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Sample records for carcinoma long-term outcomes

  1. Long-Term Outcomes of Nasopharyngeal Carcinoma in 148 Children and Adolescents

    Science.gov (United States)

    Lu, Suying; Chang, Hui; Sun, Xiaofei; Zhen, Zijun; Sun, Feifei; Zhu, Jia; Wang, Juan; Huang, Junting; Liao, Ru; Guo, Xiaofang; Lu, Lixia; Gao, Yuanhong

    2016-01-01

    Abstract The aim of this study was to investigate the survival and long-term morbidities of nasopharyngeal carcinoma (NPC) in children and adolescents. We retrospectively reviewed children and adolescents with NPC treated at Sun Yat-sen University Cancer Center from February 1991 to October 2010, where the prognostic factors and long-term effects of therapy were analyzed. A total of 148 patients were identified. The median age was 15 years old (range, 5–18 years) and the male to female ratio was 3.6:1. Most of the tumor histopathology was undifferentiated nonkeratinizing carcinoma (97.3%). The number of patients staged with IVa, IVb, IVc, III, and II were 45 (30.4%), 12 (8.1%), 5 (3.4%), 70 (47.3%), and 16 (10.8%), respectively. For the whole series with a median follow-up of 81 months (range, 6–282 months), the 5-year overall survival (OS) and disease-free survival (DFS) ratios were 79.3% and 69.7%, respectively. We observed significant differences in the 5-year OS (81.1% vs 25.0%, P = 0.002) and the DFS rates (72.2% vs 0.0%, P = 0.000) between patients with stage II to IVb disease and stage IVc disease. For patients with stage II, III, IVa, and IVb disease, we found a high radiation dose (dose > 66 Gy to the primary lesion) would not significantly improve the survival compared to the sub-high radiation dose group (dose = 60–66 Gy to the primary lesion), even considering the type of radiation therapy technologies. However, the incidences of sequelae (grades I–IV) in patients with high radiation dose were apparently higher than those in patients with low radiation dose. Considering the late sequelae, a dose of 60 to 66 Gy to the primary lesions seems to be enough for children and adolescents with NPC. PMID:27124036

  2. 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.

  3. The Impact of Transarterial Therapy in Hepatitis C Related Hepatocellular Carcinoma on Long Term Outcomes after Liver Transplantation

    Science.gov (United States)

    Cabrera, Roniel; Dhanasekaran, Renu; Caridi, James; Clark, Virgina; Morelli, Giuseppe; Soldevila-Pico, Consuelo; Magglioca, Joseph; Nelson, David; Firpi, Roberto Jose

    2011-01-01

    Objectives To evaluate the impact for long term outcomes of transarterial embolization (TAE) therapy in patients with HCV-related hepatocellular carcinoma (HCC) on the waiting list for liver transplantation (LT). Methods We retrospectively evaluated the post-LT patients with HCV-related HCC who received TAE intervention (n=33) and those who had no treatment (n=47) while on the waiting list to determine long term outcomes. Results Over a ten year period, of the 424 patients transplanted with HCV, 80 patients had HCC with a tumor burden within Milan criteria. For the entire study cohort the mean duration of post-LT follow-up was 3.5 yrs; mean time on transplant waiting list was 120 days; and median post-LT survival was 8.9 yrs. The survival rates at 1, 3, 5 and 10 yrs were 82%, 70%, 55% and 35%, respectively. From the study cohort, 33 patients received TAE and 47 patients did not while on the waiting list. The two groups were well matched, except, that the intervention subjects received post-LT interferon more often and had a shorter time on the waiting list (56.2 days) when compared to the no treatment group (164.6 days, ptransplant. PMID:21552101

  4. 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.

  5. 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.

  6. [Giant Prostate Carcinoma : A Case Report and Long-Term Outcomes in Japanese Patients].

    Science.gov (United States)

    Furumido, Jun; Abe, Takashige; Kikuchi, Hiroshi; Miyajima, Naoto; Tsuchiya, Kunihiko; Maruyama, Satoru; Shinohara, Nobuo

    2016-07-01

    A 79-year-old male was referred to the Department of Gastroenterology in our hospital due to a large palpable abdominal mass, with the suspicion of a gastrointestinal stromal tumor. An abdominal computed tomographic (CT) scan revealed a huge mass of 270×208×144 mm which occupied the entire pelvic cavity. Since the specimens obtained by an endoscopic ultrasound-guided fine-needle aspiration via lower intestinal tract revealed a Gleason score 4+4 prostate adenocarcinoma, he was then referred to our department. Prostate specific antigen (PSA) was elevated to 3,087 ng/ml, and positron emission tomography-CT revealed right obturator lymph node metastasis and bone metastasis of the left 5th rib. Degarelix was administered as an androgen deprivation therapy, and the PSA level had decreased to 62.4 ng/ml one month later. At the last follow-up, the PSA level was 0.67 ng/ml and the tumorsize had decreased to 88×83×110 mm. Next, we conducted a follow-up survey by mail of 20 reported Japanese cases of a giant prostate carcinoma, and data on 17 cases were available for analysis. In the total of 18 cases, including the present case, with a median follow-up time of 26 months, the 2-year overall survival rate was 85.7% for patients without metastasis, and 65.6% forthose with metastasis. PMID:27569357

  7. Microwave ablation of hepatocellular carcinoma as first-line treatment: long term outcomes and prognostic factors in 221 patients.

    Science.gov (United States)

    Wang, Tao; Lu, Xiao-Jie; Chi, Jia-Chang; Ding, Min; Zhang, Yuan; Tang, Xiao-Yin; Li, Ping; Zhang, Li; Zhang, Xiao-Yu; Zhai, Bo

    2016-01-01

    This retrospective study aimed at evaluating the long-term outcomes and prognostic factors of microwave ablation (MWA) as a first-line treatment for hepatocellular carcinoma (HCC). 221 consecutive patients receiving MWA in our center between October 11, 2010 and December 31, 2013 were enrolled. Technique effectiveness was evaluated one month post-ablation. Initial complete ablation (CA1(st)) was gained in 201 (90.95%) patients, secondary CA (CA2(nd)) in 8 (3.62%) patients and the remaining 12 (5.43%) patients suffered from incomplete ablation (IA2(nd)) after two sessions of MWA. Patients with tumor size >5 cm were less likely to gain CA1(st). Procedure-related complications were recorded and no procedure-related death occurred. 22 (10.4%) complications occurred with 8 (3.8%) being major ones. Tumor characteristics (size, number, location) do not significantly influence complication rates. After a median follow-up of 41.0 (ranging 25.0-63.5) months, the median RFS and OS was 14.0 months (95% CI: 9.254-18.746) and 41.0 months (95% CI: 33.741-48.259) respectively. Multivariate analysis identified two significant prognosticators (levels of alpha fetal protein [AFP] and gamma-glutamyl transpeptidase [GGT]) of RFS and five significant prognosticators (tumor number, tumor size, AFP, GGT and recurrence type) of OS. In conclusion, MWA provides high technique effectiveness rate and is well tolerated in patients with HCC as a first-line treatment. PMID:27620527

  8. Long-Term Outcomes of Early-Stage Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy Alone

    Energy Technology Data Exchange (ETDEWEB)

    Su Shengfa [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China); Department of Oncology, GuiYang Medical College Hospital, Guiyang, Guizhou (China); Han Fei; Zhao Chong; Chen Chunyan; Xiao Weiwei; Li Jiaxin [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China); Lu Taixiang, E-mail: ssf2010@sina.cn [State Key Laboratory of Oncology in Southern China, Guangzhou (China); Department of Radiation Oncology, Cancer Center, Sun Yat-Sen University, Guangzhou (China)

    2012-01-01

    Purpose: Reports of intensity-modulated radiotherapy (IMRT) for early-stage nasopharyngeal carcinoma (NPC) have been limited. The present study evaluated the long-term survival outcomes and toxicity of early-stage NPC patients treated with IMRT alone. Methods and Materials: Between February 2001 and January 2008, 198 early-stage (T1-T2bN0-N1M0) NPC patients had undergone IMRT alone. The data from these patients were retrospectively analyzed. The patients were treated to 68 Gy at 2.27 Gy/fraction prescribed to the planning target volume of the primary nasopharygeal gross tumor volume. The Radiation Therapy Oncology Group scoring system was used to assess the toxicity. Results: At a median follow-up of 50.9 months (range, 12-104), the 5-year estimated disease-specific survival, local recurrence-free survival, and distant metastasis-free survival rate was 97.3%, 97.7%, and 97.8%, respectively. The 5-year local recurrence-free survival rate was 100% for those with Stage T1 and T2a and 94.2% for those with Stage T2b lesions (p = 0.252). The 5-year distant metastasis-free survival rate for Stage T1N0, T2N0, T1N1, and T2N1 patients was 100%, 98.8%, 100%, and 93.8%, respectively (p = .073). All local recurrence occurred in patients with T2b lesions. Five patients developed distant metastasis. Of these 5 patients, 4 had had Stage T2bN1 disease and 1 had had Stage T2bN0 disease with retropharyngeal lymph node involvement. The most common acute toxicities were mainly Grade 1 or 2. At 24 months after IMRT, no Grade 3 or 4 xerostomia had developed, and 62 (96.9%) of 64 evaluated patients were free of trismus; only 2 patients (3.1%) had Grade 1 trismus. Radiation encephalopathy and cranial nerve injury were not observed. Conclusions: IMRT alone for Stage T1N0, T2N0, T1N1, and T2N1 yielded satisfactory survival outcomes with acceptable toxicity, and no differences were found in survival outcomes among these four subgroups. Patients with Stage T2b lesions might have relatively

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

    OpenAIRE

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

    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 enrolled in this retrospective study. The disease stage distribution ...

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

    OpenAIRE

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

    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 enrolled in this retrospective study. The disease stage distribution ...

  11. 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

  12. 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

  13. Factors determining long-term outcomes of hepatocellular carcinoma within the Milan criteria: liver transplantation versus locoregional therapy: A retrospective cohort study.

    Science.gov (United States)

    Kim, Jung Hee; Sinn, Dong Hyun; Gwak, Geum-Youn; Choi, Gyu-Seong; Kim, Jong Man; Kwon, Choon Hyuck David; Joh, Jae-Won; Kim, Ki Yeon; Kim, Kyunga; Paik, Yong-Han; Choi, Moon Seok; Lee, Joon Hyeok; Koh, Kwang Cheol; Paik, Seung Woon

    2016-08-01

    Patients with hepatocellular carcinoma (HCC) satisfying the Milan criteria are candidates for liver transplantation (LT), but locoregional therapies could be another options for them.A total of 1859 treatment-naïve HCC patients fulfilling the Milan criteria were analyzed. Survival tree analysis was performed to generate survival nodes with similar survival risks in 1729 non-LT group, and compared with the survival of 130 patients who received LT.Among patients who did not receive LT, survival tree analysis classified patients into 6 nodes according to Child-Pugh (CP) score, serum alphafetoprotein (AFP) levels, tumor size, and age, with different mortality risks (5-year survival rate of 87.3%, 77.5%, 65.8%, 64.7%, 44.0%, and 28.7% for nodes 1-6, respectively; P survival of patients in nodes 1 (CP score 5 with AFP levels patients who received LT (both P > 0.05), but the survival rates of patients in nodes 3 to 6 were worse than that of LT (P survival node, survival differed slightly according to initial treatment modality for patients who did not receive LT. For patients who received LT, tumor stage at the time of LT was associated with long-term outcome.Certain groups of non-LT patients showed survival rates that were similar to the survival rates of LT patients. CP score, AFP levels, tumor size, and age were baseline factors that can help estimate the long-term outcomes of non-LT treatment. In addition, tumor stage at the time of LT and specific initial treatment modality in non-LT patients affected the long-term outcomes. These factors can help estimate the long-term outcomes of HCC patients diagnosed within the Milan criteria. PMID:27583916

  14. Long-Term Outcomes for Older Patients with Papillary Thyroid Carcinoma: Should Another Age Cutoff Beyond 45 Years Be Added?

    OpenAIRE

    Lo, CY; Wan, KY; Lang, HHB; Wong, KP

    2014-01-01

    © 2014, Society of Surgical Oncology. Background: Although an age cutoff of 45 years has often been adopted to stratify cancer risk in papillary thyroid carcinoma (PTC), both cancer-specific survival (CSS) and disease-specific survival (DFS) continue to worsen beyond this cutoff. This study aimed to determine whether advanced age (i.e., >60 years) at diagnosis was an independent predictor of CSS and DFS in older (≥45 years) patients. Methods: This study analyzed 407 PTC patients with a minima...

  15. Long-term outcome in personality disorders.

    Science.gov (United States)

    Stone, M H

    1993-03-01

    Personality disorders meeting DSM or ICD criteria represent the severe end of the broad spectrum of personality configurations involving maladaptive traits. The literature regarding long-term outcome of personality disorders is sparse. Most attention is devoted to formerly institutionalised patients with borderline, antisocial, or schizotypal disorders. Borderline patients at 10-25-year follow-up have a wide range of outcomes, from clinical recovery (50-60%) to suicide (3-9%). Certain factors (e.g. artistic talent) conduce to higher recovery rates, others (e.g. parental cruelty) to lower rates. Schizoid and schizotypal patients tend to remain isolated, and to lead marginal lives. The long-term outcome in antisocial persons is bleak if psychopathic traits are prominent. Personality traits and their corresponding disorders are egosyntonic, harden into habit, and are both slow to change and hard to modify. There is no one treatment of choice. Psychoanalysis and related methods work best within the anxious/inhibited group; cognitive/behavioural techniques are well suited to the disorders requiring limit setting and the amelioration of maladaptive habits. PMID:8453424

  16. 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.

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    Li-Zhi Liu

    2013-10-01

    Full Text Available 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 enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%; stage III, 14 (41.2%; and stage IV, 19 (55.9%. All 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 follow-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 overall 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.

  19. Long-term treatment outcome in acromegaly.

    Science.gov (United States)

    Holdaway, I M; Rajasoorya, C R; Gamble, G D; Stewart, A W

    2003-08-01

    A number of groups have developed guidelines to indicate whether an individual with acromegaly has been cured by treatment. However, studies to date do not provide a robust definition of biochemical remission of the disorder based on correlation with long-term outcome. Available data suggest that those with a random serum growth hormone (GH) level of <2.5 microg/l, or a glucose-suppressed GH level of <1 microg/l following treatment have mortality figures indistinguishable from the general population. However, the confidence limits for these mortality estimates are quite wide. It remains possible that growth hormone levels lower than 1 microg/l for random samples, or even lower when using ultrasensitive GH assays, may indicate superior outcome, but this remains to be confirmed. There are limited data relating serum insulin-like growth factor-I (IGF-I) levels to outcome, although normalisation of serum IGF-I clearly improves outcome compared with continued elevation of measurements after treatment. Current evidence suggests that a post-treatment random serum GH <2.5 microg/l and a normal serum IGF-I value defines biochemical cure. Available data suggest that achieving similar growth hormone levels after treatment also reduces the prevalence of chronic complications of the disorder, which is subsequently reflected in improved mortality. PMID:12914751

  20. Long-term outcome of irradiation with or without chemotherapy for esophageal squamous cell carcinoma: a final report on a prospective trial

    International Nuclear Information System (INIS)

    To investigate the long-term outcome of esophageal squamous cell carcinoma (SCC) treated by irradiation with or without concurrent chemotherapy. A prospective clinical trial was carried out from 1998 to 2000. One hundred and eleven patients were randomly enrolled to receive either late course accelerated hyperfractionated irradiation (LCAF) or LCAF with concurrent chemotherapy (LCAF + CT). For LCAF, 41.4 Gy in 23 fractions was first delivered at five fractions per week, followed by 27 Gy in 18 fractions at two 1.5 Gy fractions a day. Concurrent chemotherapy of cis-platinum and 5-fluorouracil was administered for four cycles. Overall survival (OS), locoregional recurrence and distant metastasis were observed. Late toxicity was scored by RTOG criteria, and quality of life (QOL) was also evaluated. The median follow-up time was 24 months for all patients and 138 months for 17 living patients. Median survival time was 25 months and 32 months in LCAF and LCAF + CT (p = 0.653), respectively. For an entire group of patients, overall survivals were 34%, 27% and 22%; locoregional recurrence rates were 30%, 36% and 41%; and distant metastasis rates were 26%, 28% and 29% at 5-yr, 8-yr and 10-yr, respectively. Incidences of ≥ Grade 3 late toxicity were 29% at 10-yr. There were no statistically significant differences between LCAF and LCAF + CT with respect to the parameters mentioned above. Cumulative incidence of late toxicities of ≥ Grade 3 increased sharply after the attained age of 70 years. Eighty-eight percent of patients lived with good KPS (≥ 90) and 94% could eat regular or soft diet. The long-term outcome of esophageal SCC patients who received LCAF or LCAF + CT was good. The locoregional and distant failures occurred more often in the first three years after treatment, but could continuously occur up to 10 years. The late toxicity was acceptable. Late toxicities ≥ Grade 3 were more likely to occur in elderly patients. QOL was good in living patients

  1. 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.

  2. Long-Term Outcome of Idiopathic Macrocephaly

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-11-01

    Full Text Available The neuroradiological, developmental, and psychological, long-term sequelae of 41 infants (30 boys, 11 girls diagnosed with macrocephaly (an occipito-facial head circumference [OFC] >95th centile at a family health service visit between 1985 and 1986 were studied at the Royal Alexandra Hospital for Children and other centers in Sydney, Australia.

  3. 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

  4. Long-Term Inflation Outcomes after Hyperinflation: Theory and Evidence

    OpenAIRE

    Federico Guerrero

    2006-01-01

    This paper does two things. First, it shows both anecdotal and cross-country evidence that indicates that countries that have experienced hyperinflation display significantly lower long-term rates of inflation than countries that lack the same experience. Secondly, it presents a model to rationalize the main empirical finding. There is more than one mechanism through which the long-term effects of hyperinflation may have an impact on long-term inflation outcomes. The suggested explanation thi...

  5. Long-Term Neuropsychological Outcome in Preterm Twins

    OpenAIRE

    Giovanni Iannone; Clelia Tripaldi; Antonino Chindemi; Lorenzo Piscitelli; Antonio Mastrorocco; Silvano Palazzo; Luigi Esposito

    2006-01-01

    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 childre...

  6. 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

  7. 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.

  8. Management of bilateral breast carcinoma: long-term results.

    Science.gov (United States)

    Goksel, Hüsnü A; Yagmurdur, Mahmut C; Karakayali, Hamdi; Moray, Gokhan; Demirhan, Beyhan; Isiklar, Iclal; Bilgin, Nevzat; Haberal, Mehmet

    2004-01-01

    The aim of this study was to document the clinical features and long-term outcomes in 43 cases of bilateral breast carcinoma. All the women were diagnosed by a single surgeon who had evaluated 13,443 patients with breast-related complaints over a 40-year period. At the initial cancer diagnosis, 28 patients (65%) were of premenopausal age ( 46 years; group 2). The median interval between initial and subsequent cancer was 24 months (range, 12-288 months) in group 1 and 20 months (range, 14-252 months) in group 2 (P > 0.05). The distribution of initial cancer types based on pathological examination was ductal adenocarcinoma in 28 (65%) cases; lobular carcinoma in 5 (12%) cases; comedocarcinoma in 5 (12%) cases; papillary carcinoma in 2 (4.5%) cases; papillary combined with squamous cell carcinoma in 1 (2%) case; and lobular combined with medullary carcinoma in 2 (4.5%) cases. There were no significant differences between the groups with respect to the distribution of types of surgery used for the initial and subsequent carcinomas. Tumor locations were symmetrical in 26 (60%) patients. The mean palpable mass sizes for the initial and subsequent tumors in group 1 were 3 +/- 1.4 (range, 1-8 cm) and 1.3 +/- 0.5 cm (range, 1-2 cm), respectively. The corresponding means for group 2 were 2.3 +/- 1.8 (range, 0.9-7 cm) and 1.3 +/- 0.5 cm (range, 1-2 cm). The 10- and 20-year disease-free survival rates for group 1 versus group 2 were 32% versus 27% and 10% versus 8%, respectively. The rates of axillary lymph node metastasis from the primary cancer in groups 1 and 2 were statistically similar; however, the rate of axillary lymph node metastasis from subsequent cancer in group 1 was significantly higher than that in group 2 (P = 0.02). The lactation period (after each child born) in group 1 was significantly longer than that in group 2 (P = 0.04). Group 1 had a higher rate of distant metastasis at 20 years (P = 0.03), but the groups' local recurrence rates at this stage were

  9. Long-term outcomes and failure patterns of patients with nasopharyngeal carcinoma staged by magnetic resonance imaging in intensity-modulated radiotherapy era: The Zhejiang Cancer Hospital's experience

    Directory of Open Access Journals (Sweden)

    Feng Jiang

    2015-01-01

    Materials and Methods: From January 2007 to December 2011, 720 NPC patients without metastasis staged by MRI were treated with definitive IMRT at Zhejiang Cancer Hospital. The IMRT prescribed dose was 69 Gy to planning target volume (PTV of gross disease in nasopharynx and 67.5 Gy to PTV of positive lymph nodes in 30 fractions, high risk, and low risk region PTV was 60 and 54 Gy in 30 fractions, respectively. The treatment outcomes and patterns of failure were observed. Results: Using the 7th edition of the American Joint Committee on Cancer staging system for NPC, the proportions of the 720 patients with Stages I, II, III, and IVa-b disease were 2.1% (15/720, 17.8% (128/720, 51.7% (372/720, and 28.5% (205/720, respectively. After the median follow-up period of 48 months (range: 3–89 months, a total of 146/720 (20.3% patients had experienced failure: 37 (5.1% at primary sites, 17 (2.4% at regional sites, 79 (11.0% at distant sites, and 13 (1.8% at multiple sites. The 5-year overall survival, cancer-specific survival, disease-free survival, local relapse-free survival (LRFS, regional relapse-free survival, and distant metastasis (DM free survival were 86.1%, 88.1%, 76.6%, 90.8%, 93.6%, and 87.2%, respectively. LRFS of T1 to T3 was all >90% and has no significant difference. In addition to N stage, T category, and neoadjuvant chemotherapy were independent predictors for DM in multivariate analysis. Conclusion: Our long-term outcome of large NPC series supports the effectiveness of IMRT for excellent local-regional control though up to 20% patients would develop DM, which becomes the main pattern of failure. T4 disease remained difficult to be cured not only for local recurrence but distant failure. A taxane-based combination chemotherapy might be useful to reduce DM in the induction setting and worth further studying.

  10. Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: An analysis of survival and treatment toxicities

    International Nuclear Information System (INIS)

    Background and purpose: To evaluate the long-term survival outcomes and toxicity of NPC patients treated with intensity-modulated radiotherapy (IMRT). Materials and methods: From May 2001 to October 2008, 868 non-metastatic NPC patients treated by IMRT were analyzed retrospectively. The Radiation Therapy Oncology Group (RTOG) criteria were used to assess toxicity. Results: With a median follow-up of 50 months (range, 5–115 months), the 5-year estimated disease specific survival (DSS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) were 84.7%, 91.8%, 96.4% and 84.6%, respectively. Of the 868 patients, 186 (21.3%) developed failure after treatment. Distant metastasis was the major failure pattern after treatment. The 5-year OS rate in patients with stage I, II, III, and IVa–b were 100.0%, 94.3%, 83.6%, and 70.5%, respectively. The 5-year LRFS rate in patients with stage T1, T2, T3, and T4 disease were 100.0%, 96.0%, 90.4%, and 83.3%, respectively (χ2 = 26.32, P < 0.001). The 5-year DMFS for N0, N1, N2, and N3 patients were 96.1%, 85.6%, 73.7%, and 62.1%, respectively (χ2 = 65.54, P < 0.001). Concurrent chemotherapy failed to improve survival rates for patients with advanced locoregional disease. The most common acute toxicities were mainly in grade 1 or 2. Compared with IMRT alone, IMRT plus concurrent chemotherapy increased the severity of acute toxicities. The incidence of brain radiation damage was relatively high (5.5%, 48/868 cases), and was not observed in patients with stage T1–2. Conclusion: IMRT for NPC yielded excellent survival outcomes, and distant metastasis was the most commonly seen failure pattern after treatment. The role of concurrent chemotherapy for advanced locoregional stage NPC patients needs to be further investigated. Treatment-related toxicities were well tolerable. However, the incidence of brain radiation damage was relatively high, especially for patients

  11. 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. PMID:27252935

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

    OpenAIRE

    Arulkumaran, Nishkantha; Jawad, Susan; Smith, Stuart W.; Harper, Lorraine; Brogan, Paul; Charles D. Pusey; Salama, Alan D

    2011-01-01

    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 ti...

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

    OpenAIRE

    Pusey Charles D; Brogan Paul; Harper Lorraine; Smith Stuart W; Jawad Susan; Arulkumaran Nishkantha; Salama Alan D

    2011-01-01

    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 fol...

  14. 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

  15. 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...

  16. 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

  17. 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…

  18. 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

  19. The Long-Term Outcomes of Double White Dwarf Mergers

    Science.gov (United States)

    Schwab, Josiah

    2016-01-01

    Binary star systems composed of two white dwarfs are a natural outcome of stellar evolution. Angular momentum losses from gravitational wave radiation cause the binary system's orbit to shrink until the two white dwarfs merge. The final outcome of the merger depends on the masses of the white dwarfs. Some potential outcomes, such as supernova explosions, may occur during or soon after the merger. Other outcomes, which I will refer to as "long-term" outcomes, occur as the merger remnant cools and its structure adjusts to the new state created during the energetic merger.In my dissertation, I quantitatively explore the long-term outcomes of the mergers of two white dwarfs. I focus primarily on the formation of neutron stars via accretion-induced collapse and the formation of two types of unusual stars, the single sub-dwarf B stars (hot, core helium fusing stars) and the R Coronae Borealis stars (cool, carbon-rich giant stars). Beginning with the results from my previous simulations of the short-lived viscous disk initially present in these remnants, I use the state-of-the-art MESA stellar evolution code to follow their thermal evolution.This work improves the quantitative understanding of which white dwarf binaries lead to a particular outcome and better characterizes the observational signatures of these outcomes. For systems that will undergo accretion-induced collapse, these simulations yield improved progenitor models that can then be used to explore the collapse and formation of a neutron star.

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    BACKGROUND AND PURPOSE: Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding......, 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...

  1. Hyperfractionated radiotherapy and simultaneous cisplatin for stage-III and -IV carcinomas of the head and neck. Long-term results including functional outcome

    International Nuclear Information System (INIS)

    Purpose: To assess the survival rate, the probability of local control, the patterns of relapse and late sequelae including self-reported quality of life in patients treated with hyperfractionated radiotherapy (RT) and simultaneous CDDP chemotherapy for stage-III to stage-IV carcinomas of the head and neck. Methods: From 1988 to 1994, 64 patients (median age 55.5 years) with carcinomas of different subsites, excluding the nasopharynx, were treated in a pilot study with 1.2 Gy bid (6 h interval; total dose 74.4 Gy) and simultaneous CDDP (20 mg/m2 daily, 5 days in week 1 and 5) and followed at regular intervals. Overall survival and local control, as well as the rates of late toxicity, were estimated using the actuarial method. Median follow-up was 3.3 years for all and 5.2 years for surviving patients. To assess the quality of life, the EORTC QLQ-C 30 questionnaire and the H and N35 module questionnaire were sent to the patients surviving with no evidence of disease or second primary tumors; they were answered by 15/23 (67%). Results: Overall survival was 37% at 5 years, whereas disease-specific survival was 59%. Twenty-three patients died from uncontrolled head and neck cancer. Second primary tumors were observed in 13 patients, most frequently in the lung. Local control without salvage surgery was 74% at 5 years for all subsites and stages, and loco-regional disease-free survival was 72%. Eleven patients developed distant metastases, which was the only site of failure in 6 cases. Salvage surgery was successful in 2 cases. The actuarial estimates of ≥grade-3 late toxicity was 4% for the mandibular bone and 23% for dysphagia, and 50% of the patients experienced a permanent xerostomy. Self-reported global quality of life in surviving patients was good (mean 68 points on a scale 0 to 100); consequences of impaired salivary function had most impact on nutritional and social aspects. Conclusions: Hyperfractionated RT with concomitant CDDP is well tolerated and highly

  2. 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.

  3. Carpal arthrodesis in cats. Long-term functional outcome.

    Science.gov (United States)

    Calvo, I; Farrell, M; Chase, D; Aisa, J; Rayward, R; Carmichael, S

    2009-01-01

    Pancarpal and partial carpal arthrodesis were performed in 22 carpi (20 cats) using various surgical methods. Short and long-term outcomes were assessed using a retrospective review of the case notes and via owner questionnaires. Carpal arthrodesis was associated with complications that did not affect the functional outcome, and in most cases, did not necessitate major revision surgery. Following arthrodesis, the cats did not jump as high, and showed a reduction in their willingness to jump and climb. Based on our results, carpal arthrodesis is a suitable salvage surgery to treat severe carpal injuries in the cat. PMID:19876518

  4. The long-term management and outcomes of cloacal anomalies.

    OpenAIRE

    Fernando, M. A.; Creighton, S. M.; Wood, D.

    2015-01-01

    Cloacal anomalies occur when failure of the urogenital septum to separate the cloacal membrane results in the urethra, vagina, rectum and anus opening into a single common channel. The reported incidence is 1:50,000 live births. Short-term paediatric outcomes of surgery are well reported and survival into adulthood is now usual, but long-term outcome data are less comprehensive. Chronic renal failure is reported to occur in 50 % of patients with cloacal anomalies, and 26-72 % (dependant on th...

  5. The long-term management and outcomes of cloacal anomalies

    OpenAIRE

    Fernando, M. Ashani; Creighton, Sarah M.; Wood, Dan

    2014-01-01

    Cloacal anomalies occur when failure of the urogenital septum to separate the cloacal membrane results in the urethra, vagina, rectum and anus opening into a single common channel. The reported incidence is 1:50,000 live births. Short-term paediatric outcomes of surgery are well reported and survival into adulthood is now usual, but long-term outcome data are less comprehensive. Chronic renal failure is reported to occur in 50 % of patients with cloacal anomalies, and 26–72 % (dependant on th...

  6. Esophageal replacement in children: Challenges and long-term outcomes

    Directory of Open Access Journals (Sweden)

    Giampiero Soccorso

    2016-01-01

    Full Text Available Replacement of a nonexistent or damaged esophagus continues to pose a significant challenge to pediatric surgeons. Various esophageal replacement grafts and techniques have not produced consistently good outcomes to emulate normal esophagus. Therefore, many techniques are still being practiced and recommended with no clear consensus. We present a concise literature review of the currently used techniques and with discussions on the advantages and anticipated morbidity. There are no randomized controlled pediatric studies to compare different types of esophageal replacements. Management and graft choice are based on geographical and personal predilections rather than on any discernible objective data. The biggest series with long-term outcome are reported for gastric transposition and colonic replacement. Comparison of different studies shows no significant difference in early (graft necrosis and anastomotic leaks or late complications (strictures, poor feeding, gastro-esophageal reflux, tortuosity of the graft, and Barrett′s esophagus. The biggest series seem to have lower complications than small series reflecting the decennials experience in their respective centers. Long-term follow-up is recommended following esophageal replacement for the development of late strictures, excessive tortuosity, and Barrett′s changes within the graft. Once child overcomes initial morbidity and establishes oral feeding, long-term consequences and complications of pediatric esophageal replacement should be monitored and managed in adult life.

  7. Long-Term Clinical and Cosmetic Outcomes After Breast Conservation Treatment for Women With Early-Stage Breast Carcinoma According to the Type of Breast Boost

    International Nuclear Information System (INIS)

    Purpose: The present study was performed to compare outcomes after breast conservation treatment with iridium-192 implant boost vs. electron boost. Methods and Materials: From 1977 to 1983, 141 patients were treated with whole breast radiotherapy followed by iridium-192 boost after breast-conserving surgery. They were matched 1:1 to patients treated with electron boost. Outcome measures included survival, local recurrence, cosmesis, and complications. Results: Median follow-up was 16.7 and 12.6 years for the implant vs. electron groups (p < 0.001). Rates of local recurrence, freedom from distant metastases, and overall survival at 10/20 years did not differ between the groups, nor did patterns of first failure. Patients in the electron group were more likely to have excellent/good cosmesis than those in the implant group 1 year after radiotherapy (p = 0.014); this trend continued through 10 years but did not reach statistical significance at years 5/10. Complication rates were similar, although patients receiving electron boost seemed less likely to develop breast fibrosis than did those receiving implant boost (23/141 vs. 58/141, respectively, incidence rate ratio 0.7, p = 0.17). Conclusions: Twenty-year data demonstrate no difference in rates of local recurrence, freedom from distant metastases, overall survival, or patterns of failure between groups treated with these two well-described radiotherapy boost techniques. Better cosmesis was observed in the electron group 1 year after radiotherapy, with a trend continuing for 10 years. The incidence of complications was similar between the groups, with a trend toward increased fibrosis in patients receiving implant boost.

  8. Long-Term Effects of School Size on Students' Outcomes

    DEFF Research Database (Denmark)

    Humlum, Maria Knoth; Smith, Nina

    school size and alternative measures of long-term success in the educational system and the labor market. The positive impact of school size seems mainly to be driven by boys, students from families with a low educational level and students attending schools in urban areas.......We estimate the effect of school size on students' long-term outcomes such as high school completion, being out of the labor market, and earnings at the age of 30. We use rich register data on the entire population of Danish children attending grade 9 in the period 1986-2004. This allows us to...... compare the results of different fixed effect and instrumental variables estimators. We use the natural population variation in the residentail catchment areas and school openings and closures to instrument for actual school size. We find a robust positive but numerically fairly small relationship between...

  9. Long-term outcomes of vertebroplasty for osteoporotic compression fractures

    International Nuclear Information System (INIS)

    This study aimed to determine outcomes of percutaneous vertebroplasty for osteoporotic vertebral compression fractures (VCFs). Prospective assessment of short-term (≤6 weeks), medium-term (6 months) and long-term (29 months) outcomes of vertebroplasty, followed by a retrospective long-term follow-up of patients treated with vertebroplasty compared with conservative therapy. Outcomes measured were visual analogue scale pain scores, analgesic use, disability scores using the Roland Morris Disability questionnaire and a number of new VCFs. In 27 patients with acute VCFs followed prospectively, vertebroplasty resulted in significant reductions in pain levels (56-mm reduction on a 100-mm scale) and disability scores (11.8-point reduction on a 24-point scale) at all follow-up points up to a mean of 29 months compared with pre-vertebroplasty levels (P < 0.001). Analgesic use was significantly less intense in the short and medium term after vertebroplasty (P < 0.005). In 25 patients who had vertebroplasty for VCF, a sustained reduction in all outcomes was demonstrated at a mean follow-up of 30 months, with less pain, significantly lower disability scores (P < 0.05) and less analgesic use (P < 0.05) compared with nine conservatively treated subjects. During the follow-up period, six new VCFs occurred in 4/25 vertebroplasty patients compared with four new VCFs in 2/9 control subjects. Vertebroplasty provides significant and clinically meaningful reductions in pain, analgesic use, and disability in the short, medium and long term. Compared with conservative therapy, vertebroplasty provides significantly greater functional improvement and reduction in analgesic use. The procedure is relatively safe with no clearly increased risk of new vertebral fractures.

  10. Outcomes of long-term audiological rehabilitation in charge syndrome.

    Science.gov (United States)

    Trevisi, P; Ciorba, A; Aimoni, C; Bovo, R; Martini, A

    2016-06-01

    The aim of this paper is to assess the long-term audiological features and outcomes of hearing rehabilitation in a large group of individuals with CHARGE Syndrome. The study has been conducted retrospectively, on a paediatric patient database, at the Audiology Department of the University Hospitals of Ferrara and Padua. The study sample included 31 children presenting with different degrees of hearing impairment associated with CHARGE syndrome. Hearing was assessed using auditory brainstem responses (ABRs) and/or electrocochleography, or conditioned audiometry (visual reinforcement audiometry [VRA] or play audiometry). Auditory-perceptual outcomes in terms of communication skills and expressive language were also recorded. The effects of hearing rehabilitation (with hearing aids or cochlear implants) in this group of children and language outcomes after rehabilitation were monitored during long-term follow-up. The outcomes of rehabilitation measures differed in relation to the heterogeneous and often severe disabilities associated with CHARGE syndrome, e.g. developmental delay, intellectual delay, visual impairment, thin 8(th) nerve with retrocochlear auditory dysfunction (as described in cases of auditory neuropathy/dyssynchrony). Oral expressive language was severely impaired in most cases, even after lengthy follow-up, suggesting the need for alternative augmentative communication modes. The early identification of sensorineural hearing loss, and carefully planned rehabilitation treatments, can be of some benefit in children with CHARGE syndrome. PMID:27214832

  11. 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.

  12. Long-term outcome of gamma knife radiosurgery for metastatic brain tumors  originating from lung cancer

    OpenAIRE

    Bir, Shyamal C.; Sudheer Ambekar; Papireddy Bollam; Anil Nanda

    2014-01-01

    Background: Gamma knife radiosurgery (GKRS) has emerged as an important treatment option for metastasis brain tumors (MBTs). However, the long-term outcome of GKRS on MBTs originating from lung carcinoma is not well understood. The treatment of MBTs derived from lung cancer with GKRS at our institution is reviewed. Methods: We performed a retrospective review (2000-2013) of 173 patients with MBTs from lung cancer who received GKRS. Out of 173 patients, 38 patients had recurrent tumors aft...

  13. 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

  14. 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.

  15. 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.

  16. Long-term outcome of abusive head trauma.

    Science.gov (United States)

    Chevignard, Mathilde P; Lind, Katia

    2014-12-01

    Abusive head trauma is a severe inflicted traumatic brain injury, occurring under the age of 2 years, defined by an acute brain injury (mostly subdural or subarachnoidal haemorrhage), where no history or no compatible history with the clinical presentation is given. The mortality rate is estimated at 20-25% and outcome is extremely poor. High rates of impairments are reported in a number of domains, such as delayed psychomotor development; motor deficits (spastic hemiplegia or quadriplegia in 15-64%); epilepsy, often intractable (11-32%); microcephaly with corticosubcortical atrophy (61-100%); visual impairment (18-48%); language disorders (37-64%), and cognitive, behavioral and sleep disorders, including intellectual deficits, agitation, aggression, tantrums, attention deficits, memory, inhibition or initiation deficits (23-59%). Those combined deficits have obvious consequences on academic achievement, with high rates of special education in the long term. Factors associated with worse outcome include demographic factors (lower parental socioeconomic status), initial severe presentation (e.g., presence of a coma, seizures, extent of retinal hemorrhages, presence of an associated cranial fracture, extent of brain lesions, cerebral oedema and atrophy). Given the high risk of severe outcome, long-term comprehensive follow-up should be systematically performed to monitor development, detect any problem and implement timely adequate rehabilitation interventions, special education and/or support when necessary. Interventions should focus on children as well as families, providing help in dealing with the child's impairment and support with psychosocial issues. Unfortunately, follow-up of children with abusive head trauma has repeatedly been reported to be challenging, with very high attrition rates. PMID:25501726

  17. Long-term assessment of psychologic outcomes of orthognathic surgery

    DEFF Research Database (Denmark)

    Lazaridou-Terzoudi, T.; Kiyak, H.A.; Moore, R.;

    2003-01-01

    This long-term study of post-orthognathic surgery patients aimed at assessing perceptions of problems with physical and psychologic functioning, self-concept, body image, and satisfaction with the surgical outcome based on subjective evaluations. In addition, the patient's perception of self-concept....... The level of body image and self-esteem approximated but did not reach that of a nonpatient population. In view of the current psychologic and social environment, patients should be offered the appropriate treatment to correct a disfigurement if it is subjectively perceived by them as a handicap, in part......, body image, and function was compared with the perception of pretreatment patients and controls with no treatment need. Patients and Methods: One hundred seventeen patients who underwent orthognathic surgery 10 to 14 years earlier and participated in a psychologic study 10 years earlier received...

  18. 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.

  19. 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.

  20. 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

  1. The long-term outcomes of systemic vasculitis.

    Science.gov (United States)

    Westman, Kerstin; Flossmann, Oliver; Gregorini, Gina

    2015-04-01

    Patients with generalized ANCA-associated small vessel vasculitis (AAV) have a very poor outcome if the ANCA-associated vasculitis is not diagnosed, evaluated and treated properly. The introduction of treatment with immunosuppressive therapy has improved patient survival dramatically but with considerable side effects. Besides, almost 50% of surviving patients experience a relapse of vasculitis. Since 1995, the European Vasculitis Society (EUVAS) has designed and conducted several clinical trials on patients with AAV independently of pharmaceutical companies. The studies included patients with newly diagnosed AAV and were stratified according to renal function and generalized versus more localized forms. As the immediate patient survival has improved, the longer term outcome has become more important. There are several reports on outcome of patients with ANCA-associated vasculitis, but the patient groups were heterogeneous regarding diagnosis as well as treatment and follow-up. Therefore, EUVAS decided to further evaluate the effect and possible adverse events of the original randomized trials. This review presents an overview on long-term follow-up of patients with ANCA-associated vasculitis, with focus on relapse rate, patient and renal survival and development of cardiovascular disease and malignancy. PMID:25601266

  2. 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.

  3. 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.

  4. Subacute Thyroiditis: Clinical Presentation and Long Term Outcome

    Directory of Open Access Journals (Sweden)

    Assim A. Alfadda

    2014-01-01

    Full Text Available Few studies have been reported from the Kingdom of Saudi Arabia (SA to describe the clinical presentation and long term outcomes of subacute thyroiditis (SAT. Our aim was to review the demographic, anthropometric, clinical presentation, laboratory results, treatment, and disease outcome in Riyadh region and to compare those with results from different regions of the Kingdom and different parts of the world. We reviewed the medical files of patients who underwent thyroid uptake scan during an 8-year period in King Khalid University Hospital. Only 25 patients had confirmed diagnosis of thyroiditis. Age and gender distribution were similar to other studies. Most patients presented with palpitation, goiter, and weight change. Elevated thyroid hormones, suppressed thyroid-stimulating hormone, and elevated ESR were reported. Among those, 7 cases of SAT were recorded. β-Blockers were prescribed to 57% and nonsteroidal anti-inflammatory drugs to 29% of SAT. Long follow-up demonstrated that 85.7% of SAT cases recovered, while 14.3% developed permanent hypothyroidism. In conclusion, SAT is uncommon in the central region of SA. Compared to the western region, corticosteroid is not commonly prescribed, and permanent hypothyroidism is not uncommon. A nation-wide epidemiological study to explain these interprovincial differences is warranted.

  5. Determinants of long-term renal allograft outcome

    NARCIS (Netherlands)

    Leeuwen-Artz, M.A.

    2005-01-01

    Long-term renal allograft survival is markedly affected by premature death with a functioning graft, chronic allograft nephropathy, and recurrence of the original kidney disease. To improve long-term graft survival, focus is shifting from the prevention of acute rejections to the recognition and tre

  6. 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

  7. Long-term outcome of everolimus treatment in transplant patients

    Directory of Open Access Journals (Sweden)

    Salvadori M

    2011-05-01

    Full Text Available Maurizio Salvadori, Elisabetta BertoniRenal Unit, Careggi University Hospital, Florence, ItalyAbstract: The authors review the use of everolimus in long-term studies both in renal and heart transplantation. The pharmacokinetic and pharmacodynamic differences between everolimus and its parent drug, sirolimus are discussed. The improved pharmacokinetic, in particular the improved bioavailability, the reduced half-time and the reduced binding to plasma protein makes everolimus the first choice among the proliferation signal inhibitors. Everolimus is given in almost all studies in association with cyclosporine, but fixed doses of this drug can cause nephrotoxicity. The first studies used everolimus and CsA in fixed doses, but later studies with reduced CsA doses revealed which revealed improved outcomes. Finally, therapeutic drug monitoring became the better choice for both drugs. Recently very high everolimus exposure allowed the use of very low CsA exposure with improvement of the worse side effects linked to the CsA standard dose. The Zeus study revealed a complete and safe CsA withdrawal, thanks to everolimus and mycophenolic acid. In heart transplantation, everolimus resulted in improved outcomes with respect to antiproliferative drugs such as mycophenolic acid and azathioprine. Along with antirejection properties, everolimus provided evidence for antiproliferative effects on several cells. This resulted in fewer viral infections (mainly CMV, anti-atherosclerotic properties (mainly important in heart transplantation, and antineoplastic effect. The latter activity resulted in lower cancer incidence in transplant patients treated by everolimus. An important piece of evidence for this activity is documented by the use of everolimus in the treatment of some cancers, including renal cancer, neuroendocrine cancers and hepatocellular cancers, also outside the field of transplantation.Keywords: everolimus, renal transplantation, heart transplantation

  8. Long-term outcome of pediatric patients with intracranial germinomas

    International Nuclear Information System (INIS)

    Intracranial germinomas are sensitive to both chemotherapy and radiotherapy. For this reason, long-term survival or cure rate is excellent. It is therefore important for such patients, especially for younger children, to keep a high quality of life (QOL) after the treatment. Recently, whole ventricle radiotherapy with chemotherapy has been the treatment of choice for these tumors. However, in our institute, we perform radiotherapy alone as a standard treatment, using prophylactic craniospinal irradiation (CSI) or whole brain irradiation (WBI) with local tumor booster. The purpose of this study is to assess the long-term outcome of pediatric patients with intracranial germinomas in our institute. Twenty-three young patients (17 males and 6 females) ranging from 5 to 15 years were treated between 1990 and 2009 at University of Niigata. Mean age at the time of diagnosis was 10.7 years. Tumor locations were as follows: pineal regions in 6, suprasellar in 6, basal ganglia in 4, ventricles in 1, bifocal regions (pineal and suprasellar) in 2, and dissemination in 4 patients. Twenty (88%) patients had received radiotherapy alone: 15 (66%) with CSI, and 5 (22%) with WBI. Median doses for the whole brain, spine, and primary site were 26.6 Gy (range, 23.8-35.0), 25.9 Gy (range, 23.8-30.6), 49.8 Gy (range, 44.7-52.8), respectively. Three (12%) received chemotherapy with or without radiotherapy. We analyzed the survival and long-term QOL including hormonal sequel after the above treatments. The median follow-up period was 126 months (26 to 235 months). None of the 20 patients with radiotherapy alone suffered tumor recurrence, while 2 of the 3 with chemotherapy developed recurrences. Eleven (48%), including 9 with supurasellar region required hormone replacement therapy. Two (9%) were short stature compared with normal (mean-2 standard deviation). One (4%) developed a possible radiation-induced menigioma. In 15 patients aged 19 years or older, 13 (87%) graduated from senior high

  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. 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.

  11. 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.

  12. 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

  13. 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

  14. Neural systems predicting long-term outcome in dyslexia

    OpenAIRE

    Hoeft, Fumiko; McCandliss, Bruce D; Black, Jessica M.; Gantman, Alexander; Zakerani, Nahal; Hulme, Charles; Lyytinen, Heikki; Whitfield-Gabrieli, Susan; Glover, Gary H.; Reiss, Allan L.; Gabrieli, John D. E.

    2010-01-01

    Individuals with developmental dyslexia vary in their ability to improve reading skills, but the brain basis for improvement remains largely unknown. We performed a prospective, longitudinal study over 2.5 y in children with dyslexia (n = 25) or without dyslexia (n = 20) to discover whether initial behavioral or brain measures, including functional MRI (fMRI) and diffusion tensor imaging (DTI), can predict future long-term reading gains in dyslexia. No behavioral measure, including widely use...

  15. Long-term outcomes of 23-gauge transconjunctival sutureless vitrectomy

    OpenAIRE

    ÇITIRIK, Mehmet; BATMAN, Coşar; BİÇER, Tolga; Akinci, Arsen

    2011-01-01

    To assess the long-term efficacy and safety of 23-gauge transconjunctival sutureless pars plana vitrectomy in the management of vitreoretinal diseases. Materials and methods: In this study, 53 eyes of patients who underwent 23-gauge transconjunctival sutureless pars plana vitrectomy were included. A complete ophthalmological examination was performed preoperatively and at day 1, week 1, and months 1, 3, 6, and 12 after the surgery. Results: The mean age of the patients was 56.3 years (rang...

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

    OpenAIRE

    Rim, Chai Hong; Yang, Dae Sik; Park, Young Je; Yoon, Won Sup; Lee, Jung Ae; Kim, Chul Yong

    2011-01-01

    Purpose To evaluate long-term local control rate and toxicity in patients treated with external beam radiotherapy (EBRT) for pituitary adenomas. Materials and Methods 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-five patients had hormone secreting tumors, 25 patients had non-secreting tumors. Fifty-seven patients had received postoperative radiotherapy (RT), and 3 had receiv...

  17. 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

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

    International Nuclear Information System (INIS)

    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's disease

  19. Acceptable long-term outcome in elderly intensive care unit patients

    DEFF Research Database (Denmark)

    Schrøder, Morten; Poulsen, Jesper Brøndum; Perner, Anders

    2011-01-01

    The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care.......The number of elderly intensive care unit (ICU) patients is increasing. We therefore assessed the long-term outcome in the elderly following intensive care....

  20. Long-term outcome of gamma knife radiosurgery for metastatic brain tumors  originating from lung cancer

    Directory of Open Access Journals (Sweden)

    Shyamal C Bir

    2014-01-01

    Full Text Available Background: Gamma knife radiosurgery (GKRS has emerged as an important treatment option for metastasis brain tumors (MBTs. However, the long-term outcome of GKRS on MBTs originating from lung carcinoma is not well understood. The treatment of MBTs derived from lung cancer with GKRS at our institution is reviewed. Methods: We performed a retrospective review (2000-2013 of 173 patients with MBTs from lung cancer who received GKRS. Out of 173 patients, 38 patients had recurrent tumors after microsurgical resection and whole brain radiotherapy (WBT. Results: GKRS in MBTs metastasized from lung carcinoma showed significant variations in tumor growth control (decreased in 79 [45.7%] patients, arrested growth in 54 [31.2%] patients, and increased tumor size in 40 [23.1%] patients. The median survival in the study population was 14 months. Overall survival after 3 years was 25%, whereas progression-free survival after 3 years was 45%. The predictive factors for improving survival in the patients with MBTs were recursive partitioning analysis (RPA class I (P = 0.005, absence of hydrocephalus (P = 0.001, Karnofsky performance scale (KPS >70 (P = 0.007, age ≤65 (P = 0.041, tumor size ≤3 cm (P = 0.023, controlled primary tumor (P = 0.049, and single number of MBTS (P = 0.044. Conclusion: Long-term follow-up revealed that GKRS offers a high rate of tumor control and good overall survival period in both new and recurrent patients with MBTs originating from lung carcinoma. Thus, GKRS is an effective treatment option for new patients with MBTs from lung cancer, as well as an adjuvant therapy in patients with recurrent MBTs derived from lung cancer.

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

    DEFF Research Database (Denmark)

    Faurschou, Mikkel; Dreyer, Lene; Kamper, Anne-Lise;

    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....

  2. 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

  3. 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....

  4. 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.

  5. Long term outcome of treatment of end stage renal failure.

    Science.gov (United States)

    Henning, P; Tomlinson, L; Rigden, S P; Haycock, G B; Chantler, C

    1988-01-01

    The most common causes of end stage renal failure in 46 children (mean age 11 years, range 4-14) treated between January 1972 and June 1977 were: reflux nephropathy (n = 12), cystinosis (n = 7), focal and segmental glomerulosclerosis (n = 6), and Schönlein-Henoch disease (n = 5). The quality of life, degree of renal function, and height attainment of the 31 survivors were assessed in June 1985, when their mean age was 22 years (range 14-27), using hospital records and a questionnaire designed to highlight social and psychological problems. Twenty six patients had a functioning transplanted kidney. Average growth during treatment for all survivors was normal, but most were disappointed with their 'final height'. Though five patients had some form of disabling bone disease, all 31 could walk and 27 could run. Sixteen (67%) were in full or part time employment and nine were living independently. A group of 32 patients with juvenile onset diabetes treated at this hospital for at least five years were also asked to complete the questionnaire and of these, 17 responded. On average, their data could usefully be compared with those of cases of end stage renal failure. More of the diabetics had jobs, but most sexually mature patients with renal disease were concerned about their physical appearance and had not achieved any stable long term sexual relationships. We suggest that a poor body image resulting in low self esteem may be responsible for the deficiency and believe that further study in this group is warranted. PMID:3126713

  6. 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…

  7. 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 +/-

  8. 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....

  9. The long-term outcomes of systemic vasculitis.

    OpenAIRE

    Westman, Kerstin; Flossmann, Oliver; Gregorini, Gina

    2015-01-01

    Patients with generalized ANCA-associated small vessel vasculitis (AAV) have a very poor outcome if the ANCA-associated vasculitis is not diagnosed, evaluated and treated properly. The introduction of treatment with immunosuppressive therapy has improved patient survival dramatically but with considerable side effects. Besides, almost 50% of surviving patients experience a relapse of vasculitis. Since 1995, the European Vasculitis Society (EUVAS) has designed and conducted several clinical tr...

  10. How Does Parental Divorce Affect Children's Long-term Outcomes?

    OpenAIRE

    Frimmel, Wolfgang; Halla, Martin; Winter-Ebmer, Rudolf

    2016-01-01

    Numerous papers report a negative association between parental divorce and child outcomes. To provide evidence whether this correlation is driven by a causal effect, we exploit idiosyncratic variation in the extent of sexual integration in fathers' workplaces: Fathers who encounter more women in their relevant age-occupation-group on-the-job are more likely to divorce. This results holds also conditioning on the overall share of female co-workers in a firm. We find that parental divorce has p...

  11. Long-term survival in uterine clear cell carcinoma and uterine papillary serous carcinoma.

    Science.gov (United States)

    Lindahl, Bengt; Persson, Jan; Ranstam, Jonas; Willén, Roger

    2010-09-01

    Uterine clear cell carcinoma (UCC) and uterine papillary serous carcinoma (UPSC) are rare entities that differ in clinical behavior from endometrial adenocarcinoma. Compared with endometrioid adenocarcinoma, they more often metastasize early and more commonly in the upper abdomen including the omentum. Treatment programs of UCC and UPSC at different stages vary and range from no adjuvant therapy in stage Ia to a wide variety of chemotherapies and radiotherapies in more advanced stages. This study presents the outcome of 109 patients with UCC or UPSC treated according to essentially the same treatment program from May 1993 to December 2004. Most patients were treated with a simple hysterectomy with no further adjuvant treatment. In stage Ia, 2/46 patients died of their disease and amongst all the stages, 30/109 patients died of their disease. These survival outcomes are comparable to or better than those presented previously. PMID:20944161

  12. Household Crowding During Childhood and Long-Term Education Outcomes.

    Science.gov (United States)

    Lopoo, Leonard M; London, Andrew S

    2016-06-01

    Household crowding, or having more household members than rooms in one's residence, could potentially affect a child's educational attainment directly through a number of mechanisms. We use U.S. longitudinal data from the Panel Study of Income Dynamics to derive new measures of childhood crowding and estimate negative associations between crowding during one's high school years and, respectively, high school graduation by age 19 and maximum education at age 25. These negative relationships persist in multivariate models in which we control for the influence of a variety of factors, including socioeconomic status and housing-cost burden. Given the importance of educational attainment for a range of midlife and later-life outcomes, this study suggests that household crowding during one's high school years is an engine of cumulative inequality over the life course. PMID:27103537

  13. Radiotherapy for pituitary adenoma: long-term outcome and sequelae

    International Nuclear Information System (INIS)

    Purpose/Objective: To review outcome and treatment sequelae in patients treated with external-beam radiotherapy for pituitary adenomas. Materials and Methods: One hundred forty-one patients with pituitary adenomas received radiotherapy and had 2-year minimum follow-up. One hundred twenty-one patients had newly diagnosed adenomas and 20 patients had recurrent tumors. Newly diagnosed tumors were treated with surgery and radiotherapy (S + RT; n=98) or radiotherapy alone (RT; n=23). Patients with recurrent tumors received salvage treatment with S+RT (n=10) or RT (n=10). The impact of age, sex, presenting symptoms, tumor extent, surgery type, degree of resection, hormonal activity, primary or salvage therapy, and radiotherapy dose on local control and cause-specific survival was analyzed. Effect of therapy on vision, hormonal function, life satisfaction, neurocognitive function, and affective symptoms was examined. A Likert scale survey was used for assessment of life satisfaction, neurocognitive status, and affective symptoms after therapy. Survey results from the RT patients were compared to a control group treated with transsphenoidal surgery alone (S). Survival analysis employed the Kaplan-Meier method. Multivariate analysis used the forward step-wise sequence of chi-squares for the log-rank test. Results: At 10 years, local control for the S+RT group (S + RT) was 95% and not statistically different (p=.58) than for patients in the RT group (90%). Cause-specific survival rates were also similar (p=.88) between the S+RT (97%) and RT (99%) groups. Patients with prolactin- and ACTH-secreting tumors had significantly worse local control, as did patients treated for recurrent tumors. Cause-specific survival was not decreased in any patient group. Multivariate analysis for local control and cause-specific survival revealed only young age to be predictive of worse outcome (p=.0354 and p=.0355 respectively). Visual function was either unaffected or improved in most patients

  14. 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...

  15. Long-Term Quality of Life Outcome After Proton Beam Monotherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Objectives: High-dose external radiation for localized prostate cancer results in favorable clinical outcomes and low toxicity rates. Here, we report long-term quality of life (QOL) outcome for men treated with conformal protons. Methods: QOL questionnaires were sent at specified intervals to 95 men who received proton radiation. Of these, 87 men reported 3- and/or 12-month outcomes, whereas 73 also reported long-term outcomes (minimum 2 years). Symptom scores were calculated at baseline, 3 months, 12 months, and long-term follow-up. Generalized estimating equation models were constructed to assess longitudinal outcomes while accounting for correlation among repeated measures in an individual patient. Men were stratified into functional groups from their baseline questionnaires (normal, intermediate, or poor function) for each symptom domain. Long-term QOL changes were assessed overall and within functional groups using the Wilcoxon signed-rank test. Results: Statistically significant changes in all four symptom scores were observed in the longitudinal analysis. For the 73 men reporting long-term outcomes, there were significant change scores for incontinence (ID), bowel (BD) and sexual dysfunction (SD), but not obstructive/irritative voiding dysfunction (OID). When stratified by baseline functional category, only men with normal function had increased scores for ID and BD. For SD, there were significant changes in men with both normal and intermediate function, but not poor function. Conclusions: Patient reported outcomes are sensitive indicators of treatment-related morbidity. These results quantitate the long-term consequences of proton monotherapy for prostate cancer. Analysis by baseline functional category provides an individualized prediction of long-term QOL scores. High dose proton radiation was associated with small increases in bowel dysfunction and incontinence, with more pronounced changes in sexual dysfunction.

  16. Long-Term Outcomes and Toxicity of Concurrent Paclitaxel and Radiotherapy for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Purpose: To report the long-term outcomes and toxicity of a regimen of infusion paclitaxel delivered concurrently with radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck. Patients and Methods: Between 1995 and 1999, 35 patients with nonmetastatic, Stage III or IV squamous cell carcinoma of the head and neck were treated with three cycles of paclitaxel as a 120-h continuous infusion beginning on Days 1, 21, and 42, concurrent with radiotherapy. The initial 16 patients received 105 mg/m2/cycle, and the subsequent 19 patients received 120 mg/m2/cycle. External beam radiotherapy was delivered to a dose of 70.2-72 Gy at five fractions weekly. Patients were followed to evaluate the disease outcomes and late toxicity of this regimen. Results: The median follow-up for all patients was 56.5 months. The median survival was 56.5 months, and the median time to local recurrence was not reached. Of the 35 patients, 15 (43%) developed hypothyroidism. Of the 33 patients who underwent percutaneous endoscopic gastrostomy tube placement, 11 were percutaneous endoscopic gastrostomy tube dependent until death or their last follow-up visit. Also, 5 patients (14%) required a tracheostomy until death, and 3 (9%) developed a severe esophageal stricture. All evaluated long-term survivors exhibited salivary hypofunction. Fibrosis in the radiation field occurred in 24 patients (69%). Conclusion: The results of our study have shown that concurrent chemoradiotherapy with a 120-h infusion of paclitaxel provides long-term local control and survival in patients with squamous cell carcinoma of the head and neck. Xerostomia, hypothyroidism, esophageal and pharyngeal complications, and subcutaneous fibrosis were common long-term toxicities; however, the vast majority of toxicities were grade 1 or 2.

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

    OpenAIRE

    AlisaGWoods; PaulHodgkins; L.EugeneArnold; MonicaShaw; HerveCaci; JenniferKahle; SusanYoung

    2012-01-01

    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 ...

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

    OpenAIRE

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

    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 d...

  19. Jejunoileal Atresia: Factors Affecting the Outcome and Long-term Sequelae

    OpenAIRE

    Calisti, Alessandro; Olivieri, Claudio; Coletta, Riccardo; Briganti, Vito; Oriolo, Lucia; Giannino, Giuseppina

    2012-01-01

    Context: Jejunoileal atresia (JIA) is a common abnormality. The outcome is conditioned by several variables. Nutritional problems, and long-term sequelae are described among those who survive. Aim: To correlate the type of JIA and its management to the outcome and long-term quality of life. Settings and Design: Forty-three cases over a 17-year period (1992–2009). Perinatal data, management, and outcome were extracted from the clinical notes. The cases that had survived were contacted to get i...

  20. 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...

  1. Trajectories, Long-Term Outcomes and Family Experiences of 76 Adults with Autism Spectrum Disorder

    Science.gov (United States)

    Chamak, Brigitte; Bonniau, Béatrice

    2016-01-01

    The aim of this retrospective study was to retrace the trajectories and long-term outcomes of individuals with autism in France, and to explore the family experiences. Data obtained from parents enables us to follow the trajectories of 76 adults. Two-thirds of adults with severe autism had a very poor outcome. Those with moderate autism had a…

  2. 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…

  3. Long-term clinical outcome after alcohol septal ablation for obstructive hypertrophic cardiomyopathy

    DEFF Research Database (Denmark)

    Veselka, Josef; Jensen, Morten Kvistholm; Liebregts, Max;

    2016-01-01

    AIMS: The first cases of alcohol septal ablation (ASA) for obstructive hypertrophic cardiomyopathy (HCM) were published two decades ago. Although the outcomes of single-centre and national ASA registries have been published, the long-term survival and clinical outcome of the procedure are still...

  4. 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......D alleles, genotypes or haplotypes to be associated with disease. However, we did find that long-term clinical outcome was associated with the ApoD polymorphism rs7659 (P = 0.041) following adjustment for lifetime clinical global impression, age at first admission and gender....

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

    OpenAIRE

    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...

  6. 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

  7. Long-term outcome of Hurler syndrome patients after hematopoietic cell transplantation: an international multicenter study.

    Science.gov (United States)

    Aldenhoven, Mieke; Wynn, Robert F; Orchard, Paul J; O'Meara, Anne; Veys, Paul; Fischer, Alain; Valayannopoulos, Vassili; Neven, Benedicte; Rovelli, Attilio; Prasad, Vinod K; Tolar, Jakub; Allewelt, Heather; Jones, Simon A; Parini, Rossella; Renard, Marleen; Bordon, Victoria; Wulffraat, Nico M; de Koning, Tom J; Shapiro, Elsa G; Kurtzberg, Joanne; Boelens, Jaap Jan

    2015-03-26

    Mucopolysaccharidosis type I-Hurler syndrome (MPS-IH) is a lysosomal storage disease characterized by multisystem morbidity and death in early childhood. Although hematopoietic cell transplantation (HCT) has been performed in these patients for more than 30 years, large studies on the long-term outcome of patients with MPS-IH after HCT are lacking. The goal of this international study was to identify predictors of the long-term outcome of patients with MPS-IH after successful HCT. Two hundred seventeen patients with MPS-IH successfully engrafted with a median follow-up age of 9.2 years were included in this retrospective analysis. Primary endpoints were neurodevelopmental outcomes and growth. Secondary endpoints included neurologic, orthopedic, cardiac, respiratory, ophthalmologic, audiologic, and endocrinologic outcomes. Considerable residual disease burden was observed in the majority of the transplanted patients with MPS-IH, with high variability between patients. Preservation of cognitive function at HCT and a younger age at transplantation were major predictors for superior cognitive development posttransplant. A normal α-l-iduronidase enzyme level obtained post-HCT was another highly significant predictor for superior long-term outcome in most organ systems. The long-term prognosis of patients with MPS-IH receiving HCT can be improved by reducing the age at HCT through earlier diagnosis, as well as using exclusively noncarrier donors and achieving complete donor chimerism. PMID:25624320

  8. Long-term Outcomes of Elective Surgery for Diverticular Disease: A Call for Standardization.

    Science.gov (United States)

    Biondi, Alberto; Santullo, Francesco; Fico, Valeria; Persiani, Roberto

    2016-10-01

    To date, the appropriate management of diverticular disease is still controversial. The American Society of Colon and Rectal Surgeons declared that the decision between conservative or surgical approach should be taken by a case-by-case evaluation. There is still lack of evidence in literature about long-term outcomes after elective sigmoid resection for diverticular disease. Considering the potentially key role of the surgical technique in long-term outcomes, there is the need for surgeons to define strict rules to standardize the surgical technique. Currently there are 5 areas of debate in elective surgery for diverticular disease: laparoscopic versus open approach, the site of the proximal and distal colonic division, the vascular approach and the mobilization of the splenic flexure. The purpose of this paper is to review existing knowledge about technical aspects, which represent how the surgeon is able to affect the long-term results. PMID:27622373

  9. Surrogate markers of long-term outcome in primary total hip arthroplasty

    Science.gov (United States)

    Malak, T. T.; Broomfield, J. A. J.; Palmer, A. J. R.; Hopewell, S.; Carr, A.; Brown, C.; Prieto-Alhambra, D.

    2016-01-01

    Objectives High failure rates of metal-on-metal hip arthroplasty implants have highlighted the need for more careful introduction and monitoring of new implants and for the evaluation of the safety of medical devices. The National Joint Registry and other regulatory services are unable to detect failing implants at an early enough stage. We aimed to identify validated surrogate markers of long-term outcome in patients undergoing primary total hip arthroplasty (THA). Methods We conducted a systematic review of studies evaluating surrogate markers for predicting long-term outcome in primary THA. Long-term outcome was defined as revision rate of an implant at ten years according to National Institute of Health and Care Excellence guidelines. We conducted a search of Medline and Embase (OVID) databases. Separate search strategies were devised for the Cochrane database and Google Scholar. Each search was performed to include articles from the date of their inception to June 8, 2015. Results Our search strategy identified 1082 studies of which 115 studies were included for full article review. Following review, 17 articles were found that investigated surrogate markers of long-term outcome. These included one systematic review, one randomised control trial (RCT), one case control study and 13 case series. Validated surrogate markers included Radiostereometric Analysis (RSA) and Einzel-Bild-Röntgen-Analyse (EBRA), each measuring implant migration and wear. We identified five RSA studies (one systematic review and four case series) and four EBRA studies (one RCT and three case series). Patient Reported Outcome Measures (PROMs) at six months have been investigated but have not been validated against long-term outcomes. Conclusions This systematic review identified two validated surrogate markers of long-term primary THA outcome: RSA and EBRA, each measuring implant migration and wear. We recommend the consideration of RSA in the pre-market testing of new implants. EBRA can

  10. 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.

  11. Long term outcome after coronary stent implantation: a 10 year single centre experience of 1000 patients

    NARCIS (Netherlands)

    M.J.B.M. van den Brand (Marcel); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); D.P. Foley (David); W.J. van der Giessen (Wim); P.P.T. de Jaegere (Peter); R.T. van Domburg (Ron); H.L. Hamburger (Hans)

    1999-01-01

    textabstractOBJECTIVE: To describe the long term clinical outcome (up to 11 years) after coronary stenting. DESIGN: A single centre observational study encompassing 1000 consecutive patients with a first stent implantation (1560 stents) between 1986 and 1996, who were followed for

  12. 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...

  13. Long-term outcomes in children conceived with assisted reproductive technologies.

    Science.gov (United States)

    Eisenberg, E

    2014-10-01

    Over five million children have been born worldwide through assisted reproductive technology (ART) and access to ART treatment is increasing yearly. Investigations of the health, disease, cognitive, developmental and behavioral outcomes in the children conceived with ART are often confounded by parental and other social, environmental and medical factors, including multiplicity, prematurity and low birth weight. Reports of the long-term health and psychosocial adjustment of children conceived with ART show generally good outcomes. Many of the major long-term conditions observed in the children may be associated with multiple gestations, preterm delivery and low birth weight, or with subfertility of the parents. Evidence in the male infants conceived with the aid of intracytoplasmic injection (ICSI) suggests an increased risk of reproductive tract anomalies such as hypospadias. Health-related outcomes of children born after cryopreservation of cleavage stage embryos are reassuring. Currently, our knowledge and understanding of the long-term health risks and/or benefits to the children conceived is incomplete. Measuring long-term outcomes is the first step to improving and optimizing health in the offspring conceived with medical and technological assistance. PMID:25245993

  14. 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

  15. 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.

  16. Long-term functional outcome following intramedullary nailing of femoral shaft fractures

    NARCIS (Netherlands)

    el Moumni, Mostafa; Voogd, Emma Heather; ten Duis, Henk Jan; Wendt, Klaus Wilhelm

    2012-01-01

    Background: The management of femoral shaft fractures using intramedullary nailing is a popular method. The purpose of this study was to evaluate the long-term functional outcome after antegrade or retrograde intramedullary nailing of traumatic femoral shaft fractures. We further determined predicto

  17. 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…

  18. Long term outcome of benign childhood epilepsy with centrotemporal spikes : 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.

    2010-01-01

    Purpose: To determine long-term outcome in a cohort of children with newly diagnosed benign childhood epilepsy with centrotemporal spikes (BED'S). Methods: 29 children with BECTS were included in the Dutch Study of Epilepsy in Childhood. Each child was followed for 5 years, and subsequently contacte

  19. Impact of diabetes on long-term outcome after primary angioplasty: insights from the DESERT cooperation

    NARCIS (Netherlands)

    Luca, G. De; Dirksen, M.T.; Spaulding, C.; Kelbaek, H.; Schalij, M.; Thuesen, L.; Hoeven, B. van der; Vink, M.A.; Kaiser, C.; Musto, C.; Chechi, T.; Spaziani, G.; Llera, L.S. Diaz de la; Pasceri, V.; Lorenzo, E. Di; Violini, R.; Suryapranata, H.; Stone, G.W.; cooperation, D.

    2013-01-01

    OBJECTIVE: 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 me

  20. 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

    , 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...

  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. Teenage childbearing : pregnancy outcomes and long-term consequences for the mothers

    OpenAIRE

    Otterblad Olausson, Petra

    2000-01-01

    The purposes of the thesis were to study effects of low maternal age on adverse pregnancy outcomes, predictors of teenage childbearing, and long-term effects of teenage motherhood on the women's social situation later in life and risk of premature death. The effects of low maternal age at first birth on risks of adverse pregnancy outcomes, primarily preterm birth and infant mortality, were studied in three population-based cohort studies. We used the Swedish Medical Birt...

  4. Biomarkers of acute kidney injury and associations with short- and long-term outcomes

    OpenAIRE

    Schaub, Jennifer A.; Parikh, Chirag R.

    2016-01-01

    Acute kidney injury is strongly associated with increased mortality and other adverse outcomes. Medical researchers have intensively investigated novel biomarkers to predict short- and long-term outcomes of acute kidney injury in many patient care settings, such as cardiac surgery, intensive care units, heart failure, and transplant. Future research should focus on leveraging this relationship to improve enrollment for clinical trials of acute kidney injury.

  5. 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.

  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 outcomes and healthcare utilization following critical illness – a population-based study

    OpenAIRE

    Hill, A. D.; Fowler, R.A.; Pinto, R.; Herridge, M. S.; Cuthbertson, B.H.; Scales, D.C.

    2016-01-01

    Background The purpose of this study was to examine hospital mortality, long-term mortality, and health service utilization among critically ill patients. We also determined whether these outcomes differed according to demographic and clinical characteristics. Methods We conducted a retrospective cohort study of adults (age ≥18 years) who survived admission to an intensive care unit (ICU) in Ontario, Canada, between 1 April 2002 and 31 March 2012, excluding isolated admissions to step-down or...

  8. Immediate and long-term outcomes of Lichtenstein and Kugel patch operations for inguinal hernia repair

    OpenAIRE

    Dasari, Bobby; Grant, Lorraine; Irwin, Terry

    2009-01-01

    Aim The aim of this retrospective study is to compare the immediate and long-term postoperative outcomes of Lichtenstein and Kugel repair of inguinal hernia. Methods From 1996 to 2006, 219 consecutive patients underwent inguinal hernia repair - 92 using a standard Lichtenstein repair and 127 with a Kugel patch. Patient characteristics, length of postoperative hospital stay and complication rates were assessed by retrospective review of the notes. Recurrence and chronic groin pain were assesse...

  9. The Long-term Health Outcomes of Childhood Abuse: An Overview and a Call to Action

    OpenAIRE

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

    2003-01-01

    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, crimina...

  10. Nobody Home: The Effect of Maternal Labor Force Participation on Long-Term Child Outcomes

    OpenAIRE

    Haaland, Venke Furre; Rege, Mari; Votruba, Mark

    2013-01-01

    We investigate how mother’s employment during childhood affects long term child outcomes. We utilize rich longitudinal data from Norway covering the entire Norwegian population between the years 1970 to 2007. The data allows us to match all family members and to measure maternal labor force participation throughout the child’s entire childhood. Our empirical approach exploits the variation in exposure to a working mother that exists across older and younger siblings in different family types....

  11. Evans Syndrome in Children: Long-Term Outcome in a Prospective French National Observational Cohort

    OpenAIRE

    Aladjidi, Nathalie; Fernandes, Helder; Leblanc, Thierry; Vareliette, Amélie; Rieux-Laucat, Frédéric; Bertrand, Yves; Chambost, Hervé; Pasquet, Marlène; Mazingue, Françoise; Guitton, Corinne; Pellier, Isabelle; Roqueplan-Bellmann, Françoise; Armari-Alla, Corinne; Thomas, Caroline; Marie-Cardine, Aude

    2015-01-01

    Evans syndrome (ES) is a rare autoimmune disorder whose long-term outcome is not well known. In France, a collaborative pediatric network set up via the National Rare Disease Plan now provides comprehensive clinical data in children with this disease. Patients aged less than 18 years at the initial presentation of autoimmune cytopenia have been prospectively included into a national observational cohort since 2004. The definition of ES was restricted to the simultaneous or sequential associat...

  12. Local Culture, Globalization and Policy Outcomes : an Example from Long-Term Care

    OpenAIRE

    Wilson, Gail

    2006-01-01

    Abstract It is argued that the impact of globalization and global ideologies on social policy can depend on the ways that local cultures reinforce or combat global ideologies and pressures. The article discusses the importance of local policy factors in shaping responses to globalization, taking as an example the way in which global forces have affected outcomes for older people needing long-term care in on...

  13. 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

  14. Swallowing outcome after TORS for sleep apnea: short- and long-term evaluation.

    Science.gov (United States)

    Eesa, Mohamed; Montevecchi, Filippo; Hendawy, Ehsan; D'Agostino, Giovanni; Meccariello, Giuseppe; Vicini, Claudio

    2015-06-01

    The aim of this study was to evaluate outcomes related to swallowing function in patients who underwent transoral robotic surgery (TORS) for sleep apnea on both short- and long-term scales. 78 patients who underwent TORS for sleep apnea between 2011 and 2014 were followed up for an average period of 20 ± 7.12 months (range 7-32 months), then swallowing outcomes determined by MD Anderson Dysphagia Inventory (MDADI) questionnaire, gastrografin fluoroscopy imaging results, nasogastric tube dependence and subjectively by recording the patients' complaints were analyzed and reported. Minimal insignificant short-term impact on swallowing function (4.58 ± 7.03 preoperative MDADI score versus 5.18 ± 8.32 post-operative) (p = 0.56) was registered. Mean time for start of oral feeding was 1.05 ± 0.25 days (average, 1-3). In no case nasogastric tube feeding was required. Only five patients (6 %) showed significant aspiration on gastrografin fluoroscopy examination after 1 week; there was no significant correlation between the volume of tissue removed from both tongue base and epiglottis to the incidence of aspiration as shown by gastrografin fluoroscopy examination (p = 0.72). No long-term swallowing complaint was registered. Patients who underwent TORS tongue base reduction and supraglottoplasty for sleep apnea proved to have a reasonable short-term swallowing outcomes with no long-term sequelae.

  15. Cephalometric analysis and long-term outcomes of orthognathic surgical treatment for obstructive sleep apnoea.

    Science.gov (United States)

    Ubaldo, E D; Greenlee, G M; Moore, J; Sommers, E; Bollen, A-M

    2015-06-01

    The aim of this study was to describe skeletal and posterior airway changes after orthodontic treatment and surgical jaw advancement, and to evaluate whether there is a correlation between increasing advancement and a long-term reduction in obstructive sleep apnoea (OSA). Lateral cephalograms and polysomnography (apnoea-hypopnoea index, AHI) were collected from patients treated with bilateral sagittal split osteotomy (BSSO) or maxillomandibular advancement (MMA) in combination with orthodontics. Patients completed a questionnaire and the Epworth Sleepiness Scale (ESS) to assess long-term outcomes. Descriptive statistics for cephalometric measurements and linear regression were performed to find estimates of the final OSA (AHI and ESS) as a function of mandibular advancement. Forty-three patients with surgical advancement of the maxilla (5.2mm) and mandible (8.3mm) had a 4-mm increase in posterior airway. Thirty-three patients completed the long-term survey (6.3±2.6 years after treatment); 91% reported a reduction of OSA and were pleased with their facial appearance. The maxillomandibular and posterior airway increased. There was no evidence of a linear relationship between greater amounts of mandibular advancement and improvement of OSA. Patients with less than 10mm advancement had successful objective short-term and subjective long-term OSA reduction. PMID:25703596

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-03-15

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

  17. Short- and Long-Term Outcomes of Student Field Research Experiences in Special Populations.

    Science.gov (United States)

    Soliman, Amr S; Chamberlain, Robert M

    2016-06-01

    Global health education and training of biomedical students in international and minority health research is expending through U.S. academic institutions. This study addresses the short- and long-term outcomes of an NCI-funded R25 short-term summer field research training program. This program is designed for MPH and Ph.D. students in cancer epidemiology and related disciplines, in international and minority settings (special populations) in a recent 7-year period. Positive short-term outcome of 73 students was measured as publishing a manuscript from the field research data and having a job in special populations. Positive long-term outcome was measured as having a post-doc position, being in a doctoral program, and/or employment in special populations at least 3 years from finishing the program. Significant factors associated with both short- and long-term success included resourcefulness of the student and compatibility of personalities and interests between the student and the on-campus and off-campus mentors. Short-term-success of students who conducted international filed research was associated with visits of the on-campus mentor to the field site. Short-term success was also associated with extent of mentorship in the field site and with long-term success. Future studies should investigate how field research sites could enhance careers of students, appropriateness of the sites for specific training competencies, and how to maximize the learning experience of students in international and minority research sites. PMID:25773133

  18. Pregnancy following breast cancer using assisted reproduction and its effect on long-term outcome

    DEFF Research Database (Denmark)

    Goldrat, Oranite; Kroman, Niels; Peccatori, Fedro A;

    2015-01-01

    INTRODUCTION AND AIMS: We have previously shown that pregnancy is safe following breast cancer, even in endocrine sensitive disease. Yet infertility remains common following systemic treatment. To date, no study has evaluated the safety of assisted reproductive technology (ART) after breast cancer...... were eligible. Patients were divided into two groups according to whether ART following primary systemic therapy was performed to achieve pregnancy. We evaluated the association between ART use and clinic-pathological characteristics, pregnancy outcome and long-term breast cancer outcome. RESULTS...

  19. Median and Ulnar Nerve Injuries in Children and Adolescents- Long-term outcome and Cerebral reorganisation

    OpenAIRE

    Chemnitz, Anette

    2013-01-01

    A peripheral nerve injury may lead to serious disability and influence the individual´s quality of life. It is considered that children can regain better sensory and motor function after a peripheral nerve injury, but the exact mechanism behind such superior recovery is not known. The aim of the thesis was to study the long-term clinical outcome after a peripheral nerve injury in patients injured in childhood and adolescence and to relate the clinical outcome to changes in the central and ...

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

    OpenAIRE

    Johannsen, T. H.; Ripa, C. P. L.; Carlsen, E; Starup, J.; Nielsen, O. H.; Schwartz, M.; Drzewiecki, K. T.; Mortensen, E. L.; Main, K. M.

    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, and surgery. Results. Patients had larger median clitoral lengths (10.0 mm [range 2–30] versus 3.5 [2–8], P < .001), shorter vaginal length (121 mm [100–155] versus 128 [112–153], P = .12), lower uteri...

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

    OpenAIRE

    Drzewiecki; Schwartz M; Nielsen OH; Starup J; Carlsen E; Ripa CPL; Johannsen TH; Mortensen EL; Main KM

    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, and surgery. Results. Patients had larger median clitoral lengths (10.0 mm [range 2–30] versus 3.5 [2–8], ), shorter vaginal length (121 mm [100–155] versus 128 [112–153], ), lower uterine volumes (29...

  2. 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.

  3. Long-Term Outcome of Gamma Knife Radiosurgery for Treatment of Typical Trigeminal Neuralgia

    International Nuclear Information System (INIS)

    Purpose: To analyze the long-term outcomes of patients with typical trigeminal neuralgia treated with gamma knife radiosurgery (GKRS). Patients and Methods: A total of 62 consecutive patients with typical trigeminal neuralgia were treated with GKRS between 1998 and 2004. Of the 62 patients, 2 were lost to follow-up; the remaining 60 patients were followed for >12 months. The mean prescribed maximal dose was 79.7 Gy (range, 75-80), using a 4-mm shot. Results: Of the 60 patients, 48 were followed for >4 years. An additional 3 patients, followed for 70 years correlated with a favorable outcome in terms of pain recurrence after radiosurgery (hazard ratio, 0.125; 95% confidence interval, 0.016-0.975; p = .047) on multivariate analysis. Conclusion: GKRS seems to be an effective treatment modality for patients with typical trigeminal neuralgia considering the initial response rate; however, fewer than one-half of patients might continue to benefit from GKRS after long-term follow-up. Elderly patients might be good candidates for radiosurgery considering the long-term durability of efficacy.

  4. Long-term impact of postoperative radiotherapy in carcinoma of the vulva FIGO I/II

    International Nuclear Information System (INIS)

    Purpose: Between 1953 and 1978, postoperative radiotherapy was used as an adjuvant therapy for carcinoma of the vulva that had not been treated with radical vulvectomy. We evaluated long-term results and possible prognostic factors. Methods and Materials: Ninety-two patients were treated. Surgical procedures were simple vulvectomy, electrocoagulation, or local excision. Radiotherapy doses to the vulva ranged from 0 to 90 Gy. All patients received radiotherapy to the inguinal lymph nodes, ranging from 30 to 60 Gy. Thirty-year retrospective follow-up was done evaluating the records and statistical survival rates. Results: Five-year actuarial survival rates in T1 patients were 71% (77% cause-specific survival rate), for T2 patients 43% (48% cause-specific survival rate). The difference between T1 and T2 patients was significant (p < 0.05). Patients with tumors of the labia minora had a significantly higher survival rate than those with different sites affected. Doses of 45 Gy or more to the vulva were sufficient to increase the 5-year cause-specific survival rate from 55% to 88%. The results in three subgroups were analyzed, group 1 having received electrocoagulation, but no radiotherapy of the vulva; group 2, local excision and doses of 40 Gy to the vulva; group 3, local excision and doses of 60 Gy to the vulva. There was a significant effect on 10-year cause-specific survival rates: 48% in group 1, 11% in group 2, and 88% in group 3. In multivariate analysis, the significant independent factors were T classification, tumor sites and--with only marginal significance--radiation doses to the vulva. Conclusions: The prognosis in early vulva carcinoma after nonradical surgery primarily depends on T classification and the site of the primary tumor. With univariate analyses, the dose has a significant effect on survival. In multivariate analyses the dose is a marginal independent factor in the whole group of patients. After nonradical surgery of early vulva carcinoma, the

  5. 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.

  6. Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia.

    Science.gov (United States)

    Islam, Jessica Y; Keller, Roberta L; Aschner, Judy L; Hartert, Tina V; Moore, Paul E

    2015-07-15

    Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease associated with premature birth that primarily affects infants born at less than 28 weeks' gestational age. BPD is the most common serious complication experienced by premature infants, with more than 8,000 newly diagnosed infants annually in the United States alone. In light of the increasing numbers of preterm survivors with BPD, improving the current state of knowledge of long-term respiratory morbidity for infants with BPD is a priority. We undertook a comprehensive review of the published literature to analyze and consolidate current knowledge of the effects of BPD that are recognized at specific stages of life, including infancy, childhood, and adulthood. In this review, we discuss both the short-term and long-term respiratory outcomes of individuals diagnosed as infants with the disease and highlight the gaps in knowledge needed to improve early and lifelong management of these patients. PMID:26038806

  7. Long-term outcomes of the bronchial artery embolization are diagnosis dependent

    Directory of Open Access Journals (Sweden)

    Vikas Pathak

    2016-01-01

    Full Text Available Background: Bronchial artery embolization (BAE is an established, safe, and effective procedure for the treatment of hemoptysis but long-term outcomes of the BAE have never been investigated before. Objectives: To retrospectively analyze long-term outcomes of the BAE. Materials and Methods: A retrospective chart analysis was done from the hospital central database for all patients undergoing the BAE over a consecutive 14-year period (January 2000-February 2014. A total of 58 patients were identified from the database. Eight patients were excluded due to the lack of follow-up. Data such as patient demographics, reason for hemoptysis, medical imaging results, bronchoscopy findings, recurrence rates, and morbidity/mortality rates after the BAE were collected. Results: Eighty three embolizations were performed in 50 patients. The median follow-up was of 2.2 years. Cystic fibrosis (CF bronchiectasis was the most common etiology (21/50, followed by non-CF bronchiectasis (9/50. Cavitary lung disease occurred in 12/50 patients, an additional 4/50 had cancer (primary lung and metastatic, and one patient had antineutrophil cytoplasmic antibody (ANCA vasculitis. In three patients the etiology was unknown. Postprocedural complications occurred in 5/83 (6% patients, two patients with two major complications - stroke (one and paraplegia (one - and three patients with minor complications - chest pain (two and bronchial artery dissection (one. A total of 15/50 patients died during the follow-up. Three patients died of hemoptysis, and the remaining deaths were unrelated to the procedure or hemoptysis. Twenty four patients had recurrent hemoptysis. A Kaplan-Meier analysis revealed an excellent long-term survival that was 85% at 10 years. Conclusions: The BAE is a safe and effective procedure with excellent overall long-term survival.

  8. 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.

  9. Trajectories, Long-Term Outcomes and Family Experiences of 76 Adults with Autism Spectrum Disorder.

    Science.gov (United States)

    Chamak, Brigitte; Bonniau, Béatrice

    2016-03-01

    The aim of this retrospective study was to retrace the trajectories and long-term outcomes of individuals with autism in France, and to explore the family experiences. Data obtained from parents enables us to follow the trajectories of 76 adults. Two-thirds of adults with severe autism had a very poor outcome. Those with moderate autism had a better outcome. In adulthood, the majority were in residential accommodation. None were living independently. The trajectories of people with Asperger syndrome or high-functioning autism were more positive since all of them attended school for a long time and some went to university. All of them had a good outcome but they remained dependent on aging parents who had few available supports. PMID:26572660

  10. 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...

  11. Long-term seizure outcome in patients undergoing resection of lesions detected by magnetic resonance imaging

    International Nuclear Information System (INIS)

    The long-term efficacy of resective surgery was investigated in patients with lesions detected by magnetic resonance (MR) imaging. Thirty of 47 patients who had undergone lesionectomy between 1987-2001 were followed up by questionnaire. Patients with extratemporal resections outnumbered those with temporal lobe resections. The mean follow-up period was 12.4±3.7 years. Outcomes were graded according to Engel's criteria, and an arbitrary seizure outcome score was given for quantitative assessment. The mean seizure outcome scores were significantly lower in the early childhood (less than 3 years) onset group than in the late childhood (3 to 15 years) onset group, and significantly lower in the extratemporal resection of the cortical dysplasia group than in the temporal resection and the extratemporal resection of non-cortical dysplasia groups. This study indicated that lesionectomy based on MR imaging findings in patients with intractable epilepsy achieved effective long-term seizure control, and the outcome was related mainly to the pathology of the epileptogenic lesions and the temporal or extratemporal location. (author)

  12. 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.

  13. Long-Term Population-Based Cerebral Ischemic Event and Cognitive Outcomes of Direct Oral Anticoagulants Compared With Warfarin Among Long-term Anticoagulated Patients for Atrial Fibrillation.

    Science.gov (United States)

    Jacobs, Victoria; May, Heidi T; Bair, Tami L; Crandall, Brian G; Cutler, Michael J; Day, John D; Mallender, Charles; Osborn, Jeffrey S; Stevens, Scott M; Weiss, J Peter; Woller, Scott C; Bunch, T Jared

    2016-07-15

    Direct oral anticoagulants (DOACs) have been used in clinical practice in the United States for the last 4 to 6 years. Although DOACs may be an attractive alternative to warfarin in many patients, long-term outcomes of use of these medications are unknown. We performed a propensity-matched analysis to report patient important outcomes of death, stroke/transient ischemic attack (TIA), bleeding, major bleeding, and dementia in patients taking a DOAC or warfarin. Patients receiving long-term anticoagulation from June 2010 to December 2014 for thromboembolism prevention with either warfarin or a DOAC were matched 1:1 by index date and propensity score. Multivariable Cox hazard regression was performed to determine the risk of death, stroke/TIA, major bleed, and dementia by the anticoagulant therapy received. A total of 5,254 patients were studied (2,627 per group). Average age was 72.4 ± 10.9 years, and 59.0% were men. Most patients were receiving long-term anticoagulation for AF management (warfarin: 96.5% vs DOAC: 92.7%, p <0.0001). Rivaroxaban (55.3%) was the most commonly used DOAC, followed by apixaban (22.5%) and dabigatran (22.2%). The use of DOACs compared with warfarin was associated with a reduced risk of long-term adverse outcomes: death (p = 0.09), stroke/TIA (p <0.0001), major bleed (p <0.0001), and bleed (p = 0.14). No significant outcome variance was noted in DOAC-type comparison. In the AF multivariable model patients taking DOAC were 43% less likely to develop stroke/TIA/dementia (hazard ratio 0.57 [CI 0.17, 1.97], p = 0.38) than those taking warfarin. Our community-based results suggest better long-term efficacy and safety of DOACs compared with warfarin. DOAC use was associated with a lower risk of cerebral ischemic events and new-onset dementia. PMID:27236255

  14. 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

  15. 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

  16. High osteopontin levels predict long-term outcome after STEMI and primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Bjerre, Mette; Pedersen, Sune Folke; Møgelvang, Rasmus;

    2013-01-01

    between plasma OPN at admission and the long-term outcome in patients with ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). METHODS: We included a total of 730 consecutive STEMI patients admitted to a single high-volume invasive heart......BACKGROUND: Osteopontin (OPN), a multifunctional glycoprotein, has recently been found to be an important player in cardiovascular diseases and to be implicated in a variety of acute as well as chronic inflammatory processes, including atherosclerosis. This study investigates the association...

  17. 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.

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

    Science.gov (United States)

    Johannsen, T H; Ripa, C P L; Carlsen, E; Starup, J; Nielsen, O H; Schwartz, M; Drzewiecki, K T; Mortensen, E L; Main, K M

    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, and surgery. Results. Patients had larger median clitoral lengths (10.0 mm [range 2-30] versus 3.5 [2-8], P Satisfaction with genital appearance was lower and negatively correlated to degree of initial virilisation (r(s) = ≤-0.39, P ≤ .05). More patients had never had intercourse (P = .001), and age at 1st intercourse was higher (18 yrs versus 16 yrs, P = .02). Conclusion. Despite overall acceptable cosmetic results, reproductive outcomes were suboptimal, supporting that multidisciplinary teams should be involved in adult follow up of CAH patients. PMID:20981283

  19. Long-term visual outcomes of optic pathway gliomas in pediatric patients without neurofibromatosis type 1.

    Science.gov (United States)

    Wan, Michael J; Ullrich, Nicole J; Manley, Peter E; Kieran, Mark W; Goumnerova, Liliana C; Heidary, Gena

    2016-08-01

    Sporadic optic pathway gliomas (OPGs) have been reported to cause more vision loss than OPGs associated with neurofibromatosis type-1, but long-term visual outcome data are limited. The purpose of this study was to report the visual outcomes of a cohort of pediatric patients with sporadic OPGs. This was a retrospective, cohort study at a tertiary care pediatric hospital and cancer institute. The study included all patients with sporadic OPGs evaluated from 1990 to 2014. The primary outcome was visual acuity at final follow-up. Secondary outcomes were risk factors for a poor visual outcome and the rate of progression. There were 59 pediatric patients included in the study. Median age at presentation was 2.5 years old and median follow-up was 5.2 years. In the worse eye at final follow-up, 16 patients (27 %) were 20/30 or better, 9 patients (15 %) were between 20/40 and 20/80, and 34 patients (58 %) were 20/100 or worse. In the better eye at final follow-up, 33 patients (56 %) were 20/30 or better, 11 patients (19 %) were between 20/40 and 20/80, and 15 patients (25 %) were 20/100 or worse. Risk factors for a poor visual outcome included younger age at presentation, optic nerve pallor, and tumor extent. Of the 54 patients (92 %) who received treatment, 40 (74 %) experienced disease progression during or after treatment. A majority of pediatric patients with sporadic OPGs had significant long-term visual impairment. In spite of treatment, tumor progression is common. Serial ophthalmic examinations with quantitative vision measurements are essential in the management of sporadic OPGs. PMID:27311725

  20. Long-term Survival after Resection of HER2+ Infiltrating Ductal Carcinoma Metastasis to the Brainstem.

    Science.gov (United States)

    Awad, Al-Wala; Zaidi, Hasan A; Awad, Al-Homam; Spetzler, Robert

    2016-01-01

    The central nervous system is a common site of metastatic spread from neoplasms in distant organs, including breast, bone, and lung. The decision to surgically treat these metastatic lesions is often challenging, especially in the setting of systemic disease or when eloquent brain regions are involved. Treating metastatic disease in the brainstem can be technically difficult, and in many institutions, considered a contraindication to surgical intervention, given the relatively high risk of new postoperative neurological deficits. Herein, we report a case of metastatic ductal carcinoma of the breast with spread to the pontine-medullary junction that was treated with aggressive surgical resection and chronic hormonal therapy. After surgical excision of the brainstem lesion, the patient remained asymptomatic and was maintained on trastuzumab therapy over a 10-year follow-up period, with no radiographic or clinical evidence of recurrent disease. To our knowledge, this is the first report of a patient treated for a solitary metastasis to the brainstem with long-term survival. PMID:26929889

  1. 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...

  2. 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

  3. 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

  4. 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.

  5. 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.)

  6. Long-term outcomes of gamma knife surgery for posterior fossa arteriovenous malformations

    International Nuclear Information System (INIS)

    The long-term outcomes of gamma knife surgery (GKS) in patients with posterior fossa arteriovenous malformations (AVMs) were retrospectively analyzed in 82 patients followed up for more than 5 years to evaluate the efficacy and safety. The median AVM volume at GKS was 0.95 cm3. The prescribed dose to the AVM margin was median 18 Gy with 1-18 isocenters. The actual complete AVM obliteration rate was 58.5% at 3 years and 78.0% at 5 years. The significant factors for higher complete obliteration rate were younger patient age and smaller maximum/minimum nidus diameter ratio. Two patients experienced hemorrhage caused by residual AVM rupture at 4 and 49 months. Twenty patients developed peri-nidal edema as an adverse radiation-induced reaction at median 13 months. One patient developed radiation-induced necrosis at 6.8 years. Neurological complication was observed in 12 patients and 6 patients remained with neurological dysfunction permanently. Larger nidus volume and location adjacent to an eloquent area significantly increased the risk of neurological complication. Pittsburgh radiosurgery-based AVM grading scale was significantly correlated with the outcome of neurological symptoms after GKS. GKS achieved acceptable and complete obliteration rate for posterior fossa AVM with relatively low risk of morbidity on neuroimaging and neurological symptoms for the long-term period after treatment. We recommend conformable and selective treatment planning to achieve both obliteration of the AVM nidus and preservation of neurological function. (author)

  7. 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.

  8. 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.

  9. 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.)

  10. 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

  11. 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.

  12. 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.

  13. 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

  14. 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.

  15. Long-term clinical outcomes of 420 consecutive prostate cancer patients in a single institute.

    Directory of Open Access Journals (Sweden)

    Edamura,Kohei

    2005-10-01

    Full Text Available

    This study was undertaken to reveal the trends of prostate cancer and the outcome of treatment modalities for each disease stage in patients in a single institute over a 10-year period. From January 1994 through December 2003, 420 consecutive patients with previously untreated and histologically confirmed prostate cancer were analyzed for annual distributions of disease stages and treatment modalities and for long-term clinical progression-free survival, prostate cancer-specific survival, and prostate-specific antigen (PSA failure-free survival rates for each stage and treatment modality. Annual trends showed that the number of patients, especially those with clinically localized cancer, increased dramatically. The 5-year disease-specific survival rates for patients with clinically localized disease were 100 percent for all treatment modalities, including hormonal therapy alone. Patients with PSA levels less than 10 ng/ml showed an 81 percent 5-year PSA failure-free survival rate with radical prostatectomy. Stage C patients treated by surgery or radiation-based therapy with concomitant hormonal therapy obtained 93 percent and 100 percent cause-specific survival rates, respectively, and those treated by hormonal therapy alone showed a 79 percent rate. The number of patients with localized prostate cancer was increasing in this decade. While long-term hormonal therapy alone was highly efficient in controlling localized prostate cancer, radical therapies in conjunction with neo-adjuvant hormonal therapy produced better survival rates in cases of locally advanced disease.

  16. 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.

  17. 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.

  18. 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...... (range = 10.2-22.7 years), 101 of the 123 grafts (82%) were categorised as successes. Mean age in the success group was 12.1 years and 13.6 years in the failure group (p = 0.03). It was found that the success rate was significantly lower (p = 0.02) if SABG was performed after eruption of the tooth distal...

  19. Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence

    Directory of Open Access Journals (Sweden)

    Wewetzer Christoph

    2008-07-01

    Full Text Available Abstract Background In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. The aim of this follow-up study is to bridge this gap to some extent describing the long-term outcome of juvenile dissociative disorder in a clinical sample. To our knowledge there is no comparable other long-term follow-up study which is based on a case definition according to actual classification systems using standardized interviews for individual assessment of the patients at the time of follow-up. Methods The total study group was made up of all patients treated for dissociative disorder at our department for child and adolescent psychiatry between 1983 and 1992 (N = 62. Two of these former patients committed suicide during the follow-up period (3%. We got information on the clinical course of 27 former patients (44%. 17 out of these 27 former patients were female (63%. The mean age of onset of dissociative disorder was11.7 years and the mean follow-up time was 12.4 years. Most of the patients were reassessed personally (n = 23 at a mean age of 24.8 years using structured interviews covering dissociative disorders, other Axis I disorders and personality disorders (Heidelberg Dissociation Inventory HDI; Expert System for Diagnosing Mental Disorders, DIA-X; Structured Clinical Interview for DSM-IV, SCID-II. Social adjustment was assessed by a semi-structured interview and by patient self report (Social Adjustment Scale – Self Report, SAS-SR. Psychosocial outcome variables were additionally assessed in 36 healthy controls (67% female, mean age = 22.9 years. Results At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. A total of 56.5% presented with an Axis I disorder (especially

  20. 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

  1. Preschool Speech Intelligibility and Vocabulary Skills Predict Long-Term Speech and Language Outcomes Following Cochlear Implantation in Early Childhood

    OpenAIRE

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

    2013-01-01

    Speech and language measures during grade school predict adolescent speech-language outcomes in children who receive cochlear implants, 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 if early preschool measures of speech and language performance predict speech-language functioning in long-term users of cochlear implants. Early measures of speech intelligi...

  2. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbæk, Finn Noe; Hegedüs, Laszlo

    2011-01-01

    To evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules.......To evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules....

  3. 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)....

  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. Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

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    Yoon Hi Cho

    2009-01-01

    Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

  6. Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

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    Rosenthal Stephen

    2009-12-01

    Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

  7. Cosmetic Evaluation of long term results following intraoperative radiotherapy (IORT) of conservative surgery for breast carcinoma

    International Nuclear Information System (INIS)

    Introduction In breast conserving therapy (BCT) of breast cancer, cosmetic results have become next to tumor-related outcome parameters a criterion of increasing awareness. The aim of this study is the evaluation of long term cosmetic results after conservative surgery and intraoperative radiotherapy with 10 Gy electrons (IOERT), followed by whole breast radiotherapy (WBRT) with 50-54 Gy. Patients and Methods From October 1998 to October 2005, 818 patients (median age 57.89 years) were treated by IOERT during breast conserving surgery, 12 of them for bilateral cancer. 32 patients were referred to mastectomy within primary treatment, 50 were reported as dead at the beginning of the study, 4 patients had developed an in-breast-recurrence and had been salvaged by secondary mastectomy, and in 41 cases an intercurrent dissemination was noted. All 679 remaining patients were invited in written form to participate in the cosmesis study. 403 of them (59.4%) have answered and were object of the evaluation (August 2006 to April 2007). To provide reproducible examination conditions, a standardized photo-documentation in four positions (frontal, loose-hanging and elevated arms; left and right lateral, elevated arms) was accomplished. Patients and treating physicians evaluated the cosmetic results separately within a 5-point-score (Excellent, Good, Moderate, Bad, Complications). Patient-, tumor- and treatment-related factors were investigated with regard to possible impact on the cosmetic outcome in all patients (group 1). A separate subgroup analysis was carried out for 261 patients with a follow-up of at least three years after completion of local treatment (group 2). For computation of the statistic correlation between the variables and the cosmetic evaluation the rank correlation coefficients Kendall's τ Spearman's ρ were used. A correlation is significant below a p-value of 0.05. Results The self-assessment of the patients in group 1 yielded around 69% excellent, 25

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

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    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.

  9. 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

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

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    Drzewiecki

    2010-08-01

    Full Text Available 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, and surgery. Results. Patients had larger median clitoral lengths (10.0 mm [range 2–30] versus 3.5 [2–8], , shorter vaginal length (121 mm [100–155] versus 128 [112–153], , lower uterine volumes (29.1 ml [7.5–56.7] versus 47.4 [15.9–177.5], , and higher ovarian volumes (4.4 ml [1.3–10.8] versus 2.8 [0.6–10.8], than controls. Satisfaction with genital appearance was lower and negatively correlated to degree of initial virilisation (. More patients had never had intercourse (, and age at 1st intercourse was higher (18 yrs versus 16 yrs, . Conclusion. Despite overall acceptable cosmetic results, reproductive outcomes were suboptimal, supporting that multidisciplinary teams should be involved in adult follow up of CAH patients.

  11. 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

  12. 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

  13. 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. PMID:24029426

  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. Evans Syndrome in Children: Long-Term Outcome in a Prospective French National Observational Cohort.

    Science.gov (United States)

    Aladjidi, Nathalie; Fernandes, Helder; Leblanc, Thierry; Vareliette, Amélie; Rieux-Laucat, Frédéric; Bertrand, Yves; Chambost, Hervé; Pasquet, Marlène; Mazingue, Françoise; Guitton, Corinne; Pellier, Isabelle; Roqueplan-Bellmann, Françoise; Armari-Alla, Corinne; Thomas, Caroline; Marie-Cardine, Aude; Lejars, Odile; Fouyssac, Fanny; Bayart, Sophie; Lutz, Patrick; Piguet, Christophe; Jeziorski, Eric; Rohrlich, Pierre; Lemoine, Philippe; Bodet, Damien; Paillard, Catherine; Couillault, Gérard; Millot, Frédéric; Fischer, Alain; Pérel, Yves; Leverger, Guy

    2015-01-01

    Evans syndrome (ES) is a rare autoimmune disorder whose long-term outcome is not well known. In France, a collaborative pediatric network set up via the National Rare Disease Plan now provides comprehensive clinical data in children with this disease. Patients aged less than 18 years at the initial presentation of autoimmune cytopenia have been prospectively included into a national observational cohort since 2004. The definition of ES was restricted to the simultaneous or sequential association of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP). Cases were deemed secondary if associated with a primitive immunodeficiency or systemic lupus erythematosus. In December 2014, we analyzed the data pertaining to 156 children from 26 centers with ES whose diagnosis was made between 1981 and 2014. Median age (range) at the onset of cytopenia was 5.4 years (0.2-17.2). In 85 sequential cases, the time lapse between the first episodes of AIHA and ITP was 2.4 years (0.1-16.3). The follow-up period as from ES diagnosis was 6.5 years (0.1-28.8). ES was secondary, revealing another underlying disease, in 10% of cases; various associated immune manifestations (mainly lymphoproliferation, other autoimmune diseases, and hypogammaglobulinemia) were observed in 60% of cases; and ES remained primary in 30% of cases. Five-year ITP and AIHA relapse-free survival were 25 and 61%, respectively. Overall, 69% of children required one or more second-line immune treatments, and 15 patients (10%) died at the age of 14.3 years (1.7-28.1). To our knowledge, this is the first consistent long-term clinical description of this rare syndrome. It underscores the high rate of associated immune manifestations and the burden of long-term complications and treatment toxicity. Future challenges include (1) the identification of the underlying genetic defects inducing immune dysregulation and (2) the need to better characterize patient subgroups and second

  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. Short and long term outcome of bilateral pallidal stimulation in chorea-acanthocytosis.

    Directory of Open Access Journals (Sweden)

    Marie Miquel

    Full Text Available BACKGROUND: Chorea-acanthocytosis (ChAc is a neuroacanthocytosis syndrome presenting with severe movement disorders poorly responsive to drug therapy. Case reports suggest that bilateral deep brain stimulation (DBS of the ventro-postero-lateral internal globus pallidus (GPi may benefit these patients. To explore this issue, the present multicentre (n=12 retrospective study collected the short and long term outcome of 15 patients who underwent DBS. METHODS: Data were collected in a standardized way 2-6 months preoperatively, 1-5 months (early and 6 months or more (late after surgery at the last follow-up visit (mean follow-up: 29.5 months. RESULTS: Motor severity, assessed by the Unified Huntington's Disease Rating Scale-Motor Score, UHDRS-MS, was significantly reduced at both early and late post-surgery time points (mean improvement 54.3% and 44.1%, respectively. Functional capacity (UHDRS-Functional Capacity Score was also significantly improved at both post-surgery time points (mean 75.5% and 73.3%, respectively, whereas incapacity (UHDRS-Independence Score improvement reached significance at early post-surgery only (mean 37.3%. Long term significant improvement of motor symptom severity (≥ 20 % from baseline was observed in 61.5 % of the patients. Chorea and dystonia improved, whereas effects on dysarthria and swallowing were variable. Parkinsonism did not improve. Linear regression analysis showed that preoperative motor severity predicted motor improvement at both post-surgery time points. The most serious adverse event was device infection and cerebral abscess, and one patient died suddenly of unclear cause, 4 years after surgery. CONCLUSION: This study shows that bilateral DBS of the GPi effectively reduces the severity of drug-resistant hyperkinetic movement disorders such as present in ChAc.

  20. 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.)

  1. 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.

  2. Prediction of future labour market outcome in a cohort of long-term sick-listed Danes

    DEFF Research Database (Denmark)

    Pedersen, Jacob; Gerds, Thomas Alexander; Bjørner, Jakob;

    2014-01-01

    BACKGROUND: Targeted interventions for the long-term sick-listed may prevent permanent exclusion from the labour force. We aimed to develop a prediction method for identifying high risk groups for continued or recurrent long-term sickness absence, unemployment, or disability among persons on long...... data set, statistical prediction methods were built using logistic regression and a discrete event simulation approach for a one year prediction horizon. Personalized risk profiles were obtained for five outcomes: employment, unemployment, recurrent sickness absence, continuous long-term sickness...

  3. 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.

  4. 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.

  5. 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. PMID:27329290

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

    International Nuclear Information System (INIS)

    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

  7. 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.

  8. 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.

  9. Long-term health outcomes in a British cohort of breast, colorectal and prostate cancer survivors: a database study

    OpenAIRE

    Khan, N F; Mant, D.; Carpenter, L.; Forman, D.; Rose, P W

    2011-01-01

    Background: The community-based incidence of cancer treatment-related long-term consequences is uncertain. We sought to establish the burden of health outcomes that have been associated with treatment among British long-term cancer survivors. Methods: We identified 26 213 adults from the General Practice Research Database who have survived 5 years or more following breast, colorectal or prostate cancer. Four age-, sex- and general practice-matched non-cancer controls were selected for each su...

  10. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome.

    Science.gov (United States)

    Skirrow, Caroline; Cross, J Helen; Harrison, Sue; Cormack, Francesca; Harkness, William; Coleman, Rosie; Meierotto, Ellen; Gaiottino, Johanna; Vargha-Khadem, Faraneh; Baldeweg, Torsten

    2015-01-01

    volumes and greater temporal pole integrity after left temporal surgery. Results were independent of post-surgical intellectual function and language lateralization. Our findings indicate post-surgical, hemisphere-dependent material-specific improvement in memory functions in the intact temporal lobe. However, outcome was linked to the anatomical integrity of the temporal lobe memory system, indicating that compensatory mechanisms are constrained by the amount of tissue which remains in the operated temporal lobe. Careful tailoring of resections for children undergoing epilepsy surgery may enhance long-term memory outcome. PMID:25392199

  11. 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. PMID:23998347

  12. 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.

  13. 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

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

    Directory of Open Access Journals (Sweden)

    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 sports injuries : results after inpatient treatment

    NARCIS (Netherlands)

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

    2003-01-01

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

  17. Long-Term Outcomes after Dialysis-Requiring Acute Kidney Injury

    Directory of Open Access Journals (Sweden)

    Vin-Cent Wu

    2014-01-01

    Full Text Available AKI-dialysis patients had a higher incidence of long-term ESRD and mortality than the patients without AKI. The patients who recovered from dialysis were associated with a lower incidence of long-term ESRD and mortality than in the patients who still required dialysis.

  18. LONG-TERM OUTCOMES OF CORRECTIVE OSTEOTOMY FOR THE TREATMENT OF DISTAL RADIUS MALUNION

    NARCIS (Netherlands)

    S.A. Lozano-Calderón; K.M. Brouwer; J.N. Doornberg; J. Carel Goslings; P. Kloen; J.B. Jupiter

    2010-01-01

    Corrective osteotomy is an established but challenging treatment for distal radius malunion. Short- and intermediate-term results have been previously published while long-term results have not. The long-term results of 22 patients treated with corrective osteotomy for symptomatic distal radius malu

  19. 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…

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

    Directory of Open Access Journals (Sweden)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  2. 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.

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

    Directory of Open Access Journals (Sweden)

    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. 

  4. 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.

  5. 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. PMID:25950536

  6. Sustained favorable long-term outcome in the treatment of schizophrenia: a 3-year prospective observational study

    Directory of Open Access Journals (Sweden)

    Ascher-Svanum Haya

    2011-08-01

    Full Text Available Abstract Background This study of chronically ill patients with schizophrenia aimed to identify patients who achieve sustained favorable long-term outcome - when the outcome incorporates severity of symptoms, level of functioning, and use of acute care services - and to identify the best baseline predictors of achieving this sustained favorable long-term outcome. Methods Using data from the United States Schizophrenia Care and Assessment Program (US-SCAP (N = 2327, a large 3-year prospective, multisite, observational study of individuals treated for schizophrenia in the US, a hierarchical cluster analysis was performed to group patients based upon baseline symptom severity. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS scores, level of functioning, and use of acute care services. Level of functioning reflected patient-reported productivity and clinician-rated occupational role functioning. Use of acute care services reflected self-reported psychiatric hospitalization and emergency service use. Change of health state was determined over the 3-year period. A patient was classified as having a sustained favorable long-term outcome if their health state values had the closest distance to the defined "best baseline cluster" at each point over the length of the study. Stepwise logistic regression was used to determine baseline predictors of sustained favorable long-term outcome. Results At baseline, 5 distinct health state clusters were identified, ranging from "best" to "worst." Of 1635 patients with sufficient data, only 157 (10% experienced sustained favorable long-term outcome during the 2-years postbaseline. The baseline predictors associated with sustained favorable long-term outcome included better quality of life, more daily activities, patient-reported clearer thinking from medication, better global functioning, being employed, not being a victim of a crime, not having received individual therapy, and not

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

    Science.gov (United States)

    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

  8. NIPPLE RECONSTRUCTION USING THE C-V FLAP TECHNIQUE: LONG-TERM OUTCOMES

    Directory of Open Access Journals (Sweden)

    Lona Jalini

    2016-08-01

    Full Text Available Introduction: Nipple creation using the C-V flap technique is often the final step in breast reconstruction. The aim of this study was to subjectively and objectively assess the cosmetic outcomes and satisfaction of patients undergoing C-V flap nipple reconstruction. Methods: Subjective assessments of patient satisfaction with the neo-nipple were recorded by visual analogue scoring (VAS; 0-10. Objective measurements were performed using a calliper to measure nipple projection relative to the native breast. Descriptive data analysis was performed with differences in projection assessed with the Mann-Whitney test and mean and median VAS scores (with inter-quartile ranges; IQR calculated to describe satisfaction. Results: Thirty-three C-V flap nipple reconstructions were performed. 87.9% received latissimus dorsi (LD reconstructions with implants and 12.1% had transverse rectus abdominis muscle (TRAM reconstructions. The median projection of reconstructed nipples was 4.7 mm (range 4-10.2 mm at 4.6 years mean follow-up, which was not significantly different from the contralateral nipple (p = 0.34. Patient satisfaction was 9 (IQR: 8-10 with shape, 9 (IQR: 7.5-10 with projection, 5 (IQR: 2-9.6 with sensation, and 8.5 (IQR: 6-9.5 with symmetry. Median overall satisfaction was 9 (IQR: 8-10. Three patients had complete nipple loss, of whom two had undergone nipple piercing post procedure and none had received radiotherapy. Conclusion: C-V flap nipple reconstructions provide a simple and reliable method to reconstruct the nipple that enhances confidence and perception of body image. Satisfaction was high with long-term outcomes in terms of projection equivalent to the contralateral breast.

  9. LONG TERM NEURODEVELOPMENTAL OUTCOME IN A COHORT OF PRETERM INFANTS BORN AT GESTATIONAL AGE <32 WEEKS

    Directory of Open Access Journals (Sweden)

    M.G. Gatti

    2013-12-01

    Full Text Available Advances in perinatal care have led to an increase in survival of preterm children but have also increased the risk of long-term sequelae, like neurodevelopmental impairment and behavioral or emotional disturbance. To investigate neurodevelopmental patterns of preterm infants born at S. Maria alle Scotte Hospital, Siena, Italy. 128 babies with gestational age (GA ≤32 weeks were admitted in 2006-2008 to Siena Hospital; 105 infants survived and were followed until three years of age, corrected for prematurity. Neurodevelopmental follow up was performed using Bayley scale of Infant and Toddler Development IIIed that consisted of five scales: Cognitive (CS, Language (LS, Motor (MS, Social-Emotional (SES and Adaptive Behavior Scale (ABS. Intraventricular haemorrhage (IVH was associated with lower motor score (P<0,001. Babies with retinopathy of prematurity (ROP showed a lower score in CS, LS, MS and SES Bayley’s items (respectively p≤0,01; p≤0,05; p≤0,01; p≤0,05. Multiple regression analysis indicated as predictors of neurological outcome: gestational age (GA for poor cognitive (p=0,016, language (p=0,004 and social-emotional development (p<0,0001, IVH for poor motor (p<0,0001 and adaptive behavior development (p<0,0001, twinship for better language (p=0,001 and social-emotional development (p=0,003. Bronchopulmoanry dyspasia (BPD and patent ductus arteriosus (PDA had a negative effect on respectively cognitive development (p=0,049 and social-emotional development (p=0,023. ROP, BPD, IVH, PDA, and GA significantly contributes to poor neurological outcome in preterm infants. BPD and IVH are the best predictors being associated with the lowest scores at Bayley scales. Surprisingly, twinship appeared to be a protective factor.

  10. 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.

  11. Gender-Based Long-Term Surgical Outcome in Patients with Active Infective Aortic Valve Endocarditis.

    Science.gov (United States)

    Dohmen, Pascal M; Binner, Christian; Mende, Meinhart; Daviewala, Piroze; Etz, Christian D; Borger, Michael Andrew; Misfeld, Martin; Eifert, Sandra; Mohr, Friedrich Wilhelm

    2016-01-01

    BACKGROUND The aim of this observational, single-center study was to evaluate the impact of gender on surgical outcome in patients with active infective endocarditis (AIE) of the aortic valve. MATERIAL AND METHODS Between October 1994 and January 2011, 755 patients (558 men and 297 women) underwent surgery for AIE at the Leipzig Heart Center, Germany, according to the modified Duke criteria. Data were collected before surgery and as the study was ongoing. Gender influence on survival was evaluated (Kaplan-Meier curves). Cox proportional models were used to evaluate gender differences in relation to early mortality (within 30 days) and late mortality (up to 10 years). RESULTS The early mortality rate was 15.0% among men and 23.0% among women, which was statistically significant different (p=0.01). In male patients, variables associated with overall mortality were age (HR 1.63, 95% CI 1.43-1.86; pClass IV (OR 1.56, 95% CI 1.12-2.15; p=0.008), and involvement of multiple valves (OR 1.65, 95% CI 1.24-2.19; p=0.001) had a statistically significant influence on the late mortality. Focus identification (OR 1.75, 95% CI 1.08-2.77; p=0.023), involvement of multiple valves (OR 1.52, 95% CI 1.02-2.26; p=0.040), preoperative dialysis (OR 3.65, 95% CI 1.96-6.77; pgender-based differences in risk of mortality in patients with AIE (who were undergoing surgical treatment) with different early and long-term outcomes. PMID:27427831

  12. 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...

  13. Long-term body weight outcomes of antidepressant–environment interactions

    OpenAIRE

    Mastronardi, C; G.J. Paz-Filho; Valdez, E.; Maestre-Mesa, J; Licinio, J; Wong, M-L

    2010-01-01

    Both obesity rates and antidepressant use have escalated in the last 20 years. Most people who start antidepressant treatment discontinue it on their own. Meanwhile, obesity rates continue to increase. To test the hypothesis that antidepressant use is a risk factor for obesity, even after long-term discontinuation, we developed a novel animal paradigm consisting of short-term exposure to stress and antidepressants, followed by long-term high-fat diet. We show here that recurrent restraint str...

  14. 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

  15. 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.

  16. 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....

  17. Long-term outcomes following drug-eluting stent implantation in unprotected left main bifurcation lesions

    Institute of Scientific and Technical Information of China (English)

    GE Lei; Nicola Corvaja; Antonio Colombo; GE Jun-bo; John Cosgrave; Ioannis Iakovou; QIAN Ju-ying; Pierfrancesco Agostoni; Giuseppe M. Sangiorgi; Flavio Airoldi; Iassen Michev; Alaide Chieffo

    2007-01-01

    Background The safety and efficacy of drug-eluting stents (DES) implantation in unprotected left main (LM)bifurcation lesions has yet to be determined. The aim of the present report was to evaluate the long-term outcome following implantation of DES in unprotected LM bifurcation lesions.Methods We identified 70 consecutive patients treated with DES in unprotected LM bifurcation lesions from April 2003to January 2005. Of them, 42 patients were treated with sirolimus-eluting stent (SES) and 28 patients were treated with paclitaxel-eluting stent (PES).Results Stents to the left anterior descending and to the circumflex were implanted in 62 patients. During 1-year follow-up, 3 (4.3%) patients died of cardiac causes. One of them had myocardial infarction and adjudicated as possibly due to stent thrombosis. Angiographic follow-up was available in 80% of patients. The per lesion restenosis rate was 13.4% in the entire cohort, of which 10.7% occurred in lesions treated with SES and 16.1% in those treated with PES (P=0.58). All restenosis was focal and occurred in the lesions treated with a stent with stent size to post-procedural reference vessel diameter ratio <1.0 (17.6% vs 0, P=0.04). The per patient target lesion revascularization rate at 1 year was 17.1%. One year survival free from major adverse cardiac events was 77.1%.Conclusions Treatment of LM bifurcation lesions using DES is a safe and feasible way with a low one-year mortality.The need for revascularization in 17% of patients demands for improvement.

  18. 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.

  19. The Prune Belly syndrome: urological aspects and long-term outcomes of a rare disease

    Directory of Open Access Journals (Sweden)

    Vahudin Zugor

    2012-06-01

    Full Text Available Prune-Belly syndrome is a disorder characterized by the following triad of symptoms: deficiency of the abdominal muscles, malformations of the urinary tract and bilateral cryptorchidism. This study included a total of 16 patients. The findings included clinical characteristics, diagnostics, therapy and long-term clinical outcomes. All patients were asked to complete a questionnaire and, in some cases, were given further examination. All patients were diagnosed with congenital aplasia of the abdominal wall and a variety of urogenital malformations. Cryptorchidism was present in 11 patients (68.8%, malformations of the prostate in 3 (18.8%, urethral malformations in 8 (50% and mega-ureter in 14 patients (87.5%. A mega-bladder was observed in 13 patients (81.3%. Distinctive renal malformations, such as renal dysplasia, in 3 patients (18.8% and hydronephrosis in 9 patients (56.3%, respectively. Abdominoplasty was performed on 4 patients (25%. Urethral surgery was performed in 10 patients (62.5%. Seven patients (43.8% required ureter surgery, most of which involved re-implantation of the ureter and, in some cases, additional ureter modeling. Renal surgery was performed on 5 patients. Four patients with non-functioning kidneys with hydronephrosis underwent a nephrectomy and one patient pyeloplasty. We demonstrate that successful treatment is possible even in cases of serious and complex malformations, such as those of the Prune-Belly syndrome. Treatment must be tailored to the individual patient. The severity of the renal dysplasia is the main prognostic factor.

  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

    International Nuclear Information System (INIS)

    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. 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. PMID:12686334

  4. Clinical characteristics and long-term outcomes of moyamoya syndrome associated with neurofibromatosis type 1.

    Science.gov (United States)

    Han, Cong; Yang, Wei-Zhong; Zhang, Hong-Tao; Ye, Ting; Duan, Lian

    2015-02-01

    Moyamoya syndrome (MMS) associated with neurofibromatosis type 1 (NF1) has rarely been reported anywhere in the world, particularly in Asia. Because of the rarity of this disorder, its natural history, clinical symptoms, management, and follow-up findings remain unclear. The objective of this study was to evaluate the clinical presentation, neurological imaging, and long-term outcomes of patients with this disease by reviewing Chinese patients with MMS associated with NF1. A retrospective review was conducted from the moyamoya disease (MMD) and MMS patient database of our hospital. Six patients who were diagnosed with MMS associated with NF1 between January 2003 and October 2013 were identified. The clinical symptoms were transient ischemic attack (TIA, three patients), headache (one patient), intracerebral hemorrhage (one patient), and cerebral infarction (one patient). The mean age of diagnosis for NF1 and MMS was 2.7 ± 2.1 years (range, 1-6 years) and 11.4 ± 8.3 years (range, 3.5-23 years), respectively. Five of six patients (nine hemispheres) underwent revascularization surgery, and their clinical symptoms were stable during a 46.3 ± 36.1 month (range, 18-108 month) follow-up. One non-surgical patient had a new infarct that resulted in visual field deficits during follow-up. Three patients had radiographic follow-up, and the postoperative angiograms showed successful revascularizations in the operated hemispheres. To conclude, the clinical and radiographic features for MMS-NF1 are similar to those of typical MMD. Routine vascular screening for NF1 patients is necessary for the early identification of MMS and other cerebral arteriopathies. Revascularization surgery may prevent the progression of clinical symptoms and reduce the risk of subsequent strokes. PMID:25443089

  5. 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.

  6. Long-term health-related and economic consequences of short-term outcomes in evaluation of perinatal interventions

    Directory of Open Access Journals (Sweden)

    Teune Margreet J

    2010-08-01

    Full Text Available Abstract Background Many perinatal interventions are performed to improve long-term neonatal outcome. To evaluate the long-term effect of a perinatal intervention follow-up of the child after discharge from the hospital is necessary because serious sequelae from perinatal complications frequently manifest themselves only after several years. However, long-term follow-up is time-consuming, is not in the awareness of obstetricians, is expensive and falls outside the funding-period of most obstetric studies. Consequently, short-term outcomes are often reported instead of the primary long-term end-point. With this project, we will assess the current state of affairs concerning follow-up after obstetric RCTs and we will develop multivariable prediction models for different long-term health outcomes. Furthermore, we would like to encourage other researchers participating in follow-up studies after large obstetric trials (> 350 women to inform us about their studies so that we can include their follow-up study in our systematic review. We would invite these researchers also to join our effort and to collaborate with us on the external validation of our prediction models. Methods/Design A systematic review of neonatal follow-up after obstetric studies will be performed. All reviews of the Cochrane Pregnancy and Childbirth group will be assessed for reviews on interventions that aimed to improve neonatal outcome. Reviews on interventions primary looking at other aspects than neonatal outcome such as labour progress will also be included when these interventions can change the outcome of the neonate on the short or long-term. Our review will be limited to RCTs with more than 350 women. Information that will be extracted from these RCTs will address whether, how and for how long follow-up has been performed. However, in many cases long-term follow-up of the infants will not be feasible. An alternative solution to limited follow-up could be to develop

  7. 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

  8. 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

  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. Long-term outcomes of intradural cervical dorsal root rhizotomy for refractory occipital neuralgia.

    Science.gov (United States)

    Gande, Abhiram V; Chivukula, Srinivas; Moossy, John J; Rothfus, William; Agarwal, Vikas; Horowitz, Michael B; Gardner, Paul A

    2016-07-01

    OBJECT Occipital neuralgia (ON) causes chronic pain in the cutaneous distribution of the greater and lesser occipital nerves. The long-term efficacy of cervical dorsal root rhizotomy (CDR) in the management of ON has not been well described. The authors reviewed their 14-year experience with CDR to assess pain relief and functional outcomes in patients with medically refractory ON. METHODS A retrospective chart review of 75 ON patients who underwent cervical dorsal root rhizotomy, from 1998 to 2012, was performed. Fifty-five patients were included because they met the International Headache Society's (IHS) diagnostic criteria for ON, responded to CT-guided nerve blocks at the C-2 dorsal nerve root, and had at least one follow-up visit. Telephone interviews were additionally used to obtain data on patient satisfaction. RESULTS Forty-two patients (76%) were female, and the average age at surgery was 46 years (range 16-80). Average follow up was 67 months (range 5-150). Etiologies of ON included the following: idiopathic (44%), posttraumatic (27%), postsurgical (22%), post-cerebrovascular accident (4%), postherpetic (2%), and postviral (2%). At last follow-up, 35 patients (64%) reported full pain relief, 11 (20%) partial relief, and 7 (16%) no pain relief. The extent of pain relief after CDR was not significantly associated with ON etiology (p = 0.43). Of 37 patients whose satisfaction-related data were obtained, 25 (68%) reported willingness to undergo repeat surgery for similar pain relief, while 11 (30%) reported no such willingness; a single patient (2%) did not answer this question. Twenty-one individuals (57%) reported that their activity level/functional state improved after surgery, 5 (13%) reported a decline, and 11 (30%) reported no difference. The most common acute postoperative complications were infections in 9% (n = 5) and CSF leaks in 5% (n = 3); chronic complications included neck pain/stiffness in 16% (n = 9) and upper-extremity symptoms in 5% (n = 3

  11. Juxtaposing Math Self-Efficacy and Self-Concept as Predictors of Long-Term Achievement Outcomes

    Science.gov (United States)

    Parker, Philip David; Marsh, Herbert W.; Ciarrochi, Joseph; Marshall, Sarah; Abduljabbar, Adel Salah

    2014-01-01

    In this study, we tested the hypothesis that self-efficacy and self-concept reflect different underlying processes and both are critical to understanding long-term achievement outcomes. Although both types of self-belief are well established in educational psychology, research comparing and contrasting their relationship with achievement has been…

  12. 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:…

  13. 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.

  14. Long-term outcome of benign childhood epilepsy with centrotemporal spikes: Dutch Study of Epilepsy in Childhood

    NARCIS (Netherlands)

    Callenbach, P.M.C.; Bouma, P.A.D.; Geerts, A.T.; Arts, W.F.M.; Stroink, H.; Peeters, E.A.J.; Van Donselaar, C.A.; Peters, A.C.B.; Brouwer, O.F.

    2010-01-01

    Purpose: Determine long-term outcome in a cohort of children with newly diagnosed benign childhood epilepsy with centrotemporal spikes (BECTS). Method: Thirty children with BECTS were included in the Dutch Study of Epilepsy in Childhood. All children were followed for 12-17 years. Twenty children ha

  15. Long-term exercise in older adults: 4-year outcomes of music-based multitask training.

    Science.gov (United States)

    Hars, Mélany; Herrmann, François R; Fielding, Roger A; Reid, Kieran F; Rizzoli, René; Trombetti, Andrea

    2014-11-01

    Prospective controlled evidence supporting the efficacy of long-term exercise to prevent physical decline and reduce falls in old age is lacking. The present study aimed to assess the effects of long-term music-based multitask exercise (i.e., Jaques-Dalcroze eurhythmics) on physical function and fall risk in older adults. A 3-year follow-up extension of a 1-year randomized controlled trial (NCT01107288) was conducted in Geneva (Switzerland), in which 134 community-dwellers aged ≥65 years at increased risk of falls received a 6-month music-based multitask exercise program. Four years following original trial enrolment, 52 subjects (baseline mean ± SD age, 75 ± 8 years) who (i) have maintained exercise program participation through the 4-year follow-up visit ("long-term intervention group", n = 23) or (ii) have discontinued participation following original trial completion ("control group", n = 29) were studied. They were reassessed in a blind fashion, using the same procedures as at baseline. At 4 years, linear mixed-effects models showed significant gait (gait speed, P = 0.006) and balance (one-legged stance time, P = 0.015) improvements in the long-term intervention group, compared with the control group. Also, long-term intervention subjects did better on Timed Up & Go, Five-Times-Sit-to-Stand and handgrip strength tests, than controls (P music-based multitask exercise program is a promising strategy to prevent age-related physical decline in older adults. They also highlight the efficacy of sustained long-term adherence to exercise for falls prevention. PMID:25148876

  16. Herpes simplex serious neurological disease in young children: incidence and long-term outcome

    OpenAIRE

    Ward, Katherine N.; Ohrling, Anu; Bryant, Naomi J; Bowley, Jennifer S; Ross, Euan M; Verity, Christopher M

    2011-01-01

    Objective To determine the contribution of herpes simplex virus (HSV) to serious neurological disease. Setting and patients A 3-year prospective survey of children aged 2–23 months in Britain and Ireland. Results 19 children had HSV central nervous system (CNS) infection; 13 aged 2–11 months had focal neuroimaging abnormalities and 11 long-term neurological sequelae. Of six aged 12–35 months, one had abnormal neuroimaging and three long-term neurological sequelae. 17 of the 19 had serious neu...

  17. Long-Term Exercise in Older Adults: 4-Year Outcomes of Music-Based Multitask Training

    OpenAIRE

    Hars, Mélany; Herrmann, François R.; Fielding, Roger A.; Reid, Kieran F.; Rizzoli, René; Trombetti, Andrea

    2014-01-01

    Prospective controlled evidence supporting the efficacy of long-term exercise to prevent physical decline and reduce falls in old age is lacking. The present study aimed to assess the effects of long-term music-based multitask exercise (i.e., Jaques-Dalcroze eurhythmics) on physical function and fall risk in older adults. A 3-year follow-up extension of a 1-year randomized controlled trial (NCT01107288) was conducted in Geneva (Switzerland), in which 134 community-dwellers aged ≥65 years at i...

  18. A simple modified Bentall technique for surgical reconstruction of the aortic root – short and long term outcomes

    OpenAIRE

    Nezafati, Pouya; Shomali, Ali; Nezafati, Mohammad Hassan

    2015-01-01

    Background Since the first introduction of the Bentall technique, several modifications have been proposed to improve patient outcomes and decrease intra- and post-operative complications. We describe a simplified modification of the technique that tries to lessen the intra-operative time, improve homeostasis and miminize early and late complications. Our experience with the technique and short- and long-term patient outcomes are reported. Methods From August 1996 to October 2013, 110 consecu...

  19. Disruption of White Matter Integrity in Adult Survivors of Childhood Brain Tumors: Correlates with Long-Term Intellectual Outcomes

    OpenAIRE

    King, Tricia Z.; Liya Wang; Hui Mao

    2015-01-01

    Background Although chemotherapy and radiation treatment have contributed to increased survivorship, treatment-induced brain injury has been a concern when examining long-term intellectual outcomes of survivors. Specifically, disruption of brain white matter integrity and its relationship to intellectual outcomes in adult survivors of childhood brain tumors needs to be better understood. Methods Fifty-four participants underwent diffusion tensor imaging in addition to structural MRI and an in...

  20. 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

  1. 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

  2. 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

  3. 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.

  4. 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

    Studies of long-term consequences of birth in breech presentation are sparse. Therefore, we conducted a cohort study linking birth registry data with data collected during evaluation for military service in 4,298 conscripts born between 1973 and 1976. The cognitive functions were measured...

  5. Long-term outcome of Hurler syndrome patients after hematopoietic cell transplantation : an international multicenter study

    NARCIS (Netherlands)

    Aldenhoven, Mieke; Wynn, Robert F.; Orchard, Paul J.; O'Meara, Anne; Veys, Paul; Fischer, Alain; Valayannopoulos, Vassili; Neven, Benedicte; Rovelli, Attilio; Prasad, Vinod K.; Tolar, Jakub; Allewelt, Heather; Jones, Simon A.; Parini, Rossella; Renard, Marleen; Bordon, Victoria; Wulffraat, Nico M.; de Koning, Tom J.; Shapiro, Elsa G.; Kurtzberg, Joanne; Boelens, Jaap Jan

    2015-01-01

    Mucopolysaccharidosis type I-Hurler syndrome (MPS-IH) is a lysosomal storage disease characterized by multisystem morbidity and death in early childhood. Although hematopoietic cell transplantation (HCT) has been performed in these patients for more than 30 years, large studies on the long-term outc

  6. Long-term outcome of Hurler syndrome patients after hematopoietic cell transplantation : An international multicenter study

    NARCIS (Netherlands)

    Aldenhoven, Mieke; Wynn, Robert F.; Orchard, Paul J.; O'Meara, Anne; Veys, Paul; Fischer, Alain; Valayannopoulos, Vassili; Neven, Benedicte; Rovelli, Attilio; Prasad, Vinod K.; Tolar, Jakub; Allewelt, Heather; Jones, Simon A.; Parini, Rossella; Renard, Marleen; Bordon, Victoria; Wulffraat, Nico M.; de Koning, Tom J.; Shapiro, Elsa G.; Kurtzberg, Joanne; Boelens, Jaap Jan

    2015-01-01

    Mucopolysaccharidosis type I-Hurler syndrome (MPS-IH) is a lysosomal storage disease characterized by multisystem morbidity and death in early childhood. Although hematopoietic cell transplantation (HCT) has been performed in these patients for more than 30 years, large studies on the long-term outc

  7. Soluble CXCL16 and long-term outcome in acute ischemic stroke

    DEFF Research Database (Denmark)

    Ueland, T; Smedbakken, L M; Hallén, J;

    2012-01-01

    CXCL16 is a chemokine involved in atherosclerosis by promoting inflammation, lipid accumulation and matrix degradation. The level of circulating CXCL16 has been proposed as a predictor of long-term mortality in acute coronary syndromes. We studied plasma CXCL16 in acute ischemic stroke and examined...

  8. 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.

  9. Long-term neuropsychological outcomes in children and adolescents after cardiac arrest

    NARCIS (Netherlands)

    L. van Zellem (Lennart); C.M.P. Buysse (Corinne); M.J. Madderom (Marlous); J.S. Legerstee (Jeroen); F.K. Aarsen (Femke); D. Tibboel (Dick); E.M.W.J. Utens (Elisabeth)

    2015-01-01

    textabstractPurpose: Research into neuropsychological functioning of survivors of cardiac arrest (CA) in childhood is scarce. We sought to assess long-term neuropsychological functioning in children and adolescents surviving CA. Methods: Neuropsychological follow-up study involving all consecutive c

  10. 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

  11. 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)

  12. Relationship of Prior Antidepressant Exposure to Long-Term Prospective Outcome in Bipolar I Disorder Outpatients

    NARCIS (Netherlands)

    Post, Robert M.; Leverich, Gabriele S.; Altshuler, Lori L.; Frye, Mark A.; Suppes, Trisha; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Rowe, Mike; Kupka, Ralph W.; Grunze, Heinz; Goodwin, Frederick K.

    2012-01-01

    Objective:The long-term impact of prior antidepressant exposure on the subsequent course of bipolar illness remains controversial. Method: 139 outpatients (mean age, 42 years) with bipolar I disorder diagnosed by DSM-IV criteria had a detailed retrospective examination of their prior course of illne

  13. 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.

  14. Quality of life and self-esteem in patients submitted to surgical treatment of skin carcinomas: long-term results *

    OpenAIRE

    Maciel, Paula Curitiba; Veiga-Filho, Joel; de Carvalho, Marcelo Prado; Fonseca, Fernando Elias Martins; Ferreira, Lydia Masako; Veiga, Daniela Francescato

    2014-01-01

    BACKGROUND Cancer is a multifactorial disease and skin carcinomas are the most common type of cancer. Assessing quality of life and self-esteem outcomes in skin cancer patients is important because these are indicators of the results of the treatment, translating how patients face their lives and their personal relationships. OBJECTIVE To assess the late impact of the surgical treatment of head and/or neck skin carcinomas on quality of life and self-esteem of the patients. METHODS Fifty patie...

  15. 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.

  16. 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

  17. Understanding the Short- and Long-Term Respiratory Outcomes of Prematurity and Bronchopulmonary Dysplasia

    OpenAIRE

    Islam, Jessica Y; Keller, Roberta L; Aschner, Judy L.; Hartert, Tina V; Moore, Paul E

    2015-01-01

    Bronchopulmonary dysplasia (BPD) is a chronic respiratory disease associated with premature birth that primarily affects infants born at less than 28 weeks’ gestational age. BPD is the most common serious complication experienced by premature infants, with more than 8,000 newly diagnosed infants annually in the United States alone. In light of the increasing numbers of preterm survivors with BPD, improving the current state of knowledge of long-term respiratory morbidity for infants with BPD ...

  18. Long-term outcome after implantation of prosthetic disc nucleus device (PDN) in lumbar disc disease

    OpenAIRE

    Selviaridis, P; Foroglou, N; Tsitlakidis, A; Hatzisotiriou, A; Magras, I; Patsalas, I

    2010-01-01

    Background: The prosthetic disc nucleus (PDN) device offers an adjunct treatment for patients with degenerative disc disease and herniation, who necessitate surgical intervention, avoiding total-disc replacement or fusion. This prospective, clinical study aimed to gauge the long-term effectiveness of microdiscectomy followed by PDN implantation in relieving pain and improving functional status in patients with symptomatic degenerative lumbar disc disease and herniation.

  19. Bulimia nervosa, binge eating, and psychogenic vomiting: a controlled treatment study and long term outcome.

    OpenAIRE

    J. H. Lacey

    1983-01-01

    An "epidemic" prevalence of binge eating and vomiting (bulimia nervosa) has been reported, and treatment has been claimed to be difficult. This paper describes a short term outpatient treatment programme of eclectic orientation capable of being conducted by non-specialist staff, under medical supervision, in local centres. The treatment programme was evaluated in a controlled trial and in long term follow up. In 30 women with severe bulimia the treatment programme significantly reduced their ...

  20. 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.

  1. 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

    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......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...... (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...

  2. 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.

  3. Long-Term Outcome after Laparoscopic Bowel Resections for Deep Infiltrating Endometriosis: A Single-Center Experience after 900 Cases

    OpenAIRE

    Ruffo, Giacomo; Scopelliti, Filippo; Manzoni, Alberto; Sartori, Alberto; Rossini, Roberto; Ceccaroni, Marcello; Minelli, Luca; Crippa, Stefano; Partelli, Stefano; Falconi, Massimo

    2014-01-01

    Background. Laparoscopic bowel resections for endometriosis are safe and effective but only short-term follow-up has been evaluated. In the present study long-term outcome in terms of intestinal and urinary function, fertility, chronic pain, and recurrence was assessed. Materials and Methods. From January 2002 to December 2010 nine hundred patients underwent laparoscopic bowel resection for endometriosis, and on 774 (86%) a questionnaire was administered. Patients were divided into 3 groups o...

  4. Initial reduction of oxidative stress by angiotensin receptor blocker contributes long term outcomes after percutaneous coronary intervention

    OpenAIRE

    Noro, Tadanori; Takehara, Naofumi; Sumitomo, Kazuhiro; Takeuchi, Toshiharu; Ishii, Yoshinao; Kato, Jun-ichi; Kawabe, Jun-ichi; Hasebe, Naoyuki

    2014-01-01

    Background: It remains unclear whether administration of ARB with reactive oxygen species (ROS) scavenging effects improves the prognosis of patients undergoing PCI. Objectives: This study investigated whether the pre-intervention antioxidant effect of angiotensin receptor blocker (ARB) affects long-term outcomes in patients after successful percutaneous coronary intervention (PCI) without early adverse events. Methods: Fifty-two patients who underwent elective PCI were randomly assigned for ...

  5. Long-term adverse outcomes in survivors of childhood bone sarcoma: the British Childhood Cancer Survivor Study

    OpenAIRE

    Fidler, M M; Frobisher, C; Guha, J; K. Wong; Kelly, J; Winter, D. L.; Sugden, E; Duncan, R.; Whelan, J; Reulen, R C; Hawkins, M. M.

    2015-01-01

    Background: With improved survival, more bone sarcoma survivors are approaching middle age making it crucial to investigate the late effects of their cancer and its treatment. We investigated the long-term risks of adverse outcomes among 5-year bone sarcoma survivors within the British Childhood Cancer Survivor Study. Methods: Cause-specific mortality and risk of subsequent primary neoplasms (SPNs) were investigated for 664 bone sarcoma survivors. Use of health services, health and marital st...

  6. Long-term outcome after surgery for pulmonary stenosis (a longitudinal study of 22-33 years)

    OpenAIRE

    Roos-Hesselink, Jolien; Meijboom, Folkert; Spitaels, Silja; VanDomburg, R.; VanRijen, E. H M; Utens, Elisabeth; Bogers, Ad; Simoons, Maarten

    2006-01-01

    textabstractAims: Long-term (>20 years) survival and clinical outcome are only partly documented in patients who underwent surgical repair for isolated pulmonary stenosis. Yet, such data are of critical importance for the future perspectives, medical care, employability, and insurability of these patients. Methods and results: Ninety consecutive patients underwent surgery for pulmonary stenosis between 1968 and 1980 at the Thoraxcenter. A systematic follow-up study was performed in 1990 and a...

  7. Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity

    OpenAIRE

    Parag K Shah; Ramakrishnan, Minu; Sadat, Bani; Bachu, Sandeep; V Narendran; Kalpana, N.

    2014-01-01

    Aim: To report the long term refractive, visual and structural outcome post-laser for zone 1 aggressive posterior retinopathy of prematurity (AP-ROP). Materials and Methods: A retrospective analysis was performed of refractive status of premature infants with zone 1 AP-ROP who underwent laser photocoagulation from 2002 to 2007 and followed up till 2013. Once the disease regressed, children were followed up six monthly with detailed examination regarding fixation pattern, ocular motility, nyst...

  8. Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity

    OpenAIRE

    Parag K Shah; Minu Ramakrishnan; Bani Sadat; Sandeep Bachu; V Narendran; Kalpana, N.

    2014-01-01

    Aim: To report the long term refractive, visual and structural outcome post-laser for zone 1 aggressive posterior retinopathy of prematurity (AP-ROP). Materials and Methods: A retrospective analysis was performed of refractive status of premature infants with zone 1 AP-ROP who underwent laser photocoagulation from 2002 to 2007 and followed up till 2013. Once the disease regressed, children were followed up six monthly with detailed examination regarding fixation pattern, ocular motility, ...

  9. 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 ...

  10. 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.

  11. Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up.

    Science.gov (United States)

    Silverplats, Katarina; Lind, B; Zoëga, B; Halldin, K; Rutberg, L; Gellerstedt, M; Brisby, H

    2010-09-01

    Factors as age, sex, smoking, duration of leg pain, working status, type/level of disc herniation and psychosocial factors have been demonstrated to be of importance for short-term results after lumbar discectomy. There are few studies with long-term follow-up. In this prospective study of lumbar disc herniation patients undergoing surgery, the result was evaluated at 2 and 5-10 (mean 7.3) years after surgery. Predictive factors for satisfaction with treatment and objective outcome were investigated. Out of the included 171 patients undergoing lumbar discectomy, 154 (90%) patients completed the 2-year follow-up and 140 (81%) completed the long-term follow-up. Baseline data and questionnaires about leg- and back pain intensity (VAS), duration of leg pain, disability (Oswestry Disability Index), depression (Zung Depression Scale), sick leave and employment status were obtained preoperatively, at 2-year- and long-term follow-up. Primary outcome included patient satisfaction with treatment (at both time points) and assessment of an independent observer at the 2-year follow-up. Secondary outcomes at 2-year follow-up were improvement of leg and back pain, working capacity and the need for analgesics or sleeping pills. In about 70% of the patients excellent or good overall result was reported at both follow-ups, with subjective outcome measurements. The objective evaluation after 2 years was in agreement with this result. Time on sick leave was found to be a clinically important predictor of the primary outcomes, with a potential of changing the probability of a satisfactory outcome (both objective and subjective) from around 50% (sick leave >3 months) to 80% (sick leave <2 months). Time on sick leave was also an important predictor for several of the secondary outcomes; e.g. working capacity and the need for analgesics. PMID:20512513

  12. 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.

  13. Mechanisms Predisposing Penile Fracture and Long-Term Outcomes on Erectile and Voiding Functions

    Directory of Open Access Journals (Sweden)

    Leonardo O. Reis

    2014-01-01

    Full Text Available Purpose. To determine the mechanisms predisposing penile fracture as well as the rate of long-term penile deformity and erectile and voiding functions. Methods. All fractures were repaired on an emergency basis via subcoronal incision and absorbable suture with simultaneous repair of eventual urethral lesion. Patients’ status before fracture and voiding and erectile functions at long term were assessed by periodic follow-up and phone call. Detailed history included cause, symptoms, and single-question self-report of erectile and voiding functions. Results. Among the 44 suspicious cases, 42 (95.4% were confirmed, mean age was 34.5 years (range: 18–60, mean follow-up 59.3 months (range 9–155. Half presented the classical triad of audible crack, detumescence, and pain. Heterosexual intercourse was the most common cause (28 patients, 66.7%, followed by penile manipulation (6 patients, 14.3%, and homosexual intercourse (4 patients, 9.5%. “Woman on top” was the most common heterosexual position (n=14, 50%, followed by “doggy style” (n=8, 28.6%. Four patients (9.5% maintained the cause unclear. Six (14.3% patients had urethral injury and two (4.8% had erectile dysfunction, treated by penile prosthesis and PDE-5i. No patient showed urethral fistula, voiding deterioration, penile nodule/curve or pain. Conclusions. “Woman on top” was the potentially riskiest sexual position (50%. Immediate surgical treatment warrants long-term very low morbidity.

  14. Teenagers losing a parent to cancer : experiences, modifiable risk-factors and long-term outcome

    OpenAIRE

    Bylund Grenklo, Tove

    2013-01-01

    Background: We investigated the experiences of cancer-bereaved teenagers. The goal was to identify potentially modifiable risk-factors for long-term psychological consequences and thus be able to guide health-care providers in ways to support bereaved-to-be teenagers. Subjects and Methods: A study-specific questionnaire was made based on semi-structured interviews with cancer-bereaved youths and tested for face-to-face validity. Through population-based registers, we identified cancer-bere...

  15. 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

  16. 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

  17. 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.

  18. The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Tio René A

    2008-02-01

    Full Text Available Abstract Background In the present study we sought to determine the long-term prognostic value of left ventricular ejection fraction (LVEF, assessed by planar radionuclide ventriculography (PRV, after ST-elevation myocardial infarction (STEMI treated with primary percutaneous coronary intervention (PPCI. Methods In total 925 patients underwent PRV for LVEF assessment after PPCI for myocardial infarction before discharge from the hospital. PRV was performed with a standard dose of 500 Mbq of 99mTc-pertechnetate. Average follow-up time was 2.5 years. Results Mean (± SD age was 60 ± 12 years. Mean (± SD LVEF was 45.7 ± 12.2 %. 1 year survival was 97.3 % and 3 year survival was 94.2 %. Killip class, multi vessel-disease, previous cardiovascular events, peak creatin kinase and its MB fraction, age and LVEF proved to be univariate predictors of mortality. When entered in a forward conditional Cox regression model age and LVEF were independent predictors of 1 and 3 year mortality. Conclusion LVEF assessed by PRV is a powerful independent predictor of long term mortality after PPCI for STEMI.

  19. 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.

  20. 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.

  1. Clinical factors related to long-term administration of sorafenib in patients with hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Sorafenib has been approved in the indication of unresectable hepatocellular carcinoma, but there are many cases in which administration of the drug is discontinued due to severe side effects. In this study, we compared the characteristics of patients who continued and discontinued sorafenib. Ninety-six patients (75 men and 21 women) were initiated on sorafenib from July 2009 through September 2011. The patient characteristics of interest included gender, age, etiology, Child-Pugh classification, treatment history and frequency, and levels of α-fetoprotein, des- gamma-carboxy prothrombin, aspartate amino acid transferase, and alanine aminotransferase. Duration of administration of sorafenib and reasons for its discontinuation were compared. Median overall survival was 11.8 months. Discontinuation of sorafenib within 90 days was identified as an independent prognostic factor for overall survival on multivariate analysis (P < 0.0001). Transarterial chemoembolization performed six times or more (P = 0.013) was also identified as an independent factor contributing to discontinuation of sorafenib within 90 days in multivariate analysis. Patients who received sorafenib for ≥90 days had significantly longer overall survival than those who discontinued it (P < 0.0001). Prolonged treatment with sorafenib is an important factor in achieving extended overall survival. We recommend starting sorafenib before latent liver damage has occurred as a result of too many transarterial chemoembolization procedures

  2. An updated review of long-term outcomes from randomized controlled trials in approved pharmaceuticals for diabetic macular edema.

    Science.gov (United States)

    Wang, Jia-Kang; Huang, Tzu-Lun; Su, Pei-Yuan; Chang, Pei-Yao

    2015-12-01

    Diabetic macular edema (DME) is a major sight-threatening cause in diabetic patients. We review the long-term outcome of four approved pharmacotherapy for treating DME, including intravitreal injections of corticosteroids (dexamethasone implants and fluocinolone acetonide inserts) and anti-vascular endothelial growth factor (VEGF) (ranibizumab and aflibercept). They all show superior ability to improve vision and reduce macular thickness, comparing with sham injections or macular focal/grid laser treatment. Anti-VEGF agents result in low incidence of severe ocular or systemic adverse effects, but glaucoma and cataract should be aware after intravitreal corticosteroids. Prompt treatment with these agents can lead to a better outcome PMID:27215008

  3. Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting

    Directory of Open Access Journals (Sweden)

    Wallin ÅK

    2011-09-01

    Full Text Available Åsa K Wallin, Carina Wattmo, Lennart MinthonClinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, SwedenBackground: In the absence of long-term, placebo-controlled studies of cholinesterase inhibitors in Alzheimer's disease (AD, analysis of the results of open-label trials becomes crucial. This study aimed to explore the three-year effects of galantamine treatment, as well as subgroups of response and adherence to treatment.Methods: Two hundred and eighty patients with a clinical diagnosis of AD were included in the prospective, open-label, multicenter Swedish Alzheimer Treatment Study, and received galantamine treatment. Efficacy measures included cognitive tests, ie, the Mini-Mental State Examination (MMSE and Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-cog, functional rating (Instrumental Activities of Daily Living Scale [IADL], and global rating. Assessments were carried out before treatment and every six months for a period of three years. K-means cluster analysis was used to identify response subgroups.Results: After three years of treatment, the mean change from baseline was 2.6 points in MMSE and 5.6 points in ADAS-cog scores. Globally, half of the patients improved or remained unchanged for two years. Cluster analysis identified two response clusters. Cluster 1 included patients with low ability in ADAS-cog and IADL scores at baseline. Even though the patients in cluster 1 were older and less educated, they responded better at six months compared with patients in cluster 2. Cluster 2 included patients with better ADAS-cog and IADL scores at baseline. Patients in cluster 2 had a higher frequency of the APOE ε4 allele, a slower pretreatment progression rate, and remained in the study longer than those in cluster 1. Three-year completers (n = 129, 46% received higher doses of galantamine compared with dropouts.Conclusion: AD patients who received long-term galantamine treatment were

  4. Long-term Outcomes of Military Service in Aging and the Life Course: A Positive Re-envisioning.

    Science.gov (United States)

    Spiro, Avron; Settersten, Richard A; Aldwin, Carolyn M

    2016-02-01

    Most research on military service focuses on its short-term negative consequences, especially the mental and physical injuries of those deployed in warzones. However, studies of long-term outcomes reveal surprisingly positive effects of military service--both those early in adulthood that grow over time and others that can emerge later in life. These multidomain effects have been found in veterans of World War II and the Korean War and are now being seen in veterans of the Vietnam War. Although some are directly attributable to public policies such as the GI Bill, which facilitate educational and economic gains, there are personal developmental gains as well, including autonomy, emotional maturity and resilience, mastery, and leadership skills, that lead to better health and well-being in later life. These long-term effects vary across persons, change over time within persons, and often reflect processes of cumulative advantage and disadvantage. We propose a life-span model of the effects of military service that provides a perspective for probing both long-term positive and negative outcomes for aging veterans. We further explicate the model by focusing on both sociocultural dynamics and individual processes. We identify public-use data that can be examined to evaluate this model, and offer a set of questions that can be used to assess military service. Finally, we outline an agenda for dedicated inquiry into such effects and consider policy implications for the health and well-being of aging veterans in later life. PMID:26655859

  5. 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.

  6. Long term clinical outcome of peripheral nerve stimulation in patients with chronic peripheral neuropathic pain

    DEFF Research Database (Denmark)

    Calenbergh, F. Van; Gybels, J.; Laere, K. Van;

    2009-01-01

    BACKGROUND: Chronic neuropathic pain after injury to a peripheral nerve is known to be resistant to treatment. Peripheral nerve stimulation is one of the possible treatment options, which is, however, not performed frequently. In recent years we have witnessed a renewed interest for PNS. The aim...... of the present study was to evaluate the long-term clinical efficacy of PNS in a group of patients with peripheral neuropathic pain treated with PNS since the 1980s. METHODS: Of an original series of 11 patients, 5 patients could be invited for clinical examination, detailed assessment of clinical pain and QST...... functioning) also showed positive effects. Quantitative Sensory Testing results did not show significant differences in cold pain and heat pain thresholds between the "ON" and "OFF" conditions. CONCLUSION: In selected patients with peripheral neuropathic pain PNS remains effective even after more than 20...

  7. 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.

  8. 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.

  9. Long term outcome of treatment of diffuse proliferative glomerulonephritis with pulse steroids and short course pulse cyclophosphamide

    Directory of Open Access Journals (Sweden)

    S. Bombardieri

    2011-06-01

    Full Text Available Objectives: To evaluate the long- term outcome of a group of systemic lupus erythematosus (SLE patients with diffuse proliferative glomerulonephritis (DPGN treated with pulse steroids and a short course of pulse cyclophosphamide (Cyc in order to find out baseline predictor variables of disease outcome at the end of the follow-up. Methods: Female SLE patients fulfilling ACR criteria with active DPGN treated with pulse steroids and pulse Cyc were enrolled in the study and retrospectively analyzed with particular interest to renal flares and poor renal outcome at the end of follow- up as outcome measures. Results: 30 female patients with DPGN were included, of these 20 (66,7% patients are actually in follow-up at our unit, 4 (13.3% died and 6 (20% were lost during the follow-up. Fourteen patients (46.6% presented at least one renal flare (RF during the follow up for a total of 21 flares. At our last observation, 18 (60% presented a good renal outcome while 12 (40% had a poor outcome. Lower age at kidney biopsy resulted an important prognostic factor for the occurrence of both RF and poor long- term renal outcome; additionally, a poor renal outcome resulted significantly correlated with an inadequate response at the end of the protocol and with the number of renal flares after remission. Conclusions: These data suggest that, in general, a short course therapy with Cyc might be effective in controlling disease activity but demonstrated high rate of RF and poor renal outcome over time; however, this protocol might represent an effective therapeutic strategy in a subgroup of patients with specific epidemiological and clinical characteristics and suggest the possibility of tailoring immunosuppressive therapy on the basis of prognostic factor at baseline.

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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.

  15. 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.

  16. Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

    DEFF Research Database (Denmark)

    Døssing, Helle; Bennedbæk, Finn Noe; Hegedüs, Laszlo

    2011-01-01

    Aim To evaluate the long-term efficacy of interstitial laser photocoagulation (ILP) in solitary benign thyroid nodules. Design and methods A total of 78 euthyroid outpatients (45 participating in randomized trials) with a benign solitary solid and scintigraphically cold thyroid nodule causing local...... discomfort were assigned to ILP. ILP (using one laser fiber) was performed under continuous ultrasound (US) guidance and with an output power of 1.5-3.5 W. Thyroid nodule volume was assessed by US and thyroid function determined by routine assays, before and during follow-up. Pressure symptoms and cosmetic...... complaints were evaluated on a visual analogue scale (0-10 cm). Of the total patients, six had thyroid surgery 6 months after ILP and three were lost to follow-up. The median follow-up for the remaining 69 patients was 67 months (range 12-114). Results The overall median nodule volume decreased from 8.2 ml...

  17. 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.

  18. Long-term outcome assessment of closed treatment of mandibular fractures.

    Science.gov (United States)

    Fayazi, Sara; Bayat, Mohammad; Bayat-Movahed, Saeed; Sadr-Eshkevari, Pooyan; Rashad, Ashkan

    2013-05-01

    Mandibular fractures are among the most common trauma injuries of the craniomaxillofacial region. This study evaluated the late results of mandibles fractures treated with arch bar. Forty-nine patients were examined clinically and by questionnaires for late results of arch bar treatment. Demographic data (age, sex, etc), trigeminal nerve sensation (Weber test), temporomandibular joint evaluation, masticatory muscle function, and occlusion were recorded. The data were analyzed by χ test using Sigma Stat 2.0 software. Fifty-one percent of the patients with angular fractures complained of sensory disturbances. Condylar and angular fractures demonstrated higher levels of pain. According to Pearson χ test, a statistically significant relation between angular fracture and tenderness of the internal pterygoid muscles (P = 0.047), angular fracture and cross-bite (P = 0.021), parasymphysial fracture and pain upon wind blowing (P = 0.026), and body fracture and mastication discomfort (P = 0.038) was found. In closed reduction therapy, fracture location of the mandible seems to be more likely correlated in producing particular long-term complications. Regular follow-ups for functional treatments and physiotherapy of chewing muscles and temporomandibular joint, along with removal of occlusal abnormalities, should be considered following arch bar reduction of mandibular fractures. PMID:23714869

  19. Chondroitinase ABC treatment of injured spinal cord in rats Evaluation of long-term outcomes

    Institute of Scientific and Technical Information of China (English)

    Haifeng Yuan; Qingquan Kong; Yongli Ding; Yueming Song; Lihong Hu; Zili Wang; Hao Liu; Limin Liu; Quan Gong; Tao Li

    2010-01-01

    Chondroitin sulfate proteoglycans(CSPGs)which are produced by mature oligodendrocytes and reactive astrocytes can be upregulated after spinal cord injury and contribute to regenerative failure.Chondroitinase ABC(ChABC)digests glycosaminoglycan chains on CSPGs and can thereby overcome CSPG-mediated inhibition.However,many current studies have used an incomplete spinal cord injury model,and examined results after 8 12 weeks of ChABC treatment.In this study,a complete rat spinal cord transection injury model was used to study the long-term effects of ChABC treatment by subarachnoid catheter.Pathology of spinal cord regeneration was compared with control 24 weeks following ChABC treatment using immunohistochemistry and axon tracing techniques.At 24 weeks after injury,neurofilament 200 expression was significantly greater in the ChABC treatment group compared with the transection group.In the ChABC treatment group,axonal growth was demonstrated by a large number of biotinylated dextran amine positive axons caudal to,or past,the epicenter of injury.Biotinylated dextran amine-labeled fibers were found in the proximal end of the spinal cord in the transection alone group.These results confirm that ChABC can promote axon growth,neural regeneration,and repair after spinal cord injury in rats long after the initial injury.

  20. 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)

  1. 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

  2. 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.

  3. 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

  4. Effect of B-type natriuretic peptides on long-term outcomes after transcatheter aortic valve implantation.

    Science.gov (United States)

    Koskinas, Konstantinos C; O'Sullivan, Crochan J; Heg, Dik; Praz, Fabien; Stortecky, Stefan; Pilgrim, Thomas; Buellesfeld, Lutz; Jüni, Peter; Windecker, Stephan; Wenaweser, Peter

    2015-11-15

    B-type natriuretic peptide (BNP) levels are elevated in patients with aortic stenosis (AS) and decrease acutely after replacement of the stenotic valve. The long-term prognostic value of BNP after transcatheter aortic valve implantation (TAVI) and the relative prognostic utility of single versus serial peri-interventional measurements of BNP and N-terminal prohormone BNP (NT-pro-BNP) are unknown. This study sought to determine the impact of BNP levels on long-term outcomes after TAVI and to compare the utility of BNP versus NT-pro-BNP measured before and after intervention. We analyzed 340 patients with severe AS and baseline pre-TAVI assessment of BNP. In 219 patients, BNP and NT-pro-BNP were measured serially before and after intervention. Clinical outcomes over 2 years were recorded. Patients with high baseline BNP (higher tertile ≥591 pg/ml) had increased risk of all-cause mortality (adjusted hazard ratio 3.16, 95% confidence interval 1.84 to 5.42; p curve 0.75; p <0.01). Baseline-to-discharge reduction, but not baseline levels of BNP, was related to New York Heart Association functional improvement. In conclusion, high preintervention BNP independently predicts 2-year outcomes after TAVI, particularly when elevated levels persist after the intervention. BNP and NT-pro-BNP and their serial periprocedural changes provide complementary prognostic information for symptomatic improvement and survival. PMID:26428025

  5. Long-term outcome of laminectomy and instrumented fusion for cervical ossification of the posterior longitudinal ligament

    OpenAIRE

    Chen, Yu; Guo, Yongfei; Chen, Deyu; Wang, Xinwei; Lu, Xuhua; Yuan, Wen

    2008-01-01

    Between January 2000 and December 2003, a total of 83 patients (64 men and 19 women, average age: 56.4 years, range: 42–78 years) who underwent posterior laminectomy and instrumented fusion for ossification of the posterior longitudinal ligament (OPLL) were included in this study to investigate the long-term outcome of this surgical option and clarify which factors affect the prognosis. After an average 4.8-year follow-up, the mean Japanese Orthopaedic Association (JOA) score significantly in...

  6. Long-Term Breast Cancer Patient Outcomes After Adjuvant Radiotherapy Using Intensity-Modulated Radiotherapy or Conventional Tangential Radiotherapy

    OpenAIRE

    Yang, Jen-Fu; Lee, Meei-Shyuan; Lin, Chun-Shu; Chao, Hsing-Lung; Chen, Chang-Ming; Lo, Cheng-Hsiang; Fan, Chao-Yueh; Tsao, Chih-Cheng; Huang, Wen-Yen

    2016-01-01

    Abstract The aim of the article is to analyze breast cancer patient clinical outcomes after long-term follow-up using intensity-modulated radiotherapy (IMRT) or conventional tangential radiotherapy (cRT). We retrospectively reviewed patients with stage 0–III breast cancer who received breast conserving therapy between April 2004 and December 2007. Of the 234 patients, 103 (44%) were treated with IMRT and 131 (56%) were treated with cRT. A total prescription dose of 45 to 50 Gy (1.8–2 Gy per f...

  7. Cannabis and First-Episode Psychosis: Different Long-term Outcomes Depending on Continued or Discontinued Use

    OpenAIRE

    González-Pinto, Ana; Alberich, Susana; Barbeito, Sara; Gutierrez, Miguel; Vega, Patricia; Ibáñez, Berta; Haidar, Mahmoud Karim; Vieta, Eduard; Arango, Celso

    2009-01-01

    Objective: To examine the influence of cannabis use on long-term outcome in patients with a first psychotic episode, comparing patients who have never used cannabis with (a) those who used cannabis before the first episode but stopped using it during follow-up and (b) those who used cannabis both before the first episode and during follow-up. Methods: Patients were studied following their first admission for psychosis. They were interviewed at years 1, 3, and 5. At follow-up after 8 years, fu...

  8. Long-Term Cognitive Outcomes of Birth Asphyxia and the Contribution of Identified Perinatal Asphyxia to Cerebral Palsy.

    Science.gov (United States)

    Pappas, Athina; Korzeniewski, Steven J

    2016-09-01

    Neonatal encephalopathy among survivors of presumed perinatal asphyxia is recognized as an important cause of cerebral palsy (CP) and neuromotor impairment. Recent studies suggest that moderate to severe neonatal encephalopathy contributes to a wide range of neurodevelopmental and cognitive impairments among survivors with and without CP. Nearly 1 of every 4 to 5 neonates treated with hypothermia has or develops CP. Neonatal encephalopathy is diagnosed in only approximately 10% of all cases. This article reviews the long-term cognitive outcomes of children with presumed birth asphyxia and describes what is known about its contribution to CP. PMID:27524454

  9. The Long-Term Outcomes after Radical Prostatectomy of Patients with Pathologic Gleason 8–10 Disease

    OpenAIRE

    Lewinshtein, Dan; Teng, Brandon; Valencia, Ashley; Gibbons, Robert; Porter, Christopher R.

    2012-01-01

    Background. We explored the long-term clinical outcomes including metastases-free survival and prostate cancer-specific survival (PCSS) in patients with pathologic Gleason 8–10 disease after radical prostatectomy (RP). Methods. We report on 91 patients with PCSS data with a median followup of 8.2 years after RP performed between 1988 and 1997. Cox regression and Kaplan-Meier analysis were used to evaluate year of surgery, pathologic stage, and surgical margin status as predictors of PCSM. Res...

  10. Long-term executive functioning outcomes for complicated and uncomplicated mild traumatic brain injury sustained in early childhood.

    Science.gov (United States)

    Papoutsis, Jennifer; Stargatt, Robyn; Catroppa, Cathy

    2014-01-01

    This study investigated long-term executive functioning following early mild traumatic brain injury (TBI), differentiating between complicated (n=34) and uncomplicated injuries (n=18). Children post mild TBI were compared to 33 controls at least 7-years post-injury. The complicated mild TBI group performed significantly worse on divided attention compared to both groups, with younger age at injury and neurological symptoms predictors of outcome. No significant group differences existed on speed of information processing, selective attention, working memory, or goal setting. These findings indicate that specific aspects of executive function are compromised by early complicated mild TBI and argue for a stratified definition of mild TBI. PMID:25470225

  11. 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

  12. Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study.

    Science.gov (United States)

    Levy Erez, Daniella; Krause, Irit; Dagan, Amit; Cleper, Roxana; Falush, Yafa; Davidovits, Miriam

    2016-01-01

    Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995-2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5.27 yrs. (range: 1 month-24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25-17.54 years). Mean follow-up was 13.5 ± 5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90% for patients older than 5 years and 61% for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications. PMID:27597898

  13. 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.

  14. Long-term results of low dose daily cisplatin chemotherapy used concurrently with modestly accelerated radiotherapy in locally advanced squamous cell carcinomas of the head neck cancer region

    Directory of Open Access Journals (Sweden)

    Pramod Kumar Gupta

    2014-01-01

    Full Text Available Introduction: Concurrent single agent cisplatin (CDDP with radiotherapy (RT improves outcomes in locally advanced squamous cell carcinomas of the head neck (LA-SCCHN. CDDP at 100 mg/m 2 at 3 weekly intervals raise compliance, hospitalization, and supportive care issues. Low dose daily CDDP was delivered with RT to evaluate its compliance, long-term safety and efficacy. Patients and Methods: During the period of month between November 2005 and May 2007, 52 patients of stage III/IV LA-SCCHN were given with conventional RT in a phased manner (dose-70 Gy/35 fractions/6 weeks along with daily CDDP (6 mg/m 2 ; capped 10 mg-30 cycles over 6 weeks. No hospitalization or antiemetic cover was planned. Compliance, acute and late toxicity were recorded as per Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer grading system and survival outcomes were evaluated. Results : The median follow-up was 63 months. 43 (83% cases complied with RT schedule and >28 cycles of CDDP was administered in 38 (73% cases. Confluent mucositis was seen in 65%, Grade III/IV dysphagia in 67%; 77% required enteral feed and hospitalization in 15%. There were four treatment related deaths. At 5 years, the loco-regional control was 25% (median-11 months and the overall survival was 31% (median-11 months. The 5 years actuarial rates of late Grade III/IV toxicity was 24%. Late swallowing difficulty/aspiration were seen in 17%; xerostomia-40%; ototoxicity-6%; nephrotoxicity-4%; and no second malignancy. Conclusion: Low dose cisplatin with moderately accelerated RT schedule appears feasible and logistically suitable "out-patient" option without increasing long-term toxicity in LA-SCCHN cancer region.

  15. 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. PMID:22266685

  16. 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.

  17. 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…

  18. 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.

  19. Long-term outcome of ruptured abdominal aortic aneurysm: Impact of treatment and age

    NARCIS (Netherlands)

    J.W. Raats (Jelle W.); H.C. Flu (Hans C.); G.H. Ho; E.J. Veen (Eelco J.); L.D. Vos (L.); E.W. Steyerberg (Ewout); L. van der Laan (Lyckle)

    2014-01-01

    textabstractBackground: Despite advances in operative repair, ruptured abdominal aortic aneurysm (rAAA) remains associated with high mortality and morbidity rates, especially in elderly patients. The purpose of this study was to evaluate the outcomes of emergency endovascular aneurysm repair (eEVAR)

  20. 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...

  1. 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.

  2. Long-Term Outcomes of Patients with Lumbar Disc Herniation Treated with Percutaneous Discectomy: Comparative Study with Microendoscopic Discectomy

    International Nuclear Information System (INIS)

    We assessed the long-term outcomes of patients with lumbar disc herniation treated with percutaneous lumbar discectomy (PLD) or microendoscopic discectomy (MED). A retrospective study was performed in consecutive patients with lumbar disc herniation treated with PLD (n = 129) or MED (n = 101) in a single hospital from January 2000 to March 2002. All patients were followed up with MacNab criteria and self-evaluation questionnaires comprising the Oswestry Disability Index and Medical Outcomes Study 36-Item Short-Form Health Survey. Several statistical methods were used for analyses of the data, and a p value of <0.05 was considered to be statistically significant. A total of 104 patients (80.62%) with PLD and 82 patients (81.19%) with MED were eligible for analyses, with a mean follow-up period of 6.64 ± 0.67 years and 6.42 ± 0.51 years, respectively. There were no significant differences between the two groups in age, number of lesions, major symptoms and physical signs, and radiological findings. According to the MacNab criteria, 75.96% in the PLD group and 84.15% in the MED group achieved excellent or good results, respectively, this was statistically significant (p = 0.0402). With the Oswestry Disability Index questionnaires, the average scores and minimal disability, respectively, were 6.97 and 71.15% in the PLD group and 4.89 and 79.27% in the MED group. Total average scores of Medical Outcomes Study 36-Item Short-Form Health Survey were 75.88 vs. 81.86 in PLD group vs. MED group (p = 0.0582). The cost and length of hospitalization were higher or longer in MED group, a statistically significant difference (both p < 0.0001). Long-term complications were observed in two patients (2.44%) in the MED group, no such complications were observed in the PLD group. Both PLD and MED show an acceptable long-term efficacy for treatment of lumbar disc herniation. Compared with MED patients, long-term satisfaction is slightly lower in the PLD patients; complications

  3. Periapical Microsurgery: The effect of root dentinal defects on short and long term outcome

    Science.gov (United States)

    Tawil, Peter Z.; Saraiya, Veeral M.; Galicia, Johnah C.; Duggan, Derek J.

    2015-01-01

    Introduction The purpose of this prospective clinical study is to evaluate the clinical outcome of endodontic microsurgery on roots exhibiting the presence or absence of dentinal defects at one year and three-year follow up period. Methods 155 teeth were treated with periapical microsurgery using a modern microsurgical protocol in a private practice setting. The root apices were resected and inspected for dentinal defects with a Surgical Operating Microscope and a 0.8mm head diameter LED microscope diagnostic probe light. After inspection, retrograde preparations were performed using ultrasonic tips and retrograde fillings were placed. Follow up visits occurred at one year and three years post-operatively. The primary outcome measure employed was the change in the radiographic apical bone density and the secondary outcome measure used was the absence of clinical symptoms. Results Out of the 155 treated teeth, a total of 134 teeth were assessed at the one-year follow-up and 127 teeth at the three-year evaluation. The “Intact” group had 94.8% healed at one year and 97.3% healed at three years. The “Dentinal Defect” group had 29.8% healed at one year and 31.5% healed at three years. The baseline root condition of either “Dentinal Defect” or “Intact” showed a statistical difference in the healing outcome at both one year and at three years. Conclusions This prospective periapical microsurgery study showed a significant superior clinical outcome for intact roots when compared to roots with dentinal defects at both 1 year and at 3 years post-operatively. PMID:25282374

  4. Long-term outcomes in haemophilic synovitis after radiosynovectomy using rhenium-186: a single-centre experience.

    Science.gov (United States)

    Zulfikar, B; Turkmen, C; Kilicoglu, O; Dikici, F; Bezgal, F; Gorgun, O; Taser, O

    2013-03-01

    Radiosynovectomy has been performed successfully for more than 10 years in our hospital. This study investigated the long-term outcome in the context of time to progression (TTP) analysis and the factors influencing TTP following radiosynovectomy with Re-186 in patients with haemophilic synovitis. Radiosynovectomy performed in 165 joints (81 elbows, 74 ankles, 8 shoulder and 2 hip joints) of 106 patients (median age was 18.0 ± 7.5 years; 91 haemophilia A, 13 haemophilia B and 2 von Willebrand's disease between June 2001 and July 2011. The mean follow-up was 48 months (range: 9-120 months). This study revealed that patients' mean TTP after primary radiosynovectomy was satisfactory for both the ankle and elbow joints. There was no TTP differences between the ankle and elbow joint groups (67 vs. 72 months respectively; P = 0.22). We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion (ROM) status of joints and the pretreatment bleeding frequency. In this study, 18-20% of the treated joints had improved ROM and 82-79% of the treated joints had unchanged ROM after treatment both the ankle and elbow joints respectively. In this report including TTP analysis in the largest series with long-term follow-up, we demonstrated long-term effectiveness of Re-186 radiosynovectomy in haemophilic synovitis. In our experience, the main predictor of outcome following radiosynovectomy is the number of joint bleeding within 6 months after therapy. PMID:23171307

  5. A comparative study of complications and long term outcomes of Surgical Tracheostomy and two techniques of Percutaneous Tracheostomy

    Directory of Open Access Journals (Sweden)

    S Kiran

    2015-01-01

    Full Text Available Context: The operative technique for surgical tracheostomy has remained unchanged, but different techniques for percutaneous tracheostomy have evolved due to interest in minimally invasive procedures for the critically ill patient. Aims: To compare the periprocedural complications and long term outcomes of bedside surgical tracheostomy (ST with two percutaneous tracheostomy (PCT techniques, namely serial guide wire dilating forceps (GWDF and PercuTwist (PT. Settings and Design: This prospective observational study was carried out in ICU of a tertiary referral centre over three year period on adult intubated patients needing elective tracheostomy. Materials and Methods: Patients with anticipated difficult neck anatomy were assigned for ST based on discretion of intensivist. Patients included for PCT were randomly assigned to the GWDT and PT technique. 90 patients underwent either bedside ST (n = 30, PCT by GWDF technique (n = 30 or PCT with PercuTwist (n = 30 and were followed up with fibreoptic bronchoscopy monthly for 06 months. Statistical Analysis Used: Data was analyzed by applying chi square tests for categorical variables. Results: Periprocedural complications during PCT included major bleeding (>100ml in two patients in GWDF group which required conversion to ST. Periprocedural bleeding was also the main complication in ST. Increased incidence of granulation tissue and tracheal narrowing in long term was seen in both ST and PCT groups. All of the P values analysed for the intra operative, post operative complications or long term outcomes were >0.05. Conclusions : There was no statistically significant difference in incidence of complications of ST and two techniques of PCT. Proper case selection makes PCT as safe as ST.

  6. 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

  7. The Long-Term Outcome of Open Reduction and Internal Fixation of Stable Displaced Isolated Partial Articular Fractures of the Radial Head

    NARCIS (Netherlands)

    A.L.C. Lindenhovius; Q. Fesch; D. Ring; P. Kloen

    2009-01-01

    Background: Excellent long-term results have been reported for nonoperative treatment of stable isolated displaced partial articular (Mason 2) fractures of the radial head, suggesting that the role of operative treatment can be questioned. This investigation reports the long-term outcome of operativ

  8. 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.

  9. Predicting Adverse Health Outcomes in Long-Term Survivors of a Childhood Cancer

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    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.

  10. Short Term Gain, Long Term Pain:Informal Job Search Methods and Post-Displacement Outcomes

    OpenAIRE

    Green, Colin

    2012-01-01

    This paper examines the role of informal job search methods on the labour market outcomes of displaced workers. Informal job search methods could alleviate short-term labour market difficulties of displaced workers by providing information on job opportunities, allowing them to signal their productivity and may mitigate wage losses through better post-displacement job matching. However if displacement results from reductions in demand for specific sectors/skills, the use of informal job searc...

  11. Long-term graft outcome of pediatric liver transplantation in Copenhagen

    DEFF Research Database (Denmark)

    Yamauchi, Yasushi; Yamashita, Yuichi; Wettergren, Andre;

    2006-01-01

    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....

  12. Comparison of Long-Term Outcomes of Postmastectomy Radiotherapy between Breast Cancer Patients with and without Immediate Flap Reconstruction.

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    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.

  13. Long term refractive and structural outcome following laser treatment for zone 1 aggressive posterior retinopathy of prematurity

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    Parag K Shah

    2014-01-01

    Full Text Available Aim: To report the long term refractive, visual and structural outcome post-laser for zone 1 aggressive posterior retinopathy of prematurity (AP-ROP. Materials and Methods: A retrospective analysis was performed of refractive status of premature infants with zone 1 AP-ROP who underwent laser photocoagulation from 2002 to 2007 and followed up till 2013. Once the disease regressed, children were followed up six monthly with detailed examination regarding fixation pattern, ocular motility, nystagmus, detailed anterior segment and posterior segment examination, and refractive status including best corrected visual acuity. Results: Forty-eight eyes of 25 infants were included in the study. Average follow-up was 6.91 years (range, 3.8-9.5years after laser treatment. Astigmatism was noted in 43 out of 48 eyes (89.6%. Two eyes had simple myopia whereas three eyes had no refractive error. Conclusion: After successful laser treatment for zone 1 retinopathy of prematurity (ROP, 94% of our cases developed refractive error. Although most had a favorable anatomical and visual outcome, long-term follow-up even after a successful laser treatment in ROP was necessary.

  14. 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.

  15. Cost analysis of long-term outcomes of an urban mental health court.

    Science.gov (United States)

    Kubiak, Sheryl; Roddy, Juliette; Comartin, Erin; Tillander, Elizabeth

    2015-10-01

    Multiple studies have demonstrated decreased recidivism and increased treatment engagement for individuals with serious mental illness involved in Mental Health Courts (MHC). However, the limited availability of social and fiscal resources requires an analysis of the relationship between a program's effectiveness and its costs. Outcome costs associated with a sample of 105 participants discharged for more than 1 year - and grouped by completion status - were compared to an eligible sample not enrolled (n=45). Transactional costs analysis (TCA) was used to calculate outcomes associated with treatment, arrest, and confinement in the 12-month post-MHC. Total outcome costs for the Successful Group ($16,964) significantly differed from the Unsuccessful ($32,258) and Compare Groups ($39,870). Costs associated with the higher number of arrests for those in the Compare Group created the largest differences. Total cost savings between Successful and Compare (M=$22,906) equated to $916,240 and savings between Unsuccessful and Compare (M=$7612) were $494,708. The total combined cost savings for participants in the 12-month post-MHC period was $1,411,020. While it is important to understand that MHCs and the individuals that they serve vary and these results are for a felony-level court, policy makers and researchers can use these results to guide their decision-making. PMID:25982871

  16. 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

  17. 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

  18. 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

    . All patients suffered from severe cardiomyopathy. RESULTS: Mean recipient age at transplantation was 48.3 ± 4.2 yr. Mean follow-up was 55 months. No peroperative mortality occured. Two patients died within the first year (infection, multi-organ failure) of transplantation. Cumulative survival at 4......BACKGROUND: The amyloidogenic transthyretin (ATTR) mutation Leu111Met causes a primarily cardiac amyloidosis: Familial amyloidotic cardiomyopathy (FAC). Combined heart-liver transplantation (CHLTx) is the preferred treatment for patients with heart failure due to familial amyloidosis......, but information on outcome of patients with Leu111Met mutation is limited. The aim of this study was to evaluate the long-term outcome of CHLTx in patients with FAC. METHODS AND MATERIALS: Between 1998 and 2009, CHLTx was performed in 7 FAC patients (four men). Six patients underwent simultaneous transplantation...

  19. LONG TERM OUTCOME OF SURGICAL MANAGEMENT OF INTERCONDYLAR FRACTURE OF HUMERUS

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    Ravikant

    2015-05-01

    Full Text Available Distal humeral fractures are relatively difficult fractures to treat. It is essentially an intra - articular fracture and accurate reduction and rigid internal fixation is a rule. Even in the best hands the results vary greatly. The treatment of fracture is like solving a jigsaw puzzle. PURPOSE OF THE STUDY : The purpose of the study was to analyze the outcome of surgically managed cases of displaced intercondylar fracture humerus op erated between December 2003 to 2014. It was retrospective analysis where we c ompared and assessed result to find out the ideal time of surgery, best approach to the management of this fracture and physiotherapy program to be followed. MATERIALS AND METHODS : We included 48 cases of fracture intercondylar humerus operated at Chhattis garh Institute of Medical Sciences, Bilaspur. The mean age of the patient was 38 (±12. The ratio for male to female was 2 : 1. We operated most of these cases within one week from trauma. The patients were evaluated by the Aitken and Rorabeck criteria . RES ULTS : Analysis on the basis of activities of daily living revealed that outcome was excellent in 31.2% cases was good in 41.6%cases. The outcome was fair in 14.5% and only 12.5% cases exhibited poor performance in activities of daily living postoperatively. DISCUSSION : Transolecranon approach is an extensile approach and gives trouble free exposure. Plates can be applied on the posterior surface of the humerus with little difficulty and provides good results. A delay in the surgery for more than 3 weeks woul d definitely compromise results. Starting physiotherapy within 3 - 4 weeks postoperatively yields better results and are without chances of fixation failure.

  20. 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.

  1. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment

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    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

  2. Treatment of anal human papillomavirus-associated disease: a long term outcome study.

    Science.gov (United States)

    Nathan, M; Hickey, N; Mayuranathan, L; Vowler, S L; Singh, N

    2008-07-01

    Treatment for human papillomavirus (HPV)-associated anal canal disease has been unsatisfactory. The objective of our study was to determine the treatment outcome in our cohort with anal HPV disease. Overall, 181 patients were evaluated over a median period of 19.1 months (range = 2.8-125.5). Eighty-eight patients (48.6%) with high-grade anal intraepithelial neoplasia (AIN) and 82 patients (45.3%) with low-grade AIN underwent treatment. One hundred and forty-one patients (77.9%) received laser ablative treatment as an outpatient procedure. The treatment yielded cure, defined as a disease-free state at 12 months after treatment, in 63.0% (114/181). Median time to cure for the cohort was 31.5 months (95% confidence interval: 23.0-40.0). Treatment outcome showed no evidence of being affected by age, sexual preference, history of smoking or presence of high-grade disease. Median time to cure was significantly affected by a positive HIV status (P = 0.02) and the extent (volume) of the disease (P = 0.01). Contrary to the current view that treatment of HPV-related anal disease is difficult, unrewarding due to recurrences and may lead to substantial morbidity, we demonstrate that effective treatment is possible for both low- and high-grade AIN. These findings should help with the general desire to introduce screening for AIN for at-risk groups. PMID:18574114

  3. Long-term results of treatment of cervical carcinoma in the United States in 1973, 1978, and 1983: Patterns of Care Study (PCS)

    International Nuclear Information System (INIS)

    Purpose: To extend the observations of patients with carcinoma of the cervix treated in 1973 for over 15 years, in 1978 for over 10 years, and in 1983 for over 5 years for survival and local control to compare treatment times and outcome. Methods and Materials: A nationwide survey of the patterns of practice in radiation therapy for patients with squamous carcinoma of the cervix collected pretreatment and treatment data using external surveyors who reviewed patients' records. Outcome information was updated for the three separate databases by mail survey. Overall survival, no evidence of disease (NED) survival, and local control curves by stage were plotted using the estimates derived by the Kaplan--Meier method. Results: Total number of patients surveyed was 1686: 937 patients in 1973, 565 patients in 1978, and 184 patients in 1983. These are the results from changes in treatment policy, particularly the increasing use of brachytherapy. Of Stage III patients, the percentage receiving brachytherapy was 60.5% in 1973, 76.5% in 1978, and 87.9% in 1983 (p < 0.001 by linear trend test). Also, there was an increased proportion in use of higher energy for external pelvic irradiation during the more recent time period, e.g., 28% in the 1973 study, 60% in the 1978 study, and 87% in the 1983 study compared to the usage of cobalt-60 equipment. Comparison of results including overall survival, local control, and NED survival for the three different time periods showed improvement in outcome for Stage III in 1983, but not Stages I and II. The 5-year survival for Stage III increased from 25% in the 1973 survey to 47% in the 1983 survey, a linear trend that is statistically significant (p = 0.02). Conclusion: The long-term results of radiotherapy for patients with carcinoma of the cervix show improved outcome for Stage III patients, which probably results from improved treatment, including higher energy for pelvic irradiation and increase in use of brachytherapy contributing

  4. 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

  5. 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

  6. Long-Term Outcomes From Acute Rheumatic Fever and Rheumatic Heart Disease

    Science.gov (United States)

    He, Vincent Y.F.; Condon, John R.; Zhao, Yuejen; Roberts, Kathryn; de Dassel, Jessica L.; Currie, Bart J.; Fittock, Marea; Edwards, Keith N.; Carapetis, Jonathan R.

    2016-01-01

    Background: We investigated adverse outcomes for people with acute rheumatic fever (ARF) and rheumatic heart disease (RHD) and the effect of comorbidities and demographic factors on these outcomes. Methods: Using linked data (RHD register, hospital, and mortality data) for residents of the Northern Territory of Australia, we calculated ARF recurrence rates, rates of progression from ARF to RHD to severe RHD, RHD complication rates (heart failure, endocarditis, stroke, and atrial fibrillation), and mortality rates for 572 individuals diagnosed with ARF and 1248 with RHD in 1997 to 2013 (94.9% Indigenous). Results: ARF recurrence was highest (incidence, 3.7 per 100 person-years) in the first year after the initial ARF episode, but low-level risk persisted for >10 years. Progression to RHD was also highest (incidence, 35.9) in the first year, almost 10 times higher than ARF recurrence. The median age at RHD diagnosis in Indigenous people was young, especially among males (17 years). The development of complications was highest in the first year after RHD diagnosis: heart failure incidence rate per 100 person-years, 9.09; atrial fibrillation, 4.70; endocarditis, 1.00; and stroke, 0.58. Mortality was higher among Indigenous than non-Indigenous RHD patients (hazard ratio, 6.55; 95% confidence interval, 2.45–17.51), of which 28% was explained by comorbid renal failure and hazardous alcohol use. RHD complications and mortality rates were higher for urban than for remote residents. Conclusions: This study provides important new prognostic information for ARF/RHD. The residual Indigenous survival disparity in RHD patients, which persisted after accounting for comorbidities, suggests that other factors contribute to mortality, warranting further research. PMID:27407071

  7. Long-term results of a randomized phase III trial of TPF induction chemotherapy followed by surgery and radiation in locally advanced oral squamous cell carcinoma.

    Science.gov (United States)

    Zhong, Lai-ping; Zhang, Chen-ping; Ren, Guo-xin; Guo, Wei; William, William N; Hong, Christopher S; Sun, Jian; Zhu, Han-guang; Tu, Wen-yong; Li, Jiang; Cai, Yi-li; Yin, Qiu-ming; Wang, Li-zhen; Wang, Zhong-he; Hu, Yong-jie; Ji, Tong; Yang, Wen-jun; Ye, Wei-min; Li, Jun; He, Yue; Wang, Yan-an; Xu, Li-qun; Zhuang, Zhengping; Lee, J Jack; Myers, Jeffrey N; Zhang, Zhi-yuan

    2015-07-30

    Previously, we conducted a randomized phase III trial of TPF (docetaxel, cisplatin, and 5-fluorouracil) induction chemotherapy in surgically managed locally advanced oral squamous cell carcinoma (OSCC) and found no improvement in overall survival. This study reports long-term follow-up results from our initial trial. All patients had clinical stage III or IVA locally advanced OSCC. In the experimental group, patients received two cycles of TPF induction chemotherapy (75mg/m2 docetaxel d1, 75mg/m2 cisplatin d1, and 750mg/m2/day 5-fluorouracil d1-5) followed by radical surgery and post-operative radiotherapy; in the control group, patients received upfront radical surgery and post-operative radiotherapy. The primary endpoint was overall survival. Among 256 enrolled patients with a median follow-up of 70 months, estimated 5-year overall survival, disease-free survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 61.1%, 52.7%, 55.2%, and 60.4%, respectively. There were no significant differences in survival rates between experimental and control groups. However, patients with favorable pathologic responses had improved outcomes compared to those with unfavorable pathologic responses and to those in the control group. Although TPF induction chemotherapy did not improve long-term survival compared to surgery upfront in patients with stage III and IVA OSCC, a favorable pathologic response after induction chemotherapy may be used as a major endpoint and prognosticator in future studies. Furthermore, the negative results observed in this trial may be represent type II error from an underpowered study. Future larger scale phase III trials are warranted to investigate whether a significant benefit exists for TPF induction chemotherapy in surgically managed OSCC. PMID:26124084

  8. 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. PMID:23274727

  9. 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

  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 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.

  12. Successful long-term outcome of liver transplantation in late-onset lysosomal acid lipase deficiency.

    Science.gov (United States)

    Sreekantam, S; Nicklaus-Wollenteit, I; Orr, J; Sharif, K; Vijay, S; McKiernan, P J; Santra, S

    2016-09-01

    Late-onset LAL deficiency, previously referred to as cholesteryl ester storage disorder, is a rare lysosomal storage disorder characterized by accumulation of cholesteryl esters. It has a heterogeneous clinical phenotype including abdominal pain, poor growth, hyperlipidemia with vascular complications and hepatosplenomegaly. End-stage liver disease may occur, but there are few reports of successful LT. There are also concerns that systemic manifestations of the disease might persist post-LT. We report a case with excellent outcome eight yr following LT. The subject was noted to have asymptomatic hepatosplenomegaly during an intercurrent illness, and LAL deficiency was confirmed with compound heterozygosity in the LIPA. Despite dietary fat restriction, he developed signs of progressive liver disease and subsequently developed hepatopulmonary syndrome. He underwent cadaveric LT at the age of nine and a half yr and recovered with prompt resolution of hepatopulmonary syndrome. Eight yr post-transplant he has normal growth, normal lipid profile, and liver and renal function tests. Liver histology showed no evidence of disease recurrence at this stage. LT in this subject resulted in an excellent functional correction of late-onset LAL deficiency. PMID:27392817

  13. Age – related treatment strategy and long-term outcome in acute myocardial infarction patients in the PCI era

    Directory of Open Access Journals (Sweden)

    Kala Petr

    2012-04-01

    Full Text Available Abstract Background Older age, as a factor we cannot affect, is consistently one of the main negative prognostic values in patients with acute myocardial infarction. One of the most powerful factors that improves outcomes in patients with acute coronary syndromes is the revascularization preferably performed by percutaneous coronary intervention. No data is currently available for the role of age in large groups of consecutive patients with PCI as the nearly sole method of revascularization in AMI patients. The aim of this study was to analyze age-related differences in treatment strategies, results of PCI procedures and both in-hospital and long-term outcomes of consecutive patients with acute myocardial infarction. Methods Retrospective multicenter analysis of 3814 consecutive acute myocardial infarction patients divided into two groups according to age (1800 patients ≤ 65 years and 2014 patients > 65 years. Significantly more older patients had a history of diabetes mellitus and previous myocardial infarctions. Results The older population had a significantly lower rate of coronary angiographies (1726; 95.9% vs. 1860; 92.4%, p  Conclusions In a consecutive AMI population, the older group (>65 years was associated with a less pronounced impact of risk factors on long-term outcome. To ascertain the coronary anatomy by coronary angiography and proceed to PCI if suitable regardless of age is crucial in all patients, though the primary success rate of PCI in the older age is lower. Age, when viewed as a risk factor, was a dominant discriminating factor in all patients.

  14. 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.

  15. 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.

  16. Disruption of White Matter Integrity in Adult Survivors of Childhood Brain Tumors: Correlates with Long-Term Intellectual Outcomes.

    Directory of Open Access Journals (Sweden)

    Tricia Z King

    Full Text Available Although chemotherapy and radiation treatment have contributed to increased survivorship, treatment-induced brain injury has been a concern when examining long-term intellectual outcomes of survivors. Specifically, disruption of brain white matter integrity and its relationship to intellectual outcomes in adult survivors of childhood brain tumors needs to be better understood.Fifty-four participants underwent diffusion tensor imaging in addition to structural MRI and an intelligence test (IQ. Voxel-wise group comparisons of fractional anisotropy calculated from DTI data were performed using Tract Based Spatial Statistics (TBSS on 27 survivors (14 treated with radiation with and without chemotherapy and 13 treated without radiation treatment on average over 13 years since diagnosis and 27 healthy comparison participants. Whole brain white matter fractional anisotropy (FA differences were explored between each group. The relationships between IQ and FA in the regions where statistically lower FA values were found in survivors were examined, as well as the role of cumulative neurological factors.The group of survivors treated with radiation with and without chemotherapy had lower IQ relative to the group of survivors without radiation treatment and the healthy comparison group. TBSS identified white matter regions with significantly different mean fractional anisotropy between the three different groups. A lower level of white matter integrity was found in the radiation with or without chemotherapy treated group compared to the group without radiation treatment and also the healthy control group. The group without radiation treatment had a lower mean FA relative to healthy controls. The white matter disruption of the radiation with or without chemotherapy treated survivors was positively correlated with IQ and cumulative neurological factors.Lower long-term intellectual outcomes of childhood brain tumor survivors are associated with lower white

  17. Long-Term Outcome after Laparoscopic Bowel Resections for Deep Infiltrating Endometriosis: A Single-Center Experience after 900 Cases

    Directory of Open Access Journals (Sweden)

    Giacomo Ruffo

    2014-01-01

    Full Text Available Background. Laparoscopic bowel resections for endometriosis are safe and effective but only short-term follow-up has been evaluated. In the present study long-term outcome in terms of intestinal and urinary function, fertility, chronic pain, and recurrence was assessed. Materials and Methods. From January 2002 to December 2010 nine hundred patients underwent laparoscopic bowel resection for endometriosis, and on 774 (86% a questionnaire was administered. Patients were divided into 3 groups on the strength of the operation date. Postoperative diarrhea, constipation, rectal bleeding, tenesmus, dyschezia, dysuria, dyspareunia, fertility, and recurrence of disease were assessed. Results. The median follow-up was 54 months (range 1–120. All the evaluated symptoms significantly improved over time, with P=0.0001 for dyspareunia, constipation, and pelvic pain and P=0.004 for diarrhea. Nonsignificant improvement was reported for dysuria and rectal bleeding (with P=0.452 and P=0.097, resp.. Conclusions. The present results confirm that bowel resections for endometriosis are correlated with an acceptable complication rate even at long-term follow-up and that symptoms significantly improve over time, except for rectal bleeding and dysuria, the latter associated with a neurological damage.

  18. [Abdominal secondary aorto-enteric fistulae complicating aortic graft replacement: postoperative and long-term outcomes in 32 patients].

    Science.gov (United States)

    Vaillant, Jean-christophe; Schoell, Thibaut; Karoui, Mehdi; Chiche, Laurent; Gaudric, Julien; Gibert, Hadrien; Tresallet, Christophe; Koskas, Fabien; Hannoun, Laurent

    2013-01-01

    Management of patients with abdominal secondary aorto-entericfistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postope- rative and long-term outcomes of all consecutive patients operated on for SAEF betwveen 2002 and2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for SAEFa median of 5 years after initial aortic surgery. The fistulae were located in the duodenum (n = 20), small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had afeedingjejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity. Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertialy referral center with expertise in both vascular and digestive surgery. PMID:25518163

  19. Long-term outcome in the treatment of mandibular condylar fractures.

    Science.gov (United States)

    Borgiel-Marek, Halina; Drugacz, Jan; Marek, Bogdan; Jedrusik-Pawłowska, Magdalena; Głogowska-Szelag, Joanna; Witalińska-Łabuzek, Justyna

    2005-08-30

    Background. Fractures of the condylar process of the mandible, whether isolated or coexisting with other injuries, are often difficult to manage. Treatment outcome in patients with mechanical injuries of the temporomandibular joints and fractures of mandibular condylar process, which is an element of this joint, depends mostly when and how treatment is initiated. The goal of our study was to assess functional abnormalities in patients following fractures of the condylar process of the mandible in relation to the treatment method used. Material and methods. We analyzed patient documentation and the results of follow-up examinations of 147 patients hospitalized for fractures of the condylar process. This material included both isolated fractures of the condylar process and those accompanied by fractures of the body of the mandible. All mandibular body fractures were managed by means of multiplate osteosynthesis. Fractures of the condylar process were treated in a conservative-orthopedic manner or surgically, depending on the degree of shortening of the mandibular ramus. Anamnesis regarding pain and a functional examination of mandibular kinetics and audible effects gave a basis for assessing the function of temporomandibular joints following treatment. The Helkimo Dysfunction Index was used to assess changes in masticatory function and disorders in the temporomandibular joint. Results. Functional disturbances of the temporomandibular were observed in 38.1% of the examined patients. The most frequently observed symptoms of dysfunction were periodic pain and crackles on mandibular abduction, subluxation, deviation of the mandible, and slight limitation of jaw opening. The intensity depended mainly on when rehabilitation was commenced, and to a less degree on the type of treatment used. No joint dysfunctions were observed in patients of developmental age who sustained isolated condylar process fractures. PMID:17611464

  20. Progesterone improves long-term functional and histological outcomes after permanent stroke in older rats.

    Science.gov (United States)

    Wali, Bushra; Ishrat, Tauheed; Stein, Donald G; Sayeed, Iqbal

    2016-05-15

    Previous studies have shown progesterone to be beneficial in animal models of central nervous system injury, but less is known about its longer-term sustained effects on recovery of function following stroke. We evaluated progesterone's effects on a panel of behavioral tests up to 8 weeks after permanent middle cerebral artery occlusion (pMCAO). Male Sprague-Dawley rats 12m.o. were subjected to pMCAO and, beginning 3h post-pMCAO, given intraperitoneal injections of progesterone (8mg/kg) or vehicle, followed by subcutaneous injections at 8h and then every 24h for 7 days, with tapering of the last 2 treatments. The rats were then tested on functional recovery at 3, 6 and 8 weeks post-stroke. We observed that progesterone-treated animals showed attenuation of infarct volume and improved functional outcomes at 8 weeks after stroke on grip strength, sensory neglect, motor coordination and spatial navigation tests. Progesterone treatments significantly improved motor deficits in the affected limb on a number of gait parameters. Glial fibrillary acidic protein expression was increased in the vehicle group and considerably lowered in the progesterone group at 8 weeks post-stroke. With repeated post-stroke testing, sensory neglect and some aspects of spatial learning performance showed spontaneous recovery, but on gait and grip-strength measres progesterone given only in the acute stage of stroke (first 7 days) showed sustained beneficial effects on all other measures of functional recovery up to 8 weeks post-stroke. PMID:26921692

  1. Additive effect of anemia and renal impairment on long-term outcome after percutaneous coronary intervention.

    Directory of Open Access Journals (Sweden)

    Thomas Pilgrim

    Full Text Available Anemia and renal impairment are important co-morbidities among patients with coronary artery disease undergoing Percutaneous Coronary Intervention (PCI. Disease progression to eventual death can be understood as the combined effect of baseline characteristics and intermediate outcomes.Using data from a prospective cohort study, we investigated clinical pathways reflecting the transitions from PCI through intermediate ischemic or hemorrhagic events to all-cause mortality in a multi-state analysis as a function of anemia (hemoglobin concentration <120 g/l and <130 g/l, for women and men, respectively and renal impairment (creatinine clearance <60 ml/min at baseline.Among 6029 patients undergoing PCI, anemia and renal impairment were observed isolated or in combination in 990 (16.4%, 384 (6.4%, and 309 (5.1% patients, respectively. The most frequent transition was from PCI to death (6.7%, 95% CI 6.1-7.3, followed by ischemic events (4.8%, 95 CI 4.3-5.4 and bleeding (3.4%, 95% CI 3.0-3.9. Among patients with both anemia and renal impairment, the risk of death was increased 4-fold as compared to the reference group (HR 3.9, 95% CI 2.9-5.4 and roughly doubled as compared to patients with either anemia (HR 1.7, 95% CI 1.3-2.2 or renal impairment (HR 2.1, 95% CI 1.5-2.9 alone. Hazard ratios indicated an increased risk of bleeding in all three groups compared to patients with neither anemia nor renal impairment.Applying a multi-state model we found evidence for a gradient of risk for the composite of bleeding, ischemic events, or death as a function of hemoglobin value and estimated glomerular filtration rate at baseline.

  2. Early Significant Tumor Volume Reduction After Radiosurgery in Brain Metastases From Renal Cell Carcinoma Results in Long-Term Survival

    International Nuclear Information System (INIS)

    Purpose: To retrospectively evaluate survival of patients with brain metastasis from renal cell carcinoma (RCC) after radiosurgery. Patients and Methods: Between 1998 and 2010, 46 patients were treated with radiosurgery, and the total number of lesions was 99. The mean age was 58.9 years (range, 33–78 years). Twenty-six patients (56.5%) had a single brain metastasis. The mean tumor volume was 3.0 cm3 (range, 0.01–35.1 cm3), and the mean marginal dose prescribed was 20.8 Gy (range, 12–25 Gy) at the 50% isodose line. A patient was classified into the good-response group when the sum of the volume of the brain metastases decreased to less than 75% of the original volume at a 1-month follow-up evaluation using MRI. Results: As of December 28, 2010, 39 patients (84.8%) had died, and 7 (15.2%) survived. The overall median survival time was 10.0 ± 0.4 months (95% confidence interval, 9.1–10.8). After treatment, local tumor control was achieved in 72 (84.7%) of the 85 tumors assessed using MRI after radiosurgery. The good-response group survived significantly longer than the poor-response group (median survival times of 18.0 and 9.0 months, respectively; p = 0.025). In a multivariate analysis, classification in the good-response group was the only independent prognostic factor for longer survival (p = 0.037; hazard ratio = 0.447; 95% confidence interval, 0.209–0.953). Conclusions: Radiosurgery seems to be an effective treatment modality for patients with brain metastases from RCC. The early significant tumor volume reduction observed after radiosurgery seems to result in long-term survival in RCC patients with brain metastases.

  3. Mary Crosse project: systematic reviews and grading the value of neonatal tests in predicting long term outcomes

    Directory of Open Access Journals (Sweden)

    Khan Khalid S

    2009-10-01

    Full Text Available Abstract Background Events before birth, condition at birth, events immediately following birth, and condition in early childhood are linked together, and have implications for health and disease in adulthood. At present, there is lack of clarity about the tests that purport to link these various stages. This is partly because there is paucity of collated information about the best strategies for predicting longer-term outcomes before (using tests in fetal period or after birth (using tests in neonatal period, infancy as well as early childhood. Methods/Design A series of systematic reviews and meta-analyses will be undertaken to determine, amongst neonates, the ability of various tests and measures to predict infant, childhood and adult outcomes. We will search Medline, Embase, Cochrane Library, MEDION, citation lists of review articles and eligible primary articles and will contact experts in the field. Independent reviewers will select studies, extract data and assess study quality according to established criteria. Language restrictions will not be applied. Data synthesis will involve meta-analysis (where appropriate, exploration of heterogeneity and publication bias. Evidence collated will be graded for its quality to support decision making. Discussion The project will collate, synthesise and evaluate the available evidence concerning the value of tests of neonatal wellbeing to predict long term outcomes. The systematic reviews will assess the quality of available evidence and identify tests with the strongest association with outcomes, and assess their economic value. The output of this project will help formulate practice recommendations.

  4. 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.

  5. 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. PMID:26915494

  6. Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer. Long-term outcome analysis

    International Nuclear Information System (INIS)

    It has been previously reported that a short FOLFOX-4 induction significantly improves pathologic complete response in locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiation (CRT). In a larger and updated patient series, we analyzed FOLFOX-4 efficacy in terms of sphincter preservation and long-term outcomes. From January 1995 to December 2010, 335 LARC patients were treated with preoperative chemoradiation (4500-5040 cGy). Starting in May 2001, 207 consecutive patients additionally received induction FOLFOX-4. Surgery was performed 6 weeks (range 3-12 weeks) after chemoradiation. Incidence of total tumor (63 vs. 54 %, p = 0.02) and nodal downstaging (60 vs. 43 %, p = 0.002) was significantly increased by induction FOLFOX-4. In an analysis of tumors located below 5 cm from the anal verge (n = 114, 34 %), sphincter preservation was feasible in 30 % in the FOLFOX-4 versus 13 % in the upfront CRT group (p = 0.04). Median follow-up time for the entire cohort of patients was 72.6 months (range 4-205 months). FOLFOX-4 was not associated with superior locoregional control (HR 0.88, p = 0.78), disease-free survival (HR 0.83, p = 0.55), distant metastases-free survival (HR 0.94, p = 0.81), or cancer-specific survival (HR 0.70, p = 0.15). Short-intense induction FOLFOX-4 significantly improves downstaging and sphincter preservation in low rectal tumors. Long-term outcomes were not improved in the FOLFOX-4 group of patients. (orig.)

  7. 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.

  8. Rape-related symptoms in adolescents: short- and long-term outcome after cognitive behavior group therapy

    Science.gov (United States)

    Bicanic, Iva; de Roos, Carlijn; van Wesel, Floryt; Sinnema, Gerben; van de Putte, Elise

    2014-01-01

    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. PMID:24936285

  9. The Effects of Stroke Type, Locus, and Extent on Long-Term Outcome of Gait Rehabilitation: The LEAPS Experience.

    Science.gov (United States)

    Nadeau, Stephen E; Dobkin, Bruce; Wu, Samuel S; Pei, Qinglin; Duncan, Pamela W

    2016-08-01

    Background Paresis in stroke is largely a result of damage to descending corticospinal and corticobulbar pathways. Recovery of paresis predominantly reflects the impact on the neural consequences of this white matter lesion by reactive neuroplasticity (mechanisms involved in spontaneous recovery) and experience-dependent neuroplasticity, driven by therapy and daily experience. However, both theoretical considerations and empirical data suggest that type of stroke (large vessel distribution/lacunar infarction, hemorrhage), locus and extent of infarction (basal ganglia, right-hemisphere cerebral cortex), and the presence of leukoaraiosis or prior stroke might influence long-term recovery of walking ability. In this secondary analysis based on the 408 participants in the Locomotor Experience Applied Post-Stroke (LEAPS) study database, we seek to address these possibilities. Methods Lesion type, locus, and extent were characterized by the 2 neurologists in the LEAPS trial on the basis of clinical computed tomography and magnetic resonance imaging scans. A series of regression models was used to test our hypotheses regarding the effects of lesion type, locus, extent, and laterality on 2- to 12-month change in gait speed, controlling for baseline gait speed, age, and Berg Balance Scale score. Results Gait speed change at 1 year was significantly reduced in participants with basal ganglia involvement and prior stroke. There was a trend toward reduction of gait speed change in participants with lacunar infarctions. The presence of right-hemisphere cortical involvement had no significant impact on outcome. Conclusions Type, locus, and extent of lesion, and the loss of substrate for neuroplastic effect as a result of prior stroke may affect long-term outcome of rehabilitation of hemiparetic gait. PMID:26498434

  10. 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.

  11. 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.

  12. 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

  13. Biochemical Response to Androgen Deprivation Therapy Before External Beam Radiation Therapy Predicts Long-term Prostate Cancer Survival Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Gomez, Daniel R.; Polkinghorn, William R.; Pei, Xin; Kollmeier, Marisa [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2013-07-01

    Purpose: To determine whether the response to neoadjuvant androgen deprivation therapy (ADT) defined by a decline in prostate-specific antigen (PSA) to nadir values is associated with improved survival outcomes after external beam radiation therapy (EBRT) for prostate cancer. Methods and Materials: One thousand forty-five patients with localized prostate cancer were treated with definitive EBRT in conjunction with neoadjuvant and concurrent ADT. A 6-month course of ADT was used (3 months during the neoadjuvant phase and 2 to 3 months concurrently with EBRT). The median EBRT prescription dose was 81 Gy using a conformal-based technique. The median follow-up time was 8.5 years. Results: The 10-year PSA relapse-free survival outcome among patients with pre-radiation therapy PSA nadirs of ≤0.3 ng/mL was 74.3%, compared with 57.7% for patients with higher PSA nadir values (P<.001). The 10-year distant metastases-free survival outcome among patients with pre-radiation therapy PSA nadirs of ≤0.3 ng/mL was 86.1%, compared with 78.6% for patients with higher PSA nadir values (P=.004). In a competing-risk analysis, prostate cancer-related deaths were also significantly reduced among patients with pre-radiation therapy PSA nadirs of <0.3 ng/mL compared with higher values (7.8% compared with 13.7%; P=.009). Multivariable analysis demonstrated that the pre-EBRT PSA nadir value was a significant predictor of long-term biochemical tumor control, distant metastases-free survival, and cause-specific survival outcomes. Conclusions: Pre-radiation therapy nadir PSA values of ≤0.3 ng/mL after neoadjuvant ADT were associated with improved long-term biochemical tumor control, reduction in distant metastases, and prostate cancer-related death. Patients with higher nadir values may require alternative adjuvant therapies to improve outcomes.

  14. 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 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.

  15. 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 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. PMID:26298305

  16. 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.

  17. Margin Size Has No Impact on Patients' Long-term Outcomes after Nephron Sparing Surgery for Early Localized Renal Cell Carcinoma%切缘大小对早期肾癌保肾手术远期临床效果的影响

    Institute of Scientific and Technical Information of China (English)

    李泉林; 关宏伟; 秦杰; 姜涛; 宋希双

    2011-01-01

    Objective To explore the safety and efficacy of mini margin nephron sparing surgery for early localized renal cell carcinoma (RCC). Methods Total of 325 cases of RCC 4 cm or less with normal contralateral kidneys and staged as Tla were included in the study. According to the margin size, 125 of them were with surgical margin 5 mm or less (group ≤5 mm), 102 with margin 5-10 mm (group 5 to 10 mm) and 98 with margin 10 mm or more (group>10 mm). The margin was pathologically evaluated and clinical results were followed and analyzed. Results None of the patients had positive surgical margins. The mean and median margin width was 2.2 and 2.0 mm (range 0 to 5) for group≤5 mm,6.7 and 6.0 mm for group 5 to 10 mm and 11.8 and 12.0 mm for group>10 mm. The difference was statistically significant (P= 0.025). The mean and median follow-up for all the patients was 79 and 83 months (range 15 to 132),and that was 69 and 73 months (range 15-130) for group≤5 mm,83 and 86 (range 17 to 132) for group 5-10 mm and 82 and 82 (range 60-103) for group>10 mm. Three patients in group ≤5 mm,5 in group 5 to 10 mm and 2 in group>10 mm died of non-cancer related disease during followup. One patient in group ≤5 mm (0.74%) experienced ectopic local recurrence in the same kidney and one in group 5 to 10 mm was detected local recurrence in the tumor bed (0.98%). No distant metastasis was detected in all the patients. The over-all 5-year survival was 99.2% for group ≤5 mm,99.0% for group 5 to 10 mm and 98.0% for group>10 mm,respectively. Kaplan-Meier survival analysis,Log Rank,χ21-511 ,P =0.470. Conclusion Mini margin nephron sparing surgery was as well safe and effective in treating stage Tla RCC,It provided excellent renal function preservation,favorable long-term progression-free survival,lower complication rate,and was not associated with an increased risk of local recurrence.%目的 比较不同切缘保肾手术患者远期临床效果,探讨小切缘保肾手术治疗早期肾癌

  18. Long-term outcome of mycophenolate mofetil treatment for patients with microscopic polyangiitis: an observational study in Chinese patients.

    Science.gov (United States)

    Chen, Yinghua; Gao, Erzhi; Yang, Liu; Liu, Xia; Li, Kang; Liu, Zhengzhao; Zeng, Caihong; Zhang, Haitao; Liu, Zhihong; Hu, Weixin

    2016-07-01

    This study aimed to retrospectively analyze the long-term outcome of mycophenolate mofetil (MMF) therapy for microscopic polyangiitis (MPA) with mild to moderate renal involvement in Chinese patients. Thirty-four MPA patients (24 females, 10 males, aged 44.7 ± 17 years, BVAS score 13.8 ± 3.2, SCr 2.2 ± 1.1 mg/dl) with SCr < 5 mg/dl and who received glucocorticoids plus MMF therapy for inducing and maintaining remission were included in this study. The remission and relapse rates, patient and renal survival rates and adverse events were retrospectively analyzed. We found that 31 (91.2 %) of 34 patients achieved remission and were continuously treated with glucocorticoids plus MMF for maintaining remission. The median duration of MMF treatment was 24 months (IQR 15-53 months) and follow-up time was 86 months (IQR 29-124 months). During the follow-up, 7 (22.6 %) patients relapsed, one patient died, and one patient progressed into end-stage renal disease. The 5-year patient and renal survival rates were 92.8 and 95.2 %, respectively. 11 (32.4 %) patients suffered 16 adverse events, 13 of which were pulmonary infection. In conclusion, glucocorticoids plus MMF regimen as induction and maintenance therapy could achieve high remission rate and good long-term renal survival in MPA patients with mild to moderate renal involvement. Prospective controlled trials with a large sample size are needed to confirm the efficacy of MMF in this population. PMID:27169414

  19. Long-Term Outcomes of Fractionated Stereotactic Radiation Therapy for Pituitary Adenomas at the BC Cancer Agency

    International Nuclear Information System (INIS)

    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

  20. 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.

  1. 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.

  2. 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.

  3. Immediate results and long-term cardiovascular outcomes of endovascular therapy in octogenarians and nonoctogenarians with peripheral arterial diseases

    Directory of Open Access Journals (Sweden)

    Huang HL

    2016-05-01

    Full Text Available Hsuan-Li Huang,1 Jyh-Ming Jimmy Juang,2 Hsin-Hua Chou,1,3 Chien-An Hsieh,1 Shih-Jung Jang,1 Shih-Tsung Cheng,1,3 Yu-Lin Ko1,3 1Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, 2Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, 3School of Medicine, Tzu Chi University, Hualien, Taiwan Purpose: To investigate the clinical outcomes of endovascular therapy (EVT in octogenarians and nonoctogenarians with peripheral arterial disease. Methods: A retrospective analysis of 511 patients (654 affected legs who underwent EVT between July 2005 and December 2013 was conducted in a prospectively maintained database. Immediate results and long-term vascular outcomes were analyzed and compared between octogenarians and nonoctogenarians. Results: Octogenarians were more likely to be female and have atrial fibrillation (AF, whereas nonoctogenarians had higher rates of obesity, claudication, and medical comorbidities. There were no differences in the rates of EVT success, 30-day major adverse vascular events, and 6-month functional improvement between groups. Over the 10-year follow-up period, the rates of 3-year limb salvage, sustained clinical success, freedom from major cerebrovascular and cardiovascular events, and composite vascular events were similar between groups, but the survival rate was better in nonoctogenarians than in octogenarians (73% vs 63%, respectively, P=0.004. In Cox regression analysis, dependence on dialysis and AF were significant predictors of death (odds ratio [OR] 4.44 in dialyzed and 2.83 in AF patients, major cerebrovascular and cardiovascular events (OR 3.49 and 2.45, and composite vascular events (OR 3.14 and 2.25. Conclusion: EVT in octogenarians was feasible, without an increased risk of periprocedural complications. The

  4. Long-term results of a randomized phase III trial of TPF induction chemotherapy followed by surgery and radiation in locally advanced oral squamous cell carcinoma

    OpenAIRE

    Zhong, Lai-ping; Zhang, Chen-Ping; Ren, Guo-xin; Guo, Wei; William, William N.; Hong, Christopher S.; Sun, Jian; ZHU, HAN-GUANG; Tu, Wen-yong; Li, Jiang; Cai, Yi-li; Yin, Qiu-ming; WANG, LI-ZHEN; Wang, Zhong-he; Hu, Yong-jie

    2015-01-01

    Previously, we conducted a randomized phase III trial of TPF (docetaxel, cisplatin, and 5-fluorouracil) induction chemotherapy in surgically managed locally advanced oral squamous cell carcinoma (OSCC) and found no improvement in overall survival. This study reports long-term follow-up results from our initial trial. All patients had clinical stage III or IVA locally advanced OSCC. In the experimental group, patients received two cycles of TPF induction chemotherapy (75mg/m2 docetaxel d1, 75m...

  5. Long-Term Outcomes of Homografts in the Aortic Valve and Root Position: A 20-Year Experience

    Science.gov (United States)

    Kim, Joo Yeon; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won

    2016-01-01

    Background The advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position. Methods This is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months). Results Aortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were 80.0%±7.3% and 60.8%±10.1%, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were 92.3%±5.2%, 68.9%±10.2%, and 50.3%±13.6%, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were 91.7%±8.0%, 41.7%±14.2%, and 25.0%±12.5%, respectively. Conclusion Homografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis. PMID:27525234

  6. Perioperative and long-term operative outcomes after surgery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation

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    Anderson Douglas

    2008-07-01

    Full Text Available Abstract Objectives Numerous medical and surgical therapies have been utilized to treat the symptoms of trigeminal neuralgia (TN. This retrospective study compares patients undergoing either microvascular decompression or balloon ablation of the trigeminal ganglion and determines which produces the best long-term outcomes. Methods A 10-year retrospective chart review was performed on patients who underwent microvascular decompression (MVD or percutaneous balloon ablation (BA surgery for TN. Demographic data, intraoperative variables, length of hospitalization and symptom improvement were assessed along with complications and recurrences of symptoms after surgery. Appropriate statistical comparisons were utilized to assess differences between the two surgical techniques. Results MVD patients were younger but were otherwise similar to BA patients. Intraoperatively, twice as many BA patients developed bradycardia compared to MVD patients. 75% of BA patients with bradycardia had an improvement of symptoms. Hospital stay was shorter in BA patients but overall improvement of symptoms was better with MVD. Postoperative complication rates were similar (21% vs 26% between the BA and MVD groups. Discussion MVD produced better overall outcomes compared to BA and may be the procedure of choice for surgery to treat TN.

  7. 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.

  8. 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

  9. 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.

  10. 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

  11. Transient versus Persistent BK Viremia and Long-Term Outcomes after Kidney and Kidney–Pancreas Transplantation

    Science.gov (United States)

    Elfadawy, Nissreen; Schold, Jesse D.; Srinivas, Titte R.; Poggio, Emilio; Fatica, Richard; Avery, Robin; Mossad, Sherif B.

    2014-01-01

    Background and objectives The objective was to study the long-term impact of transient versus persistent BK viremia on kidney transplant outcomes. Design, setting, participants, & measurements In total, 609 recipients who underwent kidney transplant from 2007 to 2011 were screened at months 1–12 for the occurrence of polyomavirus BK viremia; 130 patients (21.7%) developed BK viremia during the first year post-transplant. BK viremia patients were classified according to duration of infection (more or less than 3 months), and BK viral loads (more or less than 10,000 copies/ml) were classified as transient low viremia (n=42), transient high viremia (n=18), persistent low viremia (n=23), and persistent high viremia (n=47). All patients were followed a median of 36 (3–66) months. The rates of BK polyomavirus–associated nephropathy, acute rejection, and 1-year graft function were compared with the polyomavirus BK–negative control group. Results Patient and graft survival were not significantly different among the groups. Graft function (creatinine; milligrams per deciliter) at 1 year was significantly worse in the persistent high viremia (1.75±0.6) and transient high viremia (1.85±0.7) groups compared with aviremic controls (1.47±0.4; P=0.01 and P=0.01, respectively). The incidence of BK polyomavirus–associated nephropathy was limited to the persistent high viremia group (1.3%, P<0.001). The transient high viremia (50%) and persistent high viremia (34%) groups showed significantly (P=0.01) increased incidence of acute rejection versus aviremic controls (21.5%), transient low viremia (19%), or persistent low viremia (17.3%) groups. Conclusion Low viral load BK viremia, either transient or persistent, was not associated with long-term transplant outcomes. Persistent high viremia was associated with a greater risk for BK polyomavirus–associated nephropathy and subsequent graft dysfunction. Although transient high viremia was not associated with BK

  12. Long-term Neurodevelopmental Impairment in Neonates Surgically Treated for Necrotizing Enterocolitis : Enterostomy Associated with a Worse Outcome

    NARCIS (Netherlands)

    Ta, B. D. P.; Roze, E.; van Braeckel, K. N. J. A.; Bos, A. F.; Rassouli-Kirchmeier, R.; Hulscher, J. B. F.

    2011-01-01

    Background: Necrotizing enterocolitis (NEC) patients often have neurodevelopmental impairment, but the long-term follow-up data is limited. We determined whether surgical factors were of prognostic value for long-term neurodevelopment in children surviving surgery for NEC (SNEC). Patients and method

  13. Clinical study of radioprotective effects of amifostine (YM-08310, WR-2721) on long-term outcome for patients with cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Mitsuhashi, Norio; Takahashi, Iku; Takahashi, Mitsuhiro; Hayakawa, Kazushige; Niibe, Hideo (Gumma Univ. School of Medicine (Japan))

    1993-06-15

    A retrospective analysis was performed to investigate the radioprotective effects of amifostine on the long-term outcome of radiation therapy for patients with carcinoma of the uterine cervix. Eighty-three patients with histologically proven epidermoid carcinoma (Stage II-IVA disease) of the uterine cervix were treated with definite radiation therapy between January 1978 and December 1984. Forty-six patients were treated with radiation alone, whereas 37 patients were treated with radiation plus amifostine daily from the initiation of the course of radiation therapy. The median total dose of amifostine given was 1300 mg/m[sub 2], with a range of 280 mg/m[sup 2] to 3700 mg/m[sup 2]. The 5-year overall actuarial survival for the patients treated with radiation along and with radiation plus amifostine were: 72% and 88% in Stage II disease (p = 0.45); 52% and 50% in Stage III disease (p = 0.68); and 40% and 43% in Stage IVA disease (p = 0.51), respectively. The 5-year intra-pelvic recurrence rates in the patients treated with amifostine were almost the same as those observed in the patients treated without amifostine (0% vs. 6% in Stage II disease; 15% vs. 10% in Stage III disease; 25% vs. 40% in Stage IVA disease). There was also no statistically significant difference of the chronic rectal or bladder complication rate between the groups treated by each regimen. The authors concluded that any radioprotective effects of amifostine on tumor tissue and any beneficial effects of amifostine against chronic radiation injury were not observed in the patients with cervical cancer followed up for more than 5 years after radiation therapy. 17 refs., 3 figs., 3 tabs.

  14. Long-term outcome after radiation therapy for subfoveal choroidal neovascularization associated with age-related macular degeneration

    Energy Technology Data Exchange (ETDEWEB)

    Mandai, Michiko; Takahashi, Masayo; Miyamoto, Hideki; Hiroshiba, Naoko; Kimura, Hideya; Ogura, Yuichiro; Honda, Yoshihito; Sasai, Keisuke [Kyoto Univ. (Japan). Graduate School of Medicine

    2000-10-01

    The purpose of this study was to investigate the long-term effect of low-dose radiation therapy on subfoveal choroidal neovascularization associated with age-related macular degeneration. The clinical course and visual outcome were compared retrospectively among two treated groups and a control group; 15 patients (15 eyes) received 10 Gy, another 15 patients (15 eyes) received 20 Gy. The control group consisted of 15 patients (15 eyes) without treatment. All patients were followed up for at least 18 months, and most were followed up for 3 years. The macula was irradiated with either 10 Gy in 5 fractions or with 20 Gy in 10 fractions after computed tomography (CT) simulation enabled real-time treatment planning from multiple CT slices. During the 3 years of follow-up, the lesions became better in 5 eyes, unchanged in 1, and worse in 9 with 10 Gy radiation; better in 7 eyes, unchanged in 1, and worse in 7 eyes with 20 Gy; and better in 1 eye and worse in 14 with no treatment. The difference between the groups treated with radiation and the control was statistically significant (P<.05). Visual acuity was also significantly better in the group receiving 20 Gy than in the control group up to 2 years after radiation (P<.01). Radiation may extend the period of good visual function substantially by reducing subfoveal choroidal neovascularization activity. (author)

  15. 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.

  16. The Long-Term Outcomes after Radical Prostatectomy of Patients with Pathologic Gleason 8–10 Disease

    Directory of Open Access Journals (Sweden)

    Dan Lewinshtein

    2012-01-01

    Full Text Available Background. We explored the long-term clinical outcomes including metastases-free survival and prostate cancer-specific survival (PCSS in patients with pathologic Gleason 8–10 disease after radical prostatectomy (RP. Methods. We report on 91 patients with PCSS data with a median followup of 8.2 years after RP performed between 1988 and 1997. Cox regression and Kaplan-Meier analysis were used to evaluate year of surgery, pathologic stage, and surgical margin status as predictors of PCSM. Results. Median age was 65 years (IQR: 61–9, and median PSA was 9.7 ng/ml (IQR: 6.1–13.4. Of all patients, 62 (68.9% had stage T3 disease or higher, and 48 (52.7% had a positive surgical margin. On multivariate analysis, none of the predictors were statistically significant. Of all patients, the predicted 10-year BCR-free survival, mets-free survival, and PCSS were 59% (CI: 53%–65%, 88% (CI: 84%–92%, and 94% (CI: 91%–97%, respectively. Conclusions. We have demonstrated that cancer control is durable even 10 years after RP in those with pathologic Gleason 8–10 disease. Although 40% will succumb to BCR, only 6% of patients died of their disease. These results support the use of RP for patients with high-risk localized prostate cancer.

  17. 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

  18. 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

  19. 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

    : Compared with men, women were older, weighed less, were less likely to have prior myocardial infarction or revascularization, and had lower baseline creatinine clearance and hemoglobin level values. Rates of the composite of cardiovascular death/myocardial infarction/stroke (20.2% vs 19.1%; P = .56), all......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 ischemic and bleeding outcomes and platelet reactivity for medically managed ACS patients randomized to prasugrel versus clopidogrel plus aspirin. METHODS: Data from 9,326 patients enrolled in TRILOGY ACS were analyzed to determine differences in long-term ischemic and bleeding outcomes between women (n...

  20. 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.

  1. Long-term reading and spelling outcome in Italian adolescents with a history of specific language impairment.

    Science.gov (United States)

    Brizzolara, Daniela; Gasperini, Filippo; Pfanner, Lucia; Cristofani, Paola; Casalini, Claudia; Chilosi, Anna M

    2011-09-01

    Specific language impairment (SLI) diagnosed in the pre-school years is frequently associated with reading and writing difficulties at school age. The nature of this relationship is unclear, despite the availability of a large number of studies, mostly on English speaking children. Phonological processing deficits have been considered the prominent cause of both difficulties. However recent findings in both children with SLI and in children with reading difficulties are not easily accommodated within a single dimensional model explaining the relationship between oral and written language deficits. Our study focuses on the long-term reading and spelling outcome in relation to preschool oral language skills in a group of Italian adolescents with a documented history of SLI. Sixteen Italian adolescents diagnosed as SLI at our Hospital in the pre-school years and 32 normal controls were submitted to an extensive assessment of oral and written language skills. At a group level SLI adolescents had weak oral and written language skills in almost all tests. Results show that reading difficulties have some features in common with those of Italian developmental dyslexics but also have distinct characteristics, since reading accuracy and written comprehension, usually relatively spared in Italian developmental dyslexics, were impaired in adolescents with SLI. Longitudinal analyses showed that expressive morpho-syntactic and lexical abilities at pre-school age were the oral language skills that best predicted reading and spelling outcomes in adolescents with SLI. However, also children with severe phonological impairment in the absence of other oral language deficits showed later literacy difficulties, although less severe and mainly limited to reading accuracy. Our study supports the notion that there is a complex relationship between oral and written language difficulties which may change at different developmental time points, not captured by a single deficit model, but

  2. The Modern Role of Radiation Therapy in Treating Advanced-Stage Retinoblastoma: Long-Term Outcomes and Racial Differences

    International Nuclear Information System (INIS)

    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

  3. 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.

  4. Optimization of dental status improves long-term outcome after alveolar bone grafting in unilateral cleft lip and palate.

    Science.gov (United States)

    Jabbari, Fatima; Skoog, Valdemar; Reiser, Eicka; Hakelius, Malin; Nowinski, Daniel

    2015-03-01

    Objective : To evaluate the importance of dental status for long-term outcome after alveolar bone grafting in patients with unilateral cleft lip and palate. Design : Retrospective longitudinal study. Setting : Cleft lip and palate-craniofacial center, Uppsala University Hospital, Sweden. Patients : A total of 67 consecutive patients with unilateral complete cleft lip and palate. Interventions : Secondary alveolar bone grafting, prior to the eruption of the permanent canine, was performed at the average age of 10.0 years (range, 8.5 to 12.0 years). Main Outcome Measures : Alveolar bone height was evaluated with the modified Bergland index at 1 and 10 years after surgery. Results : Of the patients, 97% had modified Bergland index grade I and the remaining 3% had modified Bergland index grade II at 1 year after surgery. At 10 years' follow-up, 43% showed modified Bergland index grade I; 55%, modified Bergland index grade II; and 2% (one patient), modified Bergland index grade III. The degree of dental anomalies in the cleft area, such as enamel hypoplasia, incisor rotation, incisor inclination, canine inclination, and oral hygiene registered preoperatively, all correlated negatively to the modified Bergland index at 10 years after surgery. Enamel hypoplasia (ρ = 0.70195, P < .0001), followed by canine inclination (ρ = 0.55429, P < .0001), showed the strongest correlation to reduced bone height in the cleft area. Conclusions : In patients with unilateral cleft lip and palate, excellent results from secondary alveolar bone grafting in terms of bone height in the alveolar cleft tend to decrease with time. This seems to be correlated with factors that might to some extent be treated preoperatively through adequate planning and execution of the orthodontic treatment. PMID:24568558

  5. 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.

  6. Long-term reading and spelling outcome in Italian adolescents with a history of specific language impairment.

    Science.gov (United States)

    Brizzolara, Daniela; Gasperini, Filippo; Pfanner, Lucia; Cristofani, Paola; Casalini, Claudia; Chilosi, Anna M

    2011-09-01

    Specific language impairment (SLI) diagnosed in the pre-school years is frequently associated with reading and writing difficulties at school age. The nature of this relationship is unclear, despite the availability of a large number of studies, mostly on English speaking children. Phonological processing deficits have been considered the prominent cause of both difficulties. However recent findings in both children with SLI and in children with reading difficulties are not easily accommodated within a single dimensional model explaining the relationship between oral and written language deficits. Our study focuses on the long-term reading and spelling outcome in relation to preschool oral language skills in a group of Italian adolescents with a documented history of SLI. Sixteen Italian adolescents diagnosed as SLI at our Hospital in the pre-school years and 32 normal controls were submitted to an extensive assessment of oral and written language skills. At a group level SLI adolescents had weak oral and written language skills in almost all tests. Results show that reading difficulties have some features in common with those of Italian developmental dyslexics but also have distinct characteristics, since reading accuracy and written comprehension, usually relatively spared in Italian developmental dyslexics, were impaired in adolescents with SLI. Longitudinal analyses showed that expressive morpho-syntactic and lexical abilities at pre-school age were the oral language skills that best predicted reading and spelling outcomes in adolescents with SLI. However, also children with severe phonological impairment in the absence of other oral language deficits showed later literacy difficulties, although less severe and mainly limited to reading accuracy. Our study supports the notion that there is a complex relationship between oral and written language difficulties which may change at different developmental time points, not captured by a single deficit model, but

  7. 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.

  8. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm

    Science.gov (United States)

    Kwon, Hyunwook; Ko, Gi-Young; Kim, Min-Ju; Han, Youngjin; Noh, Minsu; Kwon, Tae-Won; Cho, Yong-Pil

    2016-01-01

    Abstract The aim of this study was to determine the association between postimplantation syndrome (PIS) and long-term clinical outcomes after elective endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm. In this single-center, observational cohort study, a total of 204 consecutive patients undergoing EVAR were included. Primary outcome was long-term mortality from any cause; secondary outcomes included long-term mortality, systemic or implant-related complications, and secondary therapeutic procedures. The diagnosis of PIS was established in 64 patients (31.4%). PIS patients were more likely to receive woven polyester endografts and have a longer postoperative hospital stay and lower incidence of type II endoleaks. In multivariate analysis, PIS was significantly associated with a decreased risk of developing type II endoleaks (P = 0.044). During follow-up period of 44 months, clinical outcomes showed no significant differences in mortality (P = 0.876), systemic (P = 0.668), or implant-related complications (P = 0.847), although rates of secondary therapeutic procedure were significantly higher in non-PIS patients (P = 0.037). The groups had similar rates of overall survival (P = 0.761) and other clinical outcomes (P = 0.562). Patients with and without PIS had similar long-term overall survival rates and other clinical outcomes. PIS was beneficial in preventing type II endoleaks during postoperative period. PMID:27512875

  9. Effects of postimplantation systemic inflammatory response on long-term clinical outcomes after endovascular aneurysm repair of an abdominal aortic aneurysm.

    Science.gov (United States)

    Kwon, Hyunwook; Ko, Gi-Young; Kim, Min-Ju; Han, Youngjin; Noh, Minsu; Kwon, Tae-Won; Cho, Yong-Pil

    2016-08-01

    The aim of this study was to determine the association between postimplantation syndrome (PIS) and long-term clinical outcomes after elective endovascular aneurysm repair (EVAR) of an abdominal aortic aneurysm.In this single-center, observational cohort study, a total of 204 consecutive patients undergoing EVAR were included. Primary outcome was long-term mortality from any cause; secondary outcomes included long-term mortality, systemic or implant-related complications, and secondary therapeutic procedures.The diagnosis of PIS was established in 64 patients (31.4%). PIS patients were more likely to receive woven polyester endografts and have a longer postoperative hospital stay and lower incidence of type II endoleaks. In multivariate analysis, PIS was significantly associated with a decreased risk of developing type II endoleaks (P = 0.044). During follow-up period of 44 months, clinical outcomes showed no significant differences in mortality (P = 0.876), systemic (P = 0.668), or implant-related complications (P = 0.847), although rates of secondary therapeutic procedure were significantly higher in non-PIS patients (P = 0.037). The groups had similar rates of overall survival (P = 0.761) and other clinical outcomes (P = 0.562).Patients with and without PIS had similar long-term overall survival rates and other clinical outcomes. PIS was beneficial in preventing type II endoleaks during postoperative period. PMID:27512875

  10. Long-term outcome after cerebral venous thrombosis: analysis of functional and vocational outcome, residual symptoms, and adverse events in 161 patients.

    Science.gov (United States)

    Hiltunen, Sini; Putaala, Jukka; Haapaniemi, Elena; Tatlisumak, Turgut

    2016-03-01

    Cerebral venous thrombosis (CVT) affects mainly working-aged individuals. Functional recovery after CVT is generally considered good with about 3/4 of patients achieving short-term independence. However, vascular events, long-term functional outcome, and employment after CVT remain poorly investigated. We identified consecutive adult CVT patients treated at the Helsinki University Hospital (1987-2013) and invited them to a follow-up visit. Each clinical examination was combined with interview. We also recorded recurrent venous thromboembolism (VTE) and hemorrhagic events during follow-up and antithrombotic medication use. A modified Rankin Scale (mRS) served to assess functional outcome. Logistic regression served to identify independent factors associated with unemployment and functional recovery. Of the 195 patients identified, 21 died, 9 declined to participate, and 4 were excluded from the study. Thus, 161 patients (106 women) underwent an examination after a median of 39 months (interquartile range 14-95). VTE (one of which was CVT) occurred in 9 (6%) patients, and severe hemorrhagic events in 10 (6%). Functional outcome was good, with 84% scoring 0-1 on the mRS; 42% reported residual symptoms. Altogether, 91 (57%) patients were employed. After adjusting for age and sex, a National Institutes of Health Stroke Scale score>2 at admission and low education level, associated with both unfavorable functional outcome and unemployment. Long-term functional outcome after CVT may appear good if measured with mRS, but patients often have residual symptoms and are frequently unable to return to their previous work. PMID:26725090

  11. Preoperative chemoradiation with or without induction oxaliplatin plus 5-fluorouracil in locally advanced rectal cancer. Long-term outcome analysis

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, F.A. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Instituto de Investigacion Sanitaria, Madrid (Spain); Sole, C.V. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Instituto de Radiomedicina, Service of Radiation Oncology, Santiago (Chile); Hospital General Universitario Gregorio Maranon, Instituto de Investigacion Sanitaria, Madrid (Spain); Serrano, J. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Valle, E. del; Rodriguez, M. [Hospital General Universitario Gregorio Maranon, Service of General Surgery I, Madrid (Spain); Munoz-Calero, A.; Garcia-Sabrido, J.L. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of General Surgery I, Madrid (Spain); Garcia-Alfonso, P. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of Medical Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Instituto de Investigacion Sanitaria, Madrid (Spain); Peligros, I. [Hospital General Universitario Gregorio Maranon, Department of Pahology, Madrid (Spain); Alvarez, E. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Department of Pahology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Instituto de Investigacion Sanitaria, Madrid (Spain)

    2014-02-15

    It has been previously reported that a short FOLFOX-4 induction significantly improves pathologic complete response in locally advanced rectal cancer (LARC) patients treated with preoperative chemoradiation (CRT). In a larger and updated patient series, we analyzed FOLFOX-4 efficacy in terms of sphincter preservation and long-term outcomes. From January 1995 to December 2010, 335 LARC patients were treated with preoperative chemoradiation (4500-5040 cGy). Starting in May 2001, 207 consecutive patients additionally received induction FOLFOX-4. Surgery was performed 6 weeks (range 3-12 weeks) after chemoradiation. Incidence of total tumor (63 vs. 54 %, p = 0.02) and nodal downstaging (60 vs. 43 %, p = 0.002) was significantly increased by induction FOLFOX-4. In an analysis of tumors located below 5 cm from the anal verge (n = 114, 34 %), sphincter preservation was feasible in 30 % in the FOLFOX-4 versus 13 % in the upfront CRT group (p = 0.04). Median follow-up time for the entire cohort of patients was 72.6 months (range 4-205 months). FOLFOX-4 was not associated with superior locoregional control (HR 0.88, p = 0.78), disease-free survival (HR 0.83, p = 0.55), distant metastases-free survival (HR 0.94, p = 0.81), or cancer-specific survival (HR 0.70, p = 0.15). Short-intense induction FOLFOX-4 significantly improves downstaging and sphincter preservation in low rectal tumors. Long-term outcomes were not improved in the FOLFOX-4 group of patients. (orig.) [German] Es wurde bereits berichtet, dass eine kurze FOLFOX-4-Induktion das gesamte pathologische Ansprechen bei Patienten mit lokal fortgeschrittenem Rektumkarzinom (LARC), die praeoperativ mittels Strahlenchemotherapie (CRT) behandelt wurden, signifikant verbessert. In einer groesseren und aktualisierten Patientengruppe analysierten wir die FOLFOX-4-Wirksamkeit hinsichtlich Sphinktererhalt und Langzeitergebnissen. Von Januar 1995 bis Dezember 2010 wurden 335 LARC-Patienten praeoperativ mit einer

  12. 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.

  13. Long-term outcome following splenectomy for chronic and persistent immune thrombocytopenia (ITP) in adults and children : Splenectomy in ITP.

    Science.gov (United States)

    Ahmed, Rayaz; Devasia, Anup J; Viswabandya, Auro; Lakshmi, Kavitha M; Abraham, Aby; Karl, Sampath; Mathai, John; Jacob, Paul M; Abraham, Deepak; Srivastava, Alok; Mathews, Vikram; George, Biju

    2016-09-01

    The purpose of this research is to study the outcomes of splenectomy for chronic and persistent immune thrombocytopenia (ITP). This study is a retrospective analysis of 254 patients with chronic or persistent ITP who underwent splenectomy at CMC, Vellore, India between 1995 and 2009. Responses were assessed based on standard criteria. One hundred and sixty seven adults and 87 children with a median age of 29 years (range 2-64) with persistent (n = 103) or chronic ITP (n = 151) was studied. Response was seen in 229 (90.2 %) including CR in 74.4 % at a median time of 1 day (range 1-54). Infections following splenectomy were reported in 16 %. Deaths related to post splenectomy sepsis occurred in 1.57 % and major bleeding in 0.78 %. At median follow-up of 54.3 months (range 1-290), 178 (70.1 %) remain in remission. The 5-year and 10-year overall survival (OS) is 97.4 ± 1.2 % and 94.9 ± 2.1 %, respectively, while the 5-year and 10-year event-free survival (EFS) is 76.5 + 2.9 % and 71.0 + 3.9 %, respectively. Splenectomy is associated with long-term remission rates of >70 % in chronic or persistent ITP. PMID:27370992

  14. 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.

  15. 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.

  16. Sustained improvement of quality of life for nasopharyngeal carcinoma treated by intensity modulated radiation therapy in long-term survivors

    OpenAIRE

    Song, Tao; Fang, Ming; Zhang, Xue-Bang; Zhang, Ping; Xie, Rui-Fei; Wu, Shi-xiu

    2015-01-01

    IMRT has achieved an excellent survival and less radiation-induced sequelae with improvement of QoL within 2 years compared to conventional radiotherapy for NPC. Whether IMRT could sustained decrease incidence of late sequelae and improve QoL further for long-term survivors remained unknown. 176 patients from Aug. 2002 to Jun. 2009 were retrospectively analyzed. Radiation-related toxicities were graded according to both the Acute and the Late Radiation Morbidity Scoring Criteria of the EORTC/...

  17. 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

  18. The Relationship of Social Support and Economic Self-Sufficiency to Substance Abuse Outcomes in a Long-Term Recovery Program for Women.

    Science.gov (United States)

    Gregoire, Thomas K.; Snively, Carol

    2001-01-01

    Explores outcomes for 59 women who attended long term substance abuse treatment in a women's facility that emphasized employment and economic self sufficiency. Results revealed that reductions in substance abuse were associated with an increase in economic self sufficiency. Additionally, women living in drug free social environments had high rates…

  19. 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…

  20. Predictors of Long-Term Enrollment and Degree Outcomes for Community College Students: Integrating Academic, Psychosocial, Socio-Demographic, and Situational Factors

    Science.gov (United States)

    Porchea, Sameano F.; Allen, Jeff; Robbins, Steve; Phelps, Richard P.

    2010-01-01

    We examined the effects of student (academic preparation, psychosocial, socio-demographic, and situational) and institutional characteristics on long-term enrollment outcomes. We tracked enrollments and degrees awarded for students who originally enrolled at two-year institutions across five years. Our findings have implications for identifying…

  1. 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

  2. Short- and long-term outcome of infants born after maternal (pre)-eclampsia, HELLP syndrome and thrombophilia a retrospective, cohort study

    NARCIS (Netherlands)

    J.M.F. Boomsma; R.A. van Lingen; J. van Eyck; P. Tamminga; B.J. Kollen; R.M. van Elburg

    2010-01-01

    Objectives To investigate the short- and long-term outcome of children born from mothers with pre-eclampsia eclampsia and/or HELLP syndrome and to determine the differences between children born from mothers with and without underlying thrombophilic disorder Study design Four hundred and nine infant

  3. 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

  4. 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

    2016-06-01

    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. PMID:26757831

  5. 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....

  6. [A case of gastric adenosquamous carcinoma with peritoneal dissemination in which treatment with S-1 plus paclitaxel therapy resulted in improved long-term survival].

    Science.gov (United States)

    Hirano, Masamitsu; Ozamoto, Yuki; Ichinose, Masumi; Togawa, Takeshi; Takao, Nobuyuki; Mizumoto, Akiyoshi; Tatsuno, Manami; Yamamoto, Yoshihiro; Yonemura, Yutaka

    2014-07-01

    Gastric adenosquamous carcinoma is a rare malignancy with a poor prognosis. We recently performed palliative gastrectomy for a gastric adenosquamous carcinoma with peritoneal dissemination and provided a course of systemic chemotherapy with S-1 plus paclitaxel(PTX)after the surgery. No serious adverse events were observed, and treatment with S-1 plus PTX was continued for 1 year before being switched to adjuvant chemotherapy with S-1 alone for another year. The tumor maker levels normalized within 2 months of the initial treatment, and the peritoneal dissemination could no longer be detected by abdominal computed tomography(CT). The patient remained in clinical remission and maintained long-term survival of over 8 years. PMID:25131877

  7. Immediate and long-term outcome analysis of lipomeningomyelocele repair in asymptomatic infants in a tertiary care center

    Directory of Open Access Journals (Sweden)

    Prashant Sadashiv Patil

    2016-01-01

    Full Text Available Objective: To analyze immediate and long-term results of lipomeningomyelocele (LMM repair in asymptomatic patients. Materials and Methods: Seventeen patients of LMM presented to Department of Paediatric Surgery over a period from 2011 to 2015 were evaluated preoperatively by magnetic resonance imaging of whole spine, and pre- and post-operative Ultrasound of kidney, ureter, bladder, and neurosonogram. Surgical procedure involved total excision of lipoma in 15 patients and near total excision in 2 patients. Division of filum terminale could be done in 15 out of 17 patients. Follow-up varied from 1 to 3.5 years (mean 1.9 years. Results: This study included 10 (58.8% patients of lumbosacral LMM, 5 (29.4% patients of sacral, and 2 (11.7% patients of thoracolumbar LMM. About 13 (76.4% patients were operated before 3 months of age, 2 (23.5% patients were operated between 3 and 6 months, and two patients were operated between 6 and 11 months. None of the patients had bladder/bowel dysfunction preoperatively. Preoperative lower limb power was normal in all patients. Objective improvement in lower limb motor function was observed in 3 (17.6% patients and three patients had decreased lower limb power. Two patients developed altered sensations and weakness of lower limb about 2.5-3 years after initial LMM repair. They needed repeat detethering of cord. Two patients had fecal pseudoincontinence, whereas one patient developed constipation. Bowel dysfunction was managed by rectal washouts, and oral laxatives were added if required. One (5.8% patient of lumbosacral LMM and 1 (5.8% patient of sacral LMM had urinary incontinence postoperatively. This was managed by clean intermittent catheterization with continuous overnight drainage. Conservative management of bladder and bowel dysfunction was effective in all patients till the last follow-up. Two patients developed hydrocephalus after LMM repair for which low-pressure ventriculoperitoneal shunt was inserted

  8. Clinical analysis of long-term outcomes of re-intervention of transjugular intrahepatic porto-systemic shunt

    International Nuclear Information System (INIS)

    Objective: To evaluate the safety,effectiveness and clinical factors of re-intervention of transjugular intrahepatic porto-systemic shunt (TIPS). Methods: A retrospective study of safety and long-term outcomes of TIPS was made in 771 patients from August 1994 to August 2010. The 625 patients had follow-up data.The patients who received TIPS once, twice, and more than twice were divided into group 1, group 2 and group 3, respectively. Clinical symptoms, survival rate and restenosis rate of each group were analyzed. Clinical influencing factors of re-intervention effect were discussed. Results: The success rate of first intervention was 98.2% (757/771), the death rate was 0.7% (5/757) and severe complication rate was 2.5% (19/757). The success rate of re-intervention was 98.7% (457/463), no death and severe complications occurred. The restenosis rate in group 3 decreased significantly than group 1 (χ2=7.908, P<0.05) in the first year of TIPS. The restenosis rates in group 2 and group 3 were lower than group 1 from 2 to 5 years of TIPS (χ2 values were 27.046, 25.724, 37.002 and 19.046, respectively, P<0.05). The survival rate in group 3 was higher than group 1 (χ2=9.114, P<0.05)and group 2 was higher than group 1 (χ2=4.929, P<0.05) in the first year of TIPS, while there was no statistical difference between group 2 and group 3 (χ2=2.678, P>0.05). The patients in group 2 and group 3 also had higher survival rates than group 1 from 2 to 5 years of TIPS (χ2 value were 41.314, 26.920, 13.692 and 6.713, respectively, P<0.05). 19.4% (79/406) of patients who received re-intervention had symptom recurrence and shunt stenosis or occlusion. 11.6% (47/406) of patients had symptom recurrence with portal hypertension signs, 62.8% (255/406) had shunt stenosis or occlusion with portal hypertension signs. Conclusions: Restenosis or occlusion of TIPS, symptom recurrence and portal hypertension signs were important factors for re-intervention. Re-intervention of TIPS was safe and

  9. 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

  10. 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

  11. 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, PD; 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

  12. 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

  13. 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.

  14. 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.

  15. Long-Term Outcome of Cognitive Behavior Therapy for Body Dysmorphic Disorder: A Naturalistic Case Series of 1 to 4 Years After a Controlled Trial.

    Science.gov (United States)

    Veale, David; Miles, Sarah; Anson, Martin

    2015-11-01

    There is some evidence for the efficacy of cognitive behavior therapy (CBT) for body dysmorphic disorder (BDD) after 1 to 6months but none in the long term. The aim of this study was to follow up the participants in a randomized controlled trial of CBT versus anxiety management to determine whether or not the treatment gains were maintained over time. Thirty of the original 39 participants who had CBT were followed up over 1 to 4years and assessed using a number of clinician and self-report measures, which included the primary outcome measure of the Yale-Brown Obsessive Compulsive Scale modified for BDD. Outcome scores generally maintained over time from end of treatment to long-term follow-up. There was a slight deterioration from n=20 (51.3%) to n=18 (46.2%) who met improvement criteria at long-term follow-up. Eleven (28.2%) were in full remission and 22 (56.4%) were in partial remission. The gains made were generally maintained at long-term follow-up. However, there were a significant number of participants who maintained chronic symptoms after treatment and may need a longer-term or more complex intervention and active medication management. PMID:26520220

  16. Long-term Trend of Decreasing Frequency of Hepatitis B Virus Infection in Hepatitis, Cirrhosis, and hepatocellular carcinoma

    OpenAIRE

    Senba, Masachika; Nakamura, Tsuyoshi

    1989-01-01

    Statistical and histopathological analysis was carried out to determine whether hepatitis B surface antigen with the necropsy diagnosis of hepatitis, cirrhosis, and hepatocellular carcinoma declined during 1964-1984. In this study, the liver specimens from 500 necropsy cases at Nagasaki University Hospital were used, and these materials were stained for hepatitis B surface antigen with immunoperoxidase method. For statistical calculations, we used Cochran's chi-squared test with one degree of...

  17. 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.

  18. Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting

    OpenAIRE

    Wallin, Åsa

    2011-01-01

    Åsa K Wallin, Carina Wattmo, Lennart MinthonClinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, SwedenBackground: In the absence of long-term, placebo-controlled studies of cholinesterase inhibitors in Alzheimer's disease (AD), analysis of the results of open-label trials becomes crucial. This study aimed to explore the three-year effects of galantamine treatment, as well as subgroups of response and adherence to treatment.Methods...

  19. The Effect of Positive Adolescent Life Skills Training on Long Term Outcomes for High-Risk Teens

    OpenAIRE

    Campbell-Heider, Nancy; Tuttle, Jane; Knapp, Thomas R.

    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...

  20. Hemodynamics in pulmonary arterial hypertension (PAH): do they explain long-term clinical outcomes with PAH-specific therapy?

    OpenAIRE

    Stewart Simon; Dalton Brad; Wlodarczyk John; Strange Geoff; Steele Peter; Gabbay Eli; Keogh Anne

    2010-01-01

    Abstract Background Pulmonary arterial hypertension (PAH) has witnessed dramatic treatment advances over the past decade. However, with the exception of epoprostenol, data from short-term randomized controlled trials (RCTs) have not shown a benefit of these drugs on survival. There remains a need to differentiate between available therapies and current endpoint responses which in turn, could be used to guide treatment selection and provide long-term prognostic information for patients. Method...

  1. 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. PMID:24991899

  2. Pubertal outcome in a female with virilizing adrenocortical carcinoma

    OpenAIRE

    Breidbart, Emily; Cameo, Tamara; Garvin, James H.; Hibshoosh, Hanina; Sharon E. Oberfield

    2016-01-01

    Adrenocortical tumors are neoplasms that rarely occur in pediatric patients. Adrenocortical carcinoma (ACC) is even more uncommon, and is an aggressive malignancy with 5-year survival of 55% in a registry series. There is a lack of information on long-term endocrine outcome in survivors. We describe a 10-year follow-up in a patient who presented at 3 years 5 months with a 1-year history of axillary odor and 6 months’ history of pubic hair development with an increased clitoral size. Androgen ...

  3. Long-term outcomes in patients with type 2 diabetes receiving glimepiride combined with liraglutide or rosiglitazone

    Directory of Open Access Journals (Sweden)

    Hammer Mette

    2009-02-01

    Full Text Available Abstract Background Poor control of type 2 diabetes results in substantial long-term consequences. Studies of new diabetes treatments are rarely designed to assess mortality, complication rates and costs. We sought to estimate the long-term consequences of liraglutide and rosiglitazone both added to glimepiride. Methods To estimate long-term clinical and economic consequences, we used the CORE diabetes model, a validated cohort model that uses epidemiologic data from long-term clinical trials to simulate morbidity, mortality and costs of diabetes. Clinical data were extracted from the LEAD-1 trial evaluating two doses (1.2 mg and 1.8 mg of a once daily GLP-1 analog liraglutide, or rosiglitazone 4 mg, on a background of glimepiride in type 2 diabetes. CORE was calibrated to the LEAD-1 baseline patient characteristics. Survival, cumulative incidence of cardiovascular, ocular and renal events and healthcare costs were estimated over three periods: 10, 20 and 30 years. Results In a hypothetical cohort of 5000 patients per treatment followed for 30 years, liraglutide 1.2 mg and 1.8 mg had higher survival rates compared to the group treated with rosiglitazone (15.0% and 16.0% vs. 12.6% after 30 years, and fewer cardiovascular, renal, and ocular events. Cardiovascular death rates after 30 years were 69.7%, 68.4% and 72.5%, for liraglutide 1.2 mg, 1.8 mg, and rosiglitazone, respectively. First and recurrent amputations were lower in the rosiglitazone group, probably due to a 'survival paradox' in the liraglutide arms (number of events: 565, 529, and 507, respectively. Overall cumulative costs per patient, were lower in both liraglutide groups compared to rosiglitazone (US$38,963, $39,239, and $40,401 for liraglutide 1.2 mg, 1.8 mg, and rosiglitazone, respectively, mainly driven by the costs of cardiovascular events in all groups. Conclusion Using data from LEAD-1 and epidemiologic evidence from the CORE diabetes model, projected rates of mortality

  4. 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

  5. Targeting brain serotonin synthesis: insights into neurodevelopmental disorders with long-term outcomes related to negative emotionality, aggression and antisocial behaviour

    OpenAIRE

    Lesch, Klaus-Peter; Araragi, Naozumi; Waider, Jonas; van den Hove, Daniel; Gutknecht, Lise

    2012-01-01

    Aggression, which comprises multi-faceted traits ranging from negative emotionality to antisocial behaviour, is influenced by an interaction of biological, psychological and social variables. Failure in social adjustment, aggressiveness and violence represent the most detrimental long-term outcome of neurodevelopmental disorders. With the exception of brain-specific tryptophan hydroxylase-2 (Tph2), which generates serotonin (5-HT) in raphe neurons, the contribution of gene variation to aggres...

  6. Long-term outcome and toxicity of hypofractionated stereotactic body radiotherapy as a boost treatment for head and neck cancer: the importance of boost volume assessment

    OpenAIRE

    Lee, Dong Soo; Kim, Yeon Sil; Cheon, Jae Seok; Song, Jin Ho; SON, Seok Hyun; Jang, Ji Sun; Kang, Young Nam; Kang, Jing Hyoung; Jung, So Lyoung; Yoo, Ie Ryung; Jang, Hong Seok

    2012-01-01

    Background The aim of this study was to report the long-term clinical outcomes of patients who received stereotactic body radiotherapy (SBRT) as a boost treatment for head and neck cancer. Materials and methods Between March 2004 and July 2007, 26 patients with locally advanced, medically inoperable head and neck cancer or gross residual tumors in close proximity to critical structures following head and neck surgery were treated with SBRT as a boost treatment. All patients were initially tre...

  7. Long-term outcome and toxicity of hypofractionated stereotactic body radiotherapy as a boost treatment for head and neck cancer: the importance of boost volume assessment

    OpenAIRE

    Lee Dong; Kim Yeon; Cheon Jae; Song Jin; Son Seok; Jang Ji; Kang Young; Kang Jing; Jung So; Yoo Ie; Jang Hong

    2012-01-01

    Abstract Background The aim of this study was to report the long-term clinical outcomes of patients who received stereotactic body radiotherapy (SBRT) as a boost treatment for head and neck cancer. Materials and methods Between March 2004 and July 2007, 26 patients with locally advanced, medically inoperable head and neck cancer or gross residual tumors in close proximity to critical structures following head and neck surgery were treated with SBRT as a boost treatment. All patients were init...

  8. Postoperative acute kidney injury defined by RIFLE criteria predicts early health outcome and long-term survival in patients undergoing redo coronary artery bypass graft surgery

    OpenAIRE

    Zakkar, Mustafa; Bruno, Vito D; Guida, Guida A; Angelini, Gianni D; Chivasso, Pierpaolo; Suleiman, M Sadeeh; Bryan, Alan J.; Ascione, Raimondo

    2016-01-01

    OBJECTIVE: To investigate the impact of postoperative acute kidney injury (AKI) on early health outcome and on long-term survival in patients undergoing redo coronary artery bypass grafting (CABG).METHODS: We performed a Cox analysis with 398 consecutive patients undergoing redo CABG over a median follow-up of 7 years (interquartile range, 4-12.2 years). Renal function was assessed using baseline and peak postoperative levels of serum creatinine. AKI was defined according to the risk, injury,...

  9. Long-term results of oncoplastic breast surgery with latissimus dorsi flap reconstruction: a pilot study of the objective cosmetic results and patient reported outcome

    OpenAIRE

    Kim, Kyeong-Deok; Kim, Zisun; Kuk, Jung Cheol; Jeong, Jaehong; Choi, Kyu Sung; Hur, Sung Mo; Jeong, Gui Ae; Chung, Jun Chul; Cho, Gyu Seok; Shin, Eung Jin; Kim, Hyung Chul; Kang, Sang-Gue; Lee, Min Hyuk; Lim, Cheol Wan

    2016-01-01

    Purpose The goal of oncoplastic breast surgery is to restore the appearance of the breast and improve patient satisfaction. Thus, the assessment of cosmetic results and patient-reported outcomes (PROs) using appropriately constructed and validated instruments is essential. The aim of the present study was to assess the long-term objective cosmetic results and corresponding PROs after oncoplastic breast surgery. Methods Cosmetic results were assessed by the patients, a medical panel, and a com...

  10. Idiopathic intracranial hypertension in adolescents with severe visual impairment: Long-term outcome and the beneficial effects of weight loss and psychological support.

    OpenAIRE

    Anastasia, Garoufi; Helen, Georgouli; George, Vartzelis; Andreas, Eliades; Joanna, Velissariou; Lydia, Kossiva

    2013-01-01

    Abstract. The aim of this manuscript is to evaluate retrospectively, the symptoms, treatment and long-term outcome of idiopathic intracranial hypertension (IIH) in adolescents with severe visual impairment, particularly in relation to body weight and compliance to treatment. We reviewed the clinical notes of adolescent patients treated in our department for IIH through a one-year period. From January 2004 to Feb 2005 four patients, aged between 12 and 13 years were diagnosed with IIH. Inclusi...

  11. 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...

  12. Somatostatin-based radiotherapy with [90Y-DOTA]-TOC in neuroendocrine tumors: long-term outcome of a phase I dose escalation study

    OpenAIRE

    Marincek Nicolas; Jörg Ann-Catherine; Brunner Philippe; Schindler Christian; Koller Michael T; Rochlitz Christoph; Müller-Brand Jan; Maecke Helmut R; Briel Matthias; Walter Martin A

    2013-01-01

    Abstract Background We describe the long-term outcome after clinical introduction and dose escalation of somatostatin receptor targeted therapy with [90Y-DOTA]-TOC in patients with metastasized neuroendocrine tumors. Methods In a clinical phase I dose escalation study we treated patients with increasing [90Y-DOTA]-TOC activities. Multivariable Cox regression and competing risk regression were used to compare efficacy and toxicities of the different dosage protocols. Results Overall, 359 patie...

  13. Hemodynamics in pulmonary arterial hypertension (PAH: do they explain long-term clinical outcomes with PAH-specific therapy?

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    Stewart Simon

    2010-02-01

    Full Text Available Abstract Background Pulmonary arterial hypertension (PAH has witnessed dramatic treatment advances over the past decade. However, with the exception of epoprostenol, data from short-term randomized controlled trials (RCTs have not shown a benefit of these drugs on survival. There remains a need to differentiate between available therapies and current endpoint responses which in turn, could be used to guide treatment selection and provide long-term prognostic information for patients. Methods We performed a systematic literature search of MEDLINE and EMBASE databases for RCTs of PAH-specific therapy published between January 1980 and May 2009. Articles were selected if they contained a placebo comparator and described hemodynamic changes from baseline. We applied the weighted mean change in hemodynamic variables to the equation developed by the National Institutes of Health (NIH Registry to estimate long-term survival with each therapy. Results Ten RCTs involving 1,635 patients met the inclusion criteria. Suitable hemodynamic data were identified for bosentan, sitaxentan, sildenafil, epoprostenol, beraprost and treprostinil. 77.6% of patients were female and the mean (SD age was 46.5 ± 4.9 years. 55.5% of patients had idiopathic PAH (iPAH, 23.9% PAH related to connective tissue disease, and 18.2% PAH related to congenital heart disease. Based on the effects observed in short-term trials and, relative to placebo, all analyzed therapies improved survival. The estimated 1-year survival was 78.4%, 77.8%, 76.1%, 75.8%, 75.2%, and 74.1% for epoprostenol, bosentan, treprostinil, sitaxentan, sildenafil, and beraprost, respectively. These estimates are considerably lower than the 1-year observed survival reported in several open-label and registry studies with PAH-specific therapies: 88% - 97%. Conclusion When applied to the NIH Registry equation, hemodynamic changes from baseline appear to underestimate the survival benefits observed with long-term PAH

  14. Long-term survival after gemcitabine and cisplatin in patients with locally advanced transitional cell carcinoma of the bladder: focus on supplementary treatment strategies

    DEFF Research Database (Denmark)

    Als, Anne Birgitte; Sengelov, Lisa; von der Maase, Hans

    2007-01-01

    radiotherapy as supplementary treatment. CONCLUSIONS: In patients with locally advanced bladder cancer, NED following chemotherapy alone or chemotherapy plus supplementary cystectomy or radiotherapy is essential to achieve long-term survival. Patients with a partial response should be offered radical......OBJECTIVE: The objective was to evaluate response and survival, as well as efficacy of subsequent supplementary treatment and follow-up strategy in patients with locally advanced transitional cell carcinoma of the bladder following combination chemotherapy with gemcitabine and cisplatin (GC......: A total of 25 patients (29.8%) with complete response to chemotherapy were followed by close surveillance. This group achieved a median overall survival of 47.6 mo. Another 25 patients had partial response to chemotherapy. Of these patients, 16 had supplementary treatment, with 10 achieving "no evidence...

  15. Preoperative Chemoradiotherapy (CRT) Followed by Laparoscopic Surgery for Rectal Cancer: Predictors of the Tumor Response and the Long-Term Oncologic Outcomes

    International Nuclear Information System (INIS)

    Purpose: We have evaluated the predictors of a tumor response to chemoradiotherapy (CRT) and the long-term oncologic outcomes of preoperative CRT and laparoscopic surgery for patients who suffer from rectal cancer. Methods and Materials: The study involved 274 patients with locally advanced rectal cancer and who had been treated with preoperative CRT and curative laparoscopic total mesorectal excision between January 2003 and January 2009. We assessed the long-term oncologic outcomes, in terms of recurrence and survival, of the treated patients. Results: Forty-two (15.3%) of the 274 patients had complete pathologic responses (pCR). The pre-CRT carcinoembryonic antigen level was the only significant predictor of a pCR on the multivariate analysis (p = 0.01). The overall survival at 5 years was 73.1%, with a mean survival period of 59.7 months (95% CI, 57.1-62.3). The disease-free survival at 5 years was 67.3% with a mean survival period of 54.7 months (95% CI, 51.7-57.8). The pCR group had a higher rate of overall survival at 5 years than did the non-pCR group, and the difference was significant (86.0% vs. 71.2%; hazard ratio = 0.87; 95% CI, 0.78-0.96; p = 0.03). The cumulative incidences of local and distant recurrences at 5 years were 5.8% and 28.3%, respectively. A total of 84.5% (234 of 274) of the patients had their anal sphincters preserved. Grade 3 or 4 acute and long-term toxic effects occurred in 22.2% and 8.4% of the patients, respectively. Conclusion: Preoperative CRT and laparoscopic surgery seems safe and feasible with favorable long-term outcomes and a high rate of sphincter preservation for the patients with low-lying tumors of the rectum.

  16. Long-Term Quality of Life and Pregnancy Outcomes of Differentiated Thyroid Cancer Survivors Treated by Total Thyroidectomy and I131 during Adolescence and Young Adulthood

    OpenAIRE

    Metallo, Melanie; Groza, Lelia; Brunaud, Laurent; Klein, Marc; Weryha, Georges; Feigerlova, Eva

    2016-01-01

    Introduction. Differentiated thyroid cancer (DTC) is rare and confers good prognosis. Long-term health related quality of life (HRQoL) and pregnancy outcomes are not well known in subjects treated during adolescence and young adulthood. Methods. Cross-sectional analysis of HRQoL and global self-esteem, using SF-36 and ISP-25 surveys, and of pregnancy outcomes in female survivors of DTC treated by total thyroidectomy and I131 before age of 25 years. Results. Forty-five of 61 patients (74%) res...

  17. Promising long-term results with attenuated adverse effects by methotrexate-containing sequential chemoradiation therapy in locally advanced head and neck squamous cell carcinoma

    International Nuclear Information System (INIS)

    To reduce severe acute and late toxicities without compromising organ preservation survival in patients with locoregionally advanced head and neck squamous cell carcinoma, we performed three-drug induction methotrexate-cisplatin-fluorouracil with weekly cisplatin-fluorouracil concurrent chemoradiation. Two induction courses of methotrexate (40 mg/m2/day, days 1, 8 and 15), cisplatin and 5-fluorouracil (25 and 750 mg/m2/day, days 1-4) were given in new diagnoses of patients with non-nasopharyngeal locoregionally advanced head and neck squamous cell carcinoma. Responders received concurrent chemoradiation with weekly cisplatin (20 mg/m2/day) and 5-fluorouracil (400 mg/m2/day) on day 1. Among 57 patients (58% with Stage IV and hypopharyngeal cancer), the rates of Grade 3-4 toxicity were 30 and 74% during induction and concurrent chemoradiotherapy (CCRT), respectively. A total of 49 patients completed induction and began concurrent chemoradiation; 47 (96%) completed all planned treatment. With a median follow-up of 62 months (range 19-83 months) for the current survivors, the 3-year overall and disease-specific survival estimates were 50 and 58%, respectively. The 3-year organ preservation survival was 74% in patients who achieved complete remission after concurrent chemoradiation, and 96% of current survivors are tracheotomy and feeding tube-free. No patient without local/regional failure suffered from distant metastasis. Methotrexate-cisplatin-fluorouracil induction chemotherapy followed by weekly cisplatin-fluorouracil concurrent chemoradiation is an acute and late toxicity-acceptable protocol without attenuating organ preservation survival in patients with locoregionally advanced head and neck squamous cell carcinoma. In this patient cohort with advanced head and neck squamous cell carcinoma, overall and organ preservation survivals were encouraging, and provided promising long-term benefits of this approach. (author)

  18. 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....

  19. 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.

  20. Long-term remission of adenoid cystic tongue carcinoma with low dose naltrexone and vitamin D3--a case report.

    Science.gov (United States)

    Khan, Akbar

    2014-09-01

    Naltrexone (ReVia®) is a long-acting oral pure opiate antagonist which is approved for the treatment of alcohol addiction as a 50mg per day tablet. The mechanism of action is complete opiate blockade, which removes the pleasure sensation derived from drinking alcohol (created by endorphins). Low Dose Naltrexone ("LDN") in the range of 3-4.5 mg per day has been shown to have the opposite effect - brief opiate receptor blockade with resulting upregulation of endogenous opiate production. Through the work of Bihari and Zagon, it has been determined that the level of the endogenous opiate methionine-enkephalin is increased by LDN. Met-enkephalin is involved in regulating cell proliferation and can inhibit cancer cell growth in multiple cell lines. Increased met-enkepahlin levels created by LDN thus have the potential to inhibit cancer growth in humans. Phase II human trials of met-enkephalin, case reports published by Berkson and Rubin, and the clinical experience of Bihari confirmed the potential role of LDN in treating pancreatic and other cancers. However, large scale trials are lacking and are unlikely to be funded given the current non-proprietary status of naltrexone. A case report is presented of successful treatment of adenoid cystic carcinoma as further evidence of LDN's potential as a unique non-toxic cancer therapy. PMID:25284545

  1. Admission Values of D-dimer and C-reactive Protein (CRP) Predict the Long-term Outcomes in Acute Aortic Dissection.

    Science.gov (United States)

    Mori, Kentaro; Tamune, Hidetaka; Tanaka, Hiroyuki; Nakamura, Mitsuhiro

    2016-01-01

    Objective Admission D-dimer and C-reactive protein (CRP) values have been reported to predict the short-term outcomes in acute aortic dissection (AAD). However, the association between D-dimer values and the long-term outcomes has not been investigated. Methods The primary endpoints included events determined to be all-cause death, recurrence of aortic dissection, aortic rupture, and surgical intervention for the aortic aneurysm following the first hospital discharge. We performed a receiver operating characteristic analysis and determined the optimal cut-off levels of admission D-dimer, admission CRP and peak CRP values in terms of the sensitivity and specificity for predicting the presence of events. Using the optimal cut-off values, we performed a multiple Cox analysis and investigated the hazard ratio of admission D-dimer, admission CRP and peak CRP. Patients We retrospectively identified 173 AAD patients hospitalized between January 2005 and December 2013. Results A multiple Cox regression analysis revealed that the hazard ratios were 3.4 for admission D-dimer [95% Confidence Interval (CI) 1.5 to 7.3, p=0.004] and 2.7 for admission CRP (95% CI 1.2 to 5.5, p=0.014). Conclusion Admission D-dimer and CRP values may predict the long-term outcomes in AAD. Moreover, admission D-dimer values may be a valuable marker to predict not only the short-term outcomes, but also the long-term outcomes in AAD. PMID:27432090

  2. Predictors and long-term clinical outcomes of newly developed atrial fibrillation in patients with cardiac implantable electronic devices

    Science.gov (United States)

    Kim, Bum Sung; Chun, Kwang Jin; Hwang, Jin kyung; Park, Seung-Jung; Park, Kyoung-Min; Kim, June Soo; On, Young Keun

    2016-01-01

    Abstract Objective: To evaluate predictors and long-term prognosis of atrial fibrillation (AF) following cardiac implantable electronic device (CIED) implantation in patients without history of AF. Methods: From May 1994 to April 2014, 1825 patients with CIED were enrolled in a retrospective, single-center registry. A total of 880 patients from the registry without prior documented AF history were included in the final analysis and were placed into either non-detected AF (NDAF) group or CIED-detected AF group according to development of AF over a follow-up period of 7 years. AF development was defined as any paroxysmal atrial tachyarrhythmia (atrial rate ≥ 180 beats/min) lasting at least 5 minutes according to CIED records. Results: Overall, 122 (13.8%) of the 880 patients experienced new development of AF during follow-up period. According to multivariate analysis, the independent predictors for development of AF were prior heart failure (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.50–3.85; P HR, 2.33; 95% CI, 1.62–3.55; P HR, 2.01; 95% CI, 1.23–3.30; P = 0.005). In CDAF group, the risk of heart failure readmission (adjusted HR, 3.79; 95% CI, 1.99–7.22; P HR, 5.33; 95% CI, 1.58–17.97; P = 0.007) was higher than in nondetected AF group. Conclusion: In patients with CIED, prior history of heart failure, sinus node dysfunction, and LA volume index ≥38.5 mL/m2 were independent predictors of new AF cases. Newly developed AF was significantly associated with increased risk of HF and stroke readmission, according to long-term follow up. PMID:27428213

  3. Long-term outcomes of oral rehabilitation with dental implants in HIV-positive patients: A retrospective case series

    Science.gov (United States)

    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

  4. Long-term effects of autologous bone marrow stem cell treatment in acute myocardial infarction: factors that may influence outcomes.

    Directory of Open Access Journals (Sweden)

    David M Clifford

    Full Text Available AIMS: To investigate whether there are important sources of heterogeneity between the findings of different clinical trials which administer autologous stem cell treatment for acute myocardial infarction (AMI and to evaluate what factors may influence the long-term effects of this treatment. METHODS AND RESULTS: MEDLINE (1950-January 2011, EMBASE (1974-January 2011, CENTRAL (The Cochrane Library 2011, Issue 1, CINAHL (1982-January 2011, and ongoing trials registers were searched for randomised trials of bone marrow stem cells as treatment for AMI. Hand-searching was used to screen recent, relevant conference proceedings (2005-2010/11. Meta-analyses were conducted using random-effects models and heterogeneity between subgroups was assessed using chi-squared tests. Planned analyses included length of follow-up, timing of cell infusion and dose, patient selection, small trial size effect, methodological quality, loss of follow-up and date of publication. Thirty-three trials with a total of 1,765 participants were included. There was no evidence of bias due to publication or time-lag, methodological quality of included studies, participant drop-out, duration of follow-up or date of the first disclosure of results. However, in long-term follow-ups the treatment seemed more effective when administered at doses greater than 10(8 cells and to patients with more severe heart dysfunction. CONCLUSIONS: Evaluation of heterogeneity between trials has not identified significant sources of bias in this study. However, clinical differences between trials are likely to exist which should be considered when undertaking future trials.

  5. 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.

  6. Early FDG PET response assessment of preoperative radiochemotherapy in locally advanced rectal cancer: correlation with long-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Avallone, Antonio; Casaretti, Rossana; Montano, Massimo; Silvestro, Lucrezia [Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione ' ' G. Pascale' ' , Department of Gastrointestinal Medical Oncology, Naples (Italy); Aloj, Luigi; Caraco, Corradina; Di Gennaro, Francesca; Lastoria, Secondo [Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione ' ' G. Pascale' ' , Department of Nuclear Medicine, Naples (Italy); Delrio, Paolo [Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione ' ' G. Pascale' ' , Department of Surgical Oncology, Naples (Italy); Pecori, Biagio [Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione ' ' G. Pascale' ' , Department of Radiation Oncology, Naples (Italy); Tatangelo, Fabiana [Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione ' ' G. Pascale' ' , Department of Pathology, Naples (Italy); Scott, Nigel [St. James University Hospital, Department of Pathology, Leeds (United Kingdom); Budillon, Alfredo [Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione ' ' G. Pascale' ' , Department of Experimental Pharmacology, Naples (Italy)

    2012-12-15

    The aim of the present study is to prospectively evaluate the prognostic value of previously defined [{sup 18}F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) criteria of early metabolic response in patients with locally advanced rectal cancer (LARC) after long-term follow-up. Forty-two patients with poor prognosis LARC underwent three biweekly courses of chemotherapy with oxaliplatin, raltitrexed and 5-fluorouracil modulated by levofolinic acid during pelvic radiotherapy. FDG PET studies were performed before and 12 days after the beginning of the chemoradiotherapy (CRT) treatment. Total mesorectal excision (TME) was carried out 8 weeks after completion of CRT. A previously identified cutoff value of {>=}52 % reduction of the baseline mean FDG standardized uptake value (SUV{sub mean}) was applied to differentiate metabolic responders from non-responders and correlated to tumour regression grade (TRG) and survival. Twenty-two metabolic responders showed complete (TRG1) or subtotal tumour regression (TRG2) and demonstrated a statistically significantly higher 5-year relapse-free survival (RFS) compared with the 20 non-responders (86 vs 55 %, p =.014) who showed TRG3 and TRG4 pathologic responses. A multivariate analysis demonstrated that early {nabla}SUV{sub mean} was the only pre-surgical parameter correlated to the likelihood of recurrence (p =.05). This study is the first prospective long-term evaluation demonstrating that FDG PET is not only an early predictor of pathologic response but is also a valuable prognostic tool. Our results indicate the potential of FDG PET for optimizing multidisciplinary management of patients with LARC. (orig.)

  7. Repair of complete atrioventricular septal defect in infants with down syndrome: outcomes and long-term results.

    Science.gov (United States)

    Tumanyan, Margarita R; Filaretova, Olga V; Chechneva, Vera V; Gulasaryan, Ruben S; Butrim, Iuliia V; Bockeria, Leo A

    2015-01-01

    In clinical practice, the combination of congenital heart disease (CHD) with malformations of other organs occurs in about 10 % of cases, including chromosomal disease with heart defects, which are observed mainly with certain syndromes. In the Bakoulev SCCS (Moscow, Russian Federation), from 01.2005 to 01.2011, complete atrioventricular septal defect (CAVSD) repair was performed on 163 patients (5.6 ± 3.0 months) with Down Syndrome (DS) using the single-patch (n = 40) and the two-patch (n = 123) methods. The control group consisted of 214 infants aged 6.49 ± 3.03 months with CAVSD and normal karyotype. A retrospective cohort study was made, as well as a comparative analysis of the immediate (up to 30 days) and long-term (12-75 months, at the average of 56 ± 15) results of the repair of CAVSD in infants with DSand normal karyotype/chromosome set (NK). During the hospital treatment period, we registered the following complications: pulmonary hypertensive crises in 6 % (n = 9) of patients with DS and in 10 % (n = 21) of infants with NK, infectious complications in 21% (n = 34) of patients with DS and in 8% (n = 17) of infants with NK. Squeal structures in groups were differentiated. The doses and duration of cardiotonic support in the NK patients were significantly higher in comparison with the DS patients (7.5 ± 2.1 days vs 3.4 ± 1.15 days, p Down syndrome. Concerning the long-term results, there was no significant difference (Gehan-Wilcoxon test) in actuarial freedom from reoperation after repair of CAVSD between DS and NK groups (p Down Syndrome in patients significantly increases the risk of severe co-morbidities that have a significant impact on the recovery period, as well as on life expectancy even after successful CHD correction. PMID:25099029

  8. Comparison of Rehabilitation Outcomes for Long Term Neurological Conditions: A Cohort Analysis of the Australian Rehabilitation Outcomes Centre Dataset for Adults of Working Age.

    Directory of Open Access Journals (Sweden)

    Lynne Turner-Stokes

    Full Text Available To describe and compare outcomes from in-patient rehabilitation (IPR in working-aged adults across different groups of long-term neurological conditions, as defined by the UK National Service Framework.Analysis of a large Australian prospectively collected dataset for completed IPR episodes (n = 28,596 from 2003-2012.De-identified data for adults (16-65 years with specified neurological impairment codes were extracted, cleaned and divided into 'Sudden-onset' conditions: (Stroke (n = 12527, brain injury (n = 7565, spinal cord injury (SCI (n = 3753, Guillain-Barré syndrome (GBS (n = 805 and 'Progressive/stable' conditions (Progressive (n = 3750 and Cerebral palsy (n = 196. Key outcomes included Functional Independence Measure (FIM scores, length of stay (LOS, and discharge destination.Mean LOS ranged from 21-57 days with significant group differences in gender, source of admission and discharge destination. All six groups showed significant change (p<0.001 between admission and discharge that was likely to be clinically important across a range of items. Significant between-group differences were observed for FIM Motor and Cognitive change scores (Kruskal-Wallis p<0.001, and item-by-item analysis confirmed distinct patterns for each of the six groups. SCI and GBS patients were generally at the ceiling of the cognitive subscale. The 'Progressive/stable' conditions made smaller improvements in FIM score than the 'Sudden-onset conditions', but also had shorter LOS.All groups made gains in independence during admission, although pattern of change varied between conditions, and ceiling effects were observed in the FIM-cognitive subscale. Relative cost-efficiency between groups can only be indirectly inferred. Limitations of the current dataset are discussed, together with opportunities for expansion and further development.

  9. Long-term effects on carotid intima-media thickness after radiotherapy in patients with nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Vascular abnormalities are the predominant histologic changes associated with radiation in nasopharyngeal carcinoma (NPC). This study examined if the duration after radiotherapy correlates with the progression of carotid intima-media thickness (IMT) and investigated its relationship with inflammatory markers. One hundred and five NPC patients post-radiotherapy for more than one year and 25 healthy control subjects were examined by B-mode ultrasound for IMT measurement at the far wall of the common carotid artery (CCA). Surrogate markers including lipid profile, HbA1c, and high sensitive C-reactive protein (hs-CRP) were assessed. The IMT of CCA was significantly increased in NPC patients and carotid plaque was detected in 38 NPC patients (38/105, 36.2%). Significant risk factors for carotid plaques included age, duration after radiotherapy, and HbA1c levels. Age, duration after radiotherapy, hs-CRP, HbA1c, and platelet count positively correlated with IMT. The cut-off value of age and duration after radiotherapy for the presence of plaque was 52.5 years and 42.5 months, respectively. In NPC subjects, multiple linear regression analysis revealed that age, gender, duration after radiotherapy and platelet counts were independently associated with CCA IMT. After adjustments for age, gender and platelet counts, IMT increased in a linear manner with duration after radiotherapy. Radiation-induced vasculopathy is a dynamic and progressive process due to late radiation effects. Extra-cranial color-coded duplex sonography can be part of routine follow-up in NPC patients aged ≥50 years at 40 months post-radiotherapy

  10. Long-Term Results of Brachytherapy for Carcinoma of the Penis Confined to the Glans (N- or NX)

    International Nuclear Information System (INIS)

    Purpose: To analyze the results of exclusive interstitial low-dose-rate brachytherapy (BT) for squamous cell carcinoma (SCC) of the penis, strictly confined to the glans. Methods and Materials: A total of 144 patients with SSC of the glans p