 60 days. Four experimental groups were established: Group C, rats bearing ovarian carcinomas (OC); Group C+EtOH, rats voluntarily consuming 10% (v/v) EtOH and bearing OC; Group C+M, rats bearing OC and receiving mel; and Group C+EtOH+M, rats with OC consuming EtOH and receiving mel. Estrous cycle and nutritional parameters were evaluated, and anatomopathological analyses of the ovarian tumors were conducted. The incidence of ovarian tumors was higher in EtOH drinking animals 120 days post-DMBA administration, and mel efficiently reduced the prevalence of some aggressive tumors. Although mel promoted high EtOH consumption, it was effective in synchronizing the estrous cycle and reducing ovarian tumor mass by 20%. While rats in the C group displayed cysts containing serous fluid, C+EtOH rats showed solid tumor masses. After mel treatment, the ovaries of these rats presented as soft and mobile tissues. EtOH consumption increased the incidence of serous papillary carcinomas and sarcomas but not clear cell carcinomas. In contrast, mel reduced the incidence of sarcomas, endometrioid carcinomas and cystic teratomas. Combination of DMBA with EtOH intake potentiated the incidence of OC with malignant histologic subtypes. We concluded that mel reduces ovarian masses and the incidence of adenocarcinomas in

  4. Long-term outcomes on spatial hearing, speech recognition and receptive vocabulary after sequential bilateral cochlear implantation in children.

    Science.gov (United States)

    Sparreboom, Marloes; Langereis, Margreet C; Snik, Ad F M; Mylanus, Emmanuel A M

    2014-11-05

    Sequential bilateral cochlear implantation in profoundly deaf children often leads to primary advantages in spatial hearing and speech recognition. It is not yet known how these children develop in the long-term and if these primary advantages will also lead to secondary advantages, e.g. in better language skills. The aim of the present longitudinal cohort study was to assess the long-term effects of sequential bilateral cochlear implantation in children on spatial hearing, speech recognition in quiet and in noise and receptive vocabulary. Twenty-four children with bilateral cochlear implants (BiCIs) were tested 5-6 years after sequential bilateral cochlear implantation. These children received their second implant between 2.4 and 8.5 years of age. Speech and language data were also gathered in a matched reference group of 26 children with a unilateral cochlear implant (UCI). Spatial hearing was assessed with a minimum audible angle (MAA) task with different stimulus types to gain global insight into the effective use of interaural level difference (ILD) and interaural timing difference (ITD) cues. In the long-term, children still showed improvements in spatial acuity. Spatial acuity was highest for ILD cues compared to ITD cues. For speech recognition in quiet and noise, and receptive vocabulary, children with BiCIs had significant higher scores than children with a UCI. Results also indicate that attending a mainstream school has a significant positive effect on speech recognition and receptive vocabulary compared to attending a school for the deaf. Despite of a period of unilateral deafness, children with BiCIs, participating in mainstream education obtained age-appropriate language scores.

  5. Impact of immune parameters on long-term survival in metastatic renal cell      carcinoma

    DEFF Research Database (Denmark)

    Donskov, Frede; Maase, Hans von der

    2006-01-01

    PURPOSE: The purpose of this study was to evaluate the impact of       immunologic prognostic factors in combination with established clinical       prognostic factors in patients with metastatic renal cell carcinoma       (mRCC). PATIENTS AND METHODS: A total of 120 consecutive patients with    ......PURPOSE: The purpose of this study was to evaluate the impact of       immunologic prognostic factors in combination with established clinical       prognostic factors in patients with metastatic renal cell carcinoma       (mRCC). PATIENTS AND METHODS: A total of 120 consecutive patients...... with estimated       5-year survival rates of 60%, 25%, and 0%, respectively. These findings       were apparent in both our own prognostic model and in an extended Memorial       Sloan-Kettering Cancer Center (New York, NY) prognostic model. CONCLUSION:       This study points on five clinical and three...

  6. Psychosocial outcome following traumatic brain injury in adults: a long-term population-based follow-up

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Teasdale, T W

    2004-01-01

    , against up to 14% of cranial fracture patients. Significantly more cerebral lesion patients than cranial fracture patients found emotional control more difficult, as well as increased difficulties with memory and concentration, maintenance of leisure time interests and general life satisfaction......PRIMARY OBJECTIVE: On a national basis to conduct a 5, 10 and 15 year follow-up study of representative samples of survivors after traumatic brain injury (TBI) and to identify factors of importance for long-term survival and life satisfaction after TBI occurring in 1982, 1987 or 1992. RESEARCH...

  7. Treatment strategies for oesophageal cancer - time-trends and long term outcome data from a large tertiary referral centre

    Directory of Open Access Journals (Sweden)

    Wolf Maria C

    2012-04-01

    Full Text Available Abstract Background and objectives Treatment options for oesophageal cancer have changed considerably over the last decades with the introduction of multimodal treatment concepts dominating the progress in the field. However, it remains unclear in how far the documented scientific progress influenced and changed the daily routine practice. Since most patients with oesophageal cancer generally suffer from reduced overall health conditions it is uncertain how high the proportion of aggressive treatments is and whether outcomes are improved substantially. In order to gain insight into this we performed a retrospective analysis of patients treated at a larger tertiary referral centre over time course of 25 years. Patients and methods Data of all patients diagnosed with squamous cell carcinoma (SCC and adenocarcinoma (AC of the oesophagus, treated between 1983 and 2007 in the department of radiation oncology of the LMU, were obtained. The primary endpoint of the data collection was overall survival (calculated from the date of diagnosis until death or last follow up. Changes in basic clinical characteristics, treatment approach and the effect on survival were analysed after dividing the cohort into five subsequent time periods (I-V with 5 years each. In a second analysis any pattern of change regarding the use of radio(chemotherapy (R(CT with and without surgery was determined. Results In total, 503 patients with SCC (78.5% and AC (18.9% of the oesophagus were identified. The average age was 60 years (range 35-91 years. 56.5% of the patients were diagnose with advanced UICC stages III-IV. R(CT was applied to 353 (70.2% patients; R(CT+ surgery was performed in 134 (26.6% patients, 63.8% of all received chemotherapy (platinum-based 5.8%, 5-fluorouracil (5-FU12.1%, 42.3% 5-FU and mitomycin C (MMC. The median follow-up period was 4.3 years. The median overall survival was 21.4 months. Over the time, patients were older, the formal tumour stage was more

  8. Novel risk markers and long-term outcomes of delirium: The Successful Aging after Elective Surgery (SAGES) Study Design and Methods

    Science.gov (United States)

    Schmitt, Eva M.; Marcantonio, Edward R.; SM; Alsop, David C.; Jones, Richard N.; Rogers, Selwyn O.; Fong, Tamara G.; Metzger, Eran; Inouye, Sharon K.

    2012-01-01

    Objectives Delirium--a costly, life-threatening, and potentially preventable condition--is a common complication for older adults following major surgery. While the basic epidemiology of delirium after surgery has been defined, the contribution of delirium to long-term outcomes remains uncertain, and novel biomarkers from plasma and neuroimaging have yet to be examined. This program project was designed to contribute to our understanding of the complex multifactorial syndrome of delirium. Design Long-term prospective cohort study. Setting 3 academic medical centers (2 hospitals and 1 coordinating center). Participants Patients without recognized dementia (targeted cohort = 550 patients) age 70 and older scheduled to undergo elective major surgery are assessed at baseline prior to surgery, daily during their hospital stay, and for 18-36 months after discharge. Measurements The Successful Aging after Elective Surgery (SAGES) study is an innovative, interdisciplinary study that includes biomarkers, neuroimaging, cognitive reserve markers, and serial neuropsychological testing to examine the contribution of delirium to long-term cognitive and functional decline. The primary goal is to examine the contribution of delirium to long-term cognitive and functional decline. In addition, novel risk markers, for delirium are being examined, including plasma biomarkers (e.g., cytokines, proteomics), advanced neuroimaging markers (e.g., volumetric, white matter hyperintensity, noncontrast blood flow, and diffusion tensor measures) and cognitive reserve markers (e.g., education, occupation, lifetime activities). Conclusion Results from this study will contribute to a fuller understanding of the etiology and prognosis of delirium. Ultimately, we hope this project will provide the groundwork for future development of prevention and treatment strategies for delirium, designed to minimize the long-term negative impact of delirium in older adults. PMID:22999782

  9. Long-term bladeless LASIK outcomes with the FS200 Femtosecond and EX500 Excimer Laser workstation: the Refractive Suite

    Directory of Open Access Journals (Sweden)

    Kanellopoulos AJ

    2013-02-01

    Full Text Available A John Kanellopoulos,1,2 George Asimellis11Laservision.gr Institute, Athens, Greece; 2NYU Medical School, NY, USAPurpose: The evaluation of the safety, efficacy, and long-term stability of LASIK procedures utilizing novel platform comprising a femtosecond and excimer laser and multiple networked diagnostics.Setting: Private clinical ophthalmology practice.Patients and methods: In consecutive cases of myopic LASIK procedure with a novel refractive platform (FS200 Femtosecond and EX500 Excimer Laser, 190 eyes (from 109 different patients were evaluated pre- and postoperatively for the following parameters: refractive error, best corrected distance visual acuity, uncorrected distance visual acuity, topography (Placido-disc based and tomography (Scheimpflug-image based, wavefront analysis, pupillometry, and contrast sensitivity. Follow-up visits were conducted for at least 12-months.Results: The change from pre- to postoperative mean refractive error was from −5.29 ± 2.39 diopters (D (range −8.0 to −0.50 D to −0.27 ± 0.09 D at the 3 month visit, −0.27 ± 0.10 D at the 6 month visit, and −0.39 ± 0.08 D at the 1-year visit. The change from pre- to postoperative refractive astigmatism was −1.07 ± 0.91 D (range −4.25 to 0 D to −0.14 ± 0.04 D at 3 months, −0.15 ± 0.04 at 6 months, and −0.16 ± 0.04 at the one-year visit. The proportion of the eyes with postoperative astigmatism within 0.5 D ranged between 95.6% and 99%. The proportion of eyes achieving uncorrected distance visual acuity of 1.0 (decimal was 93.0%.Conclusion: The myopic LASIK clinical results with the FS200 Femtosecond Laser and EX500 Excimer Laser showed outstanding efficacy, great safety, and long-term stability.Keywords: bladeless LASIK flap, femtosecond laser, myopic correction, long-term stability, regression, astigmatism correction, post-LASIK refraction

  10. A prospective study of short- and long-term cosmetic outcome after reduction mammaplasty from three different perspectives

    DEFF Research Database (Denmark)

    Breiting, Line Bro; Henriksen, Trine Foged; Kalialis, Louise Vennegaard

    2012-01-01

    Numerous studies have examined the outcome of reduction mammaplasty. This study evaluates the cosmetic outcome after reduction mammaplasty from the perspective of the patient, a ward surgeon, and a private practitioner in plastic surgery, and analyzes which factors influence it.......Numerous studies have examined the outcome of reduction mammaplasty. This study evaluates the cosmetic outcome after reduction mammaplasty from the perspective of the patient, a ward surgeon, and a private practitioner in plastic surgery, and analyzes which factors influence it....

  11. Long-Term Maintenance of Complete Response after Sorafenib Treatment for Multiple Lung Metastases from Hepatocellular Carcinoma

    Directory of Open Access Journals (Sweden)

    Eisuke Katafuchi

    2015-08-01

    Full Text Available Sorafenib is an effective treatment for unresectable hepatocellular carcinoma (HCC characterized by disease stabilization. However, the response rates are very low (<9%, and a complete response is rarely achieved. We report an extremely rare case of a HCC patient with multiple lung metastases treated with sorafenib who achieved a complete response for a long period. A 77-year-old woman was diagnosed with chronic hepatitis C in 1990. In 2007, a HCC detected in the liver was treated with percutaneous ethanol injection therapy. Subsequently, recurrence of HCC in the liver was treated with microwave coagulonecrotic therapy in 2010. In April 2011, a computed tomography (CT scan revealed innumerable multiple metastases spread diffusely in both lungs. Tumor marker levels were extremely high [α-fetoprotein (AFP 76,170 ng/ml, lens culinaris agglutinin-reactive fraction of AFP 7.5%, des-γ-carboxyprothrombin (DCP 63,400 mAU/ml]. Sorafenib was administered at a reduced dose of 400 mg/day because of old age. Four months after sorafenib treatment, AFP and DCP had decreased to within normal levels, and the multiple lung metastases had disappeared. Currently, sorafenib is administered at a reduced dose of 400 mg/day, and the complete response has been maintained for 48 months.

  12. Recurrent dermatomyositis manifesting as a sign of recurrent transitional cell carcinoma of urinary bladder: Long-term survival

    Directory of Open Access Journals (Sweden)

    John Fitzpatrick

    2014-01-01

    Full Text Available The association between urological malignancies and paraneoplastic syndromes has been well documented. We report a case of recurrent dermatomyositis manifesting as a sign of metastatic recurrence of non-muscle-invasive transitional cell carcinoma of the bladder, a relationship which has only been referred to in a few reports. The case highlights a few important clinical challenges; firstly, the importance of thorough investigation for underlying malignancy in patients with dermatomyositis, as successful treatment of such malignancy can lead to resolution of paraneoplastic symptoms, and secondly, a high index of suspicion of recurrence in cases where paraneoplastic manifestations recur. Metastatic pulmonary recurrence without local evidence of disease at a follow-up of 4 years makes this case unique. Moreover, in the light of our experience and reported literature, a framework is suggested to approach such a diagnostic dilemma in the future. Description of the case will guide clinicians in the future, in case they encounter such an unusual clinical scenario. This could also serve as a hypothesis-generating source for designing future research as well.

  13. Below-the-ankle Angioplasty and Stenting for Limb Salvage: Anatomical Considerations and Long-term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [School of Medicine, Patras University Hospital, Department of Interventional Radiology (Greece)

    2013-08-01

    PurposeTo report the long-term angiographic and clinical results in a series of below-the-ankle (BTA) angioplasty procedures and to present some biomechanical issues related to the unique anatomical geometry of the ankle.MethodsWe performed a retrospective analysis of BTA angioplasty procedures. Clinical end points included technical success, patient mortality, salvage of the treated foot, and repeat target lesion revascularization. Imaging end points included primary patency, binary restenosis of the target lesion at the 50 % threshold, and stent integrity (stent fracture, deformation, or collapse). Univariate subgroup analysis was performed.ResultsIn total, 40 limbs in 37 patients (age 73.5 {+-} 8.2 years) with critical limb ischemia were included and 42 inframalleolar lesions (4.2 {+-} 1.4 cm) were analyzed. Technical success was achieved in 95.2 % (40 of 42). Provisional stent placement was performed in 45.2 % (19 of 42). Two patients died, and two major amputations occurred up to 3 years. At 1 year, overall primary vessel patency was 50.4 {+-} 9.1 %, lesion binary restenosis rate was 64.1 {+-} 8.3 %, and repeat intervention-free survival was 93.6 {+-} 4.3 % according to life table analysis of all treated lesions. Pairwise subgroup analysis showed that BTA self-expanding stents were associated with significantly higher restenosis and poorer primary patency compared to plain balloon angioplasty or sirolimus-eluting balloon-expandable stents. Significant deformation and/or fracture of balloon-expandable stents placed BTA were identified in five of 11. Dynamic imaging showed that the dorsalis pedis artery is kinked during foot dorsiflexion, whereas the distal posterior tibial artery is kinked during plantar flexion of the foot.ConclusionBTA angioplasty for critical limb ischemia treatment is safe and feasible with satisfactory long-term results. BTA stent placement must be reserved for bailout indications.

  14. Long-Term Outcomes after Acute Necrotizing Pancreatitis: What Happens to the Pancreas and to the Patient?

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    Rafaela Cristina Goebel Winter Gasparoto

    2015-03-01

    Full Text Available Context Late consequences of acute pancreatitis have received little attention. It is controversial whether the pancreas fully recovers after an episode of acute pancreatitis, especially in the presence of necrosis. Therefore, the presence of late pancreatic dysfunction following acute necrotizing pancreatitis is uncertain and there are controversies about how it may affect long-term quality of life. Objectives To evaluate pancreatic function and morphology, besides quality of life, in patients with prior acute necrotizing pancreatitis. Patients Patients who were admitted to our hospital with acute necrotizing pancreatitis in a ten-year interval were identified and thirty-eight survivors were contacted to enroll in the study out of which sixteen patients were included. Methods Exocrine function was studied by qualitative fecal fat excretion. Endocrine function was evaluated by oral glucose tolerance test, HOMA-beta and C-peptide. Pancreatic morphology was examined by computed tomography. Quality of life was measured by 36-item short-form health survey. Tests were performed at leasttwelve months after the index episode of acute necrotizing pancreatitis. Results The prevalence of pancreatic exocrine insufficiency was 6.2%. Endocrine dysfunction was observed in half the cases, and no association with the extension of necrosis was found. Morphological changes were frequent (62.5% and more prevalent in those who faced extensive necrosis. Quality of life was considered good, and its impairment was found exclusively in mental health domain, markedly in patients who had alcoholic pancreatitis. There was no correlation between quality of life and prognostic indicators. Conclusions Exocrine function and quality of life were preserved in this group of patients. However, endocrine dysfunction and morphological abnormalities were frequent after acute necrotizing pancreatitis. These findings justify a long-term follow-up in order to initiate specific

  15. Long-term outcomes of oral rehabilitation with dental implants in HIV-positive patients: A retrospective case series

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    Gay-Escoda, Cosme; Pérez-Álvarez, Débora; Camps-Font, Octavi

    2016-01-01

    Background The existing information on oral rehabilitations with dental implants in VIH-positive patients is scarce and of poor quality. Moreover, no long-term follow-up studies are available. Hence, the aims of this study were to describe the long-term survival and success rates of dental implants in a group of HIV-positive patients and to identify the most common postoperative complications, including peri-implant diseases. Material and Methods A retrospective case series of HIV-positive subjects treated with dental implants at the School of Dentistry of the University of Barcelona (Spain) was studied. Several clinical parameters were registered, including CD4 cell count, viral load and surgical complications. Additionally, the patients were assessed for implant survival and success rates and for the prevalence of peri-implant diseases. A descriptive statistical analysis of the data was performed. Results Nine participants (57 implants) were included. The patients’ median age was 42 years (IQR=13.5 years). The implant survival and success rates were 98.3% and 68.4%, respectively, with a mean follow-up of 77.5 months (SD=16.1 months). The patient-based prevalence of peri-implant mucositis and peri-implantitis were 22.2% and 44.4% respectively at the last appointment. Patients that attended regular periodontal maintenance visits had significantly less mean bone loss than non-compliant patients (1.3 mm and 3.9 mm respectively). Conclusions Oral rehabilitation with dental implants in HIV-positive patients seems to provide satisfactory results. In order to reduce the considerably high prevalence of peri-implant diseases, strict maintenance programmes must be implemented. Key words:HIV infection, dental implants, oral implantology, complications, peri-implantitis, peri-implant diseases. PMID:26946205

  16. A meta-analysis and systematic review of the risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations.

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    Mohr-Jensen, Christina; Steinhausen, Hans-Christoph

    2016-08-01

    The primary aim of this study was to systematically review and estimate the risk of arrests, convictions, and incarcerations associated with childhood Attention Deficit/Hyperactivity Disorder (ADHD) in long-term outcome studies. In addition, all included studies were qualitatively and systematically reviewed for predictors of long-term crimes. The databases Pubmed, PsycINFO and Embase were searched for all controlled studies that included children and adolescents (age 4-15) with ADHD who had been followed longitudinally and reported the frequency of arrests, convictions or incarcerations based on data from official sources. Using random-effects models, the relative risk (RR) with 95% confidence intervals (95% CI) was estimated. A total of 15,442 individuals with childhood ADHD from nine unique samples were included. Childhood ADHD was significantly associated with adolescent and adulthood arrests (RR: 2.2, 95% CI: 1.3-3.5), convictions (RR: 3.3, 95% CI: 2.1-5.2) and incarcerations (RR: 2.9, 95% CI: 1.9-4.3). Individuals with ADHD had a younger age at onset of antisocial involvement and an increased risk of criminal recidivism. The most frequently committed criminal offenses were theft, assault, drug- and weapon-related crimes. Early antisocial behavior problems, childhood maltreatment, sex, and IQ were identified as potentially relevant predictors for antisocial outcomes. The findings support a substantial long-term risk associated with ADHD for later antisocial involvement. Early intensive and specifically targeted multimodal intervention including psychosocial, and pharmacological treatment is warranted to alter these negative long-term developmental trajectories.

  17. Long-term outcomes in chronic obstructive pulmonary disease patients: exploring the effects of inhalatory devices and their influence on the outcome

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    Fadda V

    2016-04-01

    Full Text Available Valeria Fadda, Dario Maratea Department of Pharmaceutical Sciences, University of Florence, Sesto Fiorentino, FI, Italy Purpose: Numerous systematic reviews have examined the outcomes in patients with chronic obstructive pulmonary disease managed with different therapeutic strategies. However, no such studies have specifically focused on the effect of inhalation devices. Methods: A standard PubMed search was carried out in which we identified all randomized placebo-controlled trials conducted in patients with moderate-to-severe or severe chronic obstructive pulmonary disease. The clinical end points were exacerbations rate, incidence of pneumonia, and mortality. Meta-regression was employed to assess the effect of the device. For the incidence of exacerbations, an equivalence analysis was also carried out. Results: A total of 37 studies were analyzed. Four different devices were used across these trials (Respimat®, HandiHaler®, Diskus, and Turbuhaler®. Our meta-regression analysis failed to show any significant difference between devices with regard to exacerbation rate. Equivalence was shown for some comparisons (HandiHaler® vs Respimat®, but not for others. In analyzing mortality, Respimat® was shown to worsen this end point in comparison with Turbuhaler® and HandiHaler®. Moreover, Turbuhaler® showed a protective effect over Diskus in the incidence of pneumonia. Conclusion: The results of our analysis represent the first attempt to explore the effect of the type of device on long-term outcomes. One important limitation was that most drugs were associated with one particular device, and so the effects of drugs and devices could not be reliably differentiated from one another. Keywords: COPD, inhalation device, moderate-severe, meta-analysis, equivalence

  18. The role of BRAF V600E mutation as a potential marker for prognostic stratification of papillary thyroid carcinoma: a long-term follow-up study.

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    Daliri, Mahdi; Abbaszadegan, Mohammad Reza; Bahar, Mostafa Mehrabi; Arabi, Azadeh; Yadollahi, Mona; Ghafari, Azar; Taghehchian, Negin; Zakavi, Seyed Rasoul

    2014-01-01

    Abstract Papillary carcinoma is the most prevalent malignancy of thyroid gland, and its incidence has been recently increased. The BRAF(V600E) mutation is the most frequent genetic alteration in papillary thyroid carcinoma (PTC). The role of BRAF(V600E) mutation as a potential prognostic factor has been controversially reported in different studies, with short-term follow-up. In this study, we evaluated the role of BRAF(V600E) mutation as a potential marker for prognostic stratification of patients with PTC in long-term follow-up. We studied 69 PTC patients with a mean follow-up period of 63.9 months (median: 60 m). The BRAF(V600E) mutation was analyzed by PCR-single-strand conformational polymorphism and sequencing. The correlation between the presence or absence of the BRAF(V600E) mutation, clinicopathological features and prognosis of PTC patients were studied. The BRAF(V600E) mutation was found in 28 of 69 (40.6%) PTC patients, and it was significantly more frequent in older patients (p papillary thyroid cancer in northeast of Iran. The BRAF(V600E) mutation was associated with older age and advanced tumor stage but was not correlated with incomplete response during follow-up.

  19. The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials

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    Parker, Jack; Wales, Gill; Chalhoub, Nevyne; Harpin, Val

    2013-01-01

    Purpose To systematically identify and review the currently available evidence on the long-term outcomes of recommended attention-deficit hyperactivity disorder (ADHD) interventions following randomized controlled trials with children and young people. Method A systematic search was conducted to identify trials >1 year in length using the following databases: CINAHL (January 1982– July 2012), MEDLINE (Ovid and Cambridge Scientific Abstracts [CSA]), Psych info, Science Direct (Elsevier), and Cochrane Library. Hand searches of key journals in the subject, book chapters, and conference proceedings were also carried out. Relevant papers were critically appraised using the Cochrane risk of bias tool. Results Eight controlled trials were identified as being relevant, of duration ranging from 1 year to 8 years (at follow up). The total number of participants in the studies was 1,057, of whom 579 (54.7%) were from one cohort and included 26 different outcome measures. Results suggest there is moderate-to-high-level evidence that combined pharmacological and behavioral interventions, and pharmacological interventions alone can be effective in managing the core ADHD symptoms and academic performance at 14 months. However, the effect size may decrease beyond this period. Conclusion This review has highlighted the paucity and limitations of the evidence investigating the long-term outcomes of recommended interventions for managing ADHD symptoms. There is little evidence to suggest that the effects observed over the relatively short term are maintained throughout longer periods of impairment. Furthermore, much of the existing evidence examining effectiveness beyond 12 months does not include newer medications currently available or consider significant contextual and cultural differences, such as UK/European and Asian populations. Longitudinal studies are required to examine the long-term outcomes for children and young people with ADHD managed with currently recommended

  20. Clinical characteristics and favorable long-term outcomes for patients with idiopathic inflammatory myopathies: a retrospective single center study in China

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    Shu Xiao

    2011-11-01

    Full Text Available Abstract Background Little is known about the clinical features and true survival risk factors in Chinese Han population. We conducted the current study to investigate the clinical features, long-term outcome and true potential indicators associated with mortality of idiopathic inflammatory myopathies (IIM in China. Methods We restrospectvely investigated 188 patients diagnosed with IIM at our hospital from January 1986 to April 2009. The primary outcome was determined with mortality. The secondary outcomes for survival patients were organ damage and disease activity, health status, and disability, which were assessed with Myositis Damage Index, Myositis Disease Activity Assessment Visual Analogue Scales, Health Assessment Questionnaire Disability Index, and the Modified Rankin Scale, respectively. Potential prognostic factors for mortality were analyzed with the multivariate Cox regression model. Results Mean age at disease onset was 43.8 ± 15.8 years and male to female ratio was 1:2.1 in this cohort. The 1-, 5-, 10-, 15- and 20-year survival rates were 93.6%, 88.7%, 81%, 73.6% and 65.6%. The independent predicators for mortality were age at disease onset [hazard ratio (HR:1.05, 95% CI 1.02 - 1.08], presence of cancer (HR:3.68, 95%CI 1.39 - 9.74, and elevated IgA level at diagnosis (HR:2.80, 95% CI 1.16-6.74. At the end of the follow-up, 29 patients manifested drug withdrawal within an average 4.1 years (range 0.5-15.2 year, most patients (85.9% had no disease activity and 130 patients (83.4% had no disability. Conclusions The long-term outcomes of IIM patients in our cohort have improved dramatically. Those patients most likely to survive had a high chance of reaching stable disease status, and obtained long-term or possibly permanent remission to a large extent.

  1. Effect of PlA1/A2 glycoprotein IIIa gene polymorphism on the long-term outcome after successful coronary stenting

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    Riddell John

    2007-11-01

    Full Text Available Abstract Aim To prospectively determine the role of platelet glycoprotein IIIa (GP IIIa gene PlA1/PlA2 polymorphism on the long-term clinical outcome in patients with coronary artery disease undergoing coronary stenting. Design and setting Prospective observational study in the University Hospital of Caen (France. Patients and methods 1 111 symptomatic consecutive Caucasian patients treated with percutaneous coronary intervention including stent implantation underwent genotyping for GP IIIa PlA1/A2. Main outcome measures Long-term clinical outcome in terms of the rate of major adverse cardiac events (MACE, ie death from any cause, non-fatal Q wave or non Q wave myocardial infarction, and need for coronary revascularisation was obtained and subsequently stratified according to the GP IIIa PlA1/A2 polymorphism. Results Three groups of patients were