Sample records for long-term follow-up analysis

  1. Long-term follow-up of reflux nephropathy in adults with vesicoureteral reflux - radiological and pathoanatomical analysis

    Koehler, J.; Thysell, H.; Tencer, J. [Univ. Hospital, Lund (Sweden). Dept. of Nephrology; Forsberg, L.; Hellstroem, M. [Sahlgrenska Univ. Hospital, Goeteborg (Sweden). Dept. of Diagnostic Radiology


    Purpose: To study the long-term development of urographic renal morphology in adults with vesicoureteral reflux, to investigate the relationship between renal damage and reflux grade, and to analyse the association between the long-term urographic outcome and the occurrence of acute pyelonephritis and reflux during follow-up. The purpose was also to try to distinguish between acquired and developmental renal damage, based on analyses of renal histological specimens and urographic features, and to analyse associated congenital urogenital abnormalities and family history of reflux, reflux nephropathy, urological malformation or death from end-stage renal disease. Material and Methods: Renal damage was identified in 100 (83 women) of 115 adults, selected because of documented reflux. Eighty-seven patients had two urographies done (median interval 14.3 years). The extent and progression of renal damage were assessed and features of developmental renal damage were determined. Histological renal specimens were available in 23 patients with renal damage. Results and Conclusions: The extent of renal damage correlated positively with the severity of reflux. No renal damage developed during the follow-up in 45 previously undamaged kidneys and progression of renal damage was rare (4 of 120 previously damaged kidneys), despite persisting reflux in half of the cases and episodes of acute pyelonephritis during follow-up. Thus, repeated renal imaging is rarely justified in adults with reflux nephropathy. Histological examination showed 'chronic pyelonephritis' in all 23 cases and co-existing renal dysplasia in 1 case. The detailed urographic analysis did not reveal support for developmental renal damage. High frequencies of associated congenital urogenital abnormalities and of a positive family history were found. Thus, congenital and/or hereditary factors cannot be discarded as background factors for the development of renal damage.

  2. Auditory-perceptual speech analysis in children with cerebellar tumours: a long-term follow-up study.

    De Smet, Hyo Jung; Catsman-Berrevoets, Coriene; Aarsen, Femke; Verhoeven, Jo; Mariën, Peter; Paquier, Philippe F


    Mutism and Subsequent Dysarthria (MSD) and the Posterior Fossa Syndrome (PFS) have become well-recognized clinical entities which may develop after resection of cerebellar tumours. However, speech characteristics following a period of mutism have not been documented in much detail. This study carried out a perceptual speech analysis in 24 children and adolescents (of whom 12 became mute in the immediate postoperative phase) 1-12.2 years after cerebellar tumour resection. The most prominent speech deficits in this study were distorted vowels, slow rate, voice tremor, and monopitch. Factors influencing long-term speech disturbances are presence or absence of postoperative PFS, the localisation of the surgical lesion and the type of adjuvant treatment. Long-term speech deficits may be present up to 12 years post-surgery. The speech deficits found in children and adolescents with cerebellar lesions following cerebellar tumour surgery do not necessarily resemble adult speech characteristics of ataxic dysarthria.

  3. Long-term follow-up of trigonoplasty antireflux operation.

    Sharifiaghdas, Farzaneh; Mahmoudnejad, Nastaran; Kashi, Amir H; Ramezani, Mehdi H; Narouie, Behzad


    Open trigonoplasty antireflux operation has been associated with promising results. However, its success in controlling reflux has not been evaluated in the long term. All patients who underwent trigonoplasty for vesicoureteral reflux by one surgeon from 2004 to 2014 were included. Preoperative evaluations included direct radionuclide cystography (DRNC) or voiding cystourethrography, urine analysis and culture and abdominal sonography. Urodynamic study and cystoscopy was performed in selected patients. Trigonoplasty was done by a modified Gil-Verent method. The latest available patients' DRNCs were used to judge for reflux relapse. Ninety-one patients, 142 refluxing units; median (range) age, 10.5 (1-45) years; M/F, (11/80) were followed for 18 to 135 months. Reflux resolution rate was 73.6% for patients and 75.4% for refluxing units. Relapse was associated with reflux grade (67% in grade V), ureteral orifice appearance (40% in golf hole/stadium), and patients with a history of pyelonephritis. Multivariable model based on the above variables had less than 10% sensitivity in predicting relapse. Trigonoplasty success rate can decrease with long-term follow-up.

  4. Long-term follow-up study and long-term care of childhood cancer survivors

    Hyeon Jin Park


    Full Text Available The number of long-term survivors is increasing in the western countries due to remarkable improvements in the treatment of childhood cancer. The long-term complications of childhood cancer survivors in these countries were brought to light by the childhood cancer survivor studies. In Korea, the 5-year survival rate of childhood cancer patients is approaching 70%; therefore, it is extremely important to undertake similar long-term follow-up studies and comprehensive long-term care for our population. On the basis of the experiences of childhood cancer survivorship care of the western countries and the current Korean status of childhood cancer survivors, long-term follow-up study and long-term care systems need to be established in Korea in the near future. This system might contribute to the improvement of the quality of life of childhood cancer survivors through effective intervention strategies.

  5. Long-term follow-up of congenital diaphragmatic hernia.

    Hollinger, Laura E; Harting, Matthew T; Lally, Kevin P


    Increased survival of patients with congenital diaphragmatic hernia has created a unique cohort of children, adolescent, and adult survivors with complex medical and surgical needs. Disease-specific morbidities offer the opportunity for multiple disciplines to unite together to provide long-term comprehensive follow-up, as well as an opportunity for research regarding late outcomes. These children can exhibit impaired pulmonary function, altered neurodevelopmental outcomes, nutritional insufficiency, musculoskeletal changes, and specialized surgical needs that benefit from regular monitoring and intervention, particularly in patients with increased disease severity. Below we aim to characterize the specific challenges that these survivors face as well as present an algorithm for a multidisciplinary long-term follow-up program. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Long-term follow-up analysis of microsurgical clip ligation and endovascular coil embolization for dorsal wall blister aneurysms of the internal carotid artery.

    Brown, Mason A; Guandique, Cristian F; Parish, Jonathan; McMillan, Aubrey C; Lehnert, Stephen; Mansour, Nassir; Tu, Michael; Bohnstedt, Bradley N; Payner, Troy D; Leipzig, Thomas J; DeNardo, Andrew J; Scott, John A; Cohen-Gadol, Aaron A


    non-branching sites of the dICA. The presented data and analysis is imperative to determine the necessary strict long-term clinical and angiographic follow-up. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Vertebral sarcoidosis: long-term follow-up with MRI

    Lefere, M. [University Hospitals Gasthuisberg, Department of Radiology, Leuven (Belgium); Larbi, A.; Malghem, J.; Vande Berg, B.; Dallaudiere, B. [University Hospitals St Luc, Department of Radiology, Brussels (Belgium)


    Vertebral involvement in sarcoidosis is rare and its clinical and imaging features are non-specific. Indeed, because the lesions are hard to differentiate from metastatic disease based on imaging alone, a histological confirmation is advised. Fatty replacement is a well-known finding indicating stabilization and healing in both benign and malignant conditions. It can be used as an indicator of a favorable disease course and response to treatment. We report the case of a 43-year-old woman with multifocal vertebral sarcoidosis lesions and long-term follow-up showing progressive and gradual fatty involution on magnetic resonance imaging (MRI) during 4 years of steroid treatment with a final favorable outcome. (orig.)

  8. A long-term follow-up of postpartum thyroiditis.

    Othman, S; Phillips, D I; Parkes, A B; Richards, C J; Harris, B; Fung, H; Darke, C; John, R; Hall, R; Lazarus, J H


    To investigate the long-term outcome of postpartum thyroiditis (PPT), 43 patients with PPT and 171 control women were evaluated 3.5 (range 2-4) years postpartum. Ten (23%) PPT patients were hypothyroid compared to none of the controls (P less than 0.001). Factors associated with the development of hypothyroidism were high antimicrosomal antibody titre measured at 16 weeks gestation (P less than 0.01), severity of hypothyroid phase of PPT, multiparity, and a previous history of spontaneous abortion. The presence of microsomal antibody but no PPT in one pregnancy did not prevent the occurrence of PPT in the next pregnancy in two patients and a further five patients had PPT in two successive pregnancies. There was no association between HLA haplotype, family history of thyroid disease, smoking or frequency of oral contraception, and the development of long-term hypothyroidism after PPT. It is concluded that permanent hypothyroidism is an important sequel to PPT and patients with PPT should be followed up appropriately.

  9. Long-term follow-up of atomic bomb survivors.

    Sakata, Ritsu; Grant, Eric J; Ozasa, Kotaro


    The Life Span Study (LSS) is a follow-up study of atomic bomb (A-bomb) survivors to investigate the radiation effects on human health and has collected data for over 60 years. The LSS cohort consists of 93,741 A-bomb survivors and another 26,580 age and sex-matched subjects who were not in either city at the time of the bombing. Radiation doses have been computed based on individual location and shielding status at the time of the bombings. Age at death and cause of death are gathered through the Japanese national family registry system and cancer incidence data have been collected through the Hiroshima and Nagasaki cancer registries. Noncancer disease incidence and health information are collected through biannual medical examinations among a subset of the LSS. Radiation significantly increases the risks of death (22% at 1 Gy), cancer incidence (47% at 1 Gy), death due to leukemia (310% at 1 Gy), as well as the incidence of several noncancer diseases (e.g. thyroid nodules, chronic liver disease and cirrhosis, uterine myoma, and hypertension). Significant effects on maturity (e.g. growth reduction and early menopause) were also observed. Long-term follow-up studies of the A-bomb survivors have provided reliable information on health risks for the survivors and form the basis for radiation protection standards for workers and the public. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  10. Long-term follow-up of thyroid nodule growth.

    Quadbeck, B; Pruellage, J; Roggenbuck, U; Hirche, H; Janssen, O E; Mann, K; Hoermann, R


    Benign thyroid nodules are common in iodine deficient countries. Although many recent studies have addressed the molecular basis and short-term outcome of treatment in nodular thyroid disease, data on the long-term follow-up of thyroid nodule growth are widely lacking. The aim of the present study was to evaluate the long-term behaviour of benign thyroid nodules growth. We followed 109 consecutive patients seen at yearly intervals in our Outpatient Clinic for at least 3 years (range 3-12 years, mean 4.9 +/- 2.6 years) presenting with 139 benign nodules in uni- or multinodular goiters. The size of the nodules and thyroid glands was analysed retrospectively. The study included a spectrum of benign thyroid nodules, 86 functioning and 53 non-functioning. 27 patients were treated with levothyroxine, 8 with iodide and 16 with a combination of both. 58 patients were not treated mainly because of thyroid functional autonomy. Patients with overt hyperthyroidism or suspected malignancy by fine-needle aspiration were excluded from the study. The nodules and glands were assessed by ultrasonography at yearly intervals and documented by photoprints. Relevant growth was defined as an increase in nodule volume of at least 30%. For statistical analyses, Cox Proportional Hazard Model and life-table analyses according to Kaplan-Meier were performed. Most thyroid nodules grew slowly but continuously during follow-up. After about 3 years, half of the nodules had increased their volume by at least 30%. Growth of the nodules was significantly faster than of the corresponding thyroid glands (p < 0.0001). Age and sex of the patients and size or function of the nodules at initial presentation were not significantly related to their growth. Suppression of TSH did not affect growth of the nodules irrespective of the source of thyroid hormones, endogenous or by administration of levothyroxine. In conclusion, benign thyroid nodules have a slow intrinsic growth potential, which is apparently

  11. Tumors of the peripheral nervous system: analysis of prognostic factors in a series with long-term follow-up and review of the literature.

    Montano, Nicola; D'Alessandris, Quintino Giorgio; D'Ercole, Manuela; Lauretti, Liverana; Pallini, Roberto; Di Bonaventura, Rina; La Rocca, Giuseppe; Bianchi, Federico; Fernandez, Eduardo


    OBJECT Only a few published studies of the surgical treatment of benign peripheral nerve sheath tumors (BPNSTs), malignant peripheral nerve sheath tumors (MPNSTs), and peripheral non-neural sheath tumors (PNNSTs) have analyzed the results and possible prognostic factors using multivariate analysis. The authors report on their surgical series of cases of BPNSTs, MPNSTs, and PNNSTs with long-term follow-up and analyze the role of selected factors with respect to the prognosis and risk of recurrence of these tumors using multivariate analysis. They also review the pertinent literature and discuss their results in its context. METHODS The authors retrospectively reviewed data from cases involving patients who underwent resection of a peripheral nerve tumor between January 1983 and December 2013 at their institution. Of a total of 200 patients, 150 patients (with 173 surgically treated tumors) had adequate follow-up data available for analysis. Pain was assessed using a visual analog scale (VAS), and motor and sensory function were assessed by means of the Louisiana State University grading system. They also analyzed the relationship between tumor recurrence and patient sex, patient age, diagnosis of neurofibromatosis (NF), tumor histopathology, tumor size, tumor location, and extent of resection (subtotal vs gross-total resection), using univariate and multivariate analyses. RESULTS There was a statistically significant improvement in the mean VAS pain score (preoperative 3.96 ± 2.41 vs postoperative 0.95 ± 1.6, p = 0.0001). Motor strength and sensory function were significantly improved after resection of tumors involving the brachial plexus (p = 0.0457 and p = 0.0043, respectively), tumors involving the upper limb (p = 0.0016 and p = 0.0016, respectively), BPNSTs (p = 0.0011 and p peripheral nervous system tumors (irrespective of the supposed diagnosis and tumor dimensions) because it is associated with better prognosis in term of functional outcome and overall

  12. Long-term follow-up and analysis of prediction of mortality after percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction

    Dan BAO


    Full Text Available Objective To explore the risk factors for mortality after percutaneous coronary intervention (PCI in patients with acute ST segment elevation myocardial infarction (STEMI. Methods The patients who were admitted with STEMI to our hospital between July 2008 and November 2012 undergoing PCI during hospitalization were enrolled. Case control study was conducted to observe these patients during the follow-up period for exploring the independent predictors of survival. Results  A total of 3551 consecutive patients were enrolled in this study. These patients were followed up for 5 years with a median followup time of 406[179, 892] days. A total of 106 deaths occurred during the follow-up period. Estimated 5-year survival rate was 88.6% by Kaplan-Meier method. Female, age, diabetes, stroke, dysarteriotony, renal insufficiency, elevation of creatinine kinase isoenzyme MB (CK-MB, left ventricular end diastolic dimension, anemia, anterior myocardial infarction, PCI complications and intra-aortic balloon pump (IABP were independent risk factors for mortality, whereas complete revascularization was associated with decreased risk of mortality. Conclusions Long-term mortality rate of patients with STEMI is higher even after successful PCI. Less PCI complications and early complete revascularization are independent predictors for decreasing mortality rate during follow-up period. DOI: 10.11855/j.issn.0577-7402.2015.04.05

  13. Long-term follow-up and analysis of monozygotic twins concordant for 45,X/46,XY peripheral blood karyotype but discordant for phenotypic sex.

    Tho, Sandra P; Jackson, Robert; Kulharya, Anita S; Reindollar, Richard H; Layman, Lawrence C; McDonough, Paul G


    We report on the follow-up of a set of monozygotic (MZ) twins who were concordant for peripheral blood karyotype 45,X/46,XY but discordant for phenotypic sex. One twin is a phenotypically normal male and the other twin has asymetrical gonadal dysgenesis. The female twin has the mos45,X/46,XY karyotype in all four tissues: left testis, right streak, vas deferens, and clitoral skin. The normal male twin has the normal 46,XY karyotype in all three tissues tested: foreskin, scrotal skin, and testis. Follow-up of the twins at age 21, revealed persistence of mos45,X/46,XY karyotype in peripheral blood into adult life. However, the male grew up with normal male stature, reaching an adult height of 182 cm. The female twin received low dose estrogen replacement with complete breast development at age 14 years. She reached an adult height of 156 cm. At 21 years of age the male twin had normal testicular endocrine function, but severe oligospermia. The long-term follow-up of this set of MZ twins indicate that the male twin has the mosaicism confined to peripheral blood and has the normal 46,XY male constitution. This was further confirmed by his normal male stature and normal testicular endocrine function. The 45X cell line is likely due to his receiving these cells passively from his twin sister via placental anastomoses in utero. The exposure to these 45,X cells during development may have had an impact on his spermatogenesis.

  14. Long-term follow-up of patients with pituitary macroadenomas after postoperative radiation therapy. Analysis of tumor control and functional outcome

    Langsenlehner, T.; Jakse, G.; Kapp, K.S.; Mayer, R. [Medical Univ. of Graz (Austria). Dept. of Therapeutic Radiology and Oncology; Stiegler, C. [Medical Univ. of Graz (Austria). Div. of Endocrinology and Nuclear Medicine; Quehenberger, F. [Medical Univ. of Graz (Austria). Inst. for Medical Informatics, Statistics and Documentation; Feigl, G.C. [Regensburg Univ. (Germany). Dept. of Neurosurgery; Mokry, M. [Medical Univ. of Graz (Austria). Dept. of Neurosurgery; Langsenlehner, U. [Medical Univ. of Graz (Austria). Div. of Oncology


    Purpose: Evaluation of long-term tumor control, normalization of hormonal hypersecretion, including incidence and time course of pituitary dysfunction following postoperative radiotherapy of pituitary macroadenomas. Patients and Methods: In a retrospective study, the data of 87 patients with pituitary macroadenomas (61 non-secreting adenomas, 26 secreting adenomas) treated between 1984 and 1994 were analyzed. All patients underwent surgery and received postoperative external-beam radiotherapy with a mean dose of 50.4 Gy (range 46-54 Gy). Results: After a follow-up of 15 years the local tumor control rate achieved was 93.0% for non-secreting adenomas and 100% for secreting adenomas, respectively. Normalization of endocrine hypersecretion was noted in 24 of 26 patients (92%). Detailed endocrinological follow-up data were analyzed by an experienced endocrinologist in 77 patients. After a median follow-up of 10.54 years (mean 10.22; range 1.39-20.75 years), in 75 of 77 patients (97%) a hypopituitarism was observed (partial hypopituitarism, n = 28 [36%], panhypopituitarism, n = 47 [61%]), and 68 out of 77 patients (88%) showed evidence of radiotherapy-induced pituitary disorders. The somatotropic function was most commonly affected, followed by gonadal, thyroid and adrenal function. The gonadal axis showed to be the first to be disturbed. 67 patients (87%) required a hormone replacement therapy. Conclusion: Radiotherapy after pituitary surgery is highly effective in reducing hormonal hypersecretion and preventing recurrences of pituitary adenomas. However, pituitary insufficiencies are commonly observed after radiotherapy requiring a close follow-up to ensure timely diagnosis of pituitary dysfunction and an early inception of hormone replacement therapy. (orig.)

  15. Long-term follow-up of patients with pituitary macroadenomas after postoperative radiation therapy: analysis of tumor control and functional outcome.

    Langsenlehner, Tanja; Stiegler, Claudia; Quehenberger, Franz; Feigl, Günther C; Jakse, Gabi; Mokry, Michael; Langsenlehner, Uwe; Kapp, Karin S; Mayer, Ramona


    Evaluation of long-term tumor control, normalization of hormonal hypersecretion, including incidence and time course of pituitary dysfunction following postoperative radiotherapy of pituitary macroadenomas. In a retrospective study, the data of 87 patients with pituitary macroadenomas (61 non-secreting adenomas, 26 secreting adenomas) treated between 1984 and 1994 were analyzed. All patients underwent surgery and received postoperative external-beam radiotherapy with a mean dose of 50.4 Gy (range 46-54 Gy). After a follow-up of 15 years the local tumor control rate achieved was 93.0% for non-secreting adenomas and 100% for secreting adenomas, respectively. Normalization of endocrine hypersecretion was noted in 24 of 26 patients (92%). Detailed endocrinological follow-up data were analyzed by an experienced endocrinologist in 77 patients. After a median follow-up of 10.54 years (mean 10.22; range 1.39-20.75 years), in 75 of 77 patients (97%) a hypopituitarism was observed (partial hypopituitarism, n = 28 [36%], panhypopituitarism, n = 47 [61%]), and 68 out of 77 patients (88%) showed evidence of radiotherapy-induced pituitary disorders. The somatotropic function was most commonly affected, followed by gonadal, thyroid and adrenal function. The gonadal axis showed to be the first to be disturbed. 67 patients (87%) required a hormone replacement therapy. Radiotherapy after pituitary surgery is highly effective in reducing hormonal hypersecretion and preventing recurrences of pituitary adenomas. However, pituitary insufficiencies are commonly observed after radiotherapy requiring a close follow-up to ensure timely diagnosis of pituitary dysfunction and an early inception of hormone replacement therapy.

  16. Role of brachytherapy in the treatment of cancers of the anal canal. Long-term follow-up and multivariate analysis of a large monocentric retrospective series

    Lestrade, Laetitia; Pommier, Pascal; Montbarbon, Xavier; Carrie, Christian [Leon Berard Cancer Center, Radiation Oncology, Lyon (France); De Bari, Berardino [Centre hospitalier universitaire vaudois (CHUV), Radiation Oncology, Lausanne (Switzerland); Lavergne, Emilie [Leon Berard Cancer Center, Unite de Biostatistique et d' Evaluation des Therapeutiques, Lyon (France); Ardiet, Jean-Michel [Centre Hospitalier Lyon Sud, Radiation Oncology, Lyon (France)


    There are few data on long-term clinical results and tolerance of brachytherapy in anal canal cancer. We present one of the largest retrospective analyses of anal canal cancers treated with external beam radiotherapy with/without (±) chemotherapy followed by a brachytherapy boost. We performed a retrospective analysis of clinical results in terms of efficacy and toxicity. The impact of different clinical and therapeutic variables on these outcomes was studied. From May 1992 to December 2009, 209 patients received brachytherapy after external beam radiotherapy ± chemotherapy. Of these patients, 163 were stage II or stage IIIA (UICC 2002) and 58 were N1-3. According to age, ECOG performance status (PS), and comorbidities, patients received either radiotherapy alone (58/209) or radiochemotherapy (151/209). The median follow-up was 72.8 months. The 5- and 10-year local control rates were 78.6 and 73.9 %, respectively. Globally, severe acute and late G3-4 reactions (NCI-CTC scale v. 4.0) occurred in 11.2 and 6.3 % of patients, respectively. Univariate analysis showed the statistical impact of the pelvic treatment volume (p = 0.046) and of the total dose (p = 0.02) on the risk of severe acute and late toxicities, respectively. Only six patients required permanent colostomy because of severe late anorectal toxicities. After a long follow-up time, brachytherapy showed an acceptable toxicity profile and high local control rates in patients with anal canal cancer. (orig.) [German] Es gibt gegenwaertig nur wenige klinische Daten zu den Ergebnissen und Nebenwirkungen von Brachytherapie bei Analkanaltumoren. Wir praesentieren die Daten einer der groessten retrospektiven Auswertungen fuer die Behandlung von Analkanaltumoren mit perkutaner Radiotherapie ± simultaner Chemotherapie, gefolgt von einem Brachytherapie-Boost. Wir analysierten retrospektiv die Patientendaten hinsichtlich Toxizitaet und Tumorkontrolle. Der Einfluss verschiedener klinischer und therapeutischer

  17. Long-Term Follow-Up after Treatment of Cryptorchidism

    Thorup, Jorgen; Cortes, Dina


    When considering long-term prognosis and results in adult age following treatment of cryptorchidism in childhood there are three main issues to be discussed: cosmetics, fertility, and malignancy. In the present review, the most recent research on the topics related to summaries of well-known know...

  18. Long-term Follow-up with AlloDerm in Breast Reconstruction

    Richard A. Baxter, MD, FACS


    Full Text Available Summary: Little is known about the long-term fate of acellular dermal matrices in breast implant surgery. A 12-year follow-up case with tissue analysis of AlloDerm in revision breast reconstruction reveals retention of graft volume and integration with an organized collagen structure, minimal capsule formation, and little or no indication of inflammation.

  19. Association between Escherichia coli bacteriuria and renal function in women - Long-term follow-up

    Meiland, Ruby; Stolk, Ronald P.; Geerlings, Suzanne E.; Peeters, Petra H. M.; Grobbee, Diederick E.; Coenjaerts, Frank E. J.; Brouwer, Ellen C.; Hoepelman, Andy I. M.


    Background: We sought to investigate whether Escherichia coli bacteriuria is associated with a decline in renal function or with the development of end-stage renal failure after long-term follow-up. Methods: We performed a full cohort analysis for women who participated in 2 population-based

  20. Long-term follow-up of elite controllers

    Stafford, Kristen A.; Rikhtegaran Tehrani, Zahra; Saadat, Saman; Ebadi, Maryam; Redfield, Robert R.; Sajadi, Mohammad M.


    Abstract To estimate the effect of hepatitis C virus (HCV) coinfection on the development of complications and progression of human immunodeficiency virus (HIV) disease among HIV-infected elite controllers. Single-center retrospective cohort. Kaplan–Meier methods, prevalence ratios, and Cox proportional-hazards models were used. In all, 55 HIV-infected elite controllers were included in this study. Among them, 45% were HIV/HCV coinfected and 55% were HIV mono-infected. Median follow-up time for the cohort was 11 years. Twenty-five patients experienced a complication and 16 lost elite controller status during the study period. HCV coinfected patients were 4.78 times (95% confidence interval 1.50–15.28) more likely to develop complications compared with HIV mono-infected patients. There was no association between HCV coinfection status and loss of elite control (hazard ratio 0.75, 95% confidence interval 0.27–2.06). Hepatitis C virus coinfection was significantly associated with the risk of complications even after controlling for sex, injecting drug use, and older age. HCV coinfected patients had higher levels of cellular activation while also having similar levels of lipopolysaccharide and soluble CD14. HCV coinfection was not associated with loss of elite controller status. Taken together, this suggests that HCV coinfection does not directly affect HIV replication dynamics or natural history, but that it may act synergistically with HIV to produce a greater number of associated complications. Continued follow-up will be needed to determine whether HCV cure through the use of direct-acting antivirals among HIV/HCV coinfected elite controllers will make the risk for complications among these patients similar to their HIV mono-infected counterparts. PMID:28658155

  1. Long term outcome and follow up of electrical injury

    Hamid Karimi; Mahnoush Momeni; Mahtab Vasigh


    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.

  2. Long-term follow up of patients affected by pulmonary carcinoid at the Istituto Nazionale Tumori of Milan: a retrospective analysis.

    Pusceddu, S; Catena, L; Valente, M; Buzzoni, R; Formisano, B; Del Vecchio, M; Ducceschi, M; Tavecchio, L; Fabbri, A; Bajetta, E


    Neuroendocrine tumors of the lung involve an heterogeneous group of tumors representing a wide range of histological variants, from well-differentiated typical carcinoid (TC) tumors to poorly differentiated small cell carcinomas. The epidemiology, clinical outcome, and management of these neoplasms differ significantly from other lung malignancies. The main aim of this report consists in describing the single Center experience of the Istituto Nazionale Tumori of Milan on neuroendocrine lung tumors, with an emphasis on bronchopulmonary carcinoid subtypes. From 1986 to 2009, 91 cases of carcinoid tumors were diagnosed; these were divided in two series, according to typical (66 patients) or atypical [25] histotypes. These two groups were compared in relation to various features, including pathologic classification, clinical behavior, treatment modalities and long-term survival. At the moment of diagnosis 11 patients had locally advanced/metastatic disease, while 80 patients showed non metastatic disease. The comparative analysis between typical and atypical series disclosed significant differences in terms of long-term survival; in fact, 5-year and 10-year survival rates were 98 % and 94 % for the first carcinoid series versus 76 % and 18 % for the atypical series, respectively (p<0.001). The median overall survival (OS) was 76 months (range 3-182) for atypical carcinoids and has not yet been reached for TCs patients.

  3. Long-term follow up of patients affected by pulmonary carcinoid at the Istituto Nazionale Tumori of Milan: a retrospective analysis

    Pusceddu, S; Catena, L; Valente, M; Buzzoni, R; Formisano, B; Del Vecchio, M; Ducceschi, M; Tavecchio, L; Fabbri, A; Bajetta, E


    Neuroendocrine tumors of the lung involve an heterogeneous group of tumors representing a wide range of histological variants, from well-differentiated typical carcinoid (TC) tumors to poorly differentiated small cell carcinomas. The epidemiology, clinical outcome, and management of these neoplasms differ significantly from other lung malignancies. The main aim of this report consists in describing the single Center experience of the Istituto Nazionale Tumori of Milan on neuroendocrine lung tumors, with an emphasis on bronchopulmonary carcinoid subtypes. From 1986 to 2009, 91 cases of carcinoid tumors were diagnosed; these were divided in two series, according to typical (66 patients) or atypical [25] histotypes. These two groups were compared in relation to various features, including pathologic classification, clinical behavior, treatment modalities and long-term survival. At the moment of diagnosis 11 patients had locally advanced/metastatic disease, while 80 patients showed non metastatic disease. The comparative analysis between typical and atypical series disclosed significant differences in terms of long-term survival; in fact, 5-year and 10-year survival rates were 98 % and 94 % for the first carcinoid series versus 76 % and 18 % for the atypical series, respectively (p<0.001). The median overall survival (OS) was 76 months (range 3-182) for atypical carcinoids and has not yet been reached for TCs patients. PMID:22263011

  4. Methotrexate Hepatotoxicity in Psoriatics: Report of 104 Patients from Nova Scotia, with Analysis of Risks from Obesity, Diabetes and Alcohol Consumption During Long Term Follow-Up

    DA Malatjalian


    Full Text Available BACKGROUND AND DESIGN: Methotrexate (MTX hepatotoxicity in psoriatic patients is well recognized, but there are discrepancies in the reported incidence and associated risk factors. This retrospective study describes 104 Nova Scotian patients with psoriasis seen between 1979 and 1990. Patients received MTX over one to 11 years (mean 3.38, with baseline and annual follow-up liver biopsies. Clinical data were obtained by chart review. Statistical analysis evaluated the risks associated with obesity, diabetes, alcohol consumption and duration of therapy, with the histological grade of liver biopsies.

  5. Takotsubo Cardiomyopathy: A Long Term Follow-up Shows Benefit with Risk Factor Reduction

    Koroush Khalighi


    Full Text Available Only sparse data was available on long-term of Takotusbo Cardiomyopathy (TC. Previous studies suggested prognosis is not necessarily benign. We report the long-term follow-up of 12 TC patients actively managed with risk factor reduction. Retrospective analysis of all patients diagnosed with TC at our hospital between 1998 and 2010. We identified 12 patients with TC among 1651 cases of emergent left heart catheterization over 12 years. Mean follow-up time was 8.3 ± 3.6 years. All were female, 87% had hypertension, 25% had history of Coronary Artery Disease (CAD, 67% had hyperlipidemia, 44% had some preceding emotional trauma, and 44% had some physical/physiological stress. Previous studies have shown that over 50% of TC patients experience future cardiac events, and 10% have a recurrence of TC. Patients were prescribed therapeutic lifestyle changes (TLC and guideline directed medical therapy (GDMT for aggressive risk factor reduction. TLC included diet, exercise, and cardiac rehabilitation. GDMT often included aspirin, beta-blockers, ACE-inhibitors, and statins. Follow-up echocardiograms showed recovery and maintenance of the ejection fraction. There was no cardiac mortality and no recurrences of TC. Aggressive risk factor reduction with TLC and GDMT may be effective in improving the long term outcomes of patients with TC.

  6. Long-Term follow up after intra-Uterine transfusionS; the LOTUS study

    Verduin, Esther P; Lindenburg, Irene T M; Smits-Wintjens, Vivianne E H J; van Klink, Jeanine M M; Schonewille, Henk; van Kamp, Inge L; Oepkes, Dick; Walther, Frans J; Kanhai, Humphrey H H; Doxiadis, Ilias I N; Lopriore, Enrico; Brand, Anneke


    .... We set up a large long-term observational follow-up study (LOTUS study), in cooperation with the Sanquin Blood Supply Foundation and the LUMC departments of Obstetrics, Neonatology and ImmunoHematology...

  7. Long-term cardiac follow-up in survivors of a malignant bone tumour

    Brouwer, C. A. J.; Gietema, J. A.; van den Berg, M. P.; Bink-Boelkens, M. T. E.; Elzenga, N. J.; Haaksma, J.; Kamps, W. A.; Vonk, J. M.; de Vries, E. G. E.; Postma, A.


    Background: Longitudinal studies of cardiac function in long-term childhood cancer survivors are scarce and frequently concern a median follow-up shorter than 13 years. Patients and methods: Cardiac assessment was performed in 22 doxorubicin-treated long-term survivors of a malignant bone tumour at

  8. Growth and development after oesophageal atresia surgery: Need for long-term multidisciplinary follow-up

    H. IJsselstijn (Hanneke); S.J. Gischler (Saskia); L.C.C. Toussaint (Leontien); M. Spoel (Marjolein); M.H.M. van der Cammen-van Zijp (Monique); D. Tibboel (Dick)


    markdownabstractAbstract Survival rates in oesophageal atresia patients have reached over 90%. In long-term follow-up studies the focus has shifted from purely surgical or gastrointestinal evaluation to a multidisciplinary approach. We reviewed the literature on the long-term morbidity of these

  9. Carcinoma in the Remnant Stomach During Long-Term Follow-up After Distal Gastrectomy for Gastric Cancer: Analysis of Cumulative Incidence and Associated Risk Factors.

    Hanyu, Takaaki; Wakai, Atsuhiro; Ishikawa, Takashi; Ichikawa, Hiroshi; Kameyama, Hitoshi; Wakai, Toshifumi


    The number of patients with remnant gastric cancer following resection of gastric cancer may increase. The aims of this study were to investigate the development of remnant gastric cancer after distal gastrectomy for gastric cancer and to examine its cumulative incidence, clinicopathological characteristics, and risk factors. We examined 437 patients with relapse-free survival for 5 years or more after distal gastrectomy with Billroth I reconstruction for gastric cancer performed between 1985 and 2005. A total of 17 patients suffered from remnant gastric cancer. The cumulative incidence was 3.7% at 10 years and 5.4% at 20 years. The median time until development of remnant gastric cancer was 79 months (range 30-209 months). The presence of synchronous multiple gastric cancers was a significant independent risk factor for remnant gastric cancer (hazard ratio 4.036; 95% confidence interval 1.478-11.02; P = 0.006). Of the 17 patients, the 13 whose remnant gastric cancer was detected via regular endoscopy showed better prognoses than the patients detected by other means (P gastric cancer was 5.4% at 20 years. In particular, patients who had multiple gastric cancers at initial gastrectomy were at higher risk for remnant gastric cancer. Therefore, long-term endoscopic surveillance is important.

  10. Association between dental implants in the posterior region and traumatic occlusion in the adjacent premolars: a long-term follow-up clinical and radiographic analysis


    Purpose The aim of this retrospective study was to determine the association between dental implants in the posterior region and traumatic occlusion in the adjacent premolars, using data collected during from 2002 to 2015. Methods Traumatic occlusion in the adjacent premolars was assessed by examining clinical parameters (bleeding on probing, probing pocket depth, fremitus, and tooth mobility) and radiographic parameters (loss of supporting bone and widening of the periodontal ligament space) over a mean follow-up of 5 years. Clinical factors (gender, age, implant type, maxillary or mandibular position, opposing teeth, and duration of functional loading) were evaluated statistically in order to characterize the relationship between implants in the posterior region and traumatic occlusion in the adjacent premolars. Results The study inclusion criteria were met by 283 patients, who had received 347 implants in the posterior region. The incidence of traumatic occlusion in the adjacent premolars was significantly higher for splinted implants (P=0.004), implants in the maxillary region (Pclinical factors of gender, age, and duration of functional loading were not significantly associated with traumatic occlusion. Conclusions This study found that the risk of traumatic occlusion in the adjacent premolars increased when splinted implants were placed in the maxillary molar region and when the teeth opposing an implant also contained implants. PMID:28050317

  11. A long-term follow-up of 221 hip fracture patients in southeastern Finland: analysis of survival and prior or subsequent fractures.

    Lüthje, Peter; Helkamaa, Teemu; Kaukonen, Juha-Pekka; Nurmi-Lüthje, Ilona; Kataja, Matti


    To analyze the type and effect of prior and subsequent fractures in a hip fracture cohort. Hip fracture patients (n=221) were followed for a mean of 8 years and all prior and subsequent fractures were studied. Incidence of the first fracture and subsequent fractures according to sex, age group, and time between the first and the index hip fracture were measured. The absolute fracture risk was measured in the study subjects and in the age groups hip fracture patients had sustained previous fractures. In men, these were mostly ankle or hip fractures, and in women, wrist fractures. Of the subjects, 24% suffered a subsequent fracture, which in both sexes was usually a second hip fracture. At the end of the 8-year follow-up, 74% of the patients had died. The observed absolute fracture risk was 7% at one year and 24% at 5 years. In women, excess mortality was lowest during the first 4.8 years after the index hip fracture among patients with one fracture. However, it was highest among women with two fractures. In men, excess mortality was lowest among those with two fractures and highest among those with ≥3 fractures. There were no differences between the genders in sustaining subsequent fractures. The fracture risk subsequent to hip fracture was similar in both genders. Patients with prior hip fractures had the worst survival rate. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  12. Planning for Long-Term Follow-Up: Strategies Learned from Longitudinal Studies.

    Hill, Karl G; Woodward, Danielle; Woelfel, Tiffany; Hawkins, J David; Green, Sara


    Preventive interventions are often designed and tested with the immediate program period in mind, and little thought that the intervention sample might be followed up for years or even decades beyond the initial trial. However, depending on the type of intervention and the nature of the outcomes, long-term follow-up may well be appropriate. The advantages of long-term follow-up of preventive interventions are discussed and include the capacity to examine program effects across multiple later life outcomes, the ability to examine the etiological processes involved in the development of the outcomes of interest, and the ability to provide more concrete estimates of the relative benefits and costs of an intervention. In addition, researchers have identified potential methodological risks of long-term follow-up such as inflation of type 1 error through post hoc selection of outcomes, selection bias, and problems stemming from attrition over time. The present paper presents a set of seven recommendations for the design or evaluation of studies for potential long-term follow-up organized under four areas: Intervention Logic Model, Developmental Theory and Measurement Issues; Design for Retention; Dealing with Missing Data; and Unique Considerations for Intervention Studies. These recommendations include conceptual considerations in the design of a study, pragmatic concerns in the design and implementation of the data collection for long-term follow-up, as well as criteria to be considered for the evaluation of an existing intervention for potential for long-term follow-up. Concrete examples from existing intervention studies that have been followed up over the long term are provided.

  13. Long-term follow-up after urethral injection with polyacrylamide hydrogel for female stress incontinence

    Mouritsen, Lone; Lose, Gunnar; Møller-Bek, Karl


    Urethral injection therapy for treatment of stress urinary incontinence has been in use for years, but only a few long-term follow-up studies have been published. Twenty-five women, injected with polyacrylamide hydrogel 8 years earlier, were invited for follow-up. Twenty-four could be contacted; ...

  14. Long-term follow-up results of primary and recurrent pigmented villonodular synovitis

    Verspoor, F.G.; Zee, A.A.; Hannink, G.; Geest, I.C. van der; Veth, R.P.H.; Schreuder, H.W.


    OBJECTIVE: Adequate documentation of the outcome of treatment of pigmented villonodular synovitis (PVNS) is sparse. Available case series show relatively short follow-up times and often combine locations or subtypes to increase patient numbers. This article describes the long-term follow-up of a sin

  15. Long-term follow-up of surgical treatment for thumb duplication

    Larsen, M; Nicolai, JPA


    There are few long-term follow-up reports concerning the treatment of thumb duplication. We reviewed the treatment of 19 of 74 patients treated at our institution between 1956 and 2002. The average follow-up was 22 (range, 7 years to 35 years) years. Satisfactory function was achieved in 18 thumbs a

  16. Vagus nerve stimulation: outcome and predictors of seizure freedom in long-term follow-up.

    Ghaemi, Kazem; Elsharkawy, Alaa Eldin; Schulz, Reinhard; Hoppe, Matthias; Polster, Tilman; Pannek, Heinz; Ebner, Alois


    To present long-term outcome and to identify predictors of seizure freedom after vagus nerve stimulation (VNS). All patients who had undergone VNS implantation in the Epilepsy Centre Bethel were retrospectively reviewed. There were 144 patients who had undergone complete presurgical evaluation, including detailed clinical history, magnetic resonance imaging, and long-term video-EEG with ictal and interictal recordings. After implantation, all patients were examined at regular intervals of 4 weeks for 6-9 months. During this period the antiepileptic medication remained constant. All patients included in this study were followed up for a minimum of 2 years. Ten patients remained seizure-free for more than 1 year after VNS implantation (6.9%). Seizures improved in 89 patients (61.8%) but no changes were observed in 45 patients (31.3%). The following factors were significant in the univariate analysis: age at implantation, multifocal interictal epileptiform discharges, unilateral interictal epileptiform discharge, cortical dysgenesis, and psychomotor seizure. Stepwise multivariate analysis showed that unilateral interictal epileptiform discharges (IEDs), P=0.014, HR=0.112 (95% CIs, 0.019-0.642), cortical dysgenesis P=0.007, HR=0.065 (95% CIs, 0.009-0.481) and younger age at implantation P=0.026, HR=7.533 (95% CIs 1.28-44.50) were independent predictors of seizure freedom in the long-term follow-up. VNS implantation may render patients with some forms of cortical dysgenesis (parietooccipital polymicrogyria, macrogyria) seizure-free. Patients with unilateral IEDs and earlier implantation achieved the most benefit from VNS. Copyright 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  17. Acupuncture for chronic low back pain in long-term follow-up: a meta-analysis of 13 randomized controlled trials.

    Xu, Mai; Yan, Shi; Yin, Xu; Li, Xiuyang; Gao, Shuguang; Han, Rui; Wei, Licheng; Luo, Wei; Lei, Guanghua


    Chronic low back pain is one of the most common reasons that people seek medical treatment, and the consequent disability creates a great financial burden on individuals and society. The etiology of chronic low back pain is not clear, which means it is often refractory to treatment. Acupuncture has been reported to be effective in providing symptomatic relief of chronic low back pain. However, it is not known whether the effects of acupuncture are due to the needling itself or nonspecific effects arising from the manipulation. To determine the effectiveness of acupuncture therapy, a meta-analysis was performed to compare acupuncture with sham acupuncture and other treatments. Overall, 2678 patients were identified from thirteen randomized controlled trials. The meta-analysis was performed by a random model (Cohen's test), using the I-square test for heterogeneity and Begg's test to assess for publication bias. Clinical outcomes were evaluated by pain intensity, disability, spinal flexion, and quality of life. Compared with no treatment, acupuncture achieved better outcomes in terms of pain relief, disability recovery and better quality of life, but these effects were not observed when compared to sham acupuncture. Acupuncture achieved better outcomes when compared with other treatments. No publication bias was detected. Acupuncture is an effective treatment for chronic low back pain, but this effect is likely to be produced by the nonspecific effects of manipulation.

  18. Long term azathioprine maintenance therapy in ANCA-associated vasculitis: combined results of long-term follow-up data.

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


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

  19. Long-term follow-up of coronary angioplasty in patients with diabetes compared with nondiabetics.

    Brueren, B R G; Ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Ernst, S M P G; Plokker, H W T


    Some reports have indicated that in patients with diabetes mellitus and multivessel disease, coronary artery bypass surgery is preferred over percutaneous coronary intervention (PCI). We retrospectively compared outcome PCI in diabetic and nondiabetic patients. Ninety-seven diabetics and 971 nondiabetics were included and randomised before PCI to aspirin alone or aspirin plus coumadin. Fifty diabetics and 481 nondiabetics underwent follow-up angiography. The primary endpoint comprised all-cause mortality, myocardial infarction or targetvessel revascularisation. Baseline characteristics were similar between the groups except for significantly more males and smokers among the nondiabetics. The diabetics had significantly more previous strokes, more left anterior descending coronary artery disease as well as more restenotic lesions and multivessel disease. At 30 days, the primary endpoint had occurred in five diabetics (5.2%) and 47 nondiabetics (4.9%), (p=0.8) and at one year in 17 (17.5%) and in 165 (17.1%), respectively (p=0.9). Event-free survival remained comparable during long-term follow-up (four years). Multivariate analysis showed no differences for the occurrence of any event (p=0.9, 95% CI 0.6-1.7). At six months, the minimal luminal diameter was significantly smaller in the diabetics (1.55±0.76 mm vs. 1.78±0.66 mm, p=0.01). Diabetics also had more restenosis (41% vs. 23%, p=0.003). Despite angiographical differences at six months between the diabetics and nondiabetics, both short-term and long-term clinical follow-up appeared to be similar.

  20. White mineral trioxide aggregate pulpotomies: Two case reports with long-term follow-up

    Sen Tunc Emine


    Full Text Available This case report describes the partial pulpotomy treatment of complicated crown fractures of two cases by using white mineral trioxide aggregate (WMTA with long-term follow-up. In the cases presented here, to injured incisor teeth were open apices and the pulp exposure site was large, so it was decided to perform vital pulpotomy with WMTA. Long-term follow-up examinations revealed that the treatment preserved pulpal vitality with continued root development and apex formation. WMTA may be considered as an alternative option for the treatment of traumatized immature permanent teeth.

  1. Refraction in juvenile chronic arthritis: a long-term follow-up study, with emphasis on myopia

    Fledelius, H; Zak, M; Pedersen, F K


    Assessment of refraction anomalies in juvenile chronic arthritis (JCA) on a long-term follow-up basis.......Assessment of refraction anomalies in juvenile chronic arthritis (JCA) on a long-term follow-up basis....

  2. Long term follow-up of a randomised controlled trial of services for urinary symptoms

    Cooper Nicola J


    Full Text Available Abstract Background Given the extent and priority of urinary symptoms there is little evidence available to inform service provision in relation to the long term effects of interventions. This study aims to determine the long term (6 year clinical effectiveness and costs of a new continence nurse led service compared to standard care for urinary symptoms. Methods A long term follow-up study of a 2-arm, non-blinded randomised controlled trial that recruited from a community based population between 1998-2000 in Leicestershire and Rutland UK was undertaken. 3746 men and women aged 40 years and over were followed up from the original trial. The continence nurse practitioner (CNP intervention comprised a continence service provided by specially trained nurses delivering evidence-based interventions using pre-determined care pathways. The standard care (SC arm comprised access to existing primary care including General Practitioner and continence advisory services in the area. Primary outcome: Improvement in one or more symptom. Secondary outcomes included: a Leicester Impact scale; b patient perception of problem; c number of symptoms alleviated and cost-effectiveness; all were recorded at long term follow-up (average 6 years post-randomisation. Results Overall at long-term follow-up (average 6 years significantly more individuals in the CNP group (72% had improved (i.e had fewer symptoms compared to those in the SC group (67% (difference of 5% 95% (CI = 0.6 to 9;p = 0.02. Conclusion The differences in outcome between the two randomised groups shown immediately post treatment had decreased by half in terms of symptom improvement at long term follow-up. Although the difference was statistically significant, the clinical significance may not be, although the direction of the difference favoured the new CNP service.

  3. Childhood acromegaly due to X-linked acrogigantism: long term follow-up

    Gordon, Rebecca J.; Bell, Jennifer; Chung, Wendy K.; David, Raphael; Oberfield, Sharon E.; Wardlaw, Sharon L.


    Purpose Acromegaly in infancy is extremely rare. We describe a 32 year old woman who presented at 6 months of age with isolated macrocephaly, followed by accelerated linear growth. At 21 months of age, her head circumference was 55 cm (+5.5 SD), height was 97.6 cm (+4.4 SD) and weight was 20.6 kg (+6.2 SD). She had markedly elevated levels of growth hormone (GH) (135 ng/ml), IGF-1 (1540 ng/ml) and prolactin (370 ng/ml). A pituitary macroadenoma was surgically resected. Immunohistochemical staining was positive for GH. Post-operatively, she developed ACTH and TSH deficiency and diabetes insipidus. Methods Long term clinical follow-up and genetic testing with chromosomal microarray analysis. Results Despite GH deficiency, she grew well until 7 ½ years old, with subsequent decline in growth velocity, and received GH therapy for 5 years. Puberty was initiated with estrogen therapy. As an adult, she has no stigmata of acromegaly, with a height of 164.5 cm and non-acromegalic features. IGF-1 has remained in the low normal range. Prolactin has been mildly elevated. Serial MRIs have shown no evidence of tumor recurrence. She receives replacement therapy with hydrocortisone, levothyroxine and DDAVP. Chromosomal microarray analysis revealed that she has X-linked acrogigantism (X-LAG) due to a de novo duplication of Xq26.3 (516 kb). She recently became pregnant following ovarian stimulation and chorionic villus sampling revealed that she is carrying a male with the same duplication. Conclusion This report provides detailed long term clinical follow-up of a patient with X-LAG syndrome. PMID:27631333

  4. Long-term follow-up of echolalia and question answering.

    Foxx, R M; Faw, G D


    A long-term follow-up of echolalia and correct question answering was conducted for 6 subjects from three previously published studies. The follow-up periods ranged from 26 to 57 months. In a training site follow-up, subjects were exposed to baseline/posttraining conditions in which the original trainer and/or a novel person(s) presented trained and untrained questions. Four subjects displayed echolalia below baseline levels, and another did so in some assessments. Overall, echolalia was lowe...

  5. Pulmonary function and autoantibodies in a long-term follow-up of juvenile dermatomyositis patients

    Mathiesen, Pernille Raasthøj; Buchvald, Frederik Fouirnaies; Nielsen, Kim G


    Objectives. Pulmonary disease is a rare complication in JDM, described in only a few studies. This long-term follow-up study aimed to (i) describe pulmonary involvement in a national cohort of JDM patients estimated by conventional spirometry, (ii) compare pulmonary impairment with overall JDM ou...

  6. Long-term follow-up after liver transplantation for erythropoietic protoporphyria

    Meerman, L; Haagsma, EB; Gouw, ASH; Slooff, MJH; Jansen, PLM

    Objective Erythropoietic protoporphyria (EPP) is an inherited disorder of haem synthesis, causing excess of protoporphyrin in blood, skin, liver and other organs, Protoporphyrin causes rapidly progressive liver failure in a minority of EPP patients. Long-term follow-up after liver transplantation

  7. Long-term follow-up of cancer patients treated with gene therapy medicinal products.

    Galli, Maria Cristina


    European Union requirements are discussed for the long-term follow-up of advanced therapy medicinal products, as well as how they can be applied to cancer patients treated with gene therapy medicinal products in the context of clinical trials, as described in a specific guideline issued by Gene Therapy Working Party at the European Medicine Agency.

  8. Cessation of Long-term Naltrexone Administration: Longitudinal Follow-Ups.

    Crews, W. David, Jr.; Rhodes, Robert D.; Bonaventura, Sharon H.; Rowe, Frederick B.; Goering, Aaron M.


    Longitudinal follow-ups of the cessation of long-term Naltrexone administration were conducted with a women with profound mental retardation who had previously displayed dramatic decreases in self-injurious behavior (SIB). After two and four years post-Naltrexone therapy, the subject exhibited near-zero rates of SIB despite changes in staff and in…

  9. Discontinuation of long-term benzodiazepine use : 10-year follow-up

    de Gier, N. A. H.; Gorgels, W. J. M. J.; Lucassen, P. L. B. J.; Voshaar, R. Oude; Mulder, J.; Zitman, F.


    Background. Several interventions aiming at discontinuation of long-term benzodiazepine use have been proven effective in the short term. However, data on the persistence of discontinuation are lacking. Objectives. To assess 10-year follow-up status in patients who succeeded in stopping benzodiazepi

  10. Long-Term Follow-Up of Microvascular Decompression for Trigeminal Neuralgia

    Oesman, Chenur; Mooij, Jan Jakob A.


    We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University

  11. Long-term follow-up of patients with surgical intractable acromegaly after linear accelerator radiosurgery

    Jiun-Lin Yan


    Conclusion: In comparison to other radiosurgery modalities, LINAC radiosurgery also provides a satisfactory outcome. SRS has maximum effect over the first 2 years and stabilizes after 7.5 years. Moreover, SRS elicits long-term biochemical effects and requires longer follow-up for better biochemical remission.

  12. Treatment of generalized social phobia : Results at long-term follow-up

    Scholing, A; Emmelkamp, PMG


    This study investigated the long-term follow-up effectiveness-of (cognitive-)behavioural group and individual treatments for generalized social phobia. Patients were reassessed 18 months after they had finished one of the following treatment packages: (1) exposure in vivo; (2) cognitive therapy foll

  13. Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality

    Simonsen, Rikke Kildevaeld; Giraldi, Annamaria; Kristensen, Ellids


    BACKGROUND: There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which...

  14. Long-term follow-up of indolent mastocytosis in adults

    Kors, JW; VanDoormaal, JJ; Breukelman, H; Vader, PCV; DeMonchy, JGR


    Objective. To evaluate the natural course of indolent mastocytosis in adults. Design. A retrospective long-term follow-up study. Setting. The Department of Endocrinology of a University Hospital. Patients. Sixteen adult patients with a diagnosis of indolent mastocytosis and sufficient biochemical da

  15. Long-Term Follow-Up of Microvascular Decompression for Trigeminal Neuralgia

    Oesman, Chenur; Mooij, Jan Jakob A.

    We conducted a study to evaluate the follow-up characteristics of patients with trigeminal neuralgia (TN) and to evaluate the factors affecting long-term outcome of microvascular decompression (MVD) in TN. Between 1983 and 2003, 156 patients with TN treated with MVD by 4 neurosurgeons at University

  16. A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis

    WU Li-dong 吴立东; Hans J Hahne; Toachim Hassenpflug


    Objective: To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees. Methods: A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996. Results: One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3%, 93.6% and 78.2% two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications (12 /161), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees) missed follow-up, among them 10 patients (11 knees) died.Conclusions: HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.

  17. Papillary Thyroid Carcinoma: Four Cases Required Caution during Long-Term Follow-Up

    Hea Min Yu


    Full Text Available Due to the increased prevalence of papillary thyroid carcinoma (PTC, difficult cases and unexpected events have become more common during long-term follow-up. Herein we reported four cases that exhibited poor progress during long-term follow-up. All the cases were diagnosed with PTC and treated with total thyroidectomy before several years, and the patients had been newly diagnosed with recurrent and metastatic PTC. These four cases included recurred PTC with invasion of large blood vessels, a concomitant second malignancy, malignant transformation, and refractoriness to treatment. Physicians should closely monitor patients to promptly address unforeseen circumstances during PTC follow-up, including PTC recurrence and metastasis. Furthermore, we suggest that the development of a management protocol for refractory or terminal PTC is also warranted.

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

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


    OBJECTIVE: There is increasing focus on non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to conduct a long-term clinical follow-up of patients with biopsy-confirmed fatty liver without inflammation or significant fibrosis (pure fatty liver), to analyse for potential risk....... All admissions, discharge diagnoses and causes of death during follow-up were collected. All surviving patients were invited to a clinical follow-up. RESULTS: The follow-up period was 20.4 and 21.0 years, respectively, for the NAFLD and alcoholic fatty liver disease (AFLD) groups. Two NAFLD patients...... of death. Patients with AFLD died primarily from cirrhosis and other alcohol-related disorders, whereas in patients with NAFLD the main causes of death were cardiovascular disease and cancer. CONCLUSIONS: For patients with pure non-alcoholic fatty liver, survival was good and independent...

  19. Long-Term Ultrasound Follow-Up of Thyroid Colloid Cysts

    Dong Wook Kim


    Full Text Available Objective. This study aimed to assess the interval changes of thyroid colloid cysts (TCCs by performing long-term ultrasound (US follow-up examinations. Methods. From 2007 to 2008, 437 patients underwent a lobectomy for the treatment of papillary thyroid microcarcinoma. Among them, 268 patients underwent 4 or more postoperative US follow-ups after surgery. This study investigated the prevalence and interval changes of TCCs ≥3 mm by using US follow-ups. Results. Among 268 patients, 35 (13.1% had TCCs ≥3 mm by a preoperative thyroid US, and 6 (2.2% had newly detected TCCs at a US follow-up. Through long-term US follow-up, the interval changes for TCCs were classified as follows: no interval change (n=8, gradual increase (n=8, gradual decrease (n=5, positive fluctuation (n=3, negative fluctuation (n=6, disappearance (n=5, and new detection (n=6. None of the TCC cases had a TCC that was ≥10 mm at its largest diameter, and no patient complained of any relevant symptoms pertaining to the TCCs. Conclusions. In this study, TCCs demonstrated various interval changes, but no abrupt increase was found or acute onset of symptoms occurred.

  20. Long-term follow up of renal anastomosing hemangioma mimicking renal angiosarcoma.

    Heidegger, Isabel; Pichler, Renate; Schäfer, Georg; Zelger, Bernhard; Zelger, Bettina; Aigner, Friedrich; Bektic, Jasmin; Horninger, Wolfgang


    Anastomosing hemangioma of the kidney is a very rare neoplasm, currently 19 cases have been reported in the literature. First described in 2009, histopathologically anastomosing hemangioma is similar to aggressive angiosarcoma. No long-term follow-up data of anastomosing hemangioma have been described yet. Here, we present the case of a healthy 56-year-old man diagnosed in 2002 with a 7 × 5-cm anastomosing hemangioma mimicking an aggressive renal angiosarcoma. The patient underwent nephrectomy and has been followed up disease free for 13 years.

  1. Growth and development after oesophageal atresia surgery: Need for long-term multidisciplinary follow-up.

    IJsselstijn, Hanneke; Gischler, Saskia J; Toussaint, Leontien; Spoel, Marjolein; Zijp, Monique H M van der Cammen-van; Tibboel, Dick


    Survival rates in oesophageal atresia patients have reached over 90%. In long-term follow-up studies the focus has shifted from purely surgical or gastrointestinal evaluation to a multidisciplinary approach. We reviewed the literature on the long-term morbidity of these patients and discuss mainly issues of physical growth and neurodevelopment. We conclude that growth problems - both stunting and wasting - are frequently seen, but that sufficient longitudinal data are lacking. Therefore, it is unclear whether catch-up growth into adolescence and adulthood occurs. Data on determinants of growth retardation are also lacking in current literature. Studies on neurodevelopment beyond preschool age are scarce but oesophageal atresia patients seem at risk for academic problems and motor function delay. Many factors contribute to the susceptibility to growth and development problems and we propose a multidisciplinary follow-up schedule into adulthood future care which may help improve quality of life.

  2. Long-term follow-up care for pediatric cancer survivors.


    Progress in therapy has made survival into adulthood a reality for most children, adolescents, and young adults diagnosed with cancer today. Notably, this growing population remains vulnerable to a variety of long-term therapy-related sequelae. Systematic ongoing follow-up of these patients, therefore, is important for providing for early detection of and intervention for potentially serious late-onset complications. In addition, health counseling and promotion of healthy lifestyles are important aspects of long-term follow-up care to promote risk reduction for health problems that commonly present during adulthood. Both general and subspecialty pediatric health care providers are playing an increasingly important role in the ongoing care of childhood cancer survivors, beyond the routine preventive care, health supervision, and anticipatory guidance provided to all patients. This report is based on the guidelines that have been developed by the Children's Oncology Group to facilitate comprehensive long-term follow-up of childhood cancer survivors (

  3. Long-term follow-up after complete ablation of Barrett's esophagus with argon plasma coagulation

    Ahmed Madisch; Stephan Miehlke; Ekkehard Bayerd(o)rffer; Birgit Wiedemann; David Antos; Anke Sievert; Michael Vieth; Manfred Stolte; Heinrich Schulz


    AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma.METHODS: In 70 patients with histologically proven nonneoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion.RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years.A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected.Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P = 0.0004).CONCLUSION: The long-term relapse rate of nonneoplastic BE following complete ablation with high-power APC is low (3% per year).

  4. Long-term follow-up study of radial forearm free flap reconstruction after hemiglossectomy.

    Akashi, Masaya; Hashikawa, Kazunobu; Sakakibara, Akiko; Komori, Takahide; Terashi, Hiroto


    Previous studies on postoperative long-term results in patients who underwent reconstructive free flap transfer following hemiglossectomy had some issues, including the heterogeneity of the patient population and the observation period. The present study aimed to evaluate changes of reconstructed tongues in patients who underwent radial forearm free flap (RFFF) after hemiglossectomy with long-term follow-up. We enrolled 23 patients who underwent RFFF after hemiglossectomy with a postoperative follow-up of 5 years or more. Postoperative status (eating, speech, sensation function) was assessed by concise medical inquiries. Morphological changes of flaps were evaluated by reviewing clinical photographs. Hemiglossectomy involving the base of the tongue was performed in 4 cases (17.4%) and was limited to the mobile tongue in 19 cases (82.6%). The mean follow-up was 85.4 months (range, 60-122 months). All patients experienced gradually improved postoperative status. The most significant improvement was found between 1 and 5 years after surgery (P = 0.007), but not between 1 and 3 years (P = 0.075) or between 3 and 5 years (P = 0.530). In almost all of the flaps, there were few morphological changes throughout the follow-up period. Postoperative status in patients who underwent reconstructive RFFF following hemiglossectomy improved sequentially.

  5. Long-Term Follow-Up of a Revascularized Immature Necrotic Tooth Evaluated by CBCT

    C. M. L. She


    Full Text Available This case study reports the successful treatment of an immature upper premolar with periapical pathosis and sinus tract using revascularization technique. Clinical and radiographic examination demonstrated the recovery of vitality, continued root development, and periapical healing at the 7-month follow-up. In addition, severe calcification of the canal was noted at the 36-month follow-up. At the 66-month follow-up, cone-beam computed tomography (CBCT revealed complete periapical healing, apical closure, increase in root length and thickness of dentin, and severe calcification of the root canal. Even though the nature of tissue within the root canal is unknown, revascularization appears to give good clinical and radiographic success. This case report highlights that severe calcification of the canal is one of the long-term outcomes of revascularized root canals.

  6. Long-Term Follow-Up of a Revascularized Immature Necrotic Tooth Evaluated by CBCT

    She, C. M. L.; Cheung, G. S. P.; Zhang, C. F.


    This case study reports the successful treatment of an immature upper premolar with periapical pathosis and sinus tract using revascularization technique. Clinical and radiographic examination demonstrated the recovery of vitality, continued root development, and periapical healing at the 7-month follow-up. In addition, severe calcification of the canal was noted at the 36-month follow-up. At the 66-month follow-up, cone-beam computed tomography (CBCT) revealed complete periapical healing, apical closure, increase in root length and thickness of dentin, and severe calcification of the root canal. Even though the nature of tissue within the root canal is unknown, revascularization appears to give good clinical and radiographic success. This case report highlights that severe calcification of the canal is one of the long-term outcomes of revascularized root canals. PMID:26949550

  7. Young and midlife stroke survivors' experiences with the health services and long-term follow-up needs.

    Martinsen, Randi; Kirkevold, Marit; Sveen, Unni


    The aim of this qualitative study was to explore young and midlife stroke survivors' experiences with the health services and to identify long-term follow-up needs. Sixteen participants from two cohorts were interviewed in-depth. The interviews were analyzed applying a hermeneutic-phenomenological analysis. The participants struggled to gain access to follow-up health services. They felt that whether they were systematically followed up was more coincidental than planned. Young and midlife stroke survivors thus appear vulnerable to falling outside the follow-up system. Those participants who received some follow-up care perceived it as untailored to their specific needs. To be considered supportive, the follow-up programs must be in line with their long-term needs, take into account their particular challenges as young and midlife stroke survivors, and be planned in close collaboration with the individual patient. To secure systematic and follow-up health services tailored to the individual, knowledgeable and committed healthcare professionals should play a prominent role within the community health services.

  8. Tarlov cysts: long-term follow-up after microsurgical inverted plication and sacroplasty.

    Weigel, Ralf; Polemikos, Manolis; Uksul, Nesrin; Krauss, Joachim K


    Surgical treatment of Tarlov cysts is still a matter of debate. Published literature thus far includes mainly small case series with retrospective evaluation and short-term follow-up. We present a novel microsurgical technique that combines the decompression of the nerve fibers with the prevention of recurrence. The long-term follow-up is provided. The indication for surgery was incapacitating pain refractory to medical therapy for at least 6 months. The surgical technique consisted in microsurgical opening of the cyst, relief of CSF followed by secured inverted plication of the cyst wall, packing of remnant space with fat graft, and sacroplasty. Pain and neurological deficits were evaluated according to a modified Barrow National Institute score (BNI score, 0-5) and the Departmental Neuro Score (DNS score, 0-20). A total of 13 patients (9 women, 4 men) were operated and followed up to 14 years (mean FU 5.3 years). Mean age at surgery was 51.8 (±14) years. Pain and neurological deficits improved significantly in 11/13 patients (BNI score pre-OP 5 vs 3.1 ± 1.2 at 1-year-FU, and 2.8 ± 1.2 at last follow-up visit; DNS score pre-OP 5.5 ± 1.5 vs 2.8 ± 2.1 at 1-year follow-up, and 2.6 ± 2.2 at last follow-up visit. Two patients needed revision surgery due to reoccurrence of the cyst. One patient suffered deterioration of preexisting neurological deficit. The inverted plication technique combined with sacroplasty is a promising technique. It improves pain and neurological deficits on the long term in the majority of patients with symptomatic Tarlov cysts.

  9. B-cell Lymphoma in retrieved femoral heads: a long term follow up

    van Kemenade Folkert J


    Full Text Available Abstract Background A relatively high incidence of pathological conditions in retrieved femoral heads, including a group of patients having low grade B-cell lymphoma, has been described before. At short term follow up none of these patients with low-grade B-cell lymphoma showed evidence of systemic disease. However, the long term follow up of these patients is not known. Methods From November 1994 up to and including December 2005 we screened all femoral heads removed at the time of primary total hip replacement histopathologically and included them in the bone banking protocol according to the guidelines of the American Associations of Tissue Banks (AATB and the European Association of Musculo-Skeletal Transplantation (EAMST. We determined the percentage of B-cell lymphoma in all femoral heads and in the group that fulfilled all criteria of the bone banking protocol and report on the long-term follow-up. Results Of 852 femoral heads fourteen (1.6% were highly suspicious for low-grade B-cell lymphoma. Of these 852 femoral heads, 504 were eligible for bone transplantation according to the guidelines of the AATB and the EAMST. Six femoral heads of this group of 504 were highly suspicious for low-grade B-cell lymphoma (1.2%. At long term follow up two (0.2% of all patients developed systemic malignant disease and one of them needed medical treatment for her condition. Conclusion In routine histopathological screening we found variable numbers of low-grade B-cell lymphoma throughout the years, even in a group of femoral heads that were eligible for bone transplantation. Allogenic transmission of malignancy has not yet been reported on, but surviving viruses are proven to be transmissible. Therefore, we recommend the routine histopathological evaluation of all femoral heads removed at primary total hip arthroplasty as a tool for quality control, whether the femoral head is used for bone banking or not.

  10. Pallidal stimulation for segmental dystonia: long term follow up of 11 consecutive patients.

    Sensi, Mariachiara; Cavallo, Michele A; Quatrale, Rocco; Sarubbo, Silvio; Biguzzi, Sara; Lettieri, Cristian; Capone, Jay G; Tugnoli, Valeria; Tola, Maria Rosaria; Eleopra, Roberto


    Pallidal stimulation is a convincing and valid alternative for primary generalized dystonia refractory to medical therapy or botulinum toxin. However, the clinical outcome reported in literature is variable most likely because of heterogeneity DBS techniques employed and /or to clinical dystonic pattern of the patients who undergo surgery. In this study, we report the long term follow up of a homogeneous group of eleven subjects affected by segmental dystonia who were treated with bilateral stimulation of the Globus Pallidus pars interna (GPi) from the years 2000 to 2008. All the patients were evaluated, before surgery and at 6-12-24-36 months after the treatment, in accordance with the Burke Fahn Marsden Dystonia Rating Scale (BFMDRS). Our study indicates that DBS promotes an early and significant improvement at 6 months with an even and a better outcome later on. The analysis of specific sub items of the BFMDRS revealed an earlier and striking benefit not only as far as segmental motor function of the limbs but also for the complex cranial functions like face, (eyes and mouth), speech and swallowing, differently from results reported in primary generalized dystonia. Deep Brain Stimulation of GPi should be considered a valid indication for both generalized and segmental dystonia when other therapies appear ineffective.

  11. Underuse of long-term routine hospital follow-up care in patients with a history of breast cancer?

    Schaapveld Michael


    Full Text Available Abstract Background After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods Information regarding the utilization of routine hospital follow-up care was retrieved from hospital documents of 662 patients treated for breast cancer. Utilization of hospital follow-up care was defined as the use of follow-up care according to the guidelines in that period of time. Determinants of hospital follow up care were evaluated with multivariate analysis by generalized estimating equations (GEE. Results The median follow-up time was 9.0 (0.3-18.1 years. At fifth and tenth year after diagnosis, 16.1% and 33.5% of the patients had less follow-up visits than recommended in the national guideline, and 33.1% and 40.4% had less frequent mammography than recommended. Less frequent mammography was found in older patients (age > 70; OR: 2.10; 95%CI: 1.62-2.74, patients with comorbidity (OR: 1.26; 95%CI: 1.05-1.52 and patients using hormonal therapy (OR: 1.51; 95%CI: 1.01-2.25. Conclusions Most patients with a history of breast cancer use hospital follow-up care according to the guidelines. In older patients, patients with comorbidity and patients receiving hormonal therapy yearly mammography is performed much less than recommended.

  12. Mucocele-like lesions of the breast: a long-term follow-up study


    Background Mucocele-like lesions (MLL) of the breast were originally described as benign lesions composed of multiple cysts lined by uniform flat to cuboidal epithelium with extravasated mucin, but subsequent reports described the coexistence of columnar cell lesions (CCL), atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS). Several reports have investigated whether core biopsy can diagnose MLL reliably; however, there is only one report with a long-term follow-up after excision of MLL. We report here 15 surgically excised MLL with a long-term follow-up. Findings Fifteen lesions diagnosed as MLL from 13 patients who had undergone excisional biopsy between January 2001 and December 2006 were retrieved and followed-up for 24-99 months (median 63.8). Two lesions were accompanied with CCL, 5 with ADH and 3 with low grade DCIS. Four lesions (2 ADH, 2 DCIS) were additionally resected and their histology revealed 2 ADH, one DCIS and one MLL with CCL. Of 4 lesions (3 ADH, one DCIS) without additional resection, one lesion (ADH) relapsed accompanied with DCIS at 37 months after excision. Conclusions MLL were frequently accompanied with CCL, ADH or low grade DCIS. Complete resection may be recommended in case of MLL with ADH or DCIS because of intralesional heterogeneity and the probabilities of relapse. PMID:21466711

  13. Percutaneous transhepatic lithotripsy using a choledochoscope: long-term follow-up in 14 patients.

    Hayashi, N; Sakai, T; Yamamoto, T; Inagaki, R; Ishii, Y


    The purpose of our study was to estimate the long-term prognosis of patients with bile duct stones who undergo electrohydraulic lithotripsy guided by choledochoscopy. Since 1987, at our institution, 14 patients with bile duct stones have been treated using percutaneous electrohydraulic lithotripsy guided by choledochoscopy. The procedure was performed 5-7 days after biliary drainage using a 5-mm choledochoscope placed through an 18- to 20-French sheath. All patients underwent follow-up CT, sonography, or both every 6-12 months after treatment. No complications occurred in the 14 patients who underwent treatment. During a mean follow-up period of 4.8 years (range, 2-9 years), two (14%) of the 14 patients developed recurrent common bile duct stones, and another two (14%) developed recurrent small intrahepatic stones; all patients remained asymptomatic. Percutaneous electrohydraulic lithotripsy can be safely performed using a 5-mm choledochoscope. Recurrent calculi may be seen in 28% of patients.

  14. Diastematomyelia: A Surgical Case with Long-Term Follow-Up

    Bekki, Hirofumi; Kawano, Osamu; Shiba, Keiichiro; Iwamoto, Yukihide


    Few reports have described the involvement of syringomyelia associated with diastematomyelia in the etiology of neurological deficits. We reported a case with syringomyelia associated with diastematomyelia. A female patient with diastematomyelia was followed up clinically over 14 years. At the age of 8, she developed clubfoot deformity with neurological deterioration. Motor function of the right peroneus demonstrated grade 2 in manual muscle tests. Continuous intracanial bony septum and double cords with independent double dura were observed at upper thoracic spine. Magnetic resonance imaging revealed a tethering of the spinal cord and syringomyelia distal to the level of diastematomyelia. Extirpation of the osseum septum and duralplasty were performed surgically. She grew without neurological deterioration during 7 years postoperatively. A long-term followed up case with syringomyelia that was possibly secondary to the tethering of the spinal cord associated with diastematomyelia, and effective treatment with extirpation of the osseum septum and duralplasty was described. PMID:25705341

  15. Multidisciplinary management and long-term follow-up of mesiodens: a case report.

    Cogulu, Dilsah; Yetkiner, Enver; Akay, Cemal; Seckin, Ozlem; Alpoz, Riza


    Supernumerary teeth are relatively common in the oral cavity and are characterized by an excessive number of teeth. The term "mesiodens" refers to a supernumerary tooth located in the midline of the maxilla between the central incisors. Mesiodens may cause a variety of pathological complications such as impaction of the maxillary central incisors, tooth retention or delayed eruption of the permanent incisors, crowding, eruption within the nasal cavity, formation of diastema, intraoral infection, root anomaly, root resorption of adjacent teeth and cyst formation accompanied by bone destruction. Therefore it is recommended to follow-up with regular radiographic examination. Early diagnosis minimizes treatment needs and prevents associated complications. The present case, followed for 7 years, presented bilateral mesiodens resulting in delayed eruption of the permanent incisors and emphasizes the importance of multidisciplinary management and long-term follow-up.

  16. Long-term follow-up of impulse control disorders in Parkinson's disease.

    Mamikonyan, Eugenia; Siderowf, Andrew D; Duda, John E; Potenza, Marc N; Horn, Stacy; Stern, Matthew B; Weintraub, Daniel


    Recent studies have linked dopamine agonist (DA) usage with the development of impulse control disorders (ICDs) in Parkinson's disease (PD). Little is known about optimal management strategies or the long-term outcomes of affected patients. To report on the clinical interventions and long-term outcomes of PD patients who developed an ICD after DA initiation. Subjects contacted by telephone for a follow-up interview after a mean time period of 29.2 months. They were administered a modified Minnesota Impulse Disorder Interview for compulsive buying, gambling, and sexuality, and also self-rated changes in their ICD symptomatology. Baseline and follow-up dopamine replacement therapy use was recorded and verified by chart review. Of 18 subjects, 15 (83.3%) participated in the follow-up interview. At follow-up, patients were receiving a significantly lower DA levodopa equivalent daily dosage (LEDD) (Z = -3.1, P = 0.002) and a higher daily levodopa dosage (Z = -1.9, P = 0.05), but a similar total LEDD dosage (Z = -0.47, P = 0.64) with no changes in Unified Parkinson's Disease Rating Scale motor score (Z = -1.3, P = 0.19). As part of ICD management, 12 (80.0%) patients discontinued or significantly decreased DA treatment, all of whom experienced full or partial remission of ICD symptoms by self-report, and 10 (83.3%) of whom no longer met diagnostic criteria for an ICD. For PD patients who develop an ICD in the context of DA treatment, discontinuing or significantly decreasing DA exposure, even when offset by an increase in levodopa treatment, is associated with remission of or significant reduction in ICD behaviors without worsening in motor symptoms.

  17. Long-term follow-up results of primary and recurrent pigmented villonodular synovitis.

    Verspoor, Floortje G M; Zee, Aniek A G; Hannink, Gerjon; van der Geest, Ingrid C M; Veth, Rene P H; Schreuder, H W Bart


    Adequate documentation of the outcome of treatment of pigmented villonodular synovitis (PVNS) is sparse. Available case series show relatively short follow-up times and often combine locations or subtypes to increase patient numbers. This article describes the long-term follow-up of a single institution's large consecutive series of PVNS. Retrospectively, 107 PVNS patients were identified between 1985 and 2011 by searching pathology and radiology records. Treatment complications, recurrences and quality of life were evaluated. Most patients (85.2%) were primarily or secondarily treated at our institution. Both subtypes, localized PVNS [29 (27%)] and diffuse PVNS [75 (70%)] were represented. The knee was affected in 88% of patients. Treatments received were surgery, external beam radiotherapy, radiosynovectomy, targeted therapy, immunotherapy or combinations of these. Forty-nine (46%) patients had prior treatment elsewhere. The mean follow-up from diagnosis until last contact was 7.0 years (range 0.3-27.4) for localized PVNS and 14.5 years (range 1.1-48.7) for diffuse PVNS. The 1- and 5-year recurrence-free survival rates for diffuse PVNS were 69% and 32%, respectively. Quality of life, estimated by 36-item Short Form Health Survey (SF-36) scores, were not significantly different between localized and diffuse PVNS. However, both patient groups scored lower than the general population norms on the general health component (59.2 and 56.3, respectively, P PVNS increase with time. Long-term follow-up shows, particularly in diffuse PVNS, it is a continually recurring problem, and over time it becomes increasingly difficult to cure. The quality of life is decreased in patients with PVNS compared with the general population. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email:

  18. Effect of a weight loss program in obese adolescents: a long-term follow-up

    Ilonka Rohm


    Full Text Available Objectives: Obesity during adolescence is an increasing health problem in industrial countries. The comorbidities associated with obesity include important metabolic diseases. Methods: To analyze the effect of a weight-loss program, we recruited 12 obese, male adolescents before entering this program. We determined body weight measures at baseline, 6-week and 36-month follow-up. Also, the long-term changes of blood pressure, HbAlc, and CRP were evaluated. Twenty healthy age-matched adolescents served as controls. Results: Within the intervention group ((body mass index [BMI, kg/m²] > 95th percentile for age and sex, age 13-17 years the BMI and BMI-standard deviation score [SDS] were significantly reduced in the 6-week follow-up after completing the weight loss program. However, the significant weight-reduction effect was not persistent until the 36-month follow-up. Conclusion: The 6-week weight-loss program had beneficial short-term effects on body weight, BMI, and BMI-SDS in obese adolescents, but these effects could not be maintained until the 36-month follow-up.

  19. A long-term follow-up study of 18 patients with sporadic hemiplegic migraine.

    Stam, Anine H; Louter, Mark A; Haan, Joost; de Vries, Boukje; van den Maagdenberg, Arn M J M; Frants, Rune R; Ferrari, Michel D; Terwindt, Gisela M


    Our objective was to study the long-term prognosis of sporadic hemiplegic migraine (SHM). We performed a longitudinal follow-up study in 18 patients who were diagnosed with SHM between 1993 and 1996. Follow-up time between the first and second survey ranged from nine to 14 years. These patients were included as part of a genetic study in which we systematically analysed the role of the three known familial hemiplegic migraine (FHM) genes. In 12 out of 18 patients the clinical diagnosis was unchanged. In two of the six remaining patients the attacks were no longer associated with hemiplegia; one of them had an ATP1A2 gene mutation (E120A). In the four other patients, the diagnosis changed into FHM, because a family member had developed hemiplegic migraine since the initial diagnosis was made. In two of the four patients a mutation was demonstrated (CACNA1A [R583Q] and ATP1A2 [R834X]). This study shows that the diagnosis of SHM changes into FHM in a considerable percentage of patients (22% [4 of 18]), almost a decade after the initial diagnosis. This indicates that a careful follow-up of SHM patients and their families is advisable for optimal care and counseling. Diagnostic screening of FHM genes in SHM patients can be of value. Our genetic and clinical follow-up studies reinforce the evidence that FHM and SHM are part of the same spectrum of migraine.

  20. Patient location strategies for pediatric long-term follow-up studies.

    Lovell, Matthew E; Morcuende, Jose A


    Poor follow-up rates greatly diminish the validity of prospective and long-term studies. Therefore, locating patients is of critical importance. This is especially true in populations treated during childhood because addresses will change several times in intervening years. Recent publications have reported new strategies for patient location. The purpose of this study is to test an algorithm proposed by King et al., as well as other search methods, using a cohort of patients treated for clubfoot in childhood The study population included 126 patients with clubfeet treated between 1950 and 1967. We followed the search algorithm proposed by King et al. In addition, we used state driver's license records,, and Patients were considered to be found when they returned a postage-paid reply letter or were contacted by phone. Using web pages recommended by King et al. we located 26 of 126 (21 percent) patients. Operator directory assistance failed to locate any patients not located by free internet sources. Additional websites had varied results. State driver's license records found 25 patients. found none with thirty attempted. The best search engine was which located 68 out of 126 (54 percent) patients. The algorithm proposed by King et al. is not effective for long-term follow-up studies of pediatric populations. is worth the small fee charged (dollar 22.45) as it was the most effective method of locating patients.

  1. Long-term radiographic follow-up of bisphosphonate-associated atypical femur fractures

    Favinger, Jennifer L. [University of Washington, Department of Radiology, 1959 N.E. Pacific Street, Box 357115, Seattle, WA (United States); Hippe, Daniel [University of Washington, Department of Radiology, Seattle, WA (United States); Ha, Alice S. [University of Washington, Department of Radiology, 4245 Roosevelt Way NE, Box 354755, Seattle, WA (United States)


    To evaluate the appearance of bisphosphonate-related femur insufficiency fractures on long-term follow-up radiographic studies and to describe the rate of fracture line obscuration and cortical beak healing over time. In this retrospective study, bisphosphonate-related femur fracture radiographs were reviewed by two radiologists for the presence of a fracture line, callus, and the characteristic cortical beak. Kaplan-Meier curves were used to analyze the time to first indication of healing. Femurs were also subdivided into those who underwent early versus late surgical fixation and those who underwent early versus late discontinuation of bisphosphonate. Clinical data including pain level and medication history were collected. Forty-seven femurs with a bisphosphonate-related femur fracture were identified in 28 women. Eighty-five percent took a bisphosphonate for greater than 5 years and 59 % for greater than 10 years. The median time to beak healing was 265 weeks and the median time to fracture line healing was 56 weeks in the 31 femurs with a baseline fracture. No statistically significant difference was identified between surgical fixation and conservative management. Bisphosphonate-related fractures demonstrate notably prolonged healing time on long-term follow-up. (orig.)

  2. The maintenance of behavioral change: the case for long-term follow-ups.

    Foxx, Richard M


    This article discusses response maintenance, the durability of behavior change after therapy, treatment, or training ends. Response maintenance is one of the three forms of generalized behavior change, with the others being setting/situation generalization and response generalization. Long-term maintenance of treatment effects is an important issue after behavior change has taken place and is the goal of most programs. Areas discussed include factors affecting the study of maintenance, techniques for programming it, and analyzing and evaluating strategies for promoting it. This article presents a number of long-term follow-ups of programs designed to treat the addictive behaviors of typical adults (Foxx, 1982; Foxx, Brown, & Katz, 1981) and to teach social skills (Foxx & Faw, 1992) and language (Foxx & Faw, 1990) to individuals with intellectual disabilities and autism as well as to decrease their severe maladaptive behaviors (Foxx, 1990; Foxx & Livesay, 1984). In the process, various factors that appeared to contribute to long-term maintenance are identified. The article concludes with some recommendations regarding the study of maintenance.

  3. Acute Ischemic Stroke and Long-Term Outcome After Thrombolysis: Nationwide Propensity Score-Matched Follow-Up Study

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


    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...

  4. Lung Functions During Long Term Follow-Up After Pleural Empyema Treatment in Children

    Ayhan Kırkpınar


    Full Text Available Introduction: Studies on lung functions at the long term follow-up of pleural empyema treatment in children are limited. The aim of this study was to evaluate the long term pulmonary function test results in childhood empyema cases treated with antibiotic (AB or AB+tube thoracostomy (TT or AB+TT+fibrinolytics (FT. Materials and Method: In this study, 45 cases (1 to 13 years old treated for empyema were included. The age, gender, clinical characteristics, radiological findings and laboratory results at baseline and during the follow-up periods and the treatment modalities (AB or AB+TT or AB+TT+FT were evaluated. Pulmonary function tests were performed at the end of the follow-up periods. Results: The mean ages at baseline and at the end of follow-up period of 30.4±13.5 (6-54 months were 6.3±3.3 (1-13 years and 9.3±3.4 (4-17 years, respectively. Stages of the disease at admission was acute exudative (stage 1 in 14 (31.1% cases, fibrinopurulent (stage 2 in 19 (42.2% and chronic organizing (stage 3 in 12 (26.7%. Twenty one cases (46.7%were treated with AB, 8 (17.8% with AB+TT and 16 (35.5% with AB+TT+FT. Chest roentgenograms showed abnormal findings in 15 cases (33.3% at the 3rd month, in 3 cases (6.6% at the 6th month and none at the 12th month. Pulmonary function tests were available in 25 children. The mean follow-up period of these cases was 32.7±11.9 months after the empyema treatment. Three cases (12% with a shorter mean follow-up (8.3±3.3 months had minimal restrictive patterns. Six of 25 (24% cases having pulmonary function tests were classified as stage 1, 12 (48% as stage 2, and 7 (28% as stage 3 empyema at admission. Of 25 cases having pulmonary function tests, 12 (48% were treated with AB, 4 (16% with AB+TT and 9 (36% with AB+TT+FT. Mean VC, FVC, FEV1/FVC, FEV1, FEF25-75% and PEF values did not significantly differ according to stages and treatment modalities (p>0.05.Conclusion: It was seen that after the treatment of empyema

  5. Percutaneous laser disc decompression: Clinical experience at SCTIMST and long term follow up

    Gupta Arun


    Full Text Available Background: Low backache (LBA is now increasing in younger population due to misdirected spinal kinetics secondary to improper posture, heavy load lifting and motorbike driving. Hence minimally invasive procedures are increasingly sought after. Among these, PLDD is currently popular and in use. We present our long term follow-up in the use of Nd:YAG laser for PLDD. Aim: To evaluate the efficacy of PLDD in treatment of contained herniation of lumbar discs & long term follow up results. Materials and Methods: Forty patients with contained lumbar disc herniation on MRI and who did not respond to 6 weeks conservative treatment were subjected to PLDD. L4-5 disc was treated in 31, L5-S1 in 12 and L1-2 and L3-4 in one each. Nd:YAG laser at 1064 nm was used for the procedure. Total laser energy of 1500-2000 Joules was delivered at the disc space depending upon the size. Results: There was immediate pain relief in 32/40 (80%. According to MacNab criteria good to fair response was seen in 37/40 (92% and 3 patients (7.5% responded poorly to this treatment. On follow up which ranged from 1 to 7 years, 34/40 (85% had pain relief with no need for further treatment. Complications: Significant pain at local puncture site was experienced by 8 (20%, pain during lasing was experienced by one. One patient developed muscular spasm. Conclusion: Percutaneous laser disc decompression is a safe, relatively noninvasive and effective treatment modality for contained, nonsequestered, herniated lumbar disc disease in carefully selected patients.

  6. Muscle strength in patients with acromegaly at diagnosis and during long-term follow-up.

    Füchtbauer, Laila; Olsson, Daniel S; Bengtsson, Bengt-Åke; Norrman, Lise-Lott; Sunnerhagen, Katharina S; Johannsson, Gudmundur


    Patients with acromegaly have decreased body fat (BF) and increased extracellular water (ECW) and muscle mass. Although there is a lack of systematic studies on muscle function, it is believed that patients with acromegaly may suffer from proximal muscle weakness despite their increased muscle mass. We studied body composition and muscle function in untreated acromegaly and after biochemical remission. Prospective observational study. Patients with acromegaly underwent measurements of muscle strength (dynamometers) and body composition (four-compartment model) at diagnosis (n = 48), 1 year after surgery (n = 29) and after long-term follow-up (median 11 years) (n = 24). Results were compared to healthy subjects. Untreated patients had increased body cell mass (113 ± 9% of predicted) and ECW (110 ± 20%) and decreased BF (67 ± 7.6%). At one-year follow-up, serum concentration of IGF-I was reduced and body composition had normalized. At baseline, isometric muscle strength in knee flexors and extensors was normal and concentric strength was modestly increased whereas grip strength and endurance was reduced. After one year, muscle strength was normal in both patients with still active disease and patients in remission. At long-term follow-up, all patients were in remission. Most muscle function tests remained normal, but isometric flexion and the fatigue index were increased to 153 ± 42% and 139 ± 28% of predicted values, respectively. Patients with untreated acromegaly had increased body cell mass and normal or modestly increased proximal muscle strength, whereas their grip strength was reduced. After biochemical improvement and remission, body composition was normalized, hand grip strength was increased, whereas proximal muscle fatigue increased. © 2017 European Society of Endocrinology.

  7. Metallic stents for airway complications after lung transplantation: long-term follow-up.

    Abdel-Rahman, Nader; Kramer, Mordechai R; Saute, Milton; Raviv, Yael; Fruchter, Oren


    Bronchial stenosis is still a significant source of morbidity and mortality following lung transplantation (LTX) and often mandating placement of a bronchial stent. It has been suggested that although self-expanding metal stents offer excellent early palliation, their long-term complication rates are unacceptably high, and hence, their usage in many transplantation centres has been nearly abandoned. The aim of the study was to assess short- and long-term complication rates and survival in LTX patients with bronchial stenosis treated with insertion of self-expanding metal stents. From January 1997 to March 2013, 435 patients underwent LTX (325 single-LTX and 110 bilateral LTX). Of 503 actual anastomoses at risk (derived by subtracting the number of anastomoses in 30 patients who died within 30 days of LTX), 60 airway complications (11.9%) in 47 patients required self-expanding metal stent insertion. We assessed the early results and long-term outcomes and survival compared with LTX patients in whom stents were not required. The median follow-up period ranged from 1 to 132 (median 54) months. Immediate relief of symptoms was achieved in the vast majority of patients (95%). One-, three- and five-year survival in patients who required self-expanding metal stent placement were 77.7, 66.6 and 55.5%, respectively. The corresponding survival rates in LTX patients without stents were 69, 64.9 and 61.1% (P > 0.05). Self-expanding metal stents are safe and effective tools in the management of airway complications post-LTX and provide immediate improvement in symptoms and pulmonary function tests in the vast majority of cases. The long-term complication rate is low, and mortality is similar to that in LTX patients who did not require stent insertion.

  8. Long-term follow-up of patients with choroidal neovascularization due to angioid streaks

    Martinez-Serrano, Maria Guadalupe; Rodriguez-Reyes, Abelardo; Guerrero-Naranjo, Jose Luis; Salcedo-Villanueva, Guillermo; Fromow-Guerra, Jans; García-Aguirre, Gerardo; Morales-Canton, Virgilio; Velez-Montoya, Raul


    Background The following case series describes the long-term anatomical and functional outcome of a group of seven patients with choroidal neovascularization (CNV), secondary to angioid streaks (AS), who were treated with antiangiogenic drugs in a pro re nata (PRN) regimen. After the 4-year mark, visual acuity tends to return to pretreatment level. Treatment delays and lack of awareness and self-referral by the patients are believed to be the cause of the PRN regimen failure. Purpose To assess the long-term outcomes (>4 years) of patients with CNV due to AS treated with a PRN regimen of antiangiogenic. Methods This was a retrospective, case series, single-center study. We reviewed the electronic medical records from patients with CNV due to AS. From each record, we noted general demographic data and relevant medical history; clinical presentation, changes in best-corrected visual acuity (BCVA) over time, optical coherent tomography parameters, treatment and retreatment details, and systemic associations. Changes in BCVA and central macular thickness were assessed with a Wilcoxon two-sample test, with an alpha value of ≤0.05 for statistical significance. Results The mean follow-up time was 53.8±26.8 months. BCVA at baseline was: 1.001±0.62 logMAR; at the end of follow-up: 0.996±0.56 logMAR (P=0.9). Central macular thickness at baseline was: 360.85±173.82 μm; at the end of follow-up: 323.85±100.34 μm (P=0.6). Mean number of intravitreal angiogenic drugs: 6±4.16 injections (range 4–15). Mean time between injections was 3.8±2.7 months (range 1.9–5.8 months). Conclusion Despite initial anatomical and functional improvement, patients at the end of the follow-up had no visual improvement after a pro re nata regimen of antiangiogenic drugs. The amount of retreatments, number of recurrences, and time between intravitreal injections were similar to previous reports with shorter follow-up. PMID:28031699

  9. The surgical management of urogenital tuberculosis our experience and long-term follow-up

    Punit Bansal


    Full Text Available Introduction: Urogenital tuberculosis (TB is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB. Materials and Methods: We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied. Results: There were 38 males and 22 females with a mean age of 32.5 years. The most common symptom was irritative voiding symptoms. The most common organ involved was bladder in 33 cases, and next most common was kidney in 30 cases. Preoperative bacteriologic diagnosis was confirmed in only 19 cases. A total of 66 procedures were performed as some patients needed more than one procedure. These included 35 ablative procedures and 31 reconstructive procedures. All the patients were followed-up with renal function test (RFT at 3, 6 and 12 months. The intravenous urography and diethylenetriamine pentaacetic acid scan were performed at 3 months when indicated. Then the patients were followed with RFT and ultrasonography 6 monthly for 3 years and then annual RFT. Conclusion: Many patients of urogenital TB present late with cicatrisation sequelae. Multidrug chemotherapy with judicious surgery as and when indicated is the ideal treatment. The results of reconstructive surgery are good and should be done when possible. Rigorous and long term follow-up is necessary in patients undergoing reconstructive surgery.

  10. Paraquat induced lung injury: long-term follow-up of HRCT

    Kim, Young Tong; Kim, Hyun Cheol; Bae, Won Kyung; Kim, Il Young; Im, Han Hyek [Soonchunhyang Univ., Chunan (Korea, Republic of)


    To determine the long-term follow-up CT findings of paraquat-induced lung injury. Six patients who ingested paraquat underwent sequential follow-up CT scanning during a period of at least six months, and the results were analysed. Scans were obtained 1-6 (mean, 3.3) time during a 7-84 (mean, 25.7) months period, and the findings at 1-2 months, 3-12 months, 1-2 years, 2-3 years and more than above 7 years after poisoning were analyzed. We observed irregular-shaped areas of consolidation with traction bronchiectasis at 1-2 months (5/5), irregular-shaped consolidation and ground-glass opacity (5/5) at 3-12 months, and irregular-shaped consolidations/ground-glass opacity (4/5) and focal honeycombing (1/5) one year later. In the same patients, follow-up CT scans showed that some areas of focal consolidation could not be visualized and the radio-opacity of the lesions had decreased. The HRCT findings of paraquat-induced lung injury were irregular shaped areas of consolidation 1-2 months after ingestion, and irregular-shaped consolidation and ground-glass opacity or focal honeycombing 3-12 months later. At this thim slight improvement was observed.

  11. Blood pressure in the long-term follow-up of children with hemolytic uremic syndrome.

    De Petris, Laura; Gianviti, Alessandra; Giordano, Ugo; Calzolari, Armando; Tozzi, Alberto E; Rizzoni, Gianfranco


    The hemolytic uremic syndrome (HUS) is the most common cause of acute renal failure (ARF) in young children. Most patients recover from the acute phase of the illness but they may develop arterial hypertension(AH) after many years, even in the absence of signs of renal impairment during short-term follow-up. In this study, we performed casual blood pressure (BP) measurement, 24-h blood pressure monitoring (ABPM), and a Bruce walking treadmill study (ET) in 24 children (aged 5-15 years, 13 males, 11 females) with a history of HUS and normal renal function during follow-up (median 5.8 years, range 1.8-12.4 years). There were 22 children(91%) with prodromal diarrhea associated with HUS and 20 (83%) underwent dialysis during the acute illness. All children had normal casual BP measurement. Of 13 children (54%) with normal ABPM, 5 patients (38%) had an abnormal BP response during the ET study. There were 4 (58%) of the 7 patients with AH by ABPM (29%)and an abnormal BP response during ET. These findings suggest that ET could be a useful means of identifying children with a history of HUS that could be at risk of future AH even if they had normal renal function, casual BP, and ABPM during long-term follow-up. These results should be confirmed with a large prospective clinical study.

  12. Long-Term Follow-Up of Intravitreal Bevacizumab in Retinal Arterial Macroaneurysm: A Case Report

    Shani Golan


    Full Text Available Purpose: To present the long-term effect of intravitreal bevacizumab (Avastin® therapy in a patient suffering from retinal arterial macroaneurysm. Methods: Case report of a 72-year-old female diagnosed with retinal macroaneurysm in the superior temporal artery leading to macular edema. Functional and morphological data at baseline, 4 weeks, 2 months, and 13 months following treatment with two consecutive intravitreal bevacizumab injections are presented. Results: Best-corrected visual acuity improved from 20/160 at baseline to 20/20 at the3-months follow-up and remained stable through 13 months of follow-up. Central retinal thickness measured by optical coherence tomography decreased from 364 µm at baseline to 248 µm at the 13-months follow-up. No ocular or systemic side effects were detected. Conclusions: Intravitreal bevacizumab therapy may lead to resolution of macular edema associated with retinal macroaneurysm and consequently visual improvement. This treatment may promise a long-lasting effect but warrant further investigation in larger series.

  13. Dynamic temporal change of cerebral microbleeds: long-term follow-up MRI study.

    Seung-Hoon Lee

    Full Text Available BACKGROUND: Cerebral microbleeds (MBs are understood as an important radiologic marker of intracerebral hemorrhage. We sought to investigate the temporal changes of MBs and clinical factors associated with the changes using long-term follow-up MRI. METHODS/PRINCIPAL FINDINGS: From October 2002 to July 2006, we prospectively enrolled patients with stroke or transient ischemic attack, and followed-up their brain MRIs with an interval >12 mo. We compared demographic factors, vascular risk factors, laboratory findings, and radiologic factors according to the presence or changes of MBs. A total of 224 patients successfully completed the follow-up examinations (mean, 27 months. Newly developed MBs were noted in 10 patients (6.8% among those without MBs at baseline (n = 148, and in those with MBs at baseline (n = 76, the MB count had decreased in 11 patients (14.5%, and increased in 41 patients (53.9%. The estimated annual rate of change of MB numbers was 0.80 lesions per year in all patients, a value which became greater in those patients who exhibited MBs at baseline (MBs≥5, 5.43 lesions per year. Strokes due to small vessel occlusion and intracerebral hemorrhage, as well as white matter lesions were independently associated with an increased MB count, whereas the highest quartile of low-density lipoprotein (LDL cholesterol was associated with a decreased MB count. CONCLUSION: During the follow-up period, most of MBs showed dynamic temporal change. Symptomatic or asymptomatic small vessel diseases appear to act as risk factors while in contrast, a high level of LDL cholesterol may act as a protective factor against MB increase.

  14. Pterygium surgery by means of conjunctival autograft: long term follow-up

    Valentín Huerva


    Full Text Available PURPOSE: To demonstrate the long term of follow-up of the recurrence rate after conjunctival autograft for pterygium surgery. METHODS: A total of 112 patients operated for pterygium with conjunctival autografts and with more than one year follow-up were registered. Patients were called for voluntary examinations of their respective ocular surface statuses. Completing the study was only possible in 44 cases. Seven had bilateral pterygium. (N=51 operated pterygium. RESULTS: The mean follow-up time was 49.06 months. In 29.45% of the cases, attachment was performed using non-absorbable sutures (nylon 10/0, while fibrin glue was used in 70.55% of the cases. Six cases of recurrence (11.76% were found. The recurrence rate between primary and recurrent pterygium, and between sutures and fibrin glue proved to be not statistically significant; p>0.05. There were no significant differences between women and men with respect to recurrence. The median of age in the recurrence group was 40 years old, in contrast to 55 in the non-recurrence group; p=0.01517. All of these recurrences were associated with patients of Hispanic origins (from Latin America; p=0.001506. CONCLUSIONS: After a long follow-up period after autograft pterygium surgery, there were no statistically significant differences in recurrence rates for the application of sutures as opposed to fibrin glue; similarly, there were no statistically significant differences between the use of autograft in primary and recurrent pterygium. The greatest risk factors for recurrence were young age and Hispanic ethnicity.

  15. Long term follow-up of remission patients in adult acute leukemia.

    Gerecke, D; Kress, M; Hirschmann, W D


    31 adults suffering from acute leukemia were followed for a period of more than 5 years after achieving complete remission. Maintenance chemotherapy consisted of antimetabolite treatment (mercaptopurine + methotrexate) as well as COAP reinduction every 3 months. Chemotherapy was stopped if the first complete remission lasted for 3 years ("long term remission"). This was the case in 8 out of 31 remission patients (26%). Analysis of hematological parameters at diagnose for long term remission patients revealed that the initial leukocyte count was of prognostic significance.

  16. [Neurotological long-term follow-up in Minamata disease in Niigata, Japan].

    Mizukoshi, Kanemasa; Watanabe, Yukio; Shojaku, Hideo; Aso, Shin; Asai, Masatsugu; Inukai, Kenya; Takahashi, Sugata


    To determine the long-term influence of organic mercurial intoxication on audiological and equilibrium findings, we followed up 36 patients neurotologically during 1980-1987 and 1991-2000 at Kido Hospital in Niigata. Typical findings were as follows: 1. In pure-tone audiometry, 24 of 72 ears (33%) showed slight hearing deterioration and 3 (4%) showed improvement. 2. Spontaneous nystagmus had disappeared in 5 patients (14%), but appeared in new 13 patients (36%). Positional nystagmus did not improve in any patient, and deteriorated in 11 (31%). 3. In optokinetic nystagmus (OKN) tests, especially in vertical OKN test showing significant deterioration (44%). 4. The caloric nystagmus test showed marked deterioration (47%). Body-equilibrium testing showed slight deterioration in 11 patients (31%) and improvement in 5 (14%). Neurotological findings thus varied widely among patients and we were concluded that these differences were caused both by duration of methyl mercury contamination and by aging factors in patients.

  17. Long-Term Follow-Up of Flexible Bronchoscopic Treatment for Bronchial Carcinoids with Curative Intent

    Leonardo Fuks


    sedation. Follow-up included repeat bronchoscopy every 6 months and chest CT every year. Results. Ten patients aged 24 to 70 years with endobronchial carcinoid were treated. The tumor location was variable: 2 left Main bronchus, 1 left upper lobe bronchus, 2 right main bronchus, 2 right middle lobe bronchus and 3 right lower lobe bronchus. No major complications were observed. The patients required between 2 and 4 procedures. Patients were followed for a median period of 29 months with no evidence of tumor recurrence. Conclusions. Endobronchial laser photoresection of typical bronchial carcinoids using flexible bronchsocopy under conscious sedation is an effective treatment modality for a subgroup of patients that provides excellent long-term results that are similar to outcome obtained by more invasive procedures.

  18. Long-term follow-up after successful treatment of Pythium insidiosum keratitis in Israel.

    Barequet, Irina S; Lavinsky, Fabio; Rosner, Mordechai


    The purpose of this project is to report a case of severe Pythium insidiosum keratitis confirmed by polymerase chain reaction (PCR), and its long-term cure after therapeutic penetrating keratoplasty. A 24-year-old woman with a history of contact lens wear and exposure to swimming pool water presented with a severe corneal abscess. She was treated with intensive fortified topical antibiotics and natamycin with limited response. Initial cultures suggested the presence of a septate mold, unclearly identified; therefore, both topical and intravenous voriconazole were administered. Despite the above treatment, there was worsening of the clinical picture. PCR assay revealed homology to Pythium insidiosum. Promptly, the patient underwent a large therapeutic penetrating keratoplasty. After five years of follow-up, the graft exhibits neither signs of rejection nor any recurrence of infection. We conclude that prompt identification of Pythium insidiosum keratitis and aggressive treatment by therapeutic penetrating keratoplasty may offer a cure to this disease.

  19. Long-term follow-up of radiation accident patients in Peru: review of two cases.

    Barriga, L E; Zaharia, M; Pinillos, L; Moscol, A; Heredia, A; Sarria, G; Marquina, J; Barriga, O; Picon, C


    Overexposure to radioactive sources used in radiotherapy or industrial radiography may result in severe health consequences. This report assesses the initial clinical status and the medical and psychological long-term follow-up of two radiation accident patients from Peru during the mid-to-late 1990s: one patient exposed to a radiotherapy (60)Co source in Arequipa, the other patient to a (192)Ir source in Yanango. Commonalities and differences are described. The main causes in both accidents were human error and the failure to apply appropriate safety guidelines and standard operating procedures. Education and training of the personnel working with radiation sources are essential to prevent accidents. The experience gained from the medical management of the two patients is valuable for future treatment of such patients.

  20. Long term follow up study of survival associated with cleft lip and palate at birth

    Christensen, Kaare; Juel, K.; Herskind, Anne Maria


    OBJECTIVE: To assess the overall and cause specific mortality of people from birth to 55 years with cleft lip and palate. DESIGN: Long term follow up study. SETTING: Danish register of deaths. PARTICIPANTS: People born with cleft lip and palate between 1943 and 1987, followed to 1998. MAIN OUTCOME...... MEASURES: Observed and expected numbers of deaths, summarised as overall and cause specific standardised mortality ratios. RESULTS: 5331 people with cleft lip and palate were followed for 170 421 person years. The expected number of deaths was 259, but 402 occurred, corresponding to a standardised...... of death. CONCLUSIONS: People with cleft lip and palate have increased mortality up to age 55. Children born with cleft lip and palate and possibly other congenital malformations may benefit from specific preventive health measures into and throughout adulthood....

  1. Underuse of long-term routine hospital follow-up care in patients with a history of breast cancer?

    Lu, W.L.; Jansen, L.; Schaapveld, M.; Baas, P.C.; Wiggers, T.; de Bock, G.H.


    Background: After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods: Information regarding the utilization of routine hospital follow-up care was retrieved from

  2. Right ventricular septal pacing: Safety and efficacy in a long term follow up

    Eraldo; Occhetta; Gianluca; Quirino; Lara; Baduena; Rosaria; Nappo; Chiara; Cavallino; Emanuela; Facchini; Paolo; Pistelli; Andrea; Magnani; Miriam; Bortnik; Gabriella; Francalacci; Gabriele; Dell’Era; Laura; Plebani; Paolo; Marino


    AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated:(1) 244 patients(74 ± 8 years; 169 men, 75 women) implanted with a single(132 pts) or dual chamber(112 pts) pacemaker(PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site(SEPTAL pacing);(2) 22 patients with permanent pacemaker and low percentage of pacing(< 20%)(NO pacing);(3) 33 patients with high percentage(> 80%) right ventricular apical pacing(RVA). All patients had a narrow spontaneous QRS(101 ± 14 ms). We evaluated New York Heart Association(NYHA) class, quality of life(Qo L), 6 min walking test(6MWT) and left ventricular function(end-diastolic volume, LV-EDV; end-systolic volume, LVESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable duringfollow up(21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, Qo L score and 6MWT. While LV-EDV didn’t significantly increase(104 ± 40 m L vs 100 ± 37 m L; P = 0.35), LV-ESV slightly increased(55 ± 31 m L vs 49 ± 27 m L; P = 0.05) and LV-EF slightly decreased(49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF(from 56% ± 6% to 43% ± 9%, P < 0.0001).CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.

  3. Mortality in a long-term follow-up after treatment of CIN.

    Kalliala, Ilkka; Dyba, Tadeusz; Nieminen, Pekka; Hakulinen, Timo; Anttila, Ahti


    After treatment of the cervical intraepithelial neoplasia (CIN) cervical cancer incidence remains elevated at least for 20 years. Whether the overall or cervical cancer mortality after treatment of CIN is elevated is unknown. The aim of this study was to determine the long-term survival and cause-specific mortality among women treated for CIN. The study population consisted of 7,104 women treated for CIN between 1974 and 2001 and 35,437 individually matched controls. The follow-up of mortality was based on nationwide registries and closed at death, emigration or December 31, 2005. The possible differences in mortality were assessed using Cox proportional hazard model. With follow-up time of approximately 630,000 woman-years, overall 2,781 deaths were observed, 530 among women treated for CIN and 2,251 among reference population (HR 1.1, 95% CI 1.0-1.3). Mortality from any cancer (HR 1.4, 95% CI 1.2-1.7), lung cancer (HR 2.7, 95% CI 1.8-4.1) and HPV-related anogenital cancer (HR 3.1, 95% CI 1.1-8.6) was higher among CIN patients, but mortality from cervical cancer was not (HR 1.0, 95% CI 0.3-4.0). Elevated cervical cancer incidence after treatment of CIN, documented earlier, did not predict elevation in cervical cancer mortality. This suggests high effectiveness of CIN management. Most of the excess mortality observed among CIN patients was due to increased risk of other cancers. These long-term mortality patterns should be considered when planning and evaluating the management of CIN lesions and related cervical or other cancer prevention activity.

  4. Long-term follow-up of patients with choroidal neovascularization due to angioid streaks

    Martinez-Serrano MG


    Full Text Available Maria Guadalupe Martinez-Serrano,1 Abelardo Rodriguez-Reyes,2 Jose Luis Guerrero-Naranjo,1,3 Guillermo Salcedo-Villanueva,1 Jans Fromow-Guerra,1,3 Gerardo García-Aguirre,1,3 Virgilio Morales-Canton,1 Raul Velez-Montoya1,3 1Retina Department, 2Pathology Department, Asociación para Evitar la Ceguera en Mexico, Hospital “Dr Luis Sanchez Bulnes” IAP, 3Macula Retina Consultants, Mexico City, Mexico Background: The following case series describes the long-term anatomical and functional outcome of a group of seven patients with choroidal neovascularization (CNV, secondary to angioid streaks (AS, who were treated with antiangiogenic drugs in a pro re nata (PRN regimen. After the 4-year mark, visual acuity tends to return to pretreatment level. Treatment delays and lack of aware­ness and self-referral by the patients are believed to be the cause of the PRN regimen failure. Purpose: To assess the long-term outcomes (>4 years of patients with CNV due to AS treated with a PRN regimen of antiangiogenic. Methods: This was a retrospective, case series, single-center study. We reviewed the electronic medical records from patients with CNV due to AS. From each record, we noted general demographic data and relevant medical history; clinical presentation, changes in best-corrected visual acuity (BCVA over time, optical coherent tomography parameters, treatment and retreatment details, and systemic associations. Changes in BCVA and central macular thickness were assessed with a Wilcoxon two-sample test, with an alpha value of ≤0.05 for statistical significance. Results: The mean follow-up time was 53.8±26.8 months. BCVA at baseline was: 1.001±0.62 logMAR; at the end of follow-up: 0.996±0.56 logMAR (P=0.9. Central macular thickness at baseline was: 360.85±173.82 µm; at the end of follow-up: 323.85±100.34 µm (P=0.6. Mean number of intravitreal angiogenic drugs: 6±4.16 injections (range 4–15. Mean time between injections was 3.8±2.7 months (range

  5. Long-term follow-up for Shang Ring male circumcision

    Cheng Yue; Wu Kerong; Yan Zejun; Yang Shuwei; Li Fang; Su Xinjun


    Background Shang Ring male circumcision (MC) is a safe surgery with good short-term effects.This retrospective study was performed to investigate the long-term result of patients who had undergone Shang Ring MC.Methods A total of 103 patients who underwent the surgery were recruited in the study.Before and after the surgery,a questionnaire inquiring sexual function and sexual satisfaction was filled up.Face-to-face interview was executed.Physical examination of the external genitals was performed and complications were evaluated.Results The median follow-up duration was 19.1 months (range from 9 to 28 months).The mean width of penile mucosa was (9.3±2.5) mm.The mean width of scar was (3.7±1.6) mm.No tender pain was found in participants when palpating the penis.No significant or functional complication was observed except of mucosa asymmetry in one case and scar hyperplasia in two cases.The postoperative sexual function did not differ from the preoperative one,although partners showed better satisfaction toward sexual life.Conclusion Shang Ring MC represents a good long-term cosmetic result with no significant complication or adverse effects on sexual function.

  6. Pancreaticopleural fistula:etiology, treatment and long-term follow-up

    Keith J Roberts; Maria Sheridan; Gareth Morris-Stiff; Andrew M Smith


    BACKGROUND: Pancreaticopleural fistula (PPF) are uncommon. Complex multidisciplinary treatment is required due to nutritional compromise and sepsis. This is the first description of long-term follow-up of patients with PPF. METHODS: Eleven patients with PPF treated at a specialist unit were identified. Causation, investigation, treatment and outcomes were recorded. RESULTS: Pancreatitis was the etiology of the PPF in 9 patients, and in the remaining 2 the PPF developed following distal pancreatectomy. Cross-sectional imaging demonstrated the site of duct disruption in 10 cases, with endoscopic retrograde cholangiopancreatography identifying the final case. Suppression of pancreatic exocrine secretion and percutaneous drainage formed the mainstay of treatment. Five cases resolved following pancreatic duct stent insertion and three patients required surgical treatment for established empyema. There were no complications. In all cases that resolved there has been no recurrence of PPF over a median follow-up of 50 months (range 15-62). CONCLUSIONS: PPF is an uncommon event complicating pancreatitis or pancreatectomy; pancreatic duct disruption is the common link. A step-up approach consisting of minimally invasive techniques treats the majority with surgery needed for refractory sepsis.

  7. Heart-shaped anastomosis for Hirschsprung's disease: Operative technique and long-term follow-up

    Guo Wang; Xiao-Yi Sun; Ming-Fa Wei; Yi-Zhen Weng


    AIM: To study the long-term therapeutic effect of "heartshaped" anastomosis for Hirschsprung's disease.METHODS: From January 1986 to October 1997, we performed one-stage "heart-shaped" anastomosis for 193 patients with Hirschsprung's disease (HD). One hundred and fiftytwo patients were followed up patients (follow-up rate 79%).The operative outcome and postoperative complications were retrospectively analyzed.RESULTS: Early complications included urine retention in 2patients, enteritis in 10, anastomotic stricture in 1, and intestinal obstruction in 2. No infection of abdominal cavity or wound and anastomotic leakage or death occurred in any patients. Late complications were present in 22 cases,including adhesive intestinal obstruction in 2, longer anal in 5, incision hernia in 2, enteritis in 6, occasional stool stains in 7 and 6 related with improper diet. No constipation or incontinence occurred in any patient.CONCLUSION: The early and late postoperative complication rates were 7.8% and 11.4% respectively in our "heartshaped anastomosis" procedure. "Heart-shaped"anastomosis procedure for Hirschsprung's disease provides a better therapeutic effect compared to classic procedures.

  8. Long-term virological follow up of patients with occult hepatitis C virus infection.

    Castillo, Inmaculada; Bartolomé, Javier; Quiroga, Juan A; Barril, Guillermina; Carreño, Vicente


    Patients with occult hepatitis C virus (HCV) infection (HCV-RNA in liver without detectable anti-HCV and serum HCV-RNA) may have viral RNA in peripheral blood mononuclear cells (PBMCs) and in serum after ultracentrifugation, and may present HCV-specific T-cell responses, but it is unknown whether these markers persist to be detectable over time. To perform a prospective virological long-term follow up of patients with occult HCV. Viral markers were tested every 3-4 months during 55.7 ± 20.3 months in 37 patients with occult HCV who were under ursodeoxycholic acid treatment. Viral RNA was detectable in PBMCs of 31 patients during the follow up. In 23 of them, viral RNA in PBMCs was detected intermittently and in the other eight patients HCV-RNA was positive in a single sample. After ultracentrifugation, serum HCV-RNA was detected in 33 patients, being the viraemia intermittently detectable in 28, whereas in the remaining five patients, serum HCV-RNA was positive only once. Only one patient tested always HCV-RNA negative in PBMCs and in ultracentrifuged serum during follow up. Specific Core, NS3, and/or NS4 T-cell responses were found in 31 of the patients. The patient who was always HCV-RNA negative in PBMCs and in ultracentrifuged serum had specific HCV-T-cell responses. Occult HCV infection persists over time with fluctuating viraemia levels that induce and maintain specific T-cell responses against viral proteins. © 2011 John Wiley & Sons A/S.

  9. Surgical therapy and long-term follow-up of childhood hereditary pancreatitis.

    Moir, C R; Konzen, K M; Perrault, J


    Treatment and a 15-year follow-up survey of 42 patients with hereditary pancreatitis (HP) were compared with 28 patients with idiopathic recurrent pancreatitis (RP) of childhood. There was no difference between the two groups except for pancreatic ductal dilatation and stones in patients with HP. Longitudinal pancreaticojejunostomy (20) or resection and drainage procedures (7) were more commonly required in patients with HP than RP (55% v 14%). There was no surgical mortality. Postoperatively, immediate and complete relief of symptoms was obtained in 43% of patients with HP and 25% of patients with RP. In the remainder, recurrent attacks of pancreatitis abated over 2 years such that 81% of the surgical patients were in good or excellent health. Occasional symptoms persisted in 52% of HP patients and 25% of RP patients. Of the 20 patients with HP or RP undergoing longitudinal pancreaticojejunostomy extending from the head to the tail, 75% were symptom-free on follow-up. However, 3 of 6 patients with poor results had also undergone this procedure. At long-term follow-up of patients who did not undergo operation, 75% of HP patients and 90% of RP patients reported excellent or good health despite the persistent symptoms in 68% and 42%, respectively. Surgery for childhood HP is dependent on the complications present. Longitudinal pancreaticojejunostomy is beneficial for ductal dilatation and associated pseudocysts or pancreatic ascites. The performance of this procedure in the absence of consistent pancreatic duct dilatation will give poor results. Patients without ductal dilatation and the majority of patients with RP may eventually lead near normal lives without resorting to surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Frequency and long-term follow-up of trapped fourth ventricle following neonatal posthemorrhagic hydrocephalus.

    Pomeraniec, I Jonathan; Ksendzovsky, Alexander; Ellis, Scott; Roberts, Sarah E; Jane, John A


    OBJECTIVE Intraventricular hemorrhage (IVH) is a common complication of premature neonates with small birth weight, which often leads to hydrocephalus and treatment with ventriculoperitoneal (VP) shunting procedures. Trapped fourth ventricle (TFV) can be a devastating consequence of the subsequent occlusion of the cerebral aqueduct and foramina of Luschka and Magendie. METHODS The authors retrospectively reviewed 8 consecutive cases involving pediatric patients with TFV following VP shunting for IVH due to prematurity between 2003 and 2012. The patients ranged in gestational age from 23.0 to 32.0 weeks, with an average age at first shunting procedure of 6.1 weeks (range 3.1-12.7 weeks). Three patients were managed with surgery. Patients received long-term radiographic (mean 7.1 years; range 3.4-12.2 years) and clinical (mean 7.8 years; range 4.6-12.2 years) follow-up. RESULTS The frequency of TFV following VP shunting for neonatal posthemorrhagic hydrocephalus was found to be 15.4%. Three (37.5%) patients presented with symptoms of posterior fossa compression and were treated surgically. All of these patients showed signs of radiographic improvement with stable or improved clinical examinations during postoperative follow-up. Of the 5 patients treated conservatively, 80% experienced stable ventricular size and 1 patient experienced a slight increase (3 mm) on imaging. All of the nonsurgical patients showed stable to improved clinical examinations over the follow-up period. CONCLUSIONS The frequency of TFV among premature IVH patients is relatively high. Most patients with TFV are asymptomatic at presentation and can be managed without surgery. Symptomatic patients may be treated surgically for decompression of the fourth ventricle.

  11. Chest HRCT signs predict deaths in long-term follow-up among asbestos exposed workers

    Vehmas, Tapio, E-mail: [Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250 Helsinki (Finland); Oksa, Panu, E-mail: [Health and Work Ability, Finnish Institute of Occupational Health, Uimalankatu 1, FI-33101 Tampere (Finland)


    Highlights: • Much lung and pleural pathology is found in chest CT studies. • HRCT signs were screened and subsequent mortality followed up. • Several signs were related to all-cause and disease specific deaths. • The HRCT classification system used was able to predict mortality. • Secondary preventive strategies should be developed for patients with such signs. - Abstract: Objectives: To study associations between chest HRCT signs and subsequent deaths in long-term follow-up. Methods: Lung and pleural signs of 633 asbestos exposed workers (age 45–86, mean 65) screened with HRCT were recorded by using the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) system, which contains detailed instructions for use and reference images. Subsequent mortality was checked from the national register. Cox regression adjusted for covariates (age, sex, BMI, asbestos exposure, pack-years) was used to explore the relations between HRCT signs and all-cause deaths, cardiovascular and benign respiratory deaths, and deaths from neoplasms – all according to the ICD-10 diagnostic system. Results: The follow-up totalled 5271.9 person-years (mean 8.3 y/person, range .04–10.3). 119 deaths were reported. Irregular/linear opacities, honeycombing, emphysema, large opacities, visceral pleural abnormalities and bronchial wall thickening were all significantly related to all-cause deaths. Most of these signs were associated also with deaths from neoplasms and benign respiratory disease. Deaths from cardiovascular disease were predicted by emphysema and visceral pleural abnormalities. Conclusions: Several HRCT signs predicted deaths. Careful attention should be paid on subjects with radiological signs predictive of deaths and new secondary preventive strategies developed. This calls for further focused studies among different populations.

  12. Anemia after gastrectomy for early gastric cancer: Long-term follow-up observational study

    Lim, Chul-Hyun; Kim, Sang Woo; Kim, Won Chul; Kim, Jin Soo; Cho, Yu Kyung; Park, Jae Myung; Lee, In Seok; Choi, Myung-Gyu; Song, Kyo-Young; Jeon, Hae Myung; Park, Cho-Hyun


    AIM: To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer. METHODS: The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed. Patients with anemia in the preoperative workup, cancer recurrence, undergoing systemic chemotherapy, with other medical conditions that can cause anemia, or treated during follow up with red cell transfusions or supplements for anemia were excluded. Anemia was defined by World Health Organization criteria (Hb anemia was defined as anemia with concomitant iron deficiency. Anemia from vitamin B12 deficiency was defined as megaloblastic anemia (mean cell volume > 100 fL) with vitamin B12 deficiency. The profile of anemia over 48 mo of follow-up was analyzed. RESULTS: One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed. The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery. The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery. Anemia of chronic disease and megaloblastic anemia were uncommon. The incidence of anemia in female patients was significantly higher than in male patients at 12 (40.0% vs 22.0%, P = 0.033), 24 (45.0% vs 25.0%, P = 0.023), 36 (55.0% vs 28.0%, P = 0.004), and 48 mo (52.0% vs 31.0%, P = 0.022) after surgery. Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery (60.7% vs 31.3%, P = 0.008). The incidence of iron deficiency was significantly higher in female patients than in male patients at 6 (35.4% vs 13.3%, P = 0.002), 12 (45.8% vs 16.8%, P Anemia was frequent after gastrectomy for early gastric cancer, with iron deficiency being the major cause. Evaluation for anemia including iron

  13. Long-Term Follow-Up of Children with Inflammatory Bowel Disease: Evaluation of 53 Cases

    Ömer Faruk Beşer


    Full Text Available Introduction: In this study it was aimed to determine the long-term demographic, clinical and laboratory characteristics, together with the responses to therapy, in children diagnosed with inflammatory bowel disease (IBD. Materials and Methods: Fifty-three cases, aged 0 to 18 years, followedup with the diagnosis of IBD were included in this study. The study grouponsisted of patients diagnosed as IBD according to clinical, serologic, endoscopic and histopathological criteria. Dates of birth, esophagogastroduodenoscopy/colonoscopy findings, laboratory results at the time of diagnosis and during follow-up, complaints and their durations, treatments received presently and previously and comorbid diseases were documented. Patients’ heights, weights and Z scores at the time of diagnosis and following treatment were documented, calculated and compared. Family history of IBD and autoimmune disorders were questioned and recorded together with physical examination findings.Results: Among our cases, 18 were followed up with the diagnosis of Crohn’s disease (CD and 35 had the diagnosis of ulcerative colitis (UC. Male to female ratio was 3.5/1 in CD and 1.33/1 in UC. Ten cases (18.9% had the history of having a relative with IBD in their families. Mean age for start of complaints of this group was statistically significantly lower than the group having no family history of IBD (p=0.042. Twenty of the cases (37.8% had history of consanguinity between parents. Mean age for start of complaints of this group, whose parents were consanguine, was statistically significantly lower than the group with non-related parents (p=0.025. Weight-for-age Z-score was below -2 in 18.9% of cases and seven of them were diagnosed with CD. Height-forage Z-score was below -2 in 17% of cases and nine of them were also followed-up with the diagnosis of CD. The white blood cell count, erythrocyte sedimentation rate and C-reactive protein value at the time of diagnosis were

  14. Cardiac damage after treatment of childhood cancer: A long-term follow-up

    Demšar Damjan


    Full Text Available Abstract Background With improved childhood cancer cure rate, long term sequelae are becoming an important factor of quality of life. Signs of cardiovascular disease are frequently found in long term survivors of cancer. Cardiac damage may be related to irradiation and chemotherapy. We have evaluated simultaneous influence of a series of independent variables on the late cardiac damage in childhood cancer survivors in Slovenia and identified groups at the highest risk. Methods 211 long-term survivors of different childhood cancers, at least five years after treatment were included in the study. The evaluation included history, physical examination, electrocardiograpy, exercise testing and echocardiograpy. For analysis of risk factors, beside univariate analysis, multivariate classification tree analysis statistical method was used. Results and Conclusion Patients treated latest, from 1989–98 are at highest risk for any injury to the heart (73%. Among those treated earlier are at the highest risk those with Hodgkin's disease treated with irradiation above 30 Gy and those treated for sarcoma. Among specific forms of injury, patients treated with radiation to the heart area are at highest risk of injury to the valves. Patients treated with large doses of anthracyclines or concomitantly with anthracyclines and alkylating agents are at highest risk of systolic function defect and enlarged heart chambers. Those treated with anthracyclines are at highest risk of diastolic function defect. The time period of the patient's treatment is emerged as an important risk factor for injury of the heart.

  15. [Penile prosthesis for erectile dysfunction--long-term follow-up].

    Gofrit, O N; Shenfeld, O Z; Katz, R; Shapiro, A; Landau, E H; Pode, D


    Our armamentarium for the treatment of erectile dysfunction has recently been expanded by addition of Viagra and the MUSE. However, their long-term results are still unknown. The insertion of a penile prosthesis is invasive, expensive, and irreversible, but under optimal condition provides an acceptable, definitive solution for erectile dysfunction. We evaluated our long-term results with penile prosthesis insertion (PPI). From 1987-1998, 57 patients underwent PPI in our department. Mean age was 55 years and the common causes of erectile dysfunction were atherosclerotic disease (23), radical pelvic surgery (15), and diabetes mellitus (14). Semirigid prostheses were inserted in 12 and inflatable prostheses in 45, including 42 single-component and 3 multi-component prostheses. Recently we interviewed these patients by telephone, using a standard questionnaire. Those not satisfied with the surgical results (83% of the living patients) were examined in our clinic. Mean follow-up was 53 months. In 37 (84%) the prosthesis was mechanically functional (rates after 1, 5 and 10 years were 87.8%, 80%, and 75%, respectively). In only 2 (2.5%) had serious complications led to prosthesis removal. All mechanical failures had occurred in those with inflatable prostheses after a mean of 48.5 months (range 4-113). At the time of the survey 68% were sexually active and 64% were satisfied with the surgical result. We conclude that PPI is safe treatment for erectile dysfunction. Although the rate of mechanically functioning prostheses decreases with time, modern multi-component prostheses may lead to better mechanical results.

  16. Long-term follow-up of surgical resection of microcystic meningiomas.

    Kalani, M Yashar S; Cavallo, Claudio; Coons, Stephen W; Lettieri, Salvatore C; Nakaji, Peter; Porter, Randall W; Spetzler, Robert F; Feiz-Erfan, Iman


    Microcystic meningioma is a rare tumor with myxoid and microcystic features. Our objective was to evaluate the efficacy of surgical resection of microcystic meningioma. Between December 1985 and October 2000 we treated 25 microcystic meningioma patients with surgical resection. We retrospectively analyzed the results including the long-term follow-up of this patient population. We identified 15 women and 10 men with a mean age of 53.8 years (24-76 years) who had microcystic meningiomas treated with surgery. Based on the Simpson grade, we found four Grade I (16%), 16 Grade II (64%), three Grade III (12%) and two Grade IV (8%) resections. The mean preoperative Karnofsky Performance Scale (KPS) score was 80.3 (range 60-100). The mean postoperative KPS score was 90.4 (range 60-100). At a mean follow-up of 101.7 months (range 16-221) the KPS score improved to a mean of 93.8. The recurrence/progression free survival (RFS/PFS) rates at 3 and 5 years were 96% and 88%, respectively. The 3 and 5 year RFS/PFS rates based on the Simpson grade were evaluated. The 3 year RFS/PFS rates for Grade I, II, III and IV were 100%, 100%, 66.6% and 100%, respectively. The 5 year RFS/PFS rates were 66.6%, 90%, 66.6% and 100%, respectively. Microcystic meningioma is a rare tumor, which is characterized by extracellular microcystic spaces filled by edematous fluid and peritumoral edema. Following surgical resection these tumors have a positive prognosis with a benign course. The surgical outcomes seem to be associated with the risks related to the surgical procedure. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Tai Chi for treating knee osteoarthritis: Designing a long-term follow up randomized controlled trial

    Rones Ramel


    Full Text Available Abstract Background Knee Osteoarthritis (KOA is a major cause of pain and functional impairment among elders. Currently, there are neither feasible preventive intervention strategies nor effective medical remedies for the management of KOA. Tai Chi, an ancient Chinese mind-body exercise that is reported to enhance muscle function, balance and flexibility, and to reduce pain, depression and anxiety, may safely and effectively be used to treat KOA. However, current evidence is inconclusive. Our study examines the effects of a 12-week Tai Chi program compared with an attention control (wellness education and stretching on pain, functional capacity, psychosocial variables, joint proprioception and health status in elderly people with KOA. The study will be completed by July 2009. Methods/Design Forty eligible patients, age > 55 yr, BMI ≤ 40 kg/m2 with tibiofemoral osteoarthritis (American College of Rheumatology criteria are identified and randomly allocated to either Tai Chi (10 modified forms from classical Yang style Tai Chi or attention control (wellness education and stretching. The 60-minute intervention sessions take place twice weekly for 12 weeks. The study is conducted at an urban tertiary medical center in Boston, Massachusetts. The primary outcome measure is the Western Ontario and McMaster Universities (WOMAC pain subscale at 12 weeks. Secondary outcomes include weekly WOMAC pain, function and stiffness scores, patient and physician global assessments, lower-extremity function, knee proprioception, depression, self-efficacy, social support, health-related quality of life, adherence and occurrence of adverse events after 12, 24 and 48 weeks. Discussion In this article, we present the challenges of designing a randomized controlled trial with long-term follow up. The challenges encountered in this design are: strategies for recruitment, avoidance of selection bias, the actual practice of Tai Chi, and the maximization of adherence/follow-up

  18. Ferric sulphate and formocresol in pulpotomy of primary molars: long term follow-up study.

    Ibricevic, H; Al-Jame, Q


    The objective of this study was to compare the effects of ferric sulphate (FS) to that of the full strength of formocresol (Buckley's formula) (FC) as pulpotomy agents in primary human molar teeth 42-48 months after treatment. This was to assess the succeeding premolar teeth for decalcification, abnormal morphology or any other defect. Seventy children, ranging in age from 3 to 6 years, mean 4.3 years, were treated for pulpotomy of primary molars. Ferric sulphate 15.5% solution (applied for 15 seconds for 84 teeth) and formocresol solution (5 minutes procedure for next the 80 teeth) were used as pulpotomy agents. In both groups, pulp stumps were covered with zinc oxide eugenol paste. Permanent restorations were, in most cases, stainless steel crowns and in some of them amalgams. Follow-up clinical assessments were every 3 months and the radiographic follow-up time was 6, 20 and 42-48 months after treatment. The differences were statistically analyzed using the Chi square test. These revealed 96.4% clinical success rate in the FS and 97.5% in the FC groups. Radiographic success rate in the FS group was 92.0%, while 94.6% in the FC group. No statistical significant differences were found between the radiographic assessment of the two pulpotomy agents. Ferric sulphate showed similar clinical and radiographic success rate as a pulpotomy agent for primary molar teeth after long term evaluation period, compared with formocresol. Ferric sulphate, because of its lower toxicity, may become a replacement for formocresol in primary molar teeth.

  19. Long-Term Nationwide Follow-Up Study of Simple Congenital Heart Disease Diagnosed in Otherwise Healthy Children

    Videbæk, Jørgen; Laursen, Henning Bækgaard; Olsen, Morten


    BACKGROUND: Systematic follow-up is currently not recommended for patients with simple congenital heart disease; however, only a few data exist on the long-term prognosis of simple congenital heart disease. METHODS AND RESULTS: We undertook a nationwide follow-up study of a cohort of 1241 simple ...... with simple congenital heart disease in the 1960s have substantially increased long-term mortality and cardiac morbidity compared with the general population. Further studies on the effectiveness of systematic medical follow-up programs appear warranted.......BACKGROUND: Systematic follow-up is currently not recommended for patients with simple congenital heart disease; however, only a few data exist on the long-term prognosis of simple congenital heart disease. METHODS AND RESULTS: We undertook a nationwide follow-up study of a cohort of 1241 simple...

  20. LOng-term follow-up after liVE kidney donation (LOVE) study: A longitudinal comparison study protocol

    S. Janki (Shiromani); K.W.J. Klop (Karel); F.F.P. Kimenai; J. van de Wetering (Jacqueline); W. Weimar (Willem); E.K. Massey (Emma); A. Dehghan (Abbas); D. Rizopoulos (Dimitris); H. Völzke (Henry); A. Hofman (Albert); J.N.M. IJzermans (Jan)


    textabstractBackground: The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods: The "LOng-term follow-up after liVE kidney donation" (LOVE

  1. Long-term follow-up of a randomized trial comparing laparoscopic and mini-incision open live donor nephrectomy.

    Dols, L.F.; Ijzermans, J.N.M.; Wentink, N.; Tran, T.C.K.; Zuidema, W.C.; Dooper, P.M.M.; Weimar, W.; Kok, N.F.


    Long-term physical and psychosocial effects of laparoscopic and open kidney donation are ill defined. We performed long-term follow-up of 100 live kidney donors, who had been randomly assigned to mini-incision open donor nephrectomy (MIDN) or laparoscopic donor nephrectomy (LDN). Data included blood

  2. Results of repeated transsphenoidal surgery in Cushing's disease. Long-term follow-up.

    Valderrábano, Pablo; Aller, Javier; García-Valdecasas, Leopoldo; García-Uría, José; Martín, Laura; Palacios, Nuria; Estrada, Javier


    Transsphenoidal surgery (TSS) is the treatment of choice for Cushing's disease (CD). However, the best treatment option when hypercortisolism persists or recurs remains unknown. The aim of this study was to analyze the short and long-term outcome of repeat TSS in this situation and to search for response predictors. Data from 26 patients with persistent (n=11) or recurrent (n=15) hypercortisolism who underwent repeat surgery by a single neurosurgeon between 1982 and 2009 were retrospectively analyzed. Remission was defined as normalization of urinary free cortisol (UFC) levels, and recurrence as presence of elevated UFC levels after having achieved remission. The following potential outcome predictors were analyzed: adrenal status (persistence or recurrence) after initial TSS, tumor identification in imaging tests, degree of hypercortisolism before repeat TSS, same/different surgeon in both TSS, and time to repeat surgery. Immediate postoperative remission was achieved in 12 patients (46.2%). Five of the 10 patients with available follow-up data relapsed after surgery (median time to recurrence, 13 months). New hormone deficiencies were seen in seven patients (37%), and two patients had cerebrospinal fluid leakage. No other major complications occurred. None of the preoperative factors analyzed was predictive of surgical outcome. When compared to initial surgery, repeat TSS for CD is associated to a lower remission rate and a higher risk of recurrence and complications. Further studies are needed to define outcome predictors. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  3. Maintenance immunotherapy in recurrent ovarian cancer: long term follow-up of a phase II study.

    Recchia, Francesco; Di Orio, Ferdinando; Candeloro, Giampiero; Guerriero, Gabriele; Piazze, Juan; Rea, Silvio


    Vascular endothelial growth factor (VEGF), a mediator of tumor-associated immunodeficiency, plays a key role in angiogenesis and is a prognostic factor in advanced ovarian cancer (AOC). Previously, we showed that low-dose interleukin-2 (IL-2) and 13-cis-retinoic acid (RA) improved the tumor-associated immunodeficiency and decreased VEGF in patients with AOC. Here, we report long term follow-up of a group of patients with platinum-sensitive AOC who were treated with IL-2 and RA. Sixty-five patients with AOC who had a clinical benefit from second line chemotherapy and elevated serum levels of VEGF were entered into the study from 04/98 to 04/05. Therapy consisted of low-dose subcutaneous IL-2 and oral RA, administered on intermittent schedules for up to 5 years. A statistically significant improvement in lymphocyte and NK counts and a decrease in VEGF levels were observed with respect to baseline values among the 65 evaluable patients. Five-year progression-free survival and overall survival rate were 29% and 38%, respectively. These data show that patients treated with low-dose IL-2 and RA have a statistically significant improvement in their lymphocyte and NK counts, a decrease in VEGF, and seem to have an improved clinical outcome. Copyright 2009 Elsevier Inc. All rights reserved.

  4. Long Term Follow-Up of Sulfur Mustard Related Bronchiolitis Obliterans Treatment

    Hamidreza Abtahi


    Full Text Available Bronchiolitis obliterans (BO is the most remarkable pulmonary sequels of war-related sulfur mustard inhalation. There is little if any data about long-term efficacy of associated BO treatment. Five years spirometric records of three groups of patients with obstructive pulmonary diseases (asthma, COPD, BO and documented sulfur mustard inhalation were evaluated. The BO patients were treated with inhaled Seretide 125-250/25 (2 puffs BID, azithromycin (250 mg, three times/week and N-acetylcysteine (1200-1800/day. Asthma and COPD patients were treated according to existing guidelines. Seventy-three (38 asthma, 16 COPD and 19 BO patients completed the 5 years follow-up. Basal and final FEV1 in BO patients (2.69±0.81 and 2.39±0.65 respectively were not significantly different from COPD patients (2.46±0.56 and 1.96±0.76 respectively. There was also no significant difference between the yearly FEV1 decline in BO patients compared to COPD patients (60±84 cc vs. 99±79 cc respectively, P=0.163. The non-significant difference of FEV1 decline in BO compared to COPD patients suggests the effectiveness of azithromycin, inhaled steroid and N-acetyl cysteine in BO patients. Considering safety and possible effectiveness, this treatment is recommended until more data is available from controlled clinical studies.

  5. Effectiveness of a therapeutic community treatment in Spain: a long-term follow-up study.

    Fernández-Hermida, José-Ramón; Secades-Villa, Roberto; Fernández-Ludeña, José-Javier; Marina-González, Pedro-Antonio


    In this paper, the effectiveness of the treatment program developed by Proyecto Hombre ('Project Mankind') in Asturias, Spain, is evaluated. In a long-term follow-up (range from 73 days to 8 years) with a sample of 249 subjects, the results obtained by subjects completing the treatment (194) were compared with pre-treatment results and with those of the group that dropped out (55). The measurements used were relapses in illegal drugs, alcohol, changes in family situation, educational level, employment, criminal involvement and state of health. External validation of self-report measures given in the questionnaire was carried out. Findings support the effectiveness of the treatment in all measures and the validity of self-report items. Relapse rate in 'treatment-completed' group was 10.3%, whilst in the non-completers group it reached 63.6% (significant difference, p < 0.001). Relapses of non-completers were more severe, occurred sooner after leaving the program (they stayed abstinent for shorter periods) and lasted longer than those of subjects completing the treatment.

  6. Long-term follow-up of different refractory systemic vasculitides treated with rituximab.

    Rees, Frances; Yazdani, Ramin; Lanyon, Peter


    There is increasing interest in rituximab (RTX) as an alternative to cyclophosphamide (CYC) for remission induction in systemic vasculitis. Recent studies have reported high remission rates, but it is not clear how long the initial remission lasts [1, 2]. A retrospective study was undertaken of 15 cases of refractory systemic vasculitis (11 Wegener's granulomatosis, 1 Churg-Strauss syndrome, 1 cutaneous polyarteritis nodosa and 2 cryoglobulinaemic vasculitis) treated with RTX, with a mean follow-up of 34 months. All had previously received CYC, and 14, at least one other immunosuppressive drug. All had active disease when treated (median Birmingham Vasculitis Activity Score (BVAS) 2003, 13). All cases achieved remission (BVAS 2003, 0). Thirteen required re-treatment, nine due to relapse (mean, 9 months after initial treatment) and four because of repopulation or rising ANCA in the context of CYC intolerance or previous CYC refractory disease. Relapsing cases have been successfully re-treated up to five further cycles, either at B cell repopulation or at six monthly intervals. Infections were rare. Mean IgG levels fell significantly, and IgM levels became subnormal in six cases. There were three cases of neutropenia, one severe at 10 months post-treatment. These results provide further evidence that RTX is an effective induction agent in systemic vasculitis. The optimal and long-term outcome of re-treatment remains to be defined.

  7. Chilean model for long-term follow-up of phenylketonuria (PKU

    Verónica Cornejo


    Full Text Available Chilean newborn screening program began in 1984 through of a covenant between the National Ministry of Health and the Chilean University through its Institute of Nutrition and Food Technology (INTA with the aim of implementing a pilot study for neonatal detection of phenylketonuria (PKU in Santiago’s central area. In 1989 a program for neonatal diagnosis of PKU and congenital hypothyroidism (HC was initiated by INTA along with Santiago´s occidental health ministry rural area, which covered 20% of newborn population. PKU and HC had an incidence of 1:14,640 and 1:2000 living newborns respectively. These findings allowed the establishment of a favorable cost/benefit ratio which validated the implementation of a program with National character. In 1992 the Chilean Ministry of Health ruled the initiation of PKU and HC newborn screening program and by 1998 the coverage across the country was achieved. INTA is the National Reference Center for confirmation and long term treatment for PKU and HC patients. A follow-up program consists of medical, nutritional, neurological and psychological outcome evaluations as well as periodic biochemical testing in order to guarantee normal patient growth and development. To date 184 children have been diagnosed with classic or moderate PKU, all of them follow a strict monitoring program.

  8. Pediatric familial neuromyelitis optica in two sisters with long term follow-up.

    Chuquilin, Miguel; Mullaguri, Naresh; Weinshenker, Brian


    Neuromyelitis optica causes bilateral optic neuritis and longitudinal extensive transverse myelitis. Although usually sporadic, 3% of cases of neuromyelitis optica are familial. The interval over which attacks continue and the long term prognosis for pediatric-onset neuromyelitis optica are not well defined. We describe two patients with pediatric familial neuromyelitis optica with the longest clinical follow-up of a pediatric case reported in the literature to our knowledge. One woman developed blindness with bilateral eye involvement within a few weeks at age 3. This was followed by transverse myelitis with paraparesis at age 19 leading to diagnosis of neuromyelitis optica. Her serum anti-aquaporin 4 antibody was later found to be positive. She continued with sporadic myelitis-related relapses but remained ambulant until age 40 when she had a more severe relapse. There was evidence of longitudinal extensive T2 hyperintensity in the thoracic spinal cord. Her sister also developed blindness at age 3.5 followed by myelitis 1year later with multiple relapses of gait impairment until her death from pneumonia at age 21. These patients represent the rare occurrence of neuromyelitis optica in children within the same family and show that this disease can have prolonged periods of remission but a continued tendency to relapse, supporting the need for lifelong immunosuppression.

  9. Long-term follow-up of severely symptomatic women with adenomyoma treated with combination therapy

    Wei-Min Liu


    Conclusion: Combination therapy for adenomyoma provides an effective treatment option for long-term symptom control and uterine preservation in severely symptomatic women for whom previous long-term drug therapy has failed or proven to be intolerable.

  10. Long-Term Serological Follow-Up of Acute Q-Fever Patients after a Large Epidemic

    Wielders, C.C.; Loenhout, J.A.F. van; Morroy, G.; Rietveld, A; Notermans, D.W.; Wever, P.C.; Renders, N.H.; Leenders, A.C.; Hoek, W. van der; Schneeberger, P.M.


    BACKGROUND: Serological follow-up of acute Q-fever patients is important for detection of chronic infection but there is no consensus on its frequency and duration. The 2007-2009 Q-fever epidemic in the Netherlands allowed for long-term follow-up of a large cohort of acute Q-fever patients. The aim

  11. Anemia after gastrectomy for early gastric cancer:Long-term follow-up observational study

    Chul-Hyun Lim; Sang Woo Kim; Won Chul Kim; Jin Soo Kim; Yu Kyung Cho; Jae Myung Park; In Seok Lee


    AIM:To identify the incidence and etiology of anemia after gastrectomy in patients with long-term follow-up after gastrectomy for early gastric cancer.METHODS:The medical records of those patients with early gastric adenocarcinoma who underwent curative gastrectomy between January 2006 and October 2007 were reviewed.Patients with anemia in the preoperative workup,cancer recurrence,undergoing systemic chemotherapy,with other medical conditions that can cause anemia,or treated during follow up with red cell transfusions or supplements for anemia were excluded.Anemia was defined by World Health Organization criteria (Hb < 12 g/dL in women and <13 g/dL in men).Iron deficiency was defined as serum ferritin < 20 μg/dL.Vitamin B12 deficiency was defined as serum vitamin B12 < 200 pg/mL.Iron deficiency anemia was defined as anemia with concomitant iron deficiency.Anemia from vitamin B12 deficiency was defined as megaloblastic anemia (mean cell volume >100 fL) with vitamin B12 deficiency.The profile of anemia over 48 mo of follow-up was analyzed.RESULTS:One hundred sixty-one patients with gastrectomy for early gastric cancer were analyzed.The incidence of anemia was 24.5% at 3 mo after surgery and increased up to 37.1% at 48 mo after surgery.The incidence of iron deficiency anemia increased during the follow up and became the major cause of anemia at 48 mo after surgery.Anemia of chronic disease and megaloblastic anemia were uncommon.The incidence of anemia in female patients was significantly higher than in male patients at 12 (40.0% vs 22.0%,P =0.033),24 (45.0% vs 25.0%,P =0.023),36 (55.0%vs 28.0%,P =0.004),and 48 mo (52.0% vs 31.0%,P =0.022) after surgery.Patients with total gastrectomy showed significantly higher incidence of anemia than patients with subtotal gastrectomy at 48 mo after surgery (60.7% vs 31.3%,P =0.008).The incidence of iron deficiency was significantly higher in female patients than in male patients at 6 (35.4% vs

  12. [Long-term follow-up after intravenous injection of mercury--two cases report].

    Goszcz, Halina; Szczepańska, Łucja; Lech, Teresa; Groszek, Barbara


    In this paper we present the long-term follow-up of two patients, after injection of metallic mercury. Case 1. In 1997, 29-years-old man injected himself to left elbow about 20 ml of metallic mercury by mistake (he was heroin abuser for short time). Mercury concentration in the blood was 400 microg/L. X-ray of the chest, abdomen and affected elbow area showed radiopaque foreign material (depots of mercury). Depots of mercury were also visible on the tricuspid valve in echocardiography. Mercury from the soft tissue left elbow pit was partially surgically removed. During 15 years follow-up two times chelating therapy was performed with d-penicyllamine and DMPS. In 2012, he was admitted to hospital next time. The blood and urine mercury concentration was still elevated (55.2 microg/L and 197 microg/L), mercury depots in the lung and abdomen were present. The signs and symptoms of CNS damage, like peripheral polyneuropathy and ataxia, were diagnosed. CT of brain did not revealed any changes, despite head trauma before 6 years. However neurological findings are typical for chronic mercury poisoning, it is not possible to determine whether these changes are directly related to mercury, because head trauma history, Case 2. In 2003, 16-years-old woman injected herself one month before, in suicidal attempts to both elbows several millilitres of metallic mercury. Mercury concentration in the blood was 56.2 microg/L, in urine 906 microg/L and in the hair 1.12 microg/g. Chest Xray showed depots of mercury in the lung. Mercury from the soft tissue was two times surgically removed. During 9 years two times chelating therapy was performed with d-penicyllamine and DMPS. After 9 years there is no symptoms of mercury poisoning. Mercury depots in the lung are still present. The blood and urine mercury concentration is low (13.7 microg/L and 2.53 microg/L). In mean time she gave birth two healthy children. Further patients evaluation is necessary.

  13. Long-term follow-up of blunt cerebrovascular injuries: Does time heal all wounds?

    Laser, Adriana; Bruns, Brandon R; Kufera, Joseph A; Kim, Andrew I; Feeney, Timothy; Tesoriero, Ronald B; Lauerman, Margaret H; Sliker, Clint W; Scalea, Thomas M; Stein, Deborah M


    The short-term natural history of blunt cerebrovascular injuries (BCVIs) has been previously described in the literature, but the purpose of this study was to analyze long-term serial follow-up and lesion progression of BCVI. This is a single institution's retrospective review of a prospectively collected database over four years (2009-2013). All patients with a diagnosis of BCVI by computed tomographic (CT) scan were identified, and injuries were graded based on modified Denver scale. Management followed institutional algorithm: initial whole-body contrast-enhanced CT scan, followed by CT angiography at 24 to 72 hours, 5 to 7 days, 4 to 6 weeks, and 3 months after injury. All follow-up imaging, medication management, and clinical outcomes through 6 months following injury were recorded. There were 379 patients with 509 injuries identified. Three hundred eighty-one injuries were diagnosed as BCVI on first CT (Grade 1 injuries, 126; Grade 2 injuries, 116; Grade 3 injuries, 69; and Grade 4 injuries, 70); 100 "indeterminate" on whole-body CT; 28 injuries were found in patients reimaged only for lesions detected in other vessels. Sixty percent were male, mean (SD) age was 46.5 (19.9) years, 65% were white, and 62% were victims of a motor vehicle crash. Most frequently, Grade 1 injuries were resolved at all subsequent time points. Up to 30% of Grade 2 injuries worsened, but nearly 50% improved or resolved. Forty-six percent of injuries originally not detected were subsequently diagnosed as Grade 3 injuries. Greater than 70% of all imaged Grade 3 and Grade 4 injuries remained unchanged at all subsequent time points. This study revealed that there are many changes in grade throughout the six-month time period, especially the lesions that start out undetectable or indeterminate, which become various grade injuries. Low-grade injuries (Grades 1 and 2) are likely to remain stable and eventually resolve. Higher-grade injuries (Grades 3 and 4) persist, many up to six months

  14. Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up.

    Loirat, Aurélie; Fénéon, Damien; Behaghel, Albin; Behar, Nathalie; Le Helloco, Alain; Mabo, Philippe; Daubert, Jean-Claude; Leclercq, Christophe; Martins, Raphaël P


    The rate of pacemaker implantation is rising. Given that the life expectancy of the population is projected to increase, a large number of elderly patients are likely to be implanted in the future. As pacemaker batteries can last for 8-10years, an increasing number of pacemaker recipients will require replacement of their devices when they become nonagenarians. To analyse the short- and long-term outcomes after device replacement in nonagenarians. Patients aged≥90years referred to a tertiary centre for pacemaker replacement from January 2004 to July 2014 were included retrospectively. Clinical follow-up data were obtained from clinical visits or telephone interviews with patients or their families. The primary clinical endpoint was total mortality. Secondary endpoints included early and delayed procedure-related complications and predictive risk factors for total mortality. Sixty-two patients were included (mean age 93.3±2.9years at time of pacemaker replacement). Mean procedure duration was 35.7±17.2minutes. Mean hospital stay was 2.2±1.1days. One patient died from a perioperative complication. Thirty-seven patients (59.7%) died during a median follow-up of 22.1months (interquartile range, 11.8-39.8months). Survival rates were 84.2% (95% confidence interval [CI] 71.8-91.5%) at 1year, 66.9% (95% CI 51.8-78.2%) at 2years and 22.7% (95% CI 10.6-37.7%) at 5years. Atrial fibrillation (hazard ratio 2.47, 95% CI 1.1-5.6) and non-physiological pacing (i.e. VVI pacing in patients in sinus rhythm) (hazard ratio 2.20, 95% CI 1.0-4.9) were predictors of mortality. Pacemaker replacement in nonagenarians is a safe and straightforward procedure. These data suggest that procedures can be performed securely in this old and frail population, with patients living for a median of 30months afterwards. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. Long-Term Follow-Up of Patients after Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffold

    Meneguz-Moreno, Rafael Alexandre; Costa Junior, José de Ribamar; Moscoso, Freddy Antônio Britto; Staico, Rodolfo; Tanajura, Luiz Fernando Leite; Centemero, Marinella Patrizia; Chaves, Auréa Jacob; Abizaid, Andrea Claudia Leão de Sousa; Sousa, Amanda Guerra de Moraes Rego e; Abizaid, Alexandre Antonio Cunha


    Background Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. Objectives To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Methods Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). Results All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). Conclusions In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary. PMID:28076449

  16. Long-Term Follow-Up of Quality of Life following DIEP Flap Breast Reconstruction.

    Hunsinger, Vincent; Hivelin, Mikael; Derder, Mohamed; Klein, Delphine; Velten, Michel; Lantieri, Laurent


    Sequelae resulting from breast cancer negatively impact patients' quality of life. Although the deep inferior epigastric perforator (DIEP) flap has become a standard for autologous breast reconstruction, there are limited data regarding long-term quality of life. The authors studied patients' quality of life more than 5 years after DIEP flap breast reconstruction and compare it with two French reference samples. A cross-sectional study of quality of life was performed in women who underwent DIEP flap breast reconstruction between 1995 and 2007 using the Medical Outcomes Study 36-Item Health Survey (Short Form-36). The first reference sample included subjects from the French general population (n = 3308), and the second included cancer survivors who underwent mastectomy with (n = 70) or without (n = 135) breast reconstruction. One hundred eleven respondents were analyzed among 186 eligible women. The mean follow-up period after reconstruction was 8.6 years (range, 5 to 15 years). There were no statistically significant differences in the quality of life between women from 45 to 64 years old who underwent DIEP flap breast reconstruction and from the French general population. Five of the eight Short Form-36 dimensions were significantly better in the DIEP flap breast reconstruction group in the 65- to 74-year-old cohort. In addition, quality of life of our study population was significantly higher than that of women who underwent mastectomy with or without any type of breast reconstruction. These results indicate that DIEP flap breast reconstruction allows patients with breast cancer to maintain a good postoperative quality of life comparable to that of the general population. Therapeutic, III.

  17. Myasthenia Gravis : Clinical Spectrum And Long Term Follow-Up Study

    Ashraf V V


    Full Text Available Data from 386 patients, fairly representative of myasthenic population seeking medical advice, were analyzed for clinical spectrum, course and long-term outcome. There were 237 males and 149 females (3:2 with a mean age at onset of 30.6 years. Family history of myasthenia was noted in 5.4% patients. During the first month after the onset symptoms and signs were confined to ocular muscles in 47%, bulbar muscles in 12.5% and involved extremities in 9.4% of patients while 30% individuals had generalized MG. Fifteen patients had chronic limb girdle myasthenia. Of the 181 patients with ocular myasthenia at onset, 53% patients subsequently developed generalized disease and in 44% of these patients it occurred after two years of the onset. Thymectomy was performed in 16% of patients and 70% of the patients were treated with one or more immunosuppressive drugs at sometime. At last follow-up (mean -5.1 yrs, 41 % patients were asymptomatic, 40% reported improvement and 19% deteriorated. Drug free stable remission was achieved in 11% of patients. There was a trend for better outcome in patients undergoing thymectomy than medically treated patients, however the drug free remission rate was same in both the groups. MG was lethal in 11% of patients, principally in women, older than 35 years, and in patients in grade 3 or worse at first observation. Forty-three episodes of myasthenic crisis in 34 patients were analyzed. Infection was the commonest precipitating event. Median interval between the onset of symptoms to crisis was 13 months. Nine episodes of crisis were fatal, with a mortality rate of 21%. A significant reduction in crisis mortality from 40% during 1980-1990 to 10.2% during 1991 to 1999 was noted, reflecting improvement in management strategies.

  18. Proteinuria during Follow-Up Period and Long-Term Renal Survival of Childhood IgA Nephropathy.

    Kamei, Koichi; Harada, Ryoko; Hamada, Riku; Sakai, Tomoyuki; Hamasaki, Yuko; Hataya, Hiroshi; Ito, Shuichi; Ishikura, Kenji; Honda, Masataka


    Proteinuria is the most important risk factor for IgA nephropathy progression. The purpose of this study is to evaluate the long-term outcome and risk factors for poor prognosis in childhood IgA nephropathy. Patients who were diagnosed with IgA nephropathy between 1972 and 1992 at the Tokyo Metropolitan Kiyose Children's Hospital were included. We analyzed risk factors for progression to end-stage kidney disease (ESKD) and chronic renal insufficiency (CRI) using Kaplan-Meier method and multivariate analyses of Cox proportional hazard model. One hundred patients were included and the median observation period was 11.8 years. Twelve and 17 patients progressed to ESKD and CRI, respectively. The survival probabilities were 90.0% at 10 years and 79.8% at 20 years for ESKD, and 86.1% at 10 years and 72.3% at 20 years for CRI. Notably, patients with heavy proteinuria with hypoalbuminemia during follow-up period showed extremely poor prognosis. In this group, the survival rate at 10 years from ESKD and CRI was 40.6% and 20.8%, respectively. By multivariate analysis, proteinuria at diagnosis and proteinuria during follow-up period were risk factors for ESKD, whereas glomeruli showing mesangial proliferation ≥50% and proteinuria during follow-up period were risk factors for CRI. Patients without heavy proteinuria during follow-up period did not develop CRI and 63% of patients with mild proteinuria during follow-up period showed no proteinuria at the last observation. The degree of proteinuria during follow-up period is the strongest risk factor for ESKD and CRI.

  19. Long-term follow-up of women and men after unsuccessful IVF.

    Filetto, Juliana N; Makuch, Maria Y


    The experience of 92 couples, who had unsuccessfully undergone one or more IVF cycles at a university clinic, was evaluated 3-8 years following their last failed attempt. One member of each couple completed a telephone questionnaire regarding life events during their last IVF cycle performed at the clinic and at the time of the interview. Some couples had continued further treatment and some had not. Multivariate correspondence analysis was used to analyse the data. Regarding the long-term experience of couples who had undergone further treatment, for men the main experiences were psychological problems and having adopted a child. For women, the main experiences were related to problems of self-image, psychological problems, loss of hope, and having adopted a child. These women also presented a strong association with problems in their marital relationship and with adoption. For the group that did not undergo further treatment, the women showed a strong association with considering adoption, and a less intense association with psychological problems and loss of hope. The men presented psychological problems and having adopted a child as associated variables. Comparison between men and women showed that recognizing the impossibility of conceiving a child and giving up treatment were strongly associated. Men and women who had not continued with further treatment were more affected in the long term than those who had undergone further treatment after IVF failure.

  20. Long-term follow-up of children treated with the modified Atkins diet.

    Chen, Wendy; Kossoff, Eric H


    The modified Atkins diet has been studied in mostly short-term clinical trials and case series. No studies have systematically examined the long-term benefits and side effects. The modified Atkins diet was started without prior ketogenic diet use in 87 children at the Johns Hopkins Hospital since 2002, of which 54 continued for more than 6 months. Children who had not been seen within the past 2 years were contacted by phone and email. At their most recent point during the modified Atkins diet (mean 19.9 months), 30 of 54 (55%) children with diet durations of more than 6 months achieved >50% improvement; 19 (35%) were seizure-free. Using an intent-to-treat analysis, at 12 months, 33 of 87 (38%) had >50% seizure reduction; 16 (18%) were seizure-free. These results are similar to published data for short-term modified Atkins diet and long-term ketogenic diet use. Side effects were predominantly elevations in lipid profile and gastrointestinal upset.

  1. Treatment of Hodgkin's Disease with Chemotherapy Based- Regimens: Long-term Follow-up Results with 295 Patients

    HuiqiangHuang; QingqingCai; XubingLin; YuhongLi; GuangchuanXu; LiZhang; YouiianHe; XiaofeiSun; ZongmeiZhou; DonggangLiu; RuihuoXu; TongyuLin; XiaoyuTeng; MaozhenLiu; YisunSu; WenqiJiang; ZhongzhenGuang


    OBJECTIVE Hodgkin's disease (HD) is a chemo and radio-sensitive hematologic malignancy. At the present time, improvement of its cure rate, reduction of its long-term detrimental effects, and maintenance of a good quality of life are the major concerns in the treatment of HD. In this study the results of a long -term follow-up from our cancer center was analyzed retrospectively in terms of efficacy and collateral side effects. METHODS The results were analyzed for 295 patients with histologicallyverified HD who were treated from 1970 to 2000, especially 182 patients treated from 1980 to 2000. Multivariant analysis (COX model ) was employed to elucidate the prognostic determinants. RESULTS The 5, 10 and 20-year survival for 295 patients with HD were 63.5%, 55.8% and 47.1% respectively with a median survival time of 172 months (28-352 months ). The median follow-up time was 43 months (17-352 months). The 5, 10 and 20 years overall survival and disease-free survival were 79.6%, 74.5%, 66.8% and 74.5% ,69.4%, 69.4% respectively for patients treated by regular chemotherapy and radiotherapy from 1980 to 2000. The incidence of late toxicities was low. An age of≥45 years, B symptoms and stage Ⅲ / Ⅳ were the main prognostic determinants (P=0.000, P=0.035 and P=0.047) in this clinical study. Stage Ⅰ/Ⅱ and nodularsclerosis were favorable factors in comparison with stages Ⅲ/Ⅳ and other histologic subtypes. CONCLUSIONS A chemotherapy-predominant modality plays an important role in the treatment of HD with promising long-term survival and fewer late toxicities. Further investigation for this simplified convenient comprehensive therapy is warranted.

  2. Audiologic results of surgery for cholesteatoma: short- and long-term follow-up of influential factors.

    Stankovic, Milan D


    To review the audiologic results in a cohort of patients surgically treated for cholesteatoma. Retrospective review of patient records. Tertiary referral center. A retrospective study of patients operated on for acquired middle ear cholesteatoma during the period 1990 to 2002 was performed. A total of 758 patients were followed during a short-term period, and 611 patients were followed during a long-term period. The patients were divided into 3 age groups: children, adolescents, and adults. The localization of cholesteatoma was classified as attic, sinus, or tensa. Closed tympanoplasty was always performed as the single procedure of choice on all the children, and reoperation or conversion to open tympanoplasty was made later if needed. Adult patients were treated with single classic canal wall up, or wall down (CWD), according to the propagation of disease and condition of middle ear. Preoperative and postoperative air-bone gap (ABG) and pure-tone average were compared after short-term and long-term follow-up. Average hearing improvement (reduction of ABG) amounted 20.0 dB for short-term and deteriorated to 18.0 dB during long-term analysis for all the patients. Preoperative hearing level was significantly worse for CWD than for intact canal wall technique. The ABG closure was much better in the group with attic cholesteatoma. Both preoperative and postoperative hearing levels were worse for children than for adolescents or adults. Revision operations and bilateral cholesteatoma gave worse total postoperative hearing. The long-term results of primary operations, when recurrent cholesteatoma did not occur, were stable. Damage to auditory ossicles correlated well with total preoperative and postoperative results. The most hearing improvement was verified for the frequencies between 500 and 3,000 Hz, and there was no sensorineural hearing loss. The audiologic results of cholesteatoma surgery are preserved during long-term follow-up. We found that recurrent

  3. Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee.

    Dines, Joshua S; DeBerardino, Thomas M; Wells, Jason L; Dodson, Christopher C; Shindle, Michael; DiCarlo, Edward F; Warren, Russell F


    The purpose of this study was to review a single institution's large consecutive series of localized pigmented villonodular synovitis (PVNS) of the knee. Cases for review were identified by a search of our institution's pathology records for definitive diagnoses of monoarticular localized PVNS (LPVNS) of the knee between 1970 and 1996. Patients' presenting symptoms and examination were recorded, as were the preoperative diagnosis and documentation of the PVNS nodule's location in the knee at surgery. Eighty-four patients were diagnosed with localized PVNS of the knee during the study period. Twenty-nine of these cases were incidental findings associated with planned total knee replacement and were excluded from the study. Of the remaining 55 patients constituting the study subgroup, 26 have been reviewed in detail. There were 15 males and 11 females, and the mean age at presentation was 36.7 years. Patients presented for evaluation at an average of 15 months after the onset of symptoms. Pain was the most common complaint, reported by 24 of the 26. Locking and giving way were reported by 10 and 5 patients, respectively. On examination, 13 patients had an effusion, 11 had joint line tenderness, and 10 had a palpable mass. The most common preoperative diagnosis was a meniscus tear (10 of the 26), followed by PVNS (4), "mass" (4), and anterior cruciate ligament injury (3). At surgery, the nodule of PVNS was found most frequently in the suprapatellar pouch (6 cases), followed by the femoral notch (4), lateral synovium/gutter (4), popliteal fossa (3), lateral compartment (3), and medial compartment (2). Fourteen of the procedures performed were open, and 12 were performed by arthroscopy. Ten of the 26 patients participated in a long-term follow-up via the Lysholm Knee Scoring Scale questionnaire (average, 65.8 months postoperatively; average score, 95.4/100). Of these 10, 7 returned for follow-up clinical examinations (6 excellent results and 1 good). All 10 patients

  4. Long-term follow-up of hypothenar hammer syndrome: a series of 47 patients.

    Marie, Isabelle; Hervé, Fabien; Primard, Etienne; Cailleux, Nicole; Levesque, Hervé


    Hypothenar hammer syndrome (HHS) is an uncommon form of secondary Raynaud phenomenon, occurring mainly in subjects who use the hypothenar part of the hand as a hammer; the hook of the hamate strikes the superficial palmar branch of the ulnar artery in the Guyon space, leading to occlusion and/or aneurysm of the ulnar artery. In patients with HHS, such injuries of the palmar ulnar artery may lead to severe vascular insufficiency in the hand with occlusion of digital artery. To date, only a few series have analyzed the long-term outcome of patients with HHS. This prompted us to conduct the current retrospective study to 1) evaluate the prevalence of HHS in patients with Raynaud phenomenon and 2) assess the short-term and long-term outcome in patients with HHS. From 1990 to 2006, 4148 consecutive patients were referred to the Department of Internal Medicine at the University of Rouen medical center for evaluation of Raynaud phenomenon using nailfold capillaroscopy. HHS was diagnosed in 47 of these 4148 patients (1.13% of cases).Forty-three patients (91.5%) had occupational exposure to repetitive palmar trauma. The more common occupations were factory worker (21.3%), mason (12.8%), carpenter (10.6%), and metal worker (10.6%); the mean duration of occupational exposure to repetitive palmar trauma at HHS diagnosis was 21 years. One patient (2.1%) had recreational exposure (aikido training) to repetitive trauma of the palmar ulnar artery, and 3 other patients (6.4%) developed HHS related to a single direct injury to the hypothenar area. Clinical manifestations were more often unilateral (87.2%) involving the dominant hand (93%). HHS complications included digital ischemic symptoms (ischemia: n = 21, necrosis: n = 20) and irritation of the sensory branch of the ulnar nerve (n = 11). In HHS patients, angiography demonstrated occlusion of the ulnar artery in the area of the Guyon space (59.6%), aneurysm of the ulnar artery in the area of the Guyon space (40.4%), and embolic

  5. Coronary Artery Calcification Is Related to Inflammation in Rheumatoid Arthritis: A Long-Term Follow-Up Study

    Bengt Wahlin


    Full Text Available Objective. A long-term follow-up of patients with rheumatoid arthritis (RA to evaluate factors related to coronary artery calcification (CAC. Methods. All 22 eligible patients (4 males/18 females, mean age 65 years, and RA-duration 30–36 years from the original (baseline; n=39 study of atherosclerosis were included. Inflammation, cardiovascular risk factors, and biomarkers were measured at baseline. At follow-up 13 years later, CAC was assessed by computed tomography (CT and the grade of inflammation was measured. Multivariate analysis of differences between patients with low (0–10 and high CAC (>10 was done by orthogonal projection to latent structures (OPLS. Results. Ten patients had CAC 0–10 and 12 had >10 (range 18–1700. Patients with high CAC had significantly higher ESR (24.3 versus 9.9 mm/h and swollen joint count (2 versus 0. The OPLS models discriminated between patients having high or low CAC. With only baseline variables, the sensitivity was 73% and the specificity 82%. The model that also included inflammatory variables from follow-up had a sensitivity of 89% and a specificity of 85%. Exclusion of baseline intima media thickness and plaque from the latter model modestly reduced the accuracy (sensitivity 80% and specificity 83%. Conclusions. CAC is related to inflammation in patients with RA.

  6. The Irish epilepsy surgery experience: Long-term follow-up.

    Dunlea, Orla


    To assess the long-term seizure outcome of Irish patients who underwent resective surgery for refractory epilepsy since 1975. We also wished to determine the impact of pathology and surgical technique (with particular reference to neocorticectomy) on seizure outcome.

  7. LOng-term follow-up after liVE kidney donation (LOVE) study: A longitudinal comparison study protocol

    Janki, Shiromani; Klop, Karel; Kimenai, F.F.P.; van de Wetering, Jacqueline; Weimar, Willem; Massey, Emma; Dehghan, Abbas; Rizopoulos, Dimitris; Völzke, Henry; Hofman, Albert; IJzermans,Jan


    textabstractBackground: The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods: The "LOng-term follow-up after liVE kidney donation" (LOVE) study is a single center longitudinal cohort study on long-term consequences after living kidney donation. We will study individuals who have donated a kidney from 1981 through 2010 in the Erasmu...

  8. LOng-term follow-up after liVE kidney donation (LOVE) study: a longitudinal comparison study protocol

    Janki, Shiromani; Klop, Karel W. J.; Kimenai, Hendrikus J. A. N.; van de Wetering, Jacqueline; Weimar, Willem; Massey, Emma K; Dehghan, Abbas; Rizopoulos, Dimitris; Völzke, Henry; Hofman, Albert; IJzermans, Jan N. M.


    Background The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods The “LOng-term follow-up after liVE kidney donation” (LOVE) study is a single center longitudinal cohort study on long-term consequences after living kidney donation. We will study individuals who have donated a kidney from 1981 through 2010 in the Erasmus University M...

  9. LOng-term follow-up after liVE kidney donation (LOVE) study: a longitudinal comparison study protocol

    Janki, Shiromani; Klop, Karel W. J.; Kimenai, Hendrikus J. A. N.; van de Wetering, Jacqueline; Weimar, Willem; Massey, Emma K; Dehghan, Abbas; Rizopoulos, Dimitris; Völzke, Henry; Hofman, Albert; IJzermans, Jan N. M.


    Background: The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods: The “LOng-term follow-up after liVE kidney donation” (LOVE) study is a single center longitudinal cohort study on long-term consequences after living kidney donation. We will study individuals who have donated a kidney from 1981 through 2010 in the Erasmus University...

  10. Long Term Follow-up of Ventilated Patients with Thoracic Restriction and Neuromuscular Disease

    Dina Brooks


    Full Text Available OBJECTIVE: To evaluate the long term effects of home mechanical ventilation (HMV on pulmonary function, nighttime gas exchange, daytime arterial blood gases, sleep architecture and functional exercise capacity (6 min walk. Patients with respiratory failure attributable to thoracic restrictive disease (TRD (kyphoscoliosis or neuromuscular disease (NMD were assessed, ventilated, trained and followed in a dedicated unit for the care of patients requiring long term ventilation.

  11. Clinical and radiological long-term follow-up after embolization of pulmonary arteriovenous malformations

    Andersen, Poul Erik; Kjeldsen, Anette D


    . Outcome parameters at follow-up were PaO(2) and patients' satisfaction. During follow-up, the patients had a clinical examination, measurement of arterial blood gases, chest X-ray, and contrast echocardiography performed and were asked to fill in a questionnaire exploring experience of the treatment...

  12. Health-related quality-of-life measures for long-term follow-up in children after major trauma

    Janssens, L.; Gorter, J.W.; Ketelaar, M.; Kramer, W.L.M.; Holtslag, H.R.


    Objective: Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning usin

  13. Long Term Streptomycin Toxicity in the Treatment of Buruli Ulcer : Follow-up of Participants in the BURULICO Drug Trial

    Klis, Sandor; Stienstra, Ymkje; Phillips, Richard O.; Abass, Kabiru Mohammed; Tuah, Wilson; van der Werf, Tjip S.


    Background: Buruli Ulcer (BU) is a tropical infectious skin disease that is currently treated with 8 weeks of intramuscular streptomycin and oral rifampicin. As prolonged streptomycin administration can cause both oto- and nephrotoxicity, we evaluated its long term toxicity by following-up former BU

  14. Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients : a long-term follow-up study

    Geertzen, JHB; Dijkstra, PU; van Sonderen, ELP; Groothoff, JW; ten Duis, HJ; Eisma, WH


    Objective: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. Design: A long-term follow-up study of upper extremity RSD patients. Setting: A university hospital. Subjects: Sixty-five patients, 3-9 years (mean interval 5.5 years

  15. Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients : a long-term follow-up study

    Geertzen, JHB; Dijkstra, PU; van Sonderen, ELP; Groothoff, JW; ten Duis, HJ; Eisma, WH


    Objective: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. Design: A long-term follow-up study of upper extremity RSD patients. Setting: A university hospital. Subjects: Sixty-five patients, 3-9 years (mean interval 5.5

  16. A community-based long-term follow up of women undergoing obstetric fistula repair in rural Ethiopia

    Nielsen, H S; Lindberg, L; Nygaard, U


    still suffering from fistula no change was seen (P = 0.1). Four women became pregnant following their surgery, among which there was one maternal death, three stillbirths and one re-occurrence of fistula. CONCLUSION: Community-based, long-term follow up after fistula repair succeeded in Western rural...

  17. Fecal Transplantation Treatment of Antibiotic-Induced, Noninfectious Colitis and Long-Term Microbiota Follow-Up

    Satokari, R.; Fuentes, S.; Mattila, E.; Jalanka, J.; Vos, de W.M.; Arkkila, P.


    Fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (CDI) and is considered as a treatment for other gastrointestinal (GI) diseases. We followed up the relief of symptoms and long-term, over-a-year microbiota stabilization in a 46-year-old

  18. Long-term follow-up after bariatric surgery in a national cohort.

    Thereaux, J; Lesuffleur, T; Païta, M; Czernichow, S; Basdevant, A; Msika, S; Millat, B; Fagot-Campagna, A


    Lifelong medical follow-up is mandatory after bariatric surgery. The aim of this study was to assess the 5-year follow-up after bariatric surgery in a nationwide cohort of patients. All adult obese patients who had undergone primary bariatric surgery in 2009 in France were included. Data were extracted from the French national health insurance database. Medical follow-up (medical visits, micronutrient supplementation and blood tests) during the first 5 years after bariatric surgery was assessed, and compared with national and international guidelines. Some 16 620 patients were included in the study. The percentage of patients with at least one reimbursement for micronutrient supplements decreased between the first and fifth years for iron (from 27.7 to 24.5 per cent; P bariatric surgery is poor, especially for young men with poor early follow-up. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  19. Long-term adherence to follow-up after treatment of cervical intraepithelial neoplasia

    Barken, Sidsel S; Lynge, Elsebeth; Andersen, Erik S.


    OBJECTIVE: To measure adherence to annual follow-up among women treated for cervical intraepithelial neoplasia. DESIGN: Prospective, population-based, register study. SETTING: Denmark, 1996-2007. POPULATION: All women treated for cervical intraepithelial neoplasia with conization. METHODS: Treate...

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

    M.J. Madderom (Marlous)


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

  1. Treatment of fear of blushing, sweating, or trembling - Results at long-term follow-up

    Scholing, A; Emmelkamp, PMG


    This study investigated the long-term effectiveness of cognitive-behavioral treatments for patients with a specific type of social phobia: fear of showing bodily symptoms (blushing, sweating, or trembling). Patients were reassessed 18 months after they had finished one of the following treatments: (

  2. Long-Term Follow-Up of Echolalia and Question Answering.

    Foxx, R. M.; Faw, Gerald D.


    A long-term followup (from 26 to 57 months) of echolalia and correct question-answering was conducted with six mentally retarded adult subjects identified from three previously published studies. Echolalia was lower than in baseline in 80.6 percent of the followups. Issues related to the study of maintenance are discussed. (Author/DB)

  3. Atrioventricular septal defect : advanced imaging from early development to long-term follow-up

    Calkoen, Emmeline E.


    The aim of this thesis is to review the current knowledge on atrioventricular septal defect (AVSD) (Part 1), to study the pathogenesis of AVSD (Part 2) and finally to analyze cardiac outcome long-term after AVSD correction (Part 3). Studies are performed with novel imaging techniques. In part 2 it

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

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


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

  5. Splenomegaly in sarcoidosis: Frequency, treatment, prognosis and long-term follow-up

    Pavlović-Popović Zora


    Full Text Available Introduction. The splenic involvement is common in sarcoidosis, but its real frequency is still obscure, depending doubtless on the method of splenomegaly detection. Splenomegaly may be accompanied with pain or anemia, leucopenia and thrombocytopenia. Objective. The aim of this study was to investigate the frequency of splenomegaly related to clinical characteristics of sarcoidosis and to solve the dilemma - whether to introduce medicaments, and when to perform splenectomy. Methods. The method of the study is a retrospective and prospective analysis of the patients’ material. Results. The study included 540 patients with sarcoidosis in a 20-year period. Of them, 26% had splenomegaly detected by computerized tomography screening. Splenomegaly was more frequently registered in the patients with a longer history of sarcoidosis (38%, as compared to those with a shorter history of the disease (23% (p<0.05. Splenomegaly was more frequently registered in the patients with other extrapulmonary lesions detected (33% than in those who had no extrapulmonary manifestations of sarcoidosis (17% (p<0.01. Indications, possible benefits and complications of splenectomy were analysed in 11 sarcoidosis patients undergoing this intervention for various reasons, of which the follow-up period ranged from one to 20 years. Conclusion. Splenomegaly was more frequent in chronic cases or in the patients with established sarcoid lesions of other extrapulmonary organs. The primary treatment of uncomplicated symptomatic splenic sarcoidosis includes medicamentous therapy. Occasionally, splenectomy is required. Prognostically, splenomegaly indicates an unfavorable course of the disease.

  6. A Retrospective Evaluation of 192 Implants Placed in Augmented Bone: Long-Term Follow-Up Study.

    Beretta, Mario; Cicciù, Marco; Poli, Pier Paolo; Rancitelli, Davide; Bassi, Gianluca; Grossi, Giovanni Battista; Maiorana, Carlo


    The purpose of the present study was to assess the cumulative survival rate (CSR) of 192 implants placed in association with guided bone regeneration (GBR) procedures to evaluate the long-term predictability of this technique. Moreover, the Kaplan Meier survival analysis was applied to the data in order to evaluate predictors of implant failures, including the source of the graft, the type of membrane, and the timing of implant placement. The CSR of the sample was 95.6% over a mean follow-up period of 78 months (range, 1-175 months). Considering the source of graft, a 95.0%, 93.3%, and 97.7% CSR was obtained for demineralized bovine bone mineral (DBBM), autologous, and 1:1 ratio mixture of autologous and DBBM grafts,, respectively. The CSR referred to bioabsorbable membranes was 96.5%, whereas 94.6% was the CSR reported for nonresorbable membranes. The CSR of simultaneous surgeries was 96.8%, whereas staged surgeries showed a CSR of 94.5%. According to the data, implants placed in conjunction with GBR procedures presented a satisfying survival rate even in the long term. All the procedures performed with different bone grafts and type of membranes guaranteed optimal results both in one- and two-stage approaches. No statistically significant differences could be detected among the groups; indeed, the use of DBBM associated with resorbable membranes may be suggested to reduce patients' morbidity and treatment time. Therefore, the dental implants placed in association with bone regenerative procedures presented safe and predictable long-term clinical results.

  7. [Long-term follow up of childhood cancer survivors in the Murcia Region: preferences and attitudes of Primary Care professionals].

    Cárceles-Álvarez, A; Ortega-García, J A; Fuster-Soler, J L; Rivera-Pagán, G A; Bermúdez-Cortés, M; Gomariz-Peñalver, V; Monzó-Nuñez, E; López-Hernández, F A


    To assess attitudes, beliefs and knowledge of primary medical care professionals as regards the follow-up of Childhood Cancer Survivors (CCS) and the introduction of a Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR). Descriptive cross-sectional study using a structured, self-administered questionnaire. These questionnaires were sent to all primary medical care professionals in Murcia Health District 1. Response rate of 58% (100/172), with 71% and 22% being family physicians and pediatricians, respectively, of whom 49% provided medical care to a CCS in the last 5 years, with 84% reporting that they never or rarely received a detailed report of overall assessment of the survivor. More than 75% found that access to detailed follow-up information was quite or very useful; 95% prefer to consult experts when providing medical care to survivors, and 80% believe that improving the quality of the environment may decrease the morbidity and mortality of the survivors. A statistically significant relationship was found between the length of practicing medicine and the perception of the importance of environmental factors. It seems to be important to increase the training of primary care professionals for the long-term follow-up of CCS, as well as having the detailed information through a personalized long-term follow-up of each survivor. PLASESCAP-MUR offers an integrated follow-up to CCS in a model of shared care between Long Term Monitoring Units and Primary Care Units. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  8. Conservative surgical management of in situ subungual melanoma: long-term follow-up*

    Anda-Juárez, Mariana Catalina De; Martínez-Velasco, María Abril; Fonte-Ávalos, Verónica; Toussaint-Caire, Sonia; Domínguez-Cherit, Judith


    Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas. PMID:28099619

  9. Long-term angiographic follow up, cardiac events, and survival in patients undergoing percutaneous transluminal coronary angioplasty.

    Ernst, S M; van der Feltz, T A; Bal, E T; van Bogerijen, L; van den Berg, E; Ascoop, C A; Plokker, H W


    The results of percutaneous transluminal coronary angioplasty were studied in 1352 consecutive patients. The angioplasty procedure was angiographically successful in 1163 (86%) patients and the success rate increased gradually with time. There were no significant differences in success rates in different vessels or indications. The success rate for repeat coronary angioplasty was 92%. In 85% of the patients the clinical course was uncomplicated. Myocardial infarction occurred in 3.6%, emergency coronary bypass grafting in 2.6%, elective bypass surgery in 4.6%, and there were 10 deaths (0.7%). There were 16 deaths (10 non-cardiac) during follow up in the 1163 patients in whom the first procedure was successful. Actuarial analysis showed that after a first angioplasty 77.9% remained free of symptoms and cardiac events for five years and that after a second angioplasty 76% did so. Angiographic follow up showed restenosis in 24% of patients but the overall clinical success rate was 86.2%. On the basis of the intention to treat the procedure was successful in 74.3% of all 1352 patients. Coronary artery bypass surgery was eventually performed in 11.6% of all patients. The long term angiographic success rate of coronary angioplasty is higher than previously suggested. PMID:2952153

  10. Variables affecting tooth survival and changes in probing depth: a long-term follow-up of periodontitis patients.

    Saminsky, Michael; Halperin-Sternfeld, Michal; Machtei, Eli E; Horwitz, Jacob


    To retrospectively assess tooth-survival rate and its association with patient and oral variables in periodontal office patients, followed up to 18 years. Patients in a private periodontal office whose files included initial examination (T0 ), reevaluation (TRe ) and ≥ 10 years after T0 (TF ) chartings, and received periodontal therapy and supportive periodontal therapy (SPT) after TRe were included. General health, plaque scores (PI), probing depth (PPD), bleeding on probing (BOP) at six points/tooth, tooth extractions, and SPT visits were extracted from patient files at T0 , TRe , and TF . Descriptive statistics and Cox regression analysis were performed. Fifty patients (mean 26 ± 4 teeth/patient, 1301 teeth) fulfilled inclusion criteria. About 20 and 129 teeth respectively were extracted before/after TRe , 96 of them for periodontal causes. PPD>7 mm at TRe (HR = 17.7, 95%CI 8.6, 36.6), age above 60 years (HR = 3.3, 95%CI 1.5, 7.2), multi-rooted teeth (HR = 1.9, 95%CI 1.2, 3.1) and SPTHR = 1.8, 95%CI 1.1, 2.9), were the best prognostic factors for tooth loss during follow-up. (p < 0.05, Cox regression analysis). A continuous, statistically significant reduction was observed in mean PPD among teeth that survived follow-up [4.3 ± 1.8 mm, 3.5 ± 1.4 mm, 3.2 ± 1.3 mm, at T0 , TRe , TF , respectively. (p < 0.001, Repeated-measures test)]. Regular SPT was associated with low tooth-loss rates and continuous reductions in probing depth. PPD after initial therapy, age above 60, multi-rooted teeth and infrequent SPT were strong negative prognostic factors for long-term tooth survival among periodontal patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Long term functioning in early onset psychosis: Two years prospective follow-up study

    Taha Ghada RA


    Full Text Available Abstract Background There were few studies on the outcome of schizophrenia in developing countries. Whether the outcome is similar to or different from developed world is still a point for research. The main aim of the current study was to know if patients with early onset non affective psychosis can behave and function properly after few years from start of the illness or not. Other aims included investigation of possible predictors and associated factors with remission and outcome. Method The study prospectively investigated a group of 56 patients with onset of psychosis during childhood or adolescence. Diagnosis made according to DSM-IV criteria and included; schizophrenia, psychotic disorder not otherwise specified and acute psychosis. Severity of psychosis was measured by PANSS. Measures of the outcome included; remission criteria of Andreasen et al 2005, the children's global assessment scale and educational level. Results Analysis of data was done for only 37 patients. Thirty patients diagnosed as schizophrenia and 7 with Psychotic disorder not otherwise specified. Mean duration of follow up was 38.4 +/- 16.9 months. At the end of the study, 6 patients (16.2% had one episode, 23(62.1% had multiple episodes and 8 (21.6% continuous course. Nineteen patients (51.4% achieved full remission, and only 11(29.7% achieved their average educational level for their age. Twenty seven percent of the sample had good outcome and 24.3% had poor outcome. Factors associated with non remission and poor outcome included gradual onset, low IQ, poor premorbid adjustment, negative symptoms at onset of the illness and poor adherence to drugs. Moreover, there was tendency of negative symptoms at illness start to predict poor outcome. Conclusion Some patients with early onset non affective psychosis can behave and function properly after few years from the start of the illness. Although remission is a difficult target in childhood psychosis, it is still achievable.

  12. Pemphigus with characteristics of dermatitis herpetiformis. A long-term follow-up of five patients.

    Ingber, A; Feuerman, E J


    Five patients had a form of pemphigus which in its early stages resembled dermatitis herpetiform, although the immunofluorescent findings were typical of pemphigus. Potassium iodide tests, performed for the first time in such patients, showed positive results in two patients. Follow-ups ranging from 5 to 14 years have shown a benign course with low to absent dosages of steroids.

  13. [Colonoscopy in the long-term follow-up of surgical anastomoses of the large intestine].

    Rossini, F P; Ferrari, A; Roatta, L; Presti, F; Boido, C


    On the bases of personal experience the importance of endoscopic examination of the colon in the follow-up of patients who have been subjected to resection of the large intestine is emphasized. Fibercoloscopy permits direct observation of "high" surgical anastomoses, which are inaccessible for examination with rigid rectosigmoidoscope, and thus opens the way to precise diagnosis and a correct therapeutic approach.

  14. Thiamine-responsive megaloblastic anemia syndrome: long term follow-up.

    Borgna-Pignatti, Caterina; Azzalli, Milena; Pedretti, Stefania


    Thiamine-responsive megaloblastic anemia is a rare autosomal recessive disorder whose main symptoms are anemia, diabetes mellitus, and sensorineural deafness. We describe a 20-year follow-up of 2 previously reported patients and of 1 patient diagnosed before onset of symptoms and treated with thiamine since the first sign of disease.


    VANDENHOOGEN, F.H.J.; SPRONK, P.E.; Boerbooms, A.M.T.; Bootsma, H.; DEROOIJ, D.J.R.A.; Kallenberg, Cees; VANDEPUTTE, L.B.A.


    The records of 46 patients with anti-(U1)snRNP antibodies and a minimal period of follow-up after first clinical presentation of at least 5 yr were examined with emphasis on symptoms contributing to established criteria of SLE, systemic sclerosis (SSc), RA or dermato- or polymyositis (DM/PM). At fir

  16. Heterogeneous histologic and clinical evolution in 3 cases of dense deposit disease with long-term follow-up.

    Figuères, Marie-Lucile; Frémeaux-Bacchi, Véronique; Rabant, Marion; Galmiche, Louise; Marinozzi, Maria Chiara; Grünfeld, Jean-Pierre; Noël, Laure-Hélène; Servais, Aude


    Dense deposit disease is characterized by dense deposits in the glomerular and tubular basement membranes. We report 3 cases with long-term follow-up differing in histologic pattern and clinical evolution. Clinical and histologic data were collected between 1976 and 2012. Age at the first manifestations was 6, 11, and 23 years, respectively. They included proteinuria (patient 1) and nephrotic syndrome (patients 2 and 3); renal function was normal in all cases. Two patients (1 and 3) had low complement component 3 (C3) levels. All patients had C3 nephritic factor. Genetic analysis revealed a rare variant of the factor I gene (patient 1) and a heterozygous mutation in complement factor H-related 5 gene (patient 2). Patient 1 underwent 3 biopsies during her 38 years of follow-up. Thickening of the capillary walls of the glomerular and tubular basement membranes was observed, with mild mesangial proliferation and progressive C3 and complement membrane attack complex mesangial deposits. However, renal function remained normal. Patient 2 also underwent 3 biopsies (22 years of follow-up), revealing a gradual decrease in C3 deposition and mesangial cell proliferation. He presented mild renal insufficiency. Patient 3 underwent 2 biopsies, which displayed unusual bulky membranous deposits, confirmed by electron microscopy, with no mesangial cell proliferation and little C3 and complement membrane attack complex deposits. Kidney function remained normal. These 3 cases of dense deposit disease differed in histologic pattern evolution: accumulation of C3 deposits, decrease in C3 deposits and proliferation, and isolated dense deposits. The histologic factors involved in clinical progression remain to be identified.

  17. Long-term Follow-up of Whiplash Injury of the Neck

    Sameh El-Sallakh


    Conclusion: Whiplash injury patients have long-term residual symptoms; mainly pins and needles sensation in their limbs, headache, and dizziness. Increasing age and low back pain are bad prognostic factors. Claiming compensation prolongs the time for recovery. Sex, body mass index, type of treatment, smoking, and alcohol have no association with the incidence of persistent symptoms. However, smoking had a significant worsening effect on the severity of the symptoms in patients with high WDQS. WDQS, SF-36 and time to symptom relief are sensitive outcome measures of these injuries.

  18. Long-term follow-up of the flexor carpi ulnaris transfer in spastic hemiplegic children.

    Thometz, J G; Tachdjian, M


    A retrospective study was performed on 25 patients with cerebral palsy who underwent transfer of the flexor carpi ulnaris to the radial wrist extendors. The mean age at the time of surgery was 8 years 1 month. The mean follow-up was 8 years 7 months. At follow-up, the mean active wrist dorsiflexion was 44.2 degrees, palmar flexion was 19.0 degrees, supination was 40.2 degrees, and pronation was 53.4 degrees. According to a modification of Green's evaluation system, there were six excellent, nine good, five fair, and five poor results. Two patients required further surgery to correct a supination, dorsiflexion contracture. We found the transfer to be quite effective in improving wrist dorsiflexion, although there was often a significant loss of active palmar flexion postoperatively. The patient therefore should have good digital extension (with the wrist extended passively above neutral) to be considered for the transfer.

  19. Long-term follow-up in distal renal tubular acidosis with sensorineural deafness.

    Peces, R


    A 20-year-old man presented with failure to thrive and bilateral genu valgum. On the basis of growth failure, skeletal deformity, hyperchloremic metabolic acidosis with alkaline urine and hypokalemia, nephrocalcinosis, and hearing loss, a diagnosis of distal renal tubular acidosis (DRTA) with sensorineural deafness was made. The genu valgum was treated by corrective osteotomy. Skeletal deformity was corrected and impaired growth improved after sustained therapy of metabolic acidosis with alkali supplementation. During an 8-year follow-up period the patient's glomerular filtration rate remained stable, the nephrocalcinosis did not progress, and his height increased 10 cm. Although nephrolithiasis led to atrophy of the right kidney, at last follow-up, when the patient was 44 years old, his creatinine clearance was 50 ml/min per 1.73 m2 body surface.

  20. The surgical management of urogenital tuberculosis our experience and long-term follow-up

    Punit Bansal; Neeru Bansal


    Introduction: Urogenital tuberculosis (TB) is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB). Materials and Methods: We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied. Results: There were 38 males and 22 females with a mean age of 32.5 years. The most common...

  1. Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus

    Fermand, M.; Reizine, D.; Melki, J.P.; Riche, M.C.; Merland, J.J.


    Fourty-three patients with arterio-venous fistulae of the dura of the transverse sinus with a complaint of tinnitus are reviewed, with a follow-up of 12 months to 11 years. 34 patients were embolized, 2 treated surgically, and 7 were untreated. Embolization appears to have been beneficial. The benign nature of this abnormality must be emphasized, and serious psychological study of the patient must be made before deciding on therapy.

  2. Long-term follow-up and late complications following treatment of pediatric urologic disorders.

    Akhavan, Ardavan; Stock, Jeffrey A


    Many pediatric urologic disorders have sequelae that may affect patients well into adulthood. Despite adequate treatment, many patients are at risk for progressive urologic deterioration years after surgical reconstruction. While many pediatric urologists follow their patients years after surgery, screening for late complications is a shared responsibility with primary care providers. This article discusses potential late complications and appropriate follow-up for patients who have a history of ureteral reimplantation, pyeloplasty, hypospadias repair, posterior urethral valve ablation, and intestinal interposition.

  3. Benign multiple sclerosis? Clinical course, long term follow up, and assessment of prognostic factors


    OBJECTIVE—To establish the characteristics of patients following a benign course of multiple sclerosis and evaluate the importance of potential prognostic factors. Also, an assessment of the value of the Kurtzke EDSS as a prognostic indicator has been undertaken in patients previously determined to have benign multiple sclerosis, after 10 years of follow up.
METHODS—A prevalence study in the Coleraine, Ballymena, Ballymoney, and Moyle districts of Northern Ireland used th...

  4. A Comparison of four pulpotomy techniques in primary molars: a long-term follow-up.

    Sonmez, Deniz; Sari, Saziye; Cetinbaş, Tuğba


    The study evaluated the effects of formocresol (FC), ferric sulphate (FS), calcium hydroxide (Ca[OH](2)), and mineral trioxide aggregate (MTA) as pulp dressing agents in pulpotomized primary molars. Sixteen children each with at least four primary molars requiring pulpotomy were selected. Eighty selected teeth were divided into four groups and treated with one of the pulpotomy agent. The children were recalled for clinical and radiographic examination every 6 months during 2 years of follow-up. Eleven children with 56 teeth arrived for clinical and radiographic follow-up evaluation at 24 months. The follow-up evaluations revealed that the success rate was 76.9% for FC, 73.3% for FS, 46.1% for Ca(OH)(2), and 66.6% for MTA. In conclusion, Ca(OH)(2)is less appropriate for primary teeth pulpotomies than the other pulpotomy agents. FC and FS appeared to be superior to the other agents. However, there was no statistically significant difference between the groups.

  5. [Importance of long-term follow-up of diabetes insipidus; from lymphocytic hypophysitis to germinoma].

    Amat Madramany, A; Gastaldo Simeón, E; Revert Ventura, A; Escobar Hoyos, L A; Riesgo Suárez, P


    A case is presented of a 10-year old boy who had a hypothalamic-pituitary axis disorder. He initially presented with diabetes insipidus that progressed to panhypopituitarism. A hidden hypothalamic lesion should be suspected in all these cases, and should be followed up. New lesions were found in the pituitary stem three years later. Although tumor markers were negative, there was an increase in size, and a biopsy was performed. The histopathology reported a Lymphocytic Hypophysitis. There were increases in the tumor markers during the follow-up, thus a second biopsy was performed, with the diagnosis of Germinoma. Lymphocytic Hypophysitis is an uncommon diagnosis in children. Few cases have been reported, and in some cases, they were later diagnosed with Germinoma. We believe this case highlights the importance of the follow-up of children with Central Diabetes Insipidus with a normal MRI, as well as not taking the diagnosis of Lymphocytic Hypophysitis/lymphocytic Infundibular neurohypophysitis as definitive, as it is a rare diagnosis at this age, and could mask a Germinoma, as recorded in some cases.

  6. Chronic intestinal pseudo-obstruction: treatment and long term follow up of 44 patients

    Heneyke, S; Smith, V; Spitz, L; Milla, P


    AIMS—To document the long term course of chronic idiopathic intestinal pseudo-obstruction syndrome (CIIPS) in children with defined enteric neuromuscular disease, and the place and type of surgery used in their management; in addition, to identify prognostic factors.
METHODS—Children with CIIPS were investigated and treated prospectively.
RESULTS—Twenty four children presented congenitally, eight during the 1st year of life, and 10 later. Twenty two had myopathy and 16 neuropathy (11 familial). Malrotation was present in 16 patients, 10 had short small intestine, six had non-hypertrophic pyloric stenosis, and 16 had urinary tract involvement. Thirty two patients needed long term parenteral nutrition (TPN): for less than six months in 19 and for more than six months in 13, 10 of whom are TPN dependent; 14 are now enteral feeding. Prokinetic treatment improved six of 22. Intestinal decompression stomas were used in 36, colostomy relieved symptoms in five of 11, and ileostomy in 16 of 31. A poor outcome (death (14) or TPN dependence (10)) was seen with malrotation (13 of 16), short small bowel (eight of nine), urinary tract involvement (12 of 16), and myopathic histology (15 of 22).
CONCLUSIONS—In CIIPS drugs are not helpful but decompression stomas are. Outcome was poor in 24 of 44 children (15 muscle disorder, 10nerve disease).


  7. Long-term follow-up of a patient with achondroplasia treated with an orthodontic approach.

    Mori, Hiroyo; Matsumoto, Kazuma; Kawai, Nobuhiko; Izawa, Takashi; Horiuchi, Shinya; Tanaka, Eiji


    We successfully treated a patient with achondroplasia with conventional orthodontic techniques. It was followed by long-term retention. The patient, a 12-year-old boy, had chief complaints of occlusal disturbance and mandibular protrusion. He had been diagnosed with achondroplasia and had growth hormone treatment in his early teenage years. His facial profile was concave with a bulging forehead and a retrognathic maxilla. It was characterized by a skeletal Class III jaw-base relationship with a retropositioned maxilla. At the age of 12 years 9 months, maxillary protraction was initiated with a reverse headgear; for 2 years 6 months, the maxillomandibular growth was controlled. After the growth spurt, at the age of 15 years 6 months, leveling and alignment of both dental arches were started with preadjusted edgewise appliances. After 83 months of multibracket treatment, an acceptable occlusion with a Class I molar relationship and an adequate interincisal relationship was achieved, despite the simultaneous marked vertical growth of the mandible. The resultant occlusion was stable during a 6-year retention period, although considerable forward-downward mandibular growth was observed. Conclusively, our results indicated the necessity of long-term observation in this patient with achondroplasia, especially because of the persistent mandibular growth. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  8. Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy

    Flávio Ramalho Romero


    Full Text Available Sacroiliac joint (SIJ pain is responsible for up to 40% of all cases of lumbar back pain. Objective Report the long-term efficacy of radiofrequency denervation for sacroiliac joint pain at six, twelve and eighteen months.Method Third-two adults’ patients with sacroiliac join pain diagnosis were included for a prospective study. Primary outcome measure was pain intensity on the Numeric Rating Scale (NRS. Secondary outcome measure was Patient Global Impression of Change Scale (PGIC.Results Short-term pain relief was observed, with the mean NRS pain score decreasing from 7.7 ± 1.8 at baseline to 2.8 ± 1.2 at one month and to 3.1 ± 1.9 at six months post-procedure (p < 0.001. Long-term pain relief was sustained at twelve and eighteen months post-procedure, with NRS pain remaining at 3.4 ± 2.1 and 4.0 ± 2.7, respectively.Conclusion Radiofrequency denervation of the SIJ can significantly reduce pain in selected patients with sacroiliac syndrome.

  9. Long-term use and follow-up of autologous and homologous cartilage graft in rhinoplasty

    Ghasemali Khorasani


    Full Text Available Background: Cartilage grafting is used in rhinoplasty and reconstructive surgeries. Autologous rib and nasal septum cartilage (auto graft is the preferred source of graft material in rhinoplasty, however, homologous cartilage (allograft has been extensively used to correct the nasal framework in nasal deformities. Autologous cartilage graft usage is restricted with complication of operation and limiting availability of tissue for extensive deformities. Alternatively, preserved costal cartilage allograft represents a readily available and easily contoured material. The current study was a formal systematic review of complications associated with autologous versus homologous cartilage grafting in rhinoplasty patients. Methods: In this cohort retrospective study, a total of 124 patients undergone primary or revision rhinoplasty using homologous or autologus grafts with postoperative follow-up ranging from 6 to 60 months were studied. The types of grafts and complications related to the grafts were evaluated. This included evaluation for warping, infection, resorption, mobility and fracture. Results: The total complications related to the cartilage grafts were 7 cases, which included 1 warped in auto graft group, three cases of graft displacement (two in allograft group and one in auto graft group and three fractures in allograft group. No infection and resorption was recorded. Complication rate (confidence interval 0.95 in autologous and homologous group were 1.25(0.4-3.88 and 2.08(0.78-5.55 in 1000 months follow up. There was no statistically significant difference between autologous and homologous group complications. Onset of complication in autologous and homologous group were 51.23(49.27-53.19 and 58.7(54.51-62.91 month respectively (P=0.81. Conclusion: The allograft cartilage has the advantage of avoiding donor-site scar. Moreover, it provides the same benefits as autologous costal cartilage with comparable complication rate. Therefore, it

  10. Castleman's disease in the long term follow-up of a patient with non Hodgkin's lymphoma: An unusual presentation.

    Rajjyoti Das


    Full Text Available Castleman's disease is a benign condition characterized by localized or generalized lymphadenopathy. It is an inherited disorder and usually seen concurrently with lymphomas. We present here a case of multi-centric hyaline vascular type of Castleman's disease detected in the long term follow-up of a patient who was being previously treated for non Hodgkin's lymphoma. In the long term follow-up of patient with lymphomas it can be a cause of lymph node enlargement bearing a clinical resemblance to recurrence of lymphoma. The diagnosis of should be made by a combination of clinical, radiological examination and histopathological examination with immunohistochemistry study. [Natl J Med Res 2014; 4(3.000: 259-261

  11. Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-ups

    SUNDFELD, Renato Herman; SUNDFELD-NETO, Daniel; MACHADO, Lucas Silveira; FRANCO, Laura Molinar; FAGUNDES, Ticiane Cestari; BRISO, André Luiz Fraga


    Superficial irregularities and certain intrinsic stains on the dental enamel surfaces can be resolved by enamel microabrasion, however, treatment for such defects need to be confined to the outermost regions of the enamel surface. Dental bleaching and resin-based composite repair are also often useful for certain situations for tooth color corrections. This article presented and discussed the indications and limitations of enamel microabrasion treatment. Three case reports treated by enamel microabrasion were also presented after 11, 20 and 23 years of follow-ups. PMID:25141208

  12. Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-ups

    Renato Herman SUNDFELD


    Full Text Available Superficial irregularities and certain intrinsic stains on the dental enamel surfaces can be resolved by enamel microabrasion, however, treatment for such defects need to be confined to the outermost regions of the enamel surface. Dental bleaching and resin-based composite repair are also often useful for certain situations for tooth color corrections. This article presented and discussed the indications and limitations of enamel microabrasion treatment. Three case reports treated by enamel microabrasion were also presented after 11, 20 and 23 years of follow-ups.

  13. Radiological long-term follow-up of grafted xenogeneic bone in patients with bone tumors.

    Ozaki, Toshifumi; Inoue, Hajime; Sugihara, Shinsuke; Sumii, Hiroshi


    Radiological findings on the fate of grafted Kiel bone implants for the treatment of bone tumors were evaluated in 25 lesions. The mean follow-up period was 14.8 years, ranging from 5 to 21.8 years. We classified the radiological findings into 4 grades; Excellent (4 lesions), Good (14 lesions), Fair (2 lesions), and Poor (5 lesions). All cases of the Poor grade were polyostotic fibrous dysplasia. The younger the patient at the time of the operation, the more rapidly Kiel bone grafts tended to...

  14. Long-term follow-up of corticosteroid injection for traumatic olecranon bursitis.

    Weinstein, P S; Canoso, J J; Wohlgethan, J R


    Forty-seven patients with traumatic olecranon bursitis were evaluated after a mean follow-up of 31 months (range 6 to 62 months). Twenty-two patients treated with bursal aspiration had delayed recovery and no complications of therapy. Twenty-five patients treated with intrabursal injection of 20 mg of triamcinolone hexacetonide had rapid recovery, usually within one week, but suffered complications such as infection (3 cases), skin atrophy (5 cases), and chronic local pain (7 cases). Since spontaneous resolution can be expected, a conservative approach is suggested in the treatment of traumatic olecranon bursitis. Images PMID:6696516

  15. Long-term follow-up of a pilot project on smoking prevention with adolescents.

    Telch, M J; Killen, J D; McAlister, A L; Perry, C L; Maccoby, N


    Seventh graders (N = 353) in one junior high school received an experimental smoking prevention program aimed at teaching students to resist the social pressures to smoke cigarettes. Seventh graders (N = 217) in another school served as controls. Teams of high-school students trained in basic behavior change skills led seven classroom sessions of instruction in counter-arguing during the school year. Significant differences were found between groups in reported smoking at a 9-month posttest. Results were maintained at 21- and 33-month follow-ups.

  16. Aerobic fitness after JDM--a long-term follow-up study

    Mathiesen, Pernille R; Orngreen, Mette C; Vissing, John


    with JDM. We hypothesized that fitness (VO(2max)) is reduced compared with healthy controls in the years after active JDM. Methods. A maximal exercise test was performed using a cycle ergometer. Results were compared with those of sex- and age-matched healthy controls. Results. A total of 36 patients......Objectives. It has previously been shown that patients with active JDM have decreased aerobic fitness; however, it is not known whether these patients regain their physical fitness after recovery. The objective of this study was to investigate the long-term outcome of aerobic fitness in patients...... with JDM in remission were included, 2-36 years after disease onset. Twelve patients (33%) had normal VO(2max) and 24 patients (67%) had decreased VO(2max). Mean VO(2max) was higher in the healthy controls vs patients (P

  17. Pituitary function following megavoltage therapy for Cushings' disease; long term follow up

    Sharpe, G.F.; Kendall-Taylor, P.; Prescott, R.W.G.; Ross, W.M.; Davison, C.; Watson, M.J.; Cook, D.B. (Royal Victoria Infirmary, Newcastle upon Tyne (UK))


    Eight patients who had received megavoltage therapy for Cushings' disease 5-12 years previously have been reviewed. The long term response to this therapy was assessed with respect to efficacy of treatment in inducing continued remission and disturbance of hypothalamic-pituitary function. One patient showed clear evidence of relapse of Cushings' disease. One patient had unequivocal hypopituitarism. Basal levels of growth hormone (GH), TSH, LH, and FSH were not statistically different from controls, but provocative testing revealed significant abnormalities of response of cortisol/ACTH, GH, prolactin and LH. Six out of eight patients had absent diurnal cortisol variation and five patients had elevated serum prolactin levels. Thus, in this group of patients normal pituitary-adrenal function has not been satisfactorily restored. It is clear that significant disturbances of hypothalamic-pituitary function follow megavoltage therapy and these may progress to overt hypopituitarism.

  18. Long term follow up of serostatus after maternofetal parvovirus B19 infection

    Dembinski, J; Eis-Hubinger, A; Maar, J; Schild, R; Bartmann, P


    Background: Maternofetal parvovirus B19 infection may result in fetal hydrops or abortion. Chronic infection has been associated with long term complications (polyarthritis, persistent aplastic anaemia, hepatitis). In pregnancy maternal immunosuppression caused by a TH2 dominant response to viral antigens has been observed. There is little information on long term reactivity to intrauterine infection. Aims: To assess the serological status in children and their mothers after maternofetal parvovirus B19 infection and development of fetal hydrops. Methods: A total of 18 children and their mothers, and 54 age matched control infants were studied. Main outcome measures were parvovirus B19 DNA, specific IgM and IgG against the virus proteins VP1/VP2, and NS-1 in venous blood. Results: Parvovirus B19 DNA and antiparvovirus B19 (IgM) were undetectable in all sera. A significant larger proportion of maternal sera compared to study children's sera contained IgG against the non-structural protein NS-1. Mean levels of VP1/VP2 IgG antibodies were significantly lower in the children than in their mothers (48 (36) v 197 (95) IU/ml). There was no history of chronic arthritis in mothers and children. Five women had subsequent acute but transient arthritis postpartum, which was not correlated with antibodies against NS-1. Conclusions: Serological evidence of persistent infection after maternofetal parvovirus B19 disease could not be detected. Increased maternal prevalence of anti NS-1 (IgG) and increased levels of antiparvovirus B19 (IgG) may reflect prolonged viraemia compared to fetal disease. PMID:12598382

  19. Stereotactic radiosurgery for vestibular schwannomas: average 10-year follow-up results focusing on long-term hearing preservation.

    Watanabe, Shinya; Yamamoto, Masaaki; Kawabe, Takuya; Koiso, Takao; Yamamoto, Tetsuya; Matsumura, Akira; Kasuya, Hidetoshi


    serviceable hearing before SRS who were followed up, hearing acuity was preserved in 23 (35%). Actuarial serviceable hearing preservation rates were 49%, 24%, and 12% at the 60th, 120th, and 180th post-SRS month, respectively. On univariable analysis, only cystic-type tumor (HR 3.36, 95% CI 1.18-9.36; p = 0.02) was shown to have a significantly unfavorable association with FP. Multivariable analysis followed by univariable analysis revealed that higher age (≥ 65 years: HR 2.66, 95% CI 1.16-5.92; p = 0.02), larger tumor volume (≥ 8 cm(3): HR 5.36, 95% CI 1.20-17.4; p = 0.03), and higher cochlear dose (mean cochlear dose > 4.2 Gy: HR 2.22, 95% CI 1.07-4.77; p = 0.03) were unfavorable factors for hearing preservation. CONCLUSIONS Stereotactic radiosurgery achieved good long-term results in this series. Tumor control was acceptable, and there were few serious complications in patients with small- to medium-sized VSs. Unfortunately, hearing preservation was not satisfactory. However, the longer the observation period, the more important it becomes to compare post-SRS hearing decreases with the natural decline in untreated cases.

  20. Long-term follow-up study on the safety of deep brain stimulation for treating Parkinson's disease

    Xi WU; Jian-chun CHEN; Wan-lu WANG; Hao, Bin; Chen, Xin; Xiao-wu HU


    Objective To evaluate the safety of deep brain stimulation (DBS) for treating Parkinson's disease (PD) under long-term follow-up and modify the surgical procedure. Methods A total of 362 PD patients underwent DBS, and almost 613 electrodes were implanted into these patients. Both surgical and hardware-related complications of DBS were retrospectively analyzed. Results Perioperative complications included postoperative confusion or delirium in 21 cases (5.80%), intracranial hemorrhage i...

  1. Pectus excavatum. A clinical study with long-term postoperative follow-up.

    Morshuis, W J; Mulder, H; Wapperom, G; Folgering, H T; Assman, M; Cox, A L; van Lier, H J; Vincent, J G; Lacquet, L K


    Between 1972 and 1987, 192 patients have been operated upon for pectus excavatum of which 152 patients were included in the study (79%). Mean age at operation was 15.3 +/- 5.5 years; 117 were male. Mean follow-up was 8.1 +/- 3.6 years. The deformity was noted before the age of 5 in 90%. Type I symmetrical and localized deformity was seen in 33.2%, type II symmetrical but diffuse depression in 23.7% and type III localized or diffuse asymmetrical deformity in 43.1%. It was considered severe in 68.9%, fair in 16.9% and mild in 14.2%. There were significantly more asymmetrical defects in the older age groups. The operation consisted of subperichondral chondrectomy, transverse sternotomy and division of the intercostal bundles at the outer limit of the chondrectomy and suturing the edge of this broad sheet of muscle and perichondrium to the anterior surface of the chest wall more laterally and under tension, elevating and stabilizing the sternum. Results were satisfactory in 83.6% (excellent 44.1%, good 39.5%). Results were not significantly influenced by age, sex, severity, type, symmetry, the extent of cartilage resection or follow-up. Results were inversely influenced by the occurrence of wound problems. The optimal age for operation is considered to be between 5 and 10 years. Both physical as well as psychological cosmetic factors may serve as an indication for operation.

  2. Testing for mechanistic interactions in long-term follow-up studies.

    Jui-Hsiang Lin

    Full Text Available In follow-up studies, interactions are often assessed by including a cross-product term in a (multiplicative Cox model. However, epidemiologists/clinicians often misinterpret a significant multiplicative interaction as a genuine mechanistic interaction. Though indices specific to mechanistic interactions have been proposed, including the 'relative excess risk due to interaction' (RERI and the 'peril ratio index of synergy based on multiplicativity' (PRISM, these indices assume no loss to follow up and no competing death in a study. In this paper, the authors propose a novel 'mechanistic interaction test' (MIT for censored data. Monte-Carlo simulation shows that when the hazard curves are proportional to, non-proportional to, or even crossing over one another, the proposed MIT can maintain reasonably accurate type I error rates for censored data. It has far greater powers than the modified RERI and PRISM tests (modified for censored data scenarios. To test mechanistic interactions in censored data, we recommend using MIT in light of its desirable statistical properties.

  3. Long Term Follow-Up in Inferior Alveolar Nerve Transposition: Our Experience

    Giulio Gasparini


    Full Text Available Introduction. Inferior alveolar nerve transposition (IANT is a surgical technique used in implantoprosthetic rehabilitation of the atrophic lower jaw which has not been well embraced because of the high risk of damage to the inferior alveolar nerve (IAN. There are cases in which this method is essential to obtain good morphologic and functional rebalancing of the jaw. In this paper, the authors present their experience with IANT, analyzing the various situations in which IANT is the only surgical preprosthetic option. Methods. Between 2003 and 2011, 35 patients underwent surgical IANT at our center. Thermal and physical sensitivity were evaluated in each patient during follow-up. The follow-up ranged from 14 to 101 months. Results and Conclusion. Based on our experience, absolute indications of IANT are as follows: (1 class IV, V, or VI of Cawood and Howell with extrusion of the antagonist tooth and reduced prosthetic free space; (2 class V or VI of Cawood and Howell with presence of interforaminal teeth; (3 class V or VI of Cawood and Howell if patient desires fast implantoprosthetic rehabilitation with predictable outcomes; (4 class VI of Cawood and Howell when mandibular height increase with inlay grafts is advisable.

  4. Long-term follow-up of children thought to have temporary brittle bone disease

    Paterson CR


    Full Text Available Colin R Paterson1, Elizabeth A Monk21Department of Medicine (retired, 2School of Accounting and Finance, University of Dundee, Dundee, ScotlandBackground: In addition to nonaccidental injury, a variety of bone disorders may underlie the finding of unexplained fractures in young children. One controversial postulated cause is temporary brittle bone disease, first described in 1990.Methods: Eighty-five patients with fractures showing clinical and radiological features of temporary brittle bone disease were the subject of judicial hearings to determine whether it was appropriate for them to return home. Sixty-three patients did, and follow-up information was available for 61 of these. The mean follow-up period was 6.9 years (range 1–17, median 6.Results: We found that none of the children had sustained any further injuries that were thought to represent nonaccidental injury; no child was re-removed from home. Three children had fractures. In each case there was general agreement that the fractures were accidental. Had the original fractures in these children been the result of nonaccidental injury, it would have been severe and repeated; the average number of fractures was 9.1.Conclusion: The fact that no subsequent suspicious injuries took place after return home is consistent with the view that the fractures were unlikely to have been caused by nonaccidental injury, and that temporary brittle bone disease is a distinctive and identifiable disorder.Keywords: fractures, osteogenesis imperfecta, temporary brittle bone disease, nonaccidental injury

  5. Long term follow up of newborns tested with the auditory response cradle.

    Bhattacharya, J; Bennett, M J; Tucker, S M


    The auditory response cradle is being used in a mass hearing screening project. Babies are assessed in the first week after birth by the fully automatic, microprocessor controlled cradle. The test, lasting from two to 10 minutes, compares physiological auditory responses to natural behaviour measured in control trials. More than 5000 babies have been tested and full follow up information at the age of 7 to 9 months is available from over two thirds of these. Less detailed information is available for 71% and 64% of those babies who have been followed up at 18 months and three years of age respectively. A total of 439 of 5553 neonates tested failed the first screening test. Eighty eight (1 X 6%) failed a second screening test while still in the maternity unit but 61 of these were subsequently shown to be normal, giving a false positive rate of 1 X 1%. The babies who failed the screening tests included 9 with sensorineural hearing loss, three with secretory otitis media, and three with abnormal auditory brain stem response tests. One child who passed the initial screening tests was found to have a moderately severe hearing loss at the age of 18 months. Images Figure PMID:6540071

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

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


    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.

  7. Long-term follow-up of beryllium sensitized workers from a single employer

    Curtis Anne M


    Full Text Available Abstract Background Up to 12% of beryllium-exposed American workers would test positive on beryllium lymphocyte proliferation test (BeLPT screening, but the implications of sensitization remain uncertain. Methods Seventy two current and former employees of a beryllium manufacturer, including 22 with pathologic changes of chronic beryllium disease (CBD, and 50 without, with a confirmed positive test were followed-up for 7.4 +/-3.1 years. Results Beyond predicted effects of aging, flow rates and lung volumes changed little from baseline, while DLCO dropped 17.4% of predicted on average. Despite this group decline, only 8 subjects (11.1% demonstrated physiologic or radiologic abnormalities typical of CBD. Other than baseline status, no clinical or laboratory feature distinguished those who clinically manifested CBD at follow-up from those who did not. Conclusions The clinical outlook remains favorable for beryllium-sensitized individuals over the first 5-12 years. However, declines in DLCO may presage further and more serious clinical manifestations in the future. These conclusions are tempered by the possibility of selection bias and other study limitations.

  8. Long-term Follow-up of Kidney Transplant Recipients in the Spare-the-Nephron-Trial.

    Weir, Matthew R; Pearson, Thomas C; Patel, Anita; Peddi, V Ram; Kalil, Roberto; Scandling, John; Chan, Lawrence; Baliga, Prabhakar; Melton, Larry; Mulgaonkar, Shamkant; Waid, Thomas; Schaefer, Heidi; Youssef, Nasser; Anandagoda, Lali; McCollum, David; Lawson, Sibylle; Gordon, Robert


    In the Spare-the-Nephron (STN) Study, kidney transplant recipients randomized about 115 days posttransplant to convert from CNI (calcineurin inhibitor)/MMF to sirolimus (SRL)/MMF had a significantly greater improvement in measured GFR (mGFR) at 12 months compared with those kept on CNI/MMF. The difference at 24 months was not statistically significant. From 14 top enrolling centers, 128 of 175 patients identified with a functioning graft at 2 years consented to enroll in an observational, noninterventional extension study to collect retrospectively and prospectively annual follow-up data for the interval since baseline (completion of the parent STN study at 24 months posttransplant). Overall, 11 patients died, including 5 (7.6%) in the SRL/MMF group and 6 (9.7%) in the CNI/MMF group. Twenty-two grafts have been lost including 10 (15.2%) in the SRL/MMF arm and 12 (19.4%) in the CNI/MMF arm. Death and chronic rejection were the most common causes of graft loss in both arms. There were modestly more cardiovascular events in the MMF/SRL group. Estimated creatinine clearance (Cockcroft-Gault) from baseline out to 6 additional years (8 years posttransplant, ITT analysis, SRL/MMF, n = 34; CNI/MMF, n = 26) was 63.2 ± 28.5 mL/min/1.73 m in the SRL/MMF group and 59.2 ± 27.2 mL/min/1.73 m in the CNI/MMF group and was not statistically significant, but there is a clinically meaningful trend for improved long-term renal function in the SRL/MMF group compared with the CNI/MMF group. The long-term decision for immunosuppression needs to be carefully individualized.

  9. Reconstruction of neglected achilles tendon ruptures with gastrocnemius flaps: excellent results in long-term follow-up.

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


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

  10. Behcet disease: long-term follow-up of three children and review of the literature.

    Rakover, Y; Adar, H; Tal, I; Lang, Y; Kedar, A


    Behcet disease is rare in children. There are only two reports of Behcet disease in childhood, describing seven patients. Three pediatric patients are described, in whom the age of onset ranged from 6 to 11 years. Aphthous stomatitis and arthritis were present in all of the patients; genital ulcers, iridocylitis, erythema nodosum, and CNS involvement were present in two patients. Other manifestations included Stevens-Johnson-like eruption, fever of unknown origin, and testicular involvement. All of the patients responded to glucocorticoids; two were also treated with colchicine and one was treated with chlorambucil. In two patients, follow-up of more than 10 years was done, with complete cure in one patient and benign course of illness in the other. Because of the rarity of the disease in childhood and the difficulty in making the diagnosis, there is not enough awareness by pediatricians concerning this disease.

  11. Brain abscesses in neonates: Neurosonographic diagnosis and long-term follow-up

    Obradović Slobodan


    Full Text Available Brain abscesses were neurosongraphically diagnosed in 3 out of 44 neonates who had confirmed purulent meningitis. In two cases, the cause was Proteus mirabillis, whereas in one the cause could not be isolated. The ultrasound finding indicated abscess cavities localized in the frontal (in one case bilaterally and temporal regions of the CNS. Neurosurgical interventions were carried out on all of the neonates who had abscesses (including the evacuation of purulent cavity contents, and later on a ventriculoperitoneal shunt in two cases, because of the development of hydrocephalus. Follow-up on the operated infants revealed that one infant died at the age of 9 months; one, who had a bilateral abscess, demonstrated significant neurodevelopmental retardation in the third month of his life (so far it has not been brought under control; while the third one, whom we monitored until the age of 2, displayed regular psychomotor development (preserved intellect, motor skills, sight, and hearing.

  12. The Darrach procedure defended: technique redefined and long-term follow-up.

    Tulipan, D J; Eaton, R G; Eberhart, R E


    Thirty-three patients with pain and decreased range of motion after traumatic derangement of the distal radioulnar and ulna-carpal joint were treated with a modified Darrach distal ulnar resection. Their ages ranged from 22 to 75 years (average, 50 years). Twenty-seven patients had Colles' or other distal radius fractures. Seven patients had ulnar resection for treatment of distal ulnar-carpal derangement. Follow-up averaged 54.4 months. The patients showed an average increase in extension of 58% and flexion increased by 40% (p less than 0.01). Pronation increased by 40% and supination increased by 60% (p less than 0.01). Average grip strength increased by 38% (p less than 0.05). Ninety-one percent good or excellent results were achieved with this procedure. The Darrach resection can predictably provide pain relief while improving strength and motion when attention is paid to minimal bony resection and meticulous soft tissue reconstruction.

  13. Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients.

    Ortega-García, Juan Antonio; Perales, Joseph E; Cárceles-Álvarez, Alberto; Sánchez-Sauco, Miguel Felipe; Villalona, Seiichi; Mondejar-López, Pedro; Pastor-Vivero, María Dolores; Mira Escolano, Pilar; James-Vega, Diana Carolina; Sánchez-Solís, Manuel


    This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF.

  14. Chronic abdominal pain in long-term spinal cord injury: a follow-up study

    Nielsen, Steffen D; Faaborg, Pia Møller; Christensen, Peter


    -reported constipation. The median intensity (numeric rating scale) was 6.0 (range 3-10) and it was often associated with autonomic symptoms. Nine (8%) of the 115 individuals who responded in both 2006 and 2015 had developed new abdominal pain or discomfort, 30 (26%) no longer reported it, and 28 (24%) reported......A longitudinal postal survey was carried to evaluate the prevalence and characteristics of abdominal pain in long-term spinal cord injury (SCI). In 2006, a questionnaire on chronic abdominal pain and discomfort was sent to the 284 members of the Danish SCI association who had been members...... abdominal pain. The mean time since injury was 30.5 (9.8) years. Chronic abdominal pain or discomfort was reported by 32.8% (41/125), and 23% (29/125) of responders had been at least moderately bothered by this in the past week. Abdominal pain or discomfort was more common in women and in those with self...

  15. Long-term follow-up and treatment of congenital alveolar proteinosis

    Muensterer Oliver J


    Full Text Available Abstract Background Clinical presentation, diagnosis, management and outcome of molecularly defined congenital pulmonary alveolar proteinosis (PAP due to mutations in the GM-CSF receptor are not well known. Case presentation A 2 1/2 years old girl was diagnosed as having alveolar proteinosis. Whole lung lavages were performed with a new catheter balloon technique, feasible in small sized airways. Because of some interstitial inflammation in the lung biopsy and to further improve the condition, empirical therapy with systemic steroids and azathioprin, and inhaled and subcutaneous GMCSF, were used. Based on clinical measures, total protein and lipid recovered by whole lung lavages, all these treatments were without benefit. Conversely, severe respiratory viral infections and an invasive aspergillosis with aspergilloma formation occurred. Recently the novel homozygous stop mutation p.Ser25X of the GMCSF receptor alpha chain was identified in the patient. This mutation leads to a lack of functional GMCSF receptor and a reduced response to GMCSF stimulation of CD11b expression of mononuclear cells of the patient. Subsequently a very intense treatment with monthly lavages was initiated, resulting for the first time in complete resolution of partial respiratory insufficiency and a significant improvement of the overall somato-psychosocial condition of the child. Conclusions The long term management from early childhood into young adolescence of severe alveolar proteinosis due to GMCSF receptor deficiency requires a dedicated specialized team to perform technically demanding whole lung lavages and cope with complications.

  16. Lead Fractures in Deep Brain Stimulation during Long-Term Follow-Up

    Fernando Seijo Fernández


    Full Text Available The purpose was to determine the incidence of lead fracture in patients with DBS over a long period of time. We present a retrospective study of 208 patients who received 387 DBS electrodes. Fourteen patients had sixteen lead fractures (4% of the implanted leads and two patients suffered from 2 lead fractures. Of all lead fractures, five patients had the connection between the leads and the extension cables located in mastoids region, ten in cervical area and one in thoracic region. The mean distance from the connection between the electrode and the extension cable and the lead fracture was 10.7 mm. The lead fracture is a common, although long-term complication in DBS surgery. In our experience, the most common site of electrode cable breakage is approximately between 9 and 13 mm from the junction between the lead and the extension cable. The most important cause of lead fracture is the rotational movement of the lead-extension cable system. If we suspect lead fracture, we must check the impedance of the electrode and to evaluate the side effects of voltage. Finally, we must conduct a radiological screening.

  17. Diet and pump-treated diabetes: a long-term follow-up.

    Chantelau, E A; Bockholt, M; Lie, K T; Broermann, C; Sonnenberg, G E; Berger, M


    Long-term effects of a liberalized diabetes diet without meal-planning and food-exchange were investigated in lean type-I diabetic patients treated by continuous subcutaneous insulin infusion (CSII). Food intake, body weight, HbA1c levels and serum lipids were recorded during conventional s.c. insulin injection treatment (CIT) and after 1 month or 14 months of CSII, respectively. During CSII plus liberalized diet, metabolic control improved significantly (compared to previous CIT plus conventional diet) as indicated by a decrease of HbA1c from 9.5% to 7.9% (p less than 0.005). Serum lipids remained unchanged. Body weight did not change significantly during CSII plus liberalized diet; mean body mass index increased from 21.5 to 22.4 kg/m2 (CIT vs. CSII, n.s.). During CSII, eating habits were similar to those of the general West Germany population regarding the number of meals and the nutrients composition. We conclude that during CSII, meal-planning and food-exchange that during CSII, meal-planning and food-exchange can be omitted provided the patients maintain (near-) normoglycaemia by appropriately adjusting the s.c. insulin delivery. Lean type-I diabetics on CSII do not require specific restrictions as to their caloric intake in order to prevent weight gain.

  18. A long-term follow-up of weight changes in subthalamic nucleus stimulated Parkinson's disease patients.

    Foubert-Samier, A; Maurice, S; Hivert, S; Guelh, D; Rigalleau, V; Burbaud, P; Cuny, E; Meissner, W; Tison, F


    Deep brain stimulation of the subthalamic nucleus (STN-DBS) constitutes the mainstay treatment in advanced Parkinson's disease (PD) with motor fluctuations. Despite its efficacy on motor signs and quality of life, emergent adverse events have been recently reported. Among them, weight gain (WG) is a recognized adverse event of subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD). Also, WG is poorly known at the long-term and predisposing factors have not yet been identified. We conducted a cross-sectional study of WG in 47 STN-DBS PD patients between 1999-2006. Data on disease history, motor status and dopaminergic drug treatment were retrospectively collected at surgery and 1 year post-surgery. Weight at disease diagnosis and at surgery, as well as the current weight and height were gathered by an autoquestionnaire. Moreover, the weight before surgery was obtained and verified in medical files in more than 90% of our patients. Sixty-six patients who underwent surgery between 1999-2006 were included, but six were deceased, four refused to participate and nine were lost for follow-up. So, 47 (71%) were retained in our analysis. A total of 78.7% of patients gained weight. On average 4.7 years follow up after surgery, the mean weight gain was +7.2±8.1kg compared to the preoperative assessment (p<0.001) and the mean BMI gain was +2.7±3.0kg/m(2) compared to pre-surgery values (p<0.001). The patients gained more weight after surgery than they had lost during disease evolution before surgery. Women and patients with a more severe UPDRS-III "off" drug score before surgery significantly gained more weight. Our study provides further evidence that the WG is a problem after STN-DBS and concerns a majority of patients at the long term. It may expose them to complications that should be considered for prevention and the patient's information before surgery.

  19. Long-term follow-up results and radiographic findings of anterior surgery with Cloward trephination for cervical spondylotic myelopathy.

    Xu, Bao-Shan; Zhang, Zuo-Lun; Le Huec, Jean-Charles; Xia, Qun; Hu, Yong-Cheng


    Serial retrospective long-term follow-up study. To assess the long-term results of anterior surgery with Cloward trephination and iliac strut grafting for cervical spondylotic myelopathy. Anterior surgery remains the most common surgical option and generally gives good results, although early and late deterioration after initial postoperative improvement has been noted. Although anterior decompression with trephination is a variant of the Cloward technique, little information is available concerning the long-term results after this procedure. One hundred sixty-eight consecutive patients treated with this technique by the same author from the years 1978 to 1992 were followed serially. One hundred and seven patients were followed for over 10 years (mean: 14.1 y) (follow-up rate: 71.8%). Clinical results were evaluated according to the Japanese Orthopedic Association system and the results at different postoperative intervals were analyzed. Thirty-six patients returned for the final follow-up. Plain radiographs were taken in neutral and flexion-extension positions and computed tomography scans were taken at fused segments and unfused levels. The mean recovery rate was 56.8% at final follow-up. Deterioration of 2 Japanese Orthopedic Association points or more was experienced in 44 patients at various postoperative periods and was more frequent at over 10 years follow-up. Kyphosis of fused segments was noted frequently on the radiographies of the 36 patients with a mean of 7.8 degrees. A straight or misaligned cervical spine was found in 28 (77.8%) patients and these deformities were more serious in multilevel fusions. Stenosis of the canal at fused segments was found in 15 (41.7%) patients owing to osteogenesis resulting from inadequate decompression or pseudoarthrosis. At unfused levels, the incidence of spondylolisthesis, bony bridge, disc hernia, and thickening or bulging of the ligament flavum was 19.4%, 27.8%, 33.3%, 19.4%, respectively, and these abnormalities

  20. Interactions among DUI offender characteristics and traditional intervention modalities: a long-term recidivism follow-up.

    Wells-Parker, E; Anderson, B J; McMillen, D L; Landrum, J W


    Using long-term DUI (Driving Under the Influence of Alcohol) arrest recidivism data from a controlled study of DUI intervention effectiveness, interactions among DUI interventions, age, race, education, and alcohol severity were estimated using logit analysis. Data were collected in a 9-year follow-up study of the Mississippi DUI Probation Project. The effects of short-term interventions (alcohol education schools for low alcohol severity offenders and structured group interventions for high alcohol severity offenders) were specified by educational level. Short-term rehabilitation was modestly effective for those with less than 12 years of education, but less effective or detrimental for the more highly educated. The effects of probation were specified by age and education, being more effective for those under 30 years and 55 years or older than for the middle age group. Probation was most effective for well-educated older (55+) offenders. An analysis of the under 30 years group also suggested that probation was especially effective for young well-educated Minority offenders.

  1. Dental Implants in the Elderly Population: A Long-Term Follow-up.

    Compton, Sharon M; Clark, Danielle; Chan, Stephanie; Kuc, Iris; Wubie, Berhanu A; Levin, Liran

    The objectives of this study were to evaluate implant survival and success in the elderly population and to assess indicators and risk factors for success or failure of dental implants in older adults (aged 60 years and older). This historical prospective study was developed from a cohort of patients born prior to 1950 who received dental implants in a single private dental office. Implant survival and marginal bone levels were recorded and analyzed with regard to different patient- and implant-related factors. The study examined 245 patient charts and 1,256 implants from one dental clinic. The mean age at the time of implant placement was 62.18 ± 8.6 years. Smoking was reported by 9.4% of the cohort studied. The overall survival rate of the implants was 92.9%; 7.1% of the implants had failed. Marginal bone loss depicted by exposed threads was evident in 23.3% of the implants. Presenting with generalized periodontal disease and/or severe periodontal disease negatively influenced the survival probability of the implant. Implants placed in areas where bone augmentation was performed prior to or during implant surgery did not have the same longevity compared with those that did not have augmentation prior to implantation. The overall findings concluded that implants can be successfully placed in older adults. A variety of factors are involved in the long-term success of the implant, and special consideration should be taken prior to placing implants in older adults to limit the influence of those risk factors.

  2. Neonatal hypertension – a long-term pilot follow-up study

    Chaudhari T


    Full Text Available Tejasvi Chaudhari,1 Michael C Falk,2,3 Rajeev Jyoti,2,4 Susan Arney,5 Wendy Burton,5 Alison L Kent1,2 1Department of Neonatology, Canberra Hospital, Woden, ACT, Australia; 2Australian National University Medical School, Canberra, ACT, Australia; 3Department of Nephrology, 4Medical Imaging Department, 5Centre for Newborn Care, Canberra Hospital, Woden, ACT, Australia Background: Neonatal hypertension occurs in up to 3% of neonates, more commonly in those admitted to neonatal intensive care. The aims of this study were to review renal function and renal volumes in children who had a history of neonatal hypertension. Methods: Children with a history of neonatal hypertension from January 2001 to December 2008 were included in the study during 2011. Blood pressure, weight, height, and body mass index were recorded. Renal ultrasound with 3D volume, urine for electrolytes, albumin, ß2 microglobulin, and blood for electrolytes, urea, creatinine, calcium, phosphate, renin, and aldosterone were collected depending on parental consent. Results: Of the 41 neonates with neonatal hypertension, eleven (27% were included in the study (six died; 24 moved interstate or declined involvement. One child (9% was still on antihypertensive medication and one was found to be hypertensive on review. This child had small volume kidneys and albuminuria. Three out of nine renal volume measurements were low (33% and two out of eleven had renal scarring (18%. The six available renin/aldosterone results were normal. Conclusion: This study suggests there are long-term renal and blood pressure implications for neonates with hypertension and ongoing surveillance of blood pressure and renal function should be performed throughout childhood and into early adulthood. Keywords: neonate, hypertension, renal ultrasound, 3D

  3. Congenital cloaca: Long-term follow-up results with emphasis on outcomes beyond childhood.

    Rintala, Risto J


    Persistent cloaca remains a challenge for pediatric surgeons and urologists. Reconstructive surgery of cloacal malformations aims to repair the anorectum, urinary tract, and genital organs, and achieve fecal and urinary continence as well as functional genital tract capable for sexual activity and pregnancy. Unfortunately, even in most experienced hands these goals are not always accomplished. The endpoint of the functional development of bowel, urinary, and genital functions is the completion of patient's growth and sexual maturity. It is unlikely that there will be any significant functional improvement beyond these time points. About half of the patients with cloaca attain fecal and urinary continence after their growth period. The remaining half stay clean or dry by adjunctive measures such as bowel management by enemas or ACE channel, and continent urinary diversion or intermittent catheterization. Problems related to genital organs such as obstructed menstruations, amenorrhea, and introitus stenosis are common and often require secondary surgery. Encouragingly, most adolescent and adult patients are capable of sexual life despite often complex vaginal primary and secondary reconstructions. Also, cloacal malformation does not preclude pregnancies, although they still are quite rare. Pregnant patients with cloaca require special care and follow-up to guarantee uncomplicated pregnancy and preservation of anorectal and urinary functions. Cesarean section is recommended for cloaca patients. The self-reported quality of life of cloaca patients appears to be comparable to that of female patients with less complex anorectal malformations. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Long-term follow-up of a case of gilles de la tourette's syndrome

    Soumitra Das


    Full Text Available Gilles de la Tourette's syndrome is a combined vocal and multiple motor tic disorder. Here, we present a case of Tourette's syndrome who attended our psychiatric causality with severe depression and suicidal ideation. On reviewing follow-up records of 23 years, we come to know about the academic decline and nicotine dependence in the early childhood. He also developed co-morbid obsessive compulsive disorder (OCD along with severe depression. He was agitated and self-injurious. We diagnosed him as Gilles de la Tourette's syndrome with co-morbid OCD, depression, nicotine dependence. The patient was treated with haloperidol, sertraline, and clonidine when he developed mixed switch that necessitated us to stop sertraline. Hence, he was treated with a mood stabilizer and he remitted. Here, we want to show how Tourette's syndrome can take a longer course with different co-morbidities in a single person's life. As per our knowledge, such presentation is relatively rare in Indian literature.

  5. Long-term Computed Tomography Follow-up After Open Surgical Repair of Abdominal Aortic Aneurysms

    Mantoni, M.; Neergaard, K.; Christoffersen, J. K.; Lambine, T.L.; Baekgaard, N. [Gentofte Univ. Hospital (Denmark). Depts. of Radiology and Vascular Surgery


    Purpose: To describe the findings on computed tomography (CT) of the aortic sac (AS) in patients operated on for abdominal aortic aneurysm (AAA) with insertion of a coated Dacron prosthesis. Material and Methods: A prospective study of 36 consecutive patients operated on for AAA over 2 years and followed longitudinally with CT for up to 10 years. Results: All patients had a fluid-filled AS on CT 7-10 days postoperatively. At 6 months, the AS had decreased in most patients, mainly in the antero-posterior diameter, and in two had disappeared completely. In five patients with complications, the AS increased in size. The AS disappeared completely at 10 years' follow-up in 13 patients. When present, a retroperitoneal hematoma always disappeared after 6 months. Conclusion: These data indicate that the AS after graft implantation will diminish gradually but will persist for at least 6 months. Usually the transverse diameter is bigger than the antero-posterior diameter. If the AS enlarges and becomes rounded and distended with an inhomogeneous interior, it might be a sign of graft infection. In these cases an ultrasound-guided or CT-guided puncture is recommended.

  6. Transoral outlet reduction for weight regain after gastric bypass: long-term follow-up.

    Kumar, Nitin; Thompson, Christopher C


    Dilated gastrojejunal anastomosis aperture is associated with weight regain after Roux-en-Y gastric bypass (RYGB). Transoral outlet reduction (TORe) has proved safe and effective for the treatment of weight regain. The objective of this study was to determine the long-term weight trend and number needed to treat for TORe. This prospective series included consecutive post-RYGB patients with weight regain and a gastrojejunal anastomosis aperture greater than 15 mm. TORe was performed with a full-thickness endoscopic suturing device. A total of 150 patients who had regained 49.9% ± 3.6% of the weight lost after gastric bypass (4.1 ± 0.3 kg/y after nadir) before TORe. At TORe, body mass index was 40.2 ± 0.8 kg/m(2) and weight was 110.7 ± 2.2 kg. At 1 year, weight loss was 10.5 ± 1.2 kg or 24.9 ± 2.6% excess weight loss (EWL); at 2 years, weight loss was 9.0 ± 1.7 kg or 20.0% ± 6.4% EWL; at 3 years, weight loss was 9.5 ± 2.1 kg or 19.2% ± 4.6% EWL. The number needed to treat for arrest of weight regain was 1.0 at 6 months, 1.1 at 1 year, and 1.2 at 2 and 3 years. The number needed to treat to maintain weight loss of ≥5 kg from TORe was 1.2 at 6 months, 1.5 at 1 year, 1.9 at 2 years, and 2.0 at 3 years. TORe safely and effectively arrested weight regain and provided durable weight loss with a low number needed to treat. Patients with weight regain after RYGB should be evaluated for dilation of the gastrojejunal anastomosis, as TORe can be part of a multidisciplinary strategy to address post-RYGB weight regain. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  7. Prognosis of Adamantinoma of Long Bones: A Long-Term Follow-Up Study

    Khodamorad Jamshidi


    Full Text Available Background Adamantinoma of long tubular bones is a rare primary malignant bone tumor. According to the literature, different prognosis and recurrence rates have been reported. Objectives The purpose of this case series study was to evaluate the clinical behavior and prognostic features of adamantinoma of long bones. Patients and Methods In this study, 13 histologically proven cases of adamantinoma of long bones which were treated in our hospital during March 1977 to June 2015 were evaluated. The mean follow-up period was 72 ± 44.4 months. The male:female ratio was 10:3, aged between 13 and 63 years at the time of diagnosis (mean = 24.8 ± 13.1 years. There was a period between the onset of disease and definite diagnosis (mean: 17.5 ± 14.7 months. In two cases according to the imaging and clinical symptoms the lesion seemed to be osteofibrous dysplasia, but during the follow-up, the diagnosis was changed to adamantinoma when open biopsy and pathologic assessment were performed. In 10 cases the tumor was located in the tibial diaphysis, in two cases the location was the distal shaft of the femur, and in one case the location was proximal of the humerus. All the cases underwent wide resection and intercalary or osteoarticular allograft reconstruction as the main surgery after primary incisional biopsy. Results In eight cases, at least one local recurrence happened in an average 33.4-month period after the wide resection. In four of these patients rather than one local recurrence was occurred, but in one patient despite pulmonary metastasis the patient underwent pulmonary lobectomy and was alive at the end of the study. Allograft-related complications happened in five cases (two infections, one osteoarthritis of ankle, and two allograft fractures. For five patients ultimately recurrence and complication lead to amputation. Six patients died because of this disease, in all of which pulmonary metastasis occurred. The five-year survival rate in this


    F. Scipioni


    Full Text Available Duplex system is a duplication of renal parenchyma, pelvis and collecting system. It could be complete, if ureters lead to bladder separately or incomplete, if they joint before coming out. This study aims duplex system management evaluation, defining indications of conservative or demolitive therapy, and results. Materials and methods. At the section of pediatric surgery of University of Siena we have observed 27 patients with duplex system from January 1980 to May 2011: 7 male (26% and 20 female (74%, 18 (67% with complete duplicity, 9 (33% with incomplete one. Patients were divided into 2 groups: the first one was composed by 12 children (44%, they had negative diagnostic exams for alterations of renal function and associated diseases and no symptoms;the second group had 15 children (56% whose diagnostic-therapeutic iter was based on associated malformations and symptoms of each case. We found: 5 RVU (33% with 1 Hutch diverticulum; 5 ureteroceles (33%; 3 ectopic ureters (20%; 4 megaureters (26%, 6 renal dysplasia and upper pole function <10% (40%. Results. Children belonging to second group were treated in different ways. 5 babies (33% with RVU were approached with submeatal infiltration; 1 baby (7% with ureterocele was treated with excision of the malformation and Cohen reimplatation; 2 ureteroceles (13% were incised by transurethral approach and RVU appeared, 1 of them was then treated with eminephroureterectomy; in 1 case of ureterocele (7%and 1 of ectopic ureter (7% no treatment was undertaken and 1 baby with ureterocele (7% needed eminephoureterectomy; 4 kidneys (26% with upper pole impaired function required em- inephroureterectomy. All second group patients, except 3, had a 2-16 years follow-up and they showed normal growth and no symptoms. First group children had negative exams and excellent clinic conditions. Conclusions. Our results suggest that management should be decided on patient’s age, clinic presentation and associated

  9. Long-term follow-up of exhibitionists: psychological, phallometric, and offense characteristics.

    Firestone, Philip; Kingston, Drew A; Wexler, Audrey; Bradford, John M


    Exhibitionism has historically been viewed as more of a nuisance than a serious criminal justice matter. Research has demonstrated that the number of exhibitionists who are detected re-offending is a significant under-representation of the number who actually re-offend. The objective of this study was to extend a previous study conducted on exhibitionists, while attempting to solve the limitations described in that study. Two hundred eight exhibitionists were assessed at a university teaching hospital between 1983 and 1996. Archival data were derived from police and medical files. Results indicated that, over a mean follow-up period of 13.24 years, 23.6, 31.3, and 38.9 percent of exhibitionists were charged with or convicted of sexual, violent, or criminal offenses, respectively. Undoubtedly, this is an under-representation of the true rate, as we have no way of knowing how many exhibitionists re-offended and did not get caught. Nevertheless, in the present investigation, sexual recidivists compared with non-recidivists were less educated, scored higher on the Michigan Alcohol Screening Test (MAST), the Psychopathy Checklist, Revised (PCL-R), and the Pedophile Index. Violent recidivists were also less educated and scored higher on the MAST, PCL-R, and the Pedophile Index, and had accumulated a greater number of prior violent or criminal charges and/or convictions. Criminal recidivists were less educated; scored higher on the MAST, Buss-Durkee Hostility Inventory (BDHI), PCL-R, and Pedophile Index; and had accumulated a greater number of prior sexual, violent, and criminal offenses. Finally, the hands-on sexual recidivists accumulated a greater number of prior violent and criminal charges and or convictions than did the hands-off sexual recidivists.

  10. Multidisciplinary approach and long-term follow-up in a series of 640 consecutive patients with sarcoidosis

    Mañá, Juan; Rubio-Rivas, Manuel; Villalba, Nadia; Marcoval, Joaquim; Iriarte, Adriana; Molina-Molina, María; Llatjos, Roger; García, Olga; Martínez-Yélamos, Sergio; Vicens-Zygmunt, Vanessa; Gámez, Cristina; Pujol, Ramón; Corbella, Xavier


    radiograph were indicators of good outcome. Sarcoidosis is a multisystem disease with protean clinical-radiographic manifestations. Although almost half of patients follow a spontaneous resolution or under treatment, a significant number of them may have several degrees of organ damage. This study emphasizes the value of a multidisciplinary approach and long-term follow-up by specialized teams in sarcoidosis. PMID:28723801

  11. Treatment of Chronic Hepatitis B with Interferon: Long Term Follow-Up

    Jean-Pierre Villeneuve


    Full Text Available The aim of treatment of chronic hepatitis B with interferon is to induce a transition from the replicative phase of the disease to a nonreplicative state, with loss of hepatitis B virus (HBV-DNA, seroconversion from hepatitis B e antigen (HBeAg-positive to anti-HBe antibody-positive, and normalization of liver enzymes. The authors’ experience in 22 patients with chronic hepatitis B treated with recombinant human interferon alpha-2b (5 MU/m2 subcutaneously three times/week for 16 weeks is reported. Before treatment all patients had been positive for hepatitis B surface antigen (HBsAg and HBeAg for at least six months, had abnormal serum aminotransferases, had no evidence of hepatitis D or human immunodeficiency virus (HIV infection and had compensated liver disease. Eleven of 22 patients (50% responded to treatment with loss of HBeAg and appearance of anti-HBe antibodies, and normalization of serum aminotransferases within six months of interferon cessation. Patients were followed for 3.4±1.2 years after treatment. Ten of 11 responders remained negative for HBeAg and HBV-DNA; one patient relapsed and responded to a second course of interferon with loss of HBeAg and HBV-DNA. Seven of the 11 nonresponders underwent spontaneous (n=5 or retreatment-induced (n=2 seroconversion from HBeAg to anti-HBe and loss of HBV-DNA during follow-up. The other four nonresponders remained positive for HBeAg and HBV-DNA; three of the four progressed to decompensated liver disease. It is concluded that interferon is an effective treatment of chronic hepatitis B in 50% of patients with features similar to those used as selection criteria in the present study. These criteria probably also identify patients who have a high likelihood of spontaneous HBeAg to anti-HBe seroconversion, and it is possible that the benefit of interferon is its acceleration of this seroconversion.

  12. Long-term follow-up of febrile infection-related epilepsy syndrome.

    Howell, Katherine B; Katanyuwong, Kamornwan; Mackay, Mark T; Bailey, Catherine A; Scheffer, Ingrid E; Freeman, Jeremy L; Berkovic, Samuel F; Harvey, A Simon


    Febrile infection-related epilepsy syndrome (FIRES) is an increasingly recognized epileptic syndrome that presents with multifocal refractory status epilepticus in previously normal children and evolves into a chronic, refractory, focal epilepsy with associated cognitive and behavioral difficulties. Herein we describe the features of the chronic epilepsy and critically review evidence for the etiology of this syndrome. Seven patients with FIRES were studied. The duration of follow-up in six survivors was 5-17 years. Clinical, electroencephalography (EEG), neuroimaging, and other investigative findings during the acute and chronic phases were reviewed. These previously normal children presented with a febrile illness and status epilepticus that was refractory to antiepileptic medications in all children, to immunotherapies (including immunoglobulin, corticosteroids, plasma exchange, and rituximab) in four, and to acute vagus nerve stimulation in one. Markers of cerebral inflammation were few and response to antiepileptic and immunomodulatory therapies was poor. Evolution to chronic epilepsy occurred without a silent period. Seizure characteristics in the chronic phase were strikingly stereotyped and similar to the acute phase, with head and eye version, unilateral facial jerking, asymmetric tonic posturing, and unilateral limb jerking in all patients. Electrographic ictal onset was lateralized in all recorded seizures, unilateral in one patient, and independent bilateral in three. Seizures were refractory to multiple antiepileptic medications in all patients and partly responsive to chronic vagus nerve stimulation in two patients. Moderate to severe intellectual impairment was noted in four patients, and borderline intellectual abilities were noted in two. Magnetic resonance imaging (MRI) in the chronic phase was normal in three patients and showed mild diffuse cortical atrophy and/or mild hippocampal atrophy or sclerosis in three. The similar perirolandic and

  13. Percutaneous therapy of low stage and grade urothelial neoplasia: long-term follow up.

    Montanari, Emanuele; Del Nero, Alberto; Bernardini, Paolo; Mangiarotti, Barbara; Confalonieri, Silvia; Grisotto, Massimo; Cordima, Giovanni


    Nephroureterectomy with the excision of the ipsilateral ureteral orifice and bladder cuff has been considered the standard treatment of the urinary upper transitional cell carcinoma. With the advent of sophisticated techniques for the endo-urologic management of many benign urologic diseases of the upper tract, there has been growing enthusiasm for the application of these same techniques in the management of upper tract TCC, which is also supported by recent advances in the development of small calibre telescopes with improved optics and the development of small calibre adjunctive instruments and laser fibers. A large number of cases published in the literature has confirmed the safety and efficacy of percutaneous treatment in selected patients with upper tract TCC of low grade and stage. Between 1997 and 2005 we treated 62 pts (37 pelvic transitional cell carcinoma and 25 ureteral). 4 pts (5 renal units: 4 T1G2 and 1 TaG1) underwent percutaneous resection for a tumor in a solitary kidney (2 cases), one case for bilateral neoplasm, and in the other case the lesion was unilateral with chronic renal failure. After preoperative evaluation, (excretory urography, computerized tomography and ureteroscopy with biopsy to confirm the low stage and grade of the lesion) the tumor was resected using an Amplatz sheat of 26-30 Fr and a 24 Fr resectoscope to keep a low intra-caliceal pressure. The tumor base was biopsied and fulgurated After 48 h, contrastography to assure integrity of the urinary system was performed and Mitomycin C was infused over 24 h. Second-look nephroscopy with multiple biopsies was performed in all cases 7 days later and 8 Ch nephrostomy was placed. If the biopsies resulted negative the patient was submitted to 6 weekly endocavitary instillation of BCG through the nephrostomy tube. All pts at a mean follow up of 71 months were tumor free. One patient presented a bladder relapse after 83 months. No complication of percutaneous resection was observed. The

  14. Long-Term Follow-Up Evaluation of Renal Function in Patients with Chronic Kidney Disease Undergoing Cardiac Surgery

    Eduesley Santana-Santos


    Full Text Available Background. Acute kidney injury (AKI is a common complication of cardiac surgery but its long-term consequences, in patients with chronic kidney disease (CKD, are not known. Methods. We compared the long-term prognoses of CKD patients who developed (n=23 and did not develop (n=35 AKI during the period of hospitalization after undergoing coronary artery bypass graft (CABG. Fifty-eight patients who survived (69.6±8.4 years old, 72% males, 83% Whites, 52% diabetics, baseline GFR: 46±16 mL/min were followed up for 47.8±16.4 months and treated for secondary prevention of events. Results. There were 6 deaths, 4 in the AKI+ and 2 in the AKI− group (Log-rank = 0.218, two attributed to CV causes. At the end of the study, renal function was similar in the two groups. One AKI− patient was started on dialysis. Only 4 patients had an increase in serum creatinine ≥ 0.5 mg/dL during follow-up. Conclusion. CKD patients developing AKI that survived the early perioperative period of coronary intervention present good renal and nonrenal long-term prognosis, compared to patients who did not develop AKI.

  15. 立体定向手术治疗海洛因依赖的远期随访分析%A long-term follow-up analysis of stereotactic surgery for heroin dependence

    周连银; 唐运林; 汪鲁刚; 张奕生; 刘刚; 徐越; 潘香; 蔡美玲


    目的 评估立体定向毁损术治疗海洛因依赖的手术疗效,分析术后复吸原因.方法 回顾性分析接受脑立体定向术的154例海洛因成瘾者的临床资料,采用症状自评量表对病人精神卫生状况进行调查随访.结果 随访154例,时间5~6年,其中复吸52例(33.8%,复吸组),未复吸102例(66.2%,未复吸组).复吸组术后躯体化、强迫症状、敌对、偏执、精神病性等因子明显高于未复吸组和国内常模(均P<0.05).结论 立体定向手术是海洛因依赖的安全有效的治疗方法.强迫症状和人格障碍的改善是消除心理依赖的基础及手术戒毒治疗成功的重要因素;精神病性和躯体化是复吸的主要原因.%Objective To evaluate the surgical outcome of stereotactic lesioning for heroin dependence and analyze the reasons for relapse. Methods Clinical data of 154 heroin addicts treated by stereotactic surgery were analyzed retrospectively. The state of mental health was measured by self-rating symptom scale in follow-up study. Results All the patients were followed up for 5 to 6 years. Relapse occurred in 52 patients (33.8%) as relapse group and no relapse in 102 (66.2%) as non-relapse group after surgery. The scores in somatization, obsessive-compulsive symptom, hostility, paranoid, psychotism were higher in relapse group than those in non-relapse group and domestic norm (all P < 0.05). Conclusions Stereotactic surgery is a safe and effective method for heroin dependence. The improvements in obsessive-compulsive symptom and the personality disorder are the bases of eliminating the psychological dependence and also important factors of successful withdrawal from abused drugs by surgery. Somatization and psychotism are the key reasons for relapse.

  16. Long-term follow-up of bioprosthetic aortic valve replacement in patients aged ≤60 years.

    Anselmi, Amedeo; Flecher, Erwan; Chabanne, Celine; Ruggieri, Vito Giovanni; Langanay, Thierry; Corbineau, Hervé; Leguerrier, Alain; Verhoye, Jean-Philippe


    To address the long-term durability of bioprostheses used for aortic valve replacement (AVR) in adult patients aged ≤60 years at the time of surgery. Through a retrospective review of a prospectively collected database, we identified 416 bioprosthetic AVRs performed between 1977 and 2013. A prospective follow-up of valve-related and non-valve-related events was performed. Follow-up was 98.5% complete (2423.1 patient-years; average, 6 ± 5.5 years). At 15 years, overall survival was 62.1 ± 4.4%; freedom from valve-related death was 97.1 ± 1.6%. There were 68 SVD events (11.9 ± 28.8 years after surgery). Freedom from SVD at 15 years was 48.7 ± 5.5% for Kaplan-Meier analysis and 61.4 ± 4.3% for competing-risks analysis. After stratification into age subgroups (SVD (P = .50). The average delay to SVD was not statistically different among subgroups (P = .30). There were 57 reoperations for SVD (11.8 ± 5.2 years after implantation). The 15 year freedom from reoperation for SVD was 55.4 ± 5.6% by Kaplan-Meier analysis and 67.1 ± 4.2% by competing-risks analysis. After stratification by age, freedom from reoperation for SVD was comparable (P = .13). Freedom from any valve-related complication or death was 42 ± 5% by Kaplan-Meier analysis and 54.4 ± 4.1% by competing-risks analysis. The lifetime risk of SVD is considerable in patients aged ≤60 years at the time of bioprosthesis implantation. Nonetheless, durability remains consistent during the first decade; additional data are required for the second decade. Patients' information is pivotal for valve choice (competing-risks method). Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  17. Impact of diabetes on long term follow-up of elderly patients with chronic total occlusion post percutaneous coronary intervention

    Wei Liu; Kenji Wagatsuma; Hideo Nii; Mikihito Toda; Hideo Amano; Yasuto Uchida


    Background The prognosis of elderly patients with chronic total occlusion (CTO) and diabetes mellitus (DM) treated with percutaneous coronary intervention (PCI) is not known. Objective To investigate the effect of diabetes on long-term follow-up of CTO after PCI in elderly patients. Methods A total of 153 elderly patients (age > 65 years old) with CTO lesions which were successfully treated with PCI were enrolled. Fifty one patients with diabetes and 102 without diabetes were compared for long-term outcomes (mean follow up: 36 ± 12 months). Major adverse cardiac events (MACE) which include death, myocardial infarction or target lesion revascularization (TLR) were considered as a combined endpoint. Results The combined endpoint occurred in 29.4% of diabetes patients, and 11.3% of the patients without diabetes (P < 0.05). The Cox proportional hazards model identified: drug eluting stent (DES) or bare metal stent (BMS) (HR: 0.13, follow-up. Conclusions The study demonstrates that DM is a predictive factor for MACE in elderly CTO patients treated with PCI, type of stent, final minimal lumen diameter and DM with renal impairment, and HBA1C level on admission are predictors of MACE.

  18. Follow-up of long-term survivors of breast cancer in primary care versus specialist attention.

    Baena-Cañada, José M; Ramírez-Daffós, Patricia; Cortés-Carmona, Cristina; Rosado-Varela, Petra; Nieto-Vera, Juan; Benítez-Rodríguez, Encarnación


    Hospitals have traditionally been the place where the follow-up of breast cancer patients occurs in Spain. To describe the evolution of long-term survivors of breast cancer according to type of follow-up received (in primary or specialist/hospital care), measuring impact of care type on health, cost, health-related quality of life (HRQL) and satisfaction results. Retrospective study of cohorts with disease-free patients followed up for at least 5 years in Oncology. Using personal questionnaires, the type and cost of the follow-up, events, HRQL and satisfaction were analysed. Ninety-eight women were surveyed, 60 in primary and 38 in specialist care. There were no differences between groups in diagnosis of metastasis or new primary tumours. The number of annual visits per patient was 0.98 (0.48) in primary and 1.11 (0.38) in specialist care (P = 0.19). In primary, 44.6% were programmed and 55.4% on demand; in specialist, 94.6% were programmed and 5.4% on demand (P = 0.0001). The costs of follow-up in primary care were lower--€112.86 (77.54) versus €184.61 (85.87) per patient and year (P = 0.0001). No differences were reported in HRQL. Preference for specialist care was expressed by 80%, versus 10% for primary, with 10% indifferent. Patients showed greater satisfaction with specialist care in all questionnaire dimensions. Compliance with follow-up protocol was high in both groups. In specialist care nearly all the visits were programmed and in primary almost half were on demand. In our locality, primary is more cost-effective than specialist care, but patients express greater satisfaction with specialist follow-up and hence prefer it.

  19. Long-term follow-up of cognitive dysfunction in patients with aluminum hydroxide-induced macrophagic myofasciitis (MMF).

    Passeri, Elodie; Villa, Chiara; Couette, Maryline; Itti, Emmanuel; Brugieres, Pierre; Cesaro, Pierre; Gherardi, Romain K; Bachoud-Levi, Anne-Catherine; Authier, François-Jérôme


    Macrophagic myofasciitis (MMF) is characterized by specific muscle lesions assessing long-term persistence of aluminum hydroxide within macrophages at the site of previous immunization. Affected patients are middle-aged adults, mainly presenting with diffuse arthromyalgias, chronic fatigue, and cognitive dysfunction. Representative features of MMF-associated cognitive dysfunction (MACD) include (i) dysexecutive syndrome; (i) visual memory; (iii) left ear extinction at dichotic listening test. In present study we retrospectively evaluated the progression of MACD in 30 MMF patients. Most patients fulfilled criteria for non-amnestic/dysexecutive mild cognitive impairment, even if some cognitive deficits seemed unusually severe. MACD remained stable over time, although dysexecutive syndrome tended to worsen. Long-term follow-up of a subset of patients with 3 or 4 consecutive neuropsychological evaluations confirmed the stability of MACD with time, despite marked fluctuations.

  20. Enterovirus 71 infection-associated acute flaccid paralysis: a case series of long-term neurologic follow-up.

    Lee, Hsiu-Fen; Chi, Ching-Shiang


    The authors undertook long-term neurologic outcomes of 27 patients aged 0 to 15 years with enterovirus 71-related acute flaccid paralysis from June 1998 to July 2012. Motor function outcome was graded from class I (complete recovery) to class V (permanent paralytic limbs). Twelve of 20 patients (60%) who received intravenous immunoglobulin for treatment of acute flaccid paralysis had motor function outcomes in classes III to V. The median duration of follow-up was 6 months, during which time 7 of 13 patients (54%) with central nervous system infection, 3 of 6 patients (50%) with autonomic nervous system dysregulation, and 3 of 8 patients (37%) with heart failure showed motor function outcomes in classes III to V. These findings suggested that the usage of intravenous immunoglobulin and the severity of disease staging at disease onset might not be able to predict long-term motor function outcomes.

  1. Long term streptomycin toxicity in the treatment of Buruli Ulcer: follow-up of participants in the BURULICO drug trial.

    Sandor Klis


    Full Text Available BACKGROUND: Buruli Ulcer (BU is a tropical infectious skin disease that is currently treated with 8 weeks of intramuscular streptomycin and oral rifampicin. As prolonged streptomycin administration can cause both oto- and nephrotoxicity, we evaluated its long term toxicity by following-up former BU patients that had received either 4 or 8 weeks of streptomycin in addition to other drugs between 2006 and 2008, in the context of a randomized controlled trial. METHODS: Former patients were retrieved in 2012, and oto- and nephrotoxicity were determined by audiometry and serum creatinine levels. Data were compared with baseline and week 8 measurements during the drug trial. RESULTS: Of the total of 151 former patients, 127 (84% were retrieved. Ototoxicity was present in 29% of adults and 25% of children. Adults in the 8 week streptomycin group had significantly higher hearing thresholds in all frequencies at long term follow-up, and these differences were most prominent in the high frequencies. In children, no differences between the two treatment arms were found. Nephrotoxicity that had been detected in 14% of adults and in 13% of children during treatment, was present in only 2.4% of patients at long term follow-up. CONCLUSIONS: Prolonged streptomycin administration in the adult study subjects caused significant persistent hearing loss, especially in the high frequency range. Nephrotoxicity was also present in both adults and children but appeared to be transient. Streptomycin should be given with caution especially in patients aged 16 or older, and in individuals with concurrent risks for renal dysfunction or hearing loss.

  2. Predictors for long-term seizure outcome in juvenile myoclonic epilepsy: 25-63 years of follow-up.

    Geithner, Julia; Schneider, Felix; Wang, Zhong; Berneiser, Julia; Herzer, Rosemarie; Kessler, Christof; Runge, Uwe


    The long-term seizure outcome of juvenile myoclonic epilepsy (JME) is still controversial; the value of factors that are potentially predictive for seizure outcome remains unclear. The aim of this study was both to investigate the long-term seizure outcome in patients with JME after a follow-up of at least 25 years and to identify factors that are predictive for the seizure outcome. Data from 31 patients (19 women) with JME were studied. All of them had a follow-up of at least 25 years (mean 39.1 years) and were reevaluated with a review of their medical records and direct telephone or face-to-face interview. Of 31 patients 21 (67.7%) became seizure-free; in six of them (28.6%) antiepileptic drug (AED) treatment was discontinued due to seizure freedom. The occurrence of generalized tonic-clonic seizures (GTCS) preceded by bilateral myoclonic seizures (BMS) (p = 0.03), a long duration of epilepsy with unsuccessful treatment (p = 0.022), and AED polytherapy (p = 0.023) were identified as significant predictors for a poor long-term seizure outcome, whereas complete remission of GTCS under AED significantly increased the chance for complete seizure freedom (p = 0.012). The occurrence of photoparoxysmal responses significantly increases the risk of seizure recurrence after AED discontinuation (p = 0.05). This study shows conclusively that JME is a heterogeneous epilepsy syndrome. Life-long AED treatment is not necessarily required to maintain seizure freedom. Several long-term outcome predictors that can potentially increase the ability of clinicians and their confidence to recommend different treatment options to patients with JME were identified. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

  3. Long-Term Effects of Neonatal Morphine Infusion on Pain Sensitivity: Follow-Up of a Randomized Controlled Trial.

    Valkenburg, Abraham J; van den Bosch, Gerbrich E; de Graaf, Joke; van Lingen, Richard A; Weisglas-Kuperus, Nynke; van Rosmalen, Joost; Groot Jebbink, Liesbeth J M; Tibboel, Dick; van Dijk, Monique


    Short-term and long-term effects of neonatal pain and its analgesic treatment have been topics of translational research over the years. This study aimed to identify the long-term effects of continuous morphine infusion in the neonatal period on thermal pain sensitivity, the incidence of chronic pain, and neurological functioning. Eighty-nine of the 150 participants of a neonatal randomized controlled trial on continuous morphine infusion versus placebo during mechanical ventilation underwent quantitative sensory testing and neurological examination at the age of 8 or 9 years. Forty-three children from the morphine group and 46 children from the placebo group participated in this follow-up study. Thermal detection and pain thresholds were compared with data from 28 healthy controls. Multivariate analyses revealed no statistically significant differences in thermal detection thresholds and pain thresholds between the morphine and placebo groups. The incidence of chronic pain was comparable between both groups. The neurological examination was normal in 29 (76%) of the children in the morphine group and 25 (61%) of the children in the control group (P = .14). We found that neonatal continuous morphine infusion (10 μg/kg/h) has no adverse effects on thermal detection and pain thresholds, the incidence of chronic pain, or overall neurological functioning 8 to 9 years later. Perspective: This unique long-term follow-up study shows that neonatal continuous morphine infusion (10 μg/kg/h) has no long-term adverse effects on thermal detection and pain thresholds or overall neurological functioning. These findings will help clinicians to find the most adequate and safe analgesic dosing regimens for neonates and infants.

  4. Long-term MRA follow-up after coiling of intracranial aneurysms: impact on mood and anxiety

    Ferns, Sandra P.; Nieuwkerk, Pythia T.; Majoie, Charles B.L.M. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Rooij, Willem Jan J. van [St. Elisabeth Ziekenhuis, Department of Radiology, Tilburg (Netherlands); Rinkel, Gabriel J.E. [University Medical Center, Department of Neurology, Rudolf Magnus Institute of Neuroscience, Utrecht (Netherlands)


    Magnetic resonance angiography (MRA) screening for recurrence of a coiled intracranial aneurysm and formation of new aneurysms long-term after coiling may induce anxiety and depression. In coiled patients, we evaluated effects on mood and level of anxiety from long-term follow-up MRA in comparison to general population norms. Of 162 patients participating in a long-term (>4.5 years) MRA follow-up after coiling, 120 completed the EQ-5D questionnaire, a visual analog health scale and a self-developed screening related questionnaire at the time of MRA. Three months later, the same questionnaires were completed by 100 of these 120 patients. Results were compared to general population norms adjusted for gender and age. Any problem with anxiety or depression was reported in 56 of 120 patients (47%; 95%CI38<->56%) at baseline and 42 of 100 patients (42%; 95%CI32<->52%) at 3 months, equally for screen-positives and -negatives. Compared to the reference population, participants scored 38% (95%CI9<->67%) and 27% (95%CI4<->50%) more often any problem with anxiety or depression. Three months after screening, 21% (20 of 92) of screen-negatives and 13% (one of eight) of screen-positives reported to be less afraid of subarachnoid hemorrhage (SAH) compared to before screening. One of eight screen-positives reported increased fear of SAH. Patients with coiled intracranial aneurysms participating in long-term MRA screening reported significantly more often to be anxious or depressed than a reference group. Screening did not significantly increase anxiety or depression temporarily. However, subjectively, patients did report an increase in anxiety caused by screening, which decreased after 3 months. (orig.)

  5. Temporary self-expanding metallic stents for achalasia: A prospective study with a long-term follow-up


    AIM: To compare the efficacy of self-expanding metallic stents (SEMSs) for the long-term clinical treatment of achalasia. METHODS: Ninety achalasic patients were treated with a temporary SEMS with a diameter of 20 mm (n = 30, group A), 25 mm (n = 30, group B) or 30 mm (n = 30, group C). Data on clinical symptoms, complications and treatment outcomes were collected, and follow-up was made at 6 mo and at 1, 3-5, 5-8, 8-10 and > 10 years, postoperatively.RESULTS: Stent placement was successful in all patients....

  6. Long-term follow-up of flaps for extensive Dupuytren's and Ledderhose disease in one family.

    Kan, Hester J; Hovius, Steven E R


    Dupuytren's and Ledderhose disease can be a cumbersome condition in patients with a severe diathesis with a very early onset. Two brothers are described with a reversed radial forearm flap on both hands and two upper lateral arm flaps on both feet with a long-term follow-up ranging from 14 to 25 years. They had multiple procedures of both hands before the flaps were considered. No recurrence occurred under the flap. In very severe diathesis flaps should be considered in an earlier phase to prevent multiple procedures and early recurrence.

  7. Long-term follow-up of cyclophosphamide compared with azathioprine for initial maintenance therapy in ANCA-associated vasculitis

    Walsh, M.; Faurschou, M.; Berden, A.;


    BACKGROUND AND OBJECTIVES: Treatment with azathioprine within 3 months of remission induction with cyclophosphamide is a common treatment strategy for patients with ANCA-associated vasculitis. This study comprised patients undergoing long-term follow-up who were randomly allocated to azathioprine...... after 3-6 months or after 12 months of cyclophosphamide treatment. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Patients from 39 European centers between 1995 and 1997 with a new diagnosis of ANCA-associated vasculitis that involved the kidneys or another vital organ were eligible. At the time...

  8. AA type renal amyloidosis secondary to FMF: a long-term follow-up in two patients.

    Aybal Kutlugün, Aysun; Yildirim, Tolga; Altindal, Mahmut; Arici, Mustafa; Yasavul, Unal; Turgan, Cetin


    Renal amyloidosis, which leads to renal failure, is the most important long-term complication of familial Mediterranean fever (FMF). Resolution of nephrotic syndrome secondary to amyloidosis in FMF following colchicine treatment has rarely been reported. We describe two patients with FMF and nephrotic syndrome. These patients were treated with colchicine 1.5 mg/day and had a complete remission of nephrotic syndrome with a stable clinical course over 30 years. To our knowledge, our patients have the longest follow-up time without proteinuria.

  9. Psychosocial outcome following traumatic brain injury in adults: a long-term population-based follow-up

    Engberg, Aase Worså; Teasdale, T W


    , against up to 14% of cranial fracture patients. Significantly more cerebral lesion patients than cranial fracture patients found emotional control more difficult, as well as increased difficulties with memory and concentration, maintenance of leisure time interests and general life satisfaction......PRIMARY OBJECTIVE: On a national basis to conduct a 5, 10 and 15 year follow-up study of representative samples of survivors after traumatic brain injury (TBI) and to identify factors of importance for long-term survival and life satisfaction after TBI occurring in 1982, 1987 or 1992. RESEARCH...

  10. A combined regenerative approach for the treatment of aggressive periodontitis: long-term follow-up of a familial case.

    Sant'Ana, Adriana Campos Passanezi; Passanezi, Euloir; Todescan, Sylvia Maria Correia; de Rezende, Maria Lúcia Rubo; Greghi, Sebastião Luiz Aguiar; Ribeiro, Mônica Garcia


    This article reports the longitudinal follow-up of a familial case of aggressive periodontitis treated by a combined regenerative approach that consisted of root conditioning, bone grafting, and membrane positioning. Treatment resulted in attachment level gain, reduction of probing depth, absence of bleeding on probing, and complete bone filling of the defect. The short-term results obtained after surgery were maintained after 6 years, suggesting that the combined regenerative approach is able to completely arrest the disease with long-term stability.

  11. Trastuzumab use during pregnancy: long-term survival after locally advanced breast cancer and long-term infant follow-up.

    Andrade, Jurandyr M de; Brito, Luiz G O; Moises, Elaine C D; Amorim, Andréa C; Rapatoni, Liane; Carrara, Hélio H A; Tiezzi, Daniel G


    Here, we describe the case of a patient diagnosed with locally advanced breast cancer 8 years ago. Her treatment course was neoadjuvant chemotherapy, followed by mastectomy and then adjuvant radiotherapy and trastuzumab (TTZ). During the use of adjuvant targeted therapy, an incidental pregnancy was diagnosed. Four years later, she developed bone and cerebral metastases, and since then, she has received courses of TTZ, capecitabine, lapatinib, and radiotherapy with intermittent control of the disease. Her 7-year-old son presents a normal physical and long-term neurological developmental curve according to specialized evaluation. This case is unique for several reasons: the patient received the highest dose of TTZ yet described during pregnancy (4400 mg); there has been a long period of disease-free survival after treatment for locally advanced breast cancer and long overall survival despite successive disease progressions during the metastatic phase of the disease (97 months), and there was a monitored pediatric follow-up period (7 years).

  12. Long-Term Follow-up of Patent Ductus Arteriosus Closure with the Amplatzer Duct Occluder in Children

    Mostafa Behjati-Ardakani


    Full Text Available Background: Transcatheter closure of patent ductus arteriosus (PDA has become an alternative treatment to surgery. We evaluated the long-term results of the transcatheter closure of PDA with the Amplatzer Duct Occluder (ADO in children.Methods: Between May 2004 and October 2012, 138 children with PDA (43 males and 95 females underwent transcatheter PDA closure. Clinical, electrocardiographic, echocardiographic, and hemodynamic data were assessed pre and postprocedurally and at follow-up.Results: The mean age of the patients at procedure was 3.53 ± 2.43 years (range = 1.1 to 9.5 years, mean weight was11.9±4.6 kg (range = 6 to 29 kg, median pulmonary end diameter of the PDA was 5 mm (range = 4 to 15 mm, and median diameter of the ADO was 8 mm (range = 6 to 16 mm. The mean follow-up time was 43.4 ± 23.5 months (range = 13.5 to98 months.The devices were successfully deployed in 136 (98.5% patients. Device embolization occurred in 2 patients, immediately in one patient and during the first postprocedural night in the other patient. The first patient had percutaneous device retrieval, followed by implantation of a larger device. The second patient had surgical device removal and PDA ligation. Immediately after device implantation, trivial to mild residual shunts were detected in 112 (80% patients; all the shunts, however, disappeared 24 hours after the procedure. One patient had left pulmonary artery stenosis with a gradient of 25 mm Hg at 24 hours', 40 mmHg at one month's, and 64 mmHg at 6 months' follow-up. There were no cases of late embolization, aortic obstruction, late hemolysis, infective endocarditis, or death.Conclusion: Transcatheter PDA closure with the ADO was safe and effective, with a high success rate at long-term follow-up.

  13. Clinical conditions of long-term cure in childhood-onset epilepsy: a 45-year follow-up study.

    Sillanpää, Matti; Saarinen, Maiju; Schmidt, Dieter


    Clinical conditions of long-term cure in childhood-onset epilepsy, defined as sustained remission off antiepileptic drug (AED) treatment, are not well known. To address that clinically important question, we determined clinical factors predictive of long-term seizure cure in a population-based cohort of 133 patients followed up since their first seizure before the age of 16 years. At the end of the 45-year follow-up (mean=39.8, median=44, range=11-47), 81 (61%) of the 133 patients had entered at least 5-year remission off AEDs, meeting our definition of cure. The 81 patients were seizure-free off AEDs for a mean of 34.4 (median=38, range=6-46) years and 59 (73%) of the 81 patients following the first standard medication until the end of follow-up (mean=36.5, median=39, range=14-46 years). Four independent factors were found to be associated with cure compared with having seizures while on AEDs: seizure frequency less than weekly during the first 12 months of AED treatment (p=0.002), pretreatment seizure frequency less than weekly (p=0.002), higher IQ (>70; p=0.021), and idiopathic or cryptogenic vs. symptomatic etiology (p=0.042). Patients with seizure frequency of less than once a week during early treatment and idiopathic etiology had a ninefold chance to of being cured since the onset of the first adequate antiepileptic therapy until the end of follow-up compared with patients who a symptomatic etiology had at least weekly seizures while on AEDs (RR=8.7, 95% CI=2.0-37.0; pepilepsy.

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

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


    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.

  15. Long-Term Follow-Up of Patients after Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffold.

    Meneguz-Moreno, Rafael Alexandre; Costa, José de Ribamar; Moscoso, Freddy Antônio Britto; Staico, Rodolfo; Tanajura, Luiz Fernando Leite; Centemero, Marinella Patrizia; Chaves, Auréa Jacob; Abizaid, Andrea Claudia Leão de Sousa; Sousa, Amanda Guerra de Moraes Rego E; Abizaid, Alexandre Antonio Cunha


    Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary. Os suportes vasculares bioabsorvíveis (SVB) foram desenvolvidos com o intuito de melhorar os resultados da intervenção coronária percutânea a longo prazo, restabelecendo-se a vasomotricidade. Reportar o seguimento muito tardio do implante do SVB eluidor de everolimus Absorb® (Abbot Vascular, Santa Clara, EUA) em nosso centro. Estudo observacional, retrospectivo, em um único centro brasileiro, que incluiu 49 pacientes submetidos ao implante do SVB Absorb® entre agosto/2011 e outubro/2013. Foram analisados os desfechos de segurança e eficácia na fase hospitalar e bastante tardia (> 2 anos). Todos os 49 pacientes completaram um seguimento mínimo de 2,5 anos, sendo o máximo de 4,6 anos

  16. Supporting long-term follow-up of young adult survivors of childhood cancer: Correlates of healthcare self-efficacy.

    Miller, Kimberly A; Wojcik, Katherine Y; Ramirez, Cynthia N; Ritt-Olson, Anamara; Freyer, David R; Hamilton, Ann S; Milam, Joel E


    Healthcare self-efficacy (HCSE), the perceived confidence to manage one's health care, has been identified as a critical component in the transition process from pediatric to adult-oriented care for childhood cancer survivors (CCSs). HCSE is amenable to intervention and associated with long-term follow-up care among CCSs. However, factors associated with HCSE have not been fully explored among CCSs. We identified correlates of HCSE among a sample of CCSs (n = 193). Descriptive statistics and linear regression methods were used in this cross-sectional analysis. In univariate analyses, higher physical and psychosocial quality of life, posttraumatic growth, and religious/spiritual importance were associated with higher HCSE. Attendance at a survivorship clinic, having a regular source of care (both noncancer and oncologist), and any type of health insurance were also associated with HCSE. Hispanic ethnicity was negatively associated with HCSE relative to non-Hispanics. In a multivariable model, psychosocial quality of life, religious/spiritual importance, survivorship clinic attendance, having a regular oncologist, and Hispanic ethnicity remained significantly associated with HCSE. CCSs who reported greater well-being, who rated religion and spirituality of high importance, and who accessed specialized cancer services expressed greater HCSE. Hispanic CCSs, however, reported less HCSE than non-Hispanics. Interventions that attend to the quality of life and spiritual needs of CCSs have potential to build HCSE to support the healthcare transition process. Because Hispanic CCSs may be at risk of lower perceived confidence to navigate their health care, culturally competent, efficacy-enhancing interventions are needed for this population. © 2016 Wiley Periodicals, Inc.

  17. Long-Term Follow-Up of Nonoperatively and Operatively Treated Acute Primary Patellar Dislocation in Skeletally Immature Patients

    Eva Bengtsson Moström


    Full Text Available Purpose. The present study reports a long-term follow-up of acute primary patellar dislocation in patients with open physes. The purpose of the study was to evaluate knee function and recurrence rates after surgical and nonsurgical treatment of patellar dislocation. Methods. A total of 51 patients, including 29 girls and 22 boys, who were 9–14 years of age at the time of injury, were retrospectively evaluated. The minimum follow-up time was 5 years. Thigh muscle torque, range of motion, the squat test, the knee injury and osteoarthritis outcome score (KOOS, the Kujala score, and the recurrence rate were registered. Radiological predisposing factors at the time of injury were determined. Results. Quality of life and sports/recreation were the most affected subscales, according to KOOS, and a reduced Kujala score was also observed in all treatment groups. The surgically treated patients had a significantly lower recurrence rate. Those patients also exhibited reduced muscle performance, with a hamstring to quadriceps ratio (H/Q of 1.03. The recurrence rate was not correlated with knee function. Conclusions. Patellar dislocation in children influences subjective knee function in the long term. Surgery appears to reduce the recurrence rate, but subjective knee function was not restored.

  18. Is modified brief assertiveness training for nurses effective? A single-group study with long-term follow-up.

    Yoshinaga, Naoki; Nakamura, Yohei; Tanoue, Hiroki; MacLiam, Fionnula; Aoishi, Keiko; Shiraishi, Yuko


    To evaluate the long-term effectiveness of modified brief assertiveness training (with cognitive techniques) for nurses. Most assertiveness training takes a long time to conduct; thus, briefer training is required for universal on-the-job training in the workplace. In this single-group study, nurses received two 90-min training sessions with a 1-month interval between sessions. The degree of assertiveness was assessed by using the Rathus Assertiveness Schedule as the primary outcome, at four time points: pre- and post-training, 3-month follow-up and 6-month follow-up. A total of 33 nurses received the training, and the mean Rathus Assertiveness Schedule score improved from -14.2 (SD = 16.5) pre-training to -10.5 (SD = 18.0) post-training (p assertiveness training seems feasible and may achieve long-term favourable outcomes in improving assertiveness among nurses. The ease of implementation of assertiveness training is important because creating an open environment for communication leads to improved job satisfaction, improved nursing care and increased patient safety. © 2017 The Authors. Journal of Nursing Management Published by John Wiley & Sons Ltd.

  19. Long-term follow-up on total reconstruction of the temporomandibular joint - functional, psychosocial and radiological assessments in a case-series study

    Andersen, Kristian

    Long-term follow-up on total reconstruction of the temporomandibular joint - functional, psychosocial and radiological assessments in a case-series study......Long-term follow-up on total reconstruction of the temporomandibular joint - functional, psychosocial and radiological assessments in a case-series study...

  20. Long-term follow-up of melatonin treatment in children with ADHD and chronic sleep onset insomnia.

    Hoebert, Michel; van der Heijden, Kristiaan B; van Geijlswijk, Ingeborg M; Smits, Marcel G


    We conducted this study to assess long-term melatonin treatment course, effectiveness and safety in children with attention-deficit/hyperactivity disorder (ADHD) and chronic sleep onset insomnia (CSOI). This was conducted by means of a structured questionnaire for the parents. The subjects of this study consisted of participants who previously participated in a randomised clinical trial on melatonin efficacy. The response rate was 93% (94/101). The mean time to follow up was 3.7 yr. No serious adverse events or treatment related co-morbidities were reported. Sixty-five percent of the children still used melatonin daily and 12% occasionally. Temporal discontinuation of treatment resulted in a delay of sleep onset in 92% of the children. Nine percent of the children could discontinue melatonin completely because of improvement of sleep onset insomnia. Long-term melatonin treatment was judged to be effective against sleep onset problems in 88% of the cases. Improvement of behaviour and mood was reported in 71% and 61% respectively. We conclude that melatonin remains an effective therapy on the long term for the treatment of CSOI in children with ADHD and has no safety concerns regarding serious adverse events or treatment related co-morbidity. Discontinuation of melatonin treatment usually leads to a relapse of sleep onset insomnia and in resuming melatonin treatment, even after several years of treatment.

  1. Percutaneous transluminal angioplasty for atherosclerotic stenosis of the intracranial cerebral arteries. initial results and long-term follow-up.

    Hyodo, A; Kato, N; Nakai, Y; Anno, I; Sato, H; Okazaki, M; Matsumaru, Y; Nose, T


    Percutaneous transluminal angioplasty (PTA) was carried out 52 times for 49 lesions in 47 cases of atheroscrelotic stenosis of the intracranial or skull base cerebral arteries. The stenotic lesions involved the middle cerebral artery in 21 cases, the basilar artery in eight cases, the internal carotid artery (petrous-supraclinoid portion) in 15 cases, and the intracranial vertebral artery in five cases. Nearly all cases were symptomatic, such as TIA or stroke, and the degree of stenosis ranged from 70 to 99 percent, with a mean of 80 percent. PTA was performed using a STEALTH balloon angioplasty catheter. In these trials, PTA was successfully performed (as indicated by a residual stenosis under 50%) 41 times. The initial success rate was 79% and stenosis was reduced from 80% to 25%. Clinical follow-up was performed from 7 to 84 months with a mean of 44 months. During this period, death due to myocardial infarction or pneumonia occurred in five cases, stroke related to previous PTA occurred ih one case (due to re-stenosis) and stroke unrelated tl? previous PTA occurred in two cases. Angiographic follow-up was performed in 31 cases after 41 successful PTA procedures. Re-stenosis was seen in 20% of the cases, symptomrltic complications occurred in 6%, and asymptomatic complications occurred in 6% of the cases. One case suffered severe subarachnoid hemorrhage just after the PTA due to preexisting aneurysm rupture and he died a week after the PTA. So mortality in this series was 2%. From the results described here, we may conclude that PTA of the intracranial or skull base cerebral artery is technically feasible, and it can be performed with relatively low risk. From our results, it may be a useful method and effective for long-term survival of patients. But results from a larger number of patients and more long-term follow-up data are still necessary in order to evaluate the safety and usefulness of this method.

  2. Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease.

    Kraal, T; van der Heide, H J L; van Poppel, B J; Fiocco, M; Nelissen, R G H H; Doets, H C


    Little is known about the long-term outcome of mobile-bearing total ankle replacement (TAR) in the treatment of end-stage arthritis of the ankle, and in particular for patients with inflammatory joint disease. The aim of this study was to assess the minimum ten-year outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent surgery between 1988 and 1999. No patients were lost to follow-up. At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients (39 TARs) had died and the original TAR remained in situ in 28 patients (31 TARs). The cumulative incidence of failure at 15 years was 20% (95% confidence interval (CI) 11 to 28). The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients at latest follow-up was 80.4 (95% CI 72 to 88). In total, 21 patients (23 TARs) underwent subsequent surgery: three implant exchanges, three bearing exchanges and 17 arthrodeses. Neither design of TAR described in this study, the LCS and the Buechel-Pappas, remains currently available. However, based both on this study and on other reports, we believe that TAR using current mobile-bearing designs for patients with end-stage arthritis of the ankle due to inflammatory joint disease remains justified.

  3. Long-term follow-up of Dupuytren disease after injection of triamcinolone acetonide in Chinese patients in Taiwan.

    Yin, C-Y; Yu, H-H M; Wang, J-P; Huang, Y-C; Huang, T-F; Chang, M-C


    Injection of triamcinolone acetonide is a non-operative treatment for early-stage Dupuytren disease in Caucasians, but its effectiveness in non-Caucasians is unclear. We report averaged 5-year follow-up results of 37 patients (49 affected hands) with early-stage Dupuytren disease for patients in Taiwan (non-Caucasian) who received a single dose of 5 mg triamcinolone acetonide injection into nodules monthly for 3 months. Using ultrasound, we recorded no progression of sizes of the modules following injection after 6 months. After an average 5-year follow-up, two patients with three hands (6%) experienced reactivation of the treated nodules. None required surgical intervention. Ultrasound examination showed that sizes of the treated Dupuytren nodules decreased significantly by 40% 6 months after injection and 56% at the final follow-up. We conclude that in these Chinese patients in Taiwan with early Dupuytren nodules, triamcinolone acetonide injection was effective in reducing the size of the Dupuytren nodules and maintaining long-term durable control of the nodular growth. III.

  4. Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe University School of Medicine, Department of Radiology, Ankara (Turkey)


    Simple renal cysts are rare in children and managed conservatively unless symptomatic. To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children. Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study. Indications for treatment were flank pain (n=1), hypertension (n=1), and increasing cyst size and urinary tract infection (n=1). The mean follow-up period was 5.5 years (range 3-7 years). The procedures were performed with the guidance of US and fluoroscopy and under IV sedation. After the cystogram, 95% ethanol with a volume of 40% of the cyst volume (but not more than 100 ml) was used as the sclerosing agent. Two cysts disappeared completely, while the volume reduction was 99% for the third cyst at the end of the first year. CT demonstrated calcification of the cyst without an enhancing soft-tissue component in the third one 7 years after sclerotherapy. After the procedures, hypertension and pain resolved without any medication. There were no complications during the procedures or during follow-up. Cytological examination was unremarkable in all patients. Percutaneous treatment of symptomatic simple renal cysts in children with single-session ethanol sclerotherapy is a safe, effective and minimally invasive procedure. Calcification owing to sclerotherapy can be observed on follow-up. (orig.)

  5. Entirely subcutaneous defibrillator and complex congenital heart disease: Data on long-term clinical follow-up

    Ferrero, Paolo; Ali, Hussam; Barman, Palash; Foresti, Sara; Lupo, Pierpaolo; D’Elia, Emilia; Cappato, Riccardo; Stuart, Alan Graham


    AIM To describe the long-term follow-up of patients with complex congenital heart disease who underwent subcutaneous implantable cardiac defibrillator (S-ICD), focusing on local complications, appropriate and inappropriate shocks. METHODS Patients with complex congenital heart disease underwent S-ICD implant in two centers with the conventional technique. Data at follow-up were retrieved from clinical notes and institutional database. RESULTS Eight patients were implanted in two centres between 2010 and 2016. Median age at implant was 37.5 years (range 13-57). All patients who were deemed suitable for S-ICD implant passed the pre-procedural screening. Three patients were previously implanted with a anti-bradycardia device, one of whom with CRT. In one patient the device was explanted due to local infection. During the total median follow-up of 874 d, one patient had an appropriate and one inappropriate shock triggered by fast atrial tachycardia. None of the patients had inappropriate shocks secondary to T wave oversensing or electrical interference with anti- bradycardia devices. CONCLUSION S-ICD appears to be effective and safe in patients with complex congenital heart disease. PMID:28706590

  6. Cardiovascular risk factors in children after kidney transplantation--from short-term to long-term follow-up.

    Kaidar, Maital; Berant, Michael; Krauze, Irit; Cleper, Roxana; Mor, Eitan; Bar-Nathan, Nathan; Davidovits, Miriam


    Cardiovascular-related mortality is 100-fold higher in pediatric renal transplant recipients than in the age-matched general population. Seventy-seven post-renal transplant children's charts were reviewed for cardiovascular risk factors at two and six months after transplantation (short term) and at two yr after transplantation and the last follow-up visit (mean 7.14 ± 3.5 yr) (long term). Significant reduction was seen in cardiovascular risk factors prevalence from two months after transplantation to last follow-up respectively: Hypertension from 52.1% to 14%, hypercholesterolemia from 48.7% to 33%, hypertriglyceridemia from 50% to 12.5%, anemia from 29.6% to 18.3%, hyperparathyroidism from 32% to 18.3% and hyperglycemia from 11.7% to 10%, and left ventricular hypertrophy from 25.8% at short term to 15%. There was an increase in the prevalence of obesity from 1.5% to 3.9% and of CKD 3-5 from 4.75% to 24%. The need for antihypertensive treatment decreased from 54% to 42%, and the percentage of patients controlled by one medication rose from 26% to 34%, whereas the percentage controlled by 2, 3, and 4 medications decreased from 21.9%, 5.5%, and 1.4% to 6%, 2%, and 0. Children after renal transplantation appear to have high rates of cardiovascular risk factors, mainly on short-term follow-up.

  7. Long term duration of protective effect for HPV negative women: follow-up of primary HPV screening randomised controlled trial

    Elfström, K Miriam; Smelov, Vitaly; Johansson, Anna L V; Eklund, Carina; Nauclér, Pontus; Arnheim-Dahlström, Lisen


    Objectives To assess whether the increased sensitivity of screening for human papillomavirus (HPV) may represent overdiagnosis and to compare the long term duration of protective effect against cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in HPV based and cytology based screening. Design 13 year follow-up of the Swedescreen randomised controlled trial of primary HPV screening. Setting Organised cervical screening programme in Sweden. Participants 12 527 women aged 32-38 attending organised screening were enrolled and randomised to HPV and cytology double testing (intervention arm, n=6257) or to cytology only, with samples frozen for future HPV testing (control arm, n=6270). Main outcome measures Cumulative incidence of CIN2+ and CIN3+ (Kaplan Meier curves). Longitudinal test characteristics were calculated for cytology only, HPV testing only, and cytology and HPV testing combined, adjusting for censoring. Results The increased detection of CIN2+ in the intervention arm decreased over time. After six years, the cumulative incidence of CIN3+ was similar in both trial arms, and after 11 years the cumulative incidence of CIN2+ became similar in both arms. The longitudinal sensitivity of cytology for CIN2+ in the control arm at three years was similar to the sensitivity of HPV testing in the intervention arm at five years of follow-up: 85.94% (95% confidence interval 76.85% to 91.84%) v 86.40% (79.21% to 91.37%). The sensitivity of HPV screening for CIN3+after five years was 89.34% (80.10% to 94.58%) and for cytology after three years was 92.02% (80.59% to 96.97%). Conclusions Over long term follow-up, the cumulative incidence of CIN2+ was the same for HPV screening and for cytology, implying that the increased sensitivity of HPV screening for CIN2+ reflects earlier detection rather than overdiagnosis. The low long term risks of CIN3+ among women who tested negative in HPV screening, support screening intervals of five years for such women. Trial

  8. Robotic mitral valve replacement: A single center, medium-long term follow-up of 43 cases

    Guo-peng LIU


    Full Text Available Objective To summarize the surgical experience gained from robotic mitral valve replacement (MVR, and demonstrate the long-term clinical follow-up results. Methods From Jan. 2007 to Jan. 2015, more than 700 patients underwent various types of robotic cardiac surgery in the Department the authors served in, and of them 43 patients underwent robotic MVR with da Vinci Surgical System (Intuitive Surgical, USA. Among the 43 patients, the average age was 47±11 years (ranged 19-65 years, and sex ratio (female to male was 0.8:1. Six patients were with heart function of NYHA class Ⅰ, 30 patients were of NYHA class Ⅱ and 7 patients were of NYHA class Ⅲ. The left ventricular ejection fraction (LVEF were 54%-78% (64.0%±7.1%, and 20 patients had atrial fibrillation on admission, and 35 patients were with rheumatic mitral stenosis (MS. Atrial septal defect (0.7cm in size co-existed in 1 case and 1 patient had mild aortic regurgitation. Mechanical or bioprosthetic mitral valve was replaced via left atriotomy by using da Vinci robotic surgical system after cardiopulmonary bypass (CPB set-up. Radiopaque titan clips was employed by Cor-Knot knot-tying device (LSI Solutions, Inc, Victor, NY to anchor the prosthetic valve. Trans-esophageal echocardiography (TEE was performed before and after surgery. The operative data were collected and patients were followed up at outpatient clinic regularly up to 6 years. Results All cases were performed successfully with the same surgery. No conversion to median sternotomy or operative mortality occurred. The average operation time was 292±62 minutes (ranged 140-450 minutes with CPB time of 124±26 minutes and aortic occlusion time of 88±21 minutes. The postoperative mechanical ventilation support time was continued for 15±6 hours, and the average staying length in critical care unit was 4±1 days. No myocardial infarction, ventricular tachycardia or excessive bleeding was complicated. All patients were successfully

  9. Long-term follow-up of low-dose external pituitary irradiation for Cushing's disease

    Littley, M.D.; Shalet, S.M.; Beardwell, C.G.; Ahmed, S.R.; Sutton, M.L. (Christie Hospital, Manchester (UK))


    Twenty-four patients (three male) with Cushing's disease, aged between 11 and 67 years, were treated with low-dose external pituitary irradiation (20 Gy in eight fractions over 10-12 days) and followed for between 13 and 171 months (median 93 months). Eleven patients (46%) went into remission 4-36 months after irradiation, but five subsequently relapsed. In this series, the low incidence of radiation-induced hypopituitarism and absence of other complications attributable to radiotherapy suggest that low-dose pituitary irradiation may be a useful treatment option in selected patients. However, long-term follow-up has demonstrated a high relapse rate and failure to prevent Nelson's syndrome in adrenalectomized patients, indicating that it should not be used as primary treatment in preference to selective adenomectomy. (author).

  10. The diverse impact of advance care planning: a long-term follow-up study on patients' and relatives' experiences

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine;


    BACKGROUND: Advance care planning (ACP) is a process of discussing and recording patients' preferences for future care, aiming to guide healthcare decisions at the end of life (EOL). AIM: To explore nuances in the long-term impact of ACP by studying patient and relative experiences. DESIGN......: A qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis. SETTING/PARTICIPANTS: 3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating...... issues being 'tucked away'. CONCLUSIONS: The study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual...

  11. A clinical and long-term follow-up study of perioperative sequential triple therapy for gastric cancer

    Shou Chun Zou; Hua Sheng Qiu; Cheng Wu Zhang; Hou Quan Tao


    @@INTRODUCTION Although the long-term postoperative survival rate of gastric cancer (GC) patients has been improved significantly since the local dissection of lymph node was widely used in China, yet the low curative resection rate and the high recurrence rate from peritoneal and hepatic metastases hinder it from further improvement. To alter the current unsatisfactory status of GC treatment, a sequential triple therapeutic scheme (STTS), consisting of preoperative regional intra-arterial chemotherapy,curative resection of GC, and intra-operative or early postoperative intraperitoneal chemotherapy, was designed and adopted in this department since 1989. The follow-up data demonstrated that the therapeutic response of STTS is rather satisfactory.The results are reported as follows.

  12. Long term follow-up of a child with ambiguous genitalia, mixed gonadal dysgenesis, and unusual mosaicism.

    Ostrow, Vlady; De Luca, Francesco


    Mixed gonadal dysgenesis (MGD) is a condition of abnormal and asymmetrical gonadal development. This disorder is typically associated with 45,X/46,XY mosaicism; however, other karyotypes have been rarely reported. The phenotype characterizing MGD is highly variable, although in most cases ambiguous genitalia are found. In addition, many individuals with MGD exhibit stigmata of Turner's syndrome. We describe a patient with MGD, found to have a 45,X/47,XYY karyotype, with the majority of the cell lines being 47,XYY. To our knowledge, our report is the first to describe the long-term follow-up of a patient with ambiguous genitalia diagnosed at birth with 45,X/47,XYY mosaicism.

  13. Unusual presentation and treatment of biliary ileus with long term follow up: case report and review of the literature.

    Zulian, Viola; Vasquez, Giorgio; Feo, Carlo V


    Gallstone ileus is a rare complication of cholelithiasis. It accounts for 25% of nonstrangulated small bowel obstructions in patients over the age of 65 years. The morbidity and mortality rate of gallstone ileus remains very high, partly because of misdiagnosis or delayed diagnosis. The two surgical options are: a) enterolithotomy with removal of impacted stone, cholecystectomy, and fistula repair at the same surgical operation (i.e., "one-stage" procedure) and b) enterolithotomy with stone extraction followed or not by elective biliary surgery. The latter is the most popular surgical approach, whereas enterolithotomy combined with cholecistectomy and fistulectomy is indicated only in selected cases. In this article, a case of biliary ileus with unusual presentation treated by entherolithotomy alone with long term follow up is described, and the literature on this subject is reviewed and discussed.

  14. A Questionnaire-based Long-term Follow-up of Photorefractive Keratectomy for Low to High Myopia

    Vestergaard, Anders; Hjortdal, Jesper; Ivarsen, Anders

    University Hospital NBG, Denmark Purpose: Although surgical techniques are rapidly evolving, surface ablation of the cornea is by many still considered the overall safest procedure for treatment of low myopia. Our purpose with this questionnaire-based study was to evaluate long-term patient satisfaction...... with the same broad-beam laser (SVS Apex Laser system, Summit Technology, Inc.). Questionnaires were based on linear visual analogue scales from 0 to 10, anchored at each end by adjectival descriptors. Mean scores were calculated. Also, responses for questions were divided into 1 of 4 categories: very negative...... (more than -6.00 D). In total, 204 patients (74%) completed the questionnaire. Average follow-up time was 16 years and mean age was 42 years. In total of 45% needed distance visual correction, 21% needed near-vision correction, and 10% needed both. Concerning patient satisfaction, for patients without...

  15. Transanal haemorrhoidal dearterialisation with mucopexy versus stapler haemorrhoidopexy: a randomised trial with long-term follow-up

    Lucarelli, R; Caporossi, M; De Angelis, F; Di Filippo, A; Stipa, F; Spaziani, E


    Introduction The present study aimed to compare the long-term results of transanal haemorrhoidal dearterialisation (THD) with mucopexy and stapler haemorrhoidopexy (SH) in treatment of grade III and IV haemorrhoids. Methods One hundred and twenty-four patients with grade III and IV haemorrhoids were randomised to receive THD with mucopexy (n=63) or SH (n=61). A telephone interview with a structured questionnaire was performed at a median follow-up of 42 months. The primary outcome was the occurrence of recurrent prolapse. Patients, investigators and those assessing the outcomes were blinded to group assignment. Results Recurrence was present in 21 patients (16.9%). It occurred in 16 (25.4%) in the THD group and 5 (8.2%) in the SH group (p=0.021). A second surgical procedure was performed in eight patients (6.4%). Reoperation was open haemorrhoidectomy in seven cases and SH in one case. Five patients out of six in the THD group and both patients in the SH group requiring repeat surgery presented with grade IV haemorrhoids. No significant difference was found between the two groups with respect to symptom control. Patient satisfaction for the procedure was 73.0% after THD and 85.2% after SH (p=0.705). Postoperative pain, return to normal activities and complications were similar. Conclusions The recurrence rate after THD with mucopexy is significantly higher than after SH at long-term follow-up although results are similar with respect to symptom control and patient satisfaction. A definite risk of repeat surgery is present when both procedures are performed, especially for grade IV haemorrhoids. PMID:23676807

  16. Efficacy of bronchoscopic closure of a bronchopleural fistula with amplatzer devices: long-term follow-up.

    Fruchter, Oren; El Raouf, Bayya Abed; Abdel-Rahman, Nader; Saute, Milton; Bruckheimer, Elchanan; Kramer, Mordechai R


    The development of a bronchopleural fistula (BPF) is associated with high rates of morbidity and mortality. We have developed a minimally invasive method of bronchoscopic BPF closure using Amplatzer devices (AD) and Amplatzer vascular plugs (AVP), with excellent short-term results. The aim of the present report was to explore the long-term outcome of patients treated by Amplatzer occluders and the durability of this novel modality of BPF treatment. A total of 31 central BPF in 31 patients (mean age 66.8 years, range 19-91) were sealed under moderate sedation bronchoscopically by either AD (n = 19) or AVP (n = 12). The average follow-up period was 17.6 months (range 1-68 months). The main etiology for BPF was surgery (n = 24), pneumonectomy (n = 14) or lobectomy/segmentectomy (n = 10). The underlying disease was either primary (n = 19) or metastatic (n = 2) lung cancer. The immediate success rate was 96% as symptoms related to BPF disappeared in 30 of the 31 patients. Short-term (<30 days) mortality was 13% (4 patients). At follow-up, 14 patients (45%) are still alive. Out of 12 patients with late mortality, in 5 patients (41%) the death was directly related to cancer relapse, and no patient died due to BPF recurrence. Endobronchial closure of BPF using both types of Amplatzer occluders (AD and AVP) is a minimally invasive effective modality of treatment with high safety profile and satisfactory long-term outcome considering the poor prognosis in this particular group of patients. © 2013 S. Karger AG, Basel.

  17. Long-term follow-up of study participants from prophylactic HIV vaccine clinical trials in Africa

    Schmidt, Claudia; Jaoko, Walter; Omosa-Manyonyi, Gloria; Kaleebu, Pontiano; Mpendo, Juliet; Nanvubya, Annet; Karita, Etienne; Bayingana, Roger; Bekker, Linda-Gail; Chomba, Elwyn; Kilembe, William; Nchabeleng, Maphoshane; Nyombayire, Julien; Stevens, Gwynn; Chetty, Paramesh; Lehrman, Jennifer; Cox, Josephine; Allen, Susan; Dally, Len; Smith, Carol; Fast, Patricia E


    Long-term safety is critical for the development and later use of a vaccine to prevent HIV/AIDS. Likewise, the persistence of vaccine-induced antibodies and their impact on HIV testing must be established. IAVI has sponsored several Phase I and IIA HIV vaccine trials enrolling healthy, HIV-seronegative African volunteers. Plasmid DNA and viral vector based vaccines were tested. No vaccine-related serious adverse events were reported. After completion of vaccine trials conducted between 2001–2007, both vaccine and placebo recipients were offered enrolment into an observational long-term follow-up study (LTFU) to monitor potential late health effects and persistence of immune responses. At scheduled 6-monthly clinic visits, a health questionnaire was administered; clinical events were recorded and graded for severity. Blood was drawn for HIV testing and cellular immune assays. 287 volunteers were enrolled; total follow-up after last vaccination was 1463 person years (median: 5.2 years). Ninety-three (93)% of volunteers reported good health at their last LTFU visit. Infectious diseases and injuries accounted for almost 50% of the 175 reported clinical events, of which over 95% were mild or moderate in severity. There were 30 six pregnancies, six incident HIV infections and 14 volunteers reported cases of social harm. Persistence of immune responses was rare. No safety signal was identified. No potentially vaccine-related medical condition, no immune mediated disease, or malignancy was reported. HIV vaccines studied in these trials had a low potential of induction of persisting HIV antibodies. PMID:24374365

  18. Long-Term Impact of Cyclosporin Reduction with MMF Treatment in Chronic Allograft Dysfunction: REFERENECE Study 3-Year Follow Up

    L. Frimat


    Full Text Available Calcineurin inhibitor (CNI toxicity contributes to chronic allograft nephropathy (CAN. In the 2-year, randomized, study, we showed that 50% cyclosporin (CsA reduction in combination with mycophenolate mofetil (MMF treatment improves kidney function without increasing the risk for graft rejection/loss. To investigate the long-term effect of this regimen, we conducted a follow up study in 70 kidney transplant patients until 5 years after REFERENCE initiation. The improvement of kidney function was confirmed in the MMF group but not in the control group (CsA group. Four graft losses occurred, 2 in each group (graft survival in the MMF group 95.8% and 90.9% in control group. One death occurred in the control group. There was no statistically significant difference in the occurrence of serious adverse events or acute graft rejections. A limitation is the weak proportion of patient still remaining within the control group. On the other hand, REFERENCE focuses on the CsA regimen while opinions about the tacrolimus ones are still debated. In conclusion, CsA reduction in the presence of MMF treatment seems to maintain kidney function and is well tolerated in the long term.

  19. Long-Term Impact of Cyclosporin Reduction with MMF Treatment in Chronic Allograft Dysfunction: REFERENECE Study 3-Year Follow Up.

    Frimat, L; Cassuto-Viguier, E; Provôt, F; Rostaing, L; Charpentier, B; Akposso, K; Moal, M C; Lang, P; Glotz, D; Caillard, S; Ducloux, D; Pouteil-Noble, C; Girardot-Seguin, S; Kessler, M


    Calcineurin inhibitor (CNI) toxicity contributes to chronic allograft nephropathy (CAN). In the 2-year, randomized, study, we showed that 50% cyclosporin (CsA) reduction in combination with mycophenolate mofetil (MMF) treatment improves kidney function without increasing the risk for graft rejection/loss. To investigate the long-term effect of this regimen, we conducted a follow up study in 70 kidney transplant patients until 5 years after REFERENCE initiation. The improvement of kidney function was confirmed in the MMF group but not in the control group (CsA group). Four graft losses occurred, 2 in each group (graft survival in the MMF group 95.8% and 90.9% in control group). One death occurred in the control group. There was no statistically significant difference in the occurrence of serious adverse events or acute graft rejections. A limitation is the weak proportion of patient still remaining within the control group. On the other hand, REFERENCE focuses on the CsA regimen while opinions about the tacrolimus ones are still debated. In conclusion, CsA reduction in the presence of MMF treatment seems to maintain kidney function and is well tolerated in the long term.

  20. Long-term follow-up outcomes of perinatally HIV-infected adolescents: infection control but school failure.

    Souza, Edvaldo; Santos, Nicole; Valentini, Sophia; Silva, Gerlane; Falbo, Ana


    Perinatally human immunodeficiency virus (HIV)-infected children are fighting acquired immune deficiency syndrome (AIDS) and becoming adolescents. The objective of this study was to examine long-term outcomes among perinatally HIV-1-infected adolescents. Cross-sectional clinical and laboratory data were collected for 49 perinatally HIV-infected adolescents followed at the Instituto de Medicina Integral Prof. Fernando Figueira (IMIP's) Hospital from 1987 to 2007. The mean age of these adolescents was 12.5 years, the majority were female (73.5%) with a mean follow-up duration of 9.0 years, 71.4% of adolescents had no signs of HIV infection, 81.6% had normal CD4(+) lymphocyte count, and 53.1% had undetectable HIV viral load. HIV disclosure to the adolescent was reported in 31 (63.3%) participants. The majority were in school (89.8%) but failure and drop-out were reported by 51% and 28.6% of the subjects, respectively. All five domains of quality of life (QOL) measured revealed high scores. The majority of long-term adolescent survivors showed HIV-infection control and high scores of QOL, but with problems in schooling functioning that need early detection and intervention.


    蔡煦; 苏静英; 沈卫峰; 龚兰生


    Objective To investigate clinical outcomes of early and long-term treatment with captopril on patients with acute myocardial infarction (AMI) during a five-year follow-up. Methods In a randomi-zed trial, 822 patients (623 males, 199 females) with a first AMI with less 72h of symptoms were treated with captopril (treatment group, n=478, dosage from a first 6.25mg to 25mg t.i.d) and conventional treatment (control group, n=344). Multivariable Cox regression were used to analyze relative risk of independent variables. Cumulative survival of both groups were calculated with Kaplan-Meier analysis and analyzed by using log-rank comparison. Results During the five-year follow-up, the age, Killip class (≥Ⅱ), anterior infarction, diabetes mellitus, and peak CPK increased relative risk of death after AML, but the effects of captopril, beta-blocker, antiplatelet drug, and thrombolytic therapy on the relative risk of death were contrary. The cumulative survival in different time during follow-up was higher in patients with captopril than controls (P<0.001). Conclusion Early and long-term treatment with captopril was related to a beneficial outcome during the five-year follow-up after AMI.

  2. Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up

    Johannes Struewer


    Full Text Available The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA after isolated anterior cruciate ligament (ACL reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1-T3. Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2 ± 4.8 (25-100. Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation

  3. Socioeconomic position predicts long-term depression trajectory: a 13-year follow-up of the GAZEL cohort study.

    Melchior, M; Chastang, J-F; Head, J; Goldberg, M; Zins, M; Nabi, H; Younès, N


    Individuals with low socioeconomic position have high rates of depression; however, it is not clear whether this reflects higher incidence or longer persistence of disorder. Past research focused on high-risk samples, and risk factors of long-term depression in the population are less well known. Our aim was to test the hypothesis that socioeconomic position predicts depression trajectory over 13 years of follow-up in a community sample. We studied 12 650 individuals participating in the French GAZEL study. Depression was assessed by the Center for Epidemiological Studies-Depression scale in 1996, 1999, 2002, 2005 and 2008. These five assessments served to estimate longitudinal depression trajectories (no depression, decreasing depression, intermediate/increasing depression, persistent depression). Socioeconomic position was measured by occupational grade. Covariates included year of birth, marital status, tobacco smoking, alcohol consumption, body mass index, negative life events and preexisting psychological and non-psychological health problems. Data were analyzed using multinomial regression, separately in men and women. Overall, participants in intermediate and low occupational grades were significantly more likely than those in high grades to have an unfavorable depression trajectory and to experience persistent depression (age-adjusted ORs: respectively 1.40, 95% confidence interval (CI) 1.16-1.70 and 2.65, 95% CI 2.04-3.45 in men, 2.48, 95% CI 1.36-4.54 and 4.53, 95% CI 2.38-8.63 in women). In multivariate models, the socioeconomic gradient in long-term depression decreased by 21-59% in men and women. Long-term depression trajectories appear to follow a socioeconomic gradient; therefore, efforts aiming to reduce the burden of depression should address the needs of the whole population rather than exclusively focus on high-risk groups.

  4. Primary Gonadal Insufficiency in Male and Female Childhood Cancer Survivors in a Long-Term Follow-Up Clinic.

    Gunn, Harriet M; Rinne, Ida; Emilsson, Hanna; Gabriel, Melissa; Maguire, Ann M; Steinbeck, Katharine S


    Childhood cancer survivors (CCS) are at increased risk of primary gonadal insufficiency (PGI). This study evaluated the prevalence and clinical characteristics of PGI in CCS. In this single-center, retrospective, observational, longitudinal study, we characterized CCS with PGI attending the oncology Long-Term Follow-Up (LTFU) Clinic at an Australian university hospital (January 2012-August 2014). From a cohort of 276 CCS, 54 (32 males) met criteria for PGI: elevated gonadotropins plus low estradiol/amenorrhoea (females) or low testosterone/small testicles for age (males). Median age at primary diagnosis was 4.8 years (inter-quartile range [IQR] 3.0-9.7 years) and at LTFU, it was 22.3 years (IQR 18.2-25.7 years). Fifty-three participants (98.1%) were treated with known highly gonadotoxic therapies: alkylating chemotherapy (96.3%), radiotherapy (70.3%), total body irradiation (29.6%), bone marrow transplantation (51.9%), or multimodal protocols (68.5%). At primary diagnosis, 86.7% participants were Tanner stage I and at LTFU, 89.1% participants were Tanner stage V. More females (95.5%; n = 21) than males (40.6%; n = 13) were treated with hormone development therapy (HDT) (p < 0.01). Of these, more than half (n = 18; 7 males) required pubertal induction. There was no significant difference in serum luteinizing hormone/follicle stimulating hormone (LH/FSH), testosterone/estradiol between those untreated and those treated with HDT. Among those on HDT, 60.7% had persistently elevated FSH±LH and 33.3% had low testosterone or estradiol. Six males had semen analysis (five azoospermic, one oligospermic). Psychological assessment was documented in 61.1% of participants, and two-thirds reported fertility concerns. PGI is an evolving phenotype that is common in CCS. Suboptimal treatment and non-adherence occur frequently. Ongoing assessment is essential to ensure prompt diagnosis, adequate intervention and to promote HDT adherence.

  5. Quality of life in female patients with bladder exstrophy-epispadias complex: Long-term follow-up.

    Bujons, Anna; Lopategui, Diana M; Rodríguez, Nelly; Centeno, Clara; Caffaratti, Jorge; Villavicencio, Humberto


    Bladder exstrophy-epispadias complex (BEEC) is a congenital malformation that requires multiple surgeries during childhood and life-long follow-up. It often presents with conditions that have the potential to impact quality-of-life (QoL) and psychosocial functioning of affected patients, such as incontinence and sexual dysfunction. The aim of this study is to examine the QoL, urinary continence, sexual function, and overall health in a long-term series of female patients with BEEC. A retrospective review was performed of female patients with BEEC born between 1964 and 1996. Thirty-three patients were asked to complete four validated questionnaires to evaluate their QoL regarding urinary continence and sexual activity (ICIQ, Potenziani-14, and PISQ-12 questionnaires). Nineteen patients completed and returned the questionnaires. The overall QoL was assessed with the SF-36 questionnaire, and demographics were evaluated. Statistical analysis was performed to compare the general QoL with that of the general population. The median age of the patients was 26 years (range 18-50) (Table). A low to moderate impact of urinary incontinence on QoL was reported by 30% of patients in the ICIQ. Also as a result of urinary incontinence, 84% of patients reported a moderate to severe impact on their sexual lives. Twelve patients got married with eight gestations and five births. SF-36 reported general QoL comparable with that of the general population in five out of eight items. Differences were seen in the mental health, emotional role, and physical functioning items (p < 0.001). The main factors for the differences were poor body image, anxiety, and urinary incontinence. A satisfactory social life was reported by 70% of patients. Questionnaire studies on BEEC consistently report a high rate of patients not answering, 43% in the present study. The rarity of the disease determines a small sample size, which diminishes statistical power and could potentially conceal small

  6. Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl.

    Tarani, Luigi; Costantino, Francesco; Notheis, Gundula; Wintergerst, Uwe; Venditti, Mario; Di Biasi, Claudio; Friederici, Donata; Pasquino, Anna Maria


    To demonstrate that the 2-yr clinical follow-up of our patient strongly suggests that long-term therapy with posaconazole (POS) is safe and beneficial in treatment and prevention of relapses of, otherwise fatal, central nervous system mucormycosis. Mucormycosis is a very rare opportunistic mycotic infection of diabetic children. We present the 30-month follow-up of a 12-yr-old girl affected by diabetic ketoacidotic coma, complicated by rhinocerebral mucormycosis and successfully treated with POS at the initial daily dose of 5 mg/kg t.i.d. with fatty food for 3 wk, followed by a daily dose of 10 mg/kg in four doses for 2 months and then 20 mg/kg/d in four doses for 16 months and in two doses for further 5 months. The previous amphotericin B, granulocyte colony-stimulating factor, hyperbaric oxygen and nasal and left maxillary sinus surgical debridement therapy was ineffective in stopping the progression of the infection to the brain. The patient improved within 10 d with reduced ocular swelling and pain, and 6 months after therapy stop, she is in good health and cultures are sterile. This article demonstrates that POS may be a useful drug in mucormycosis in children. We also strongly draw the attention to the main preventive procedure against invasive fungal infection that is the correct management of antidiabetic therapy that prevents the predisposing temporary neutrophils activity deficit, contributing to a better survival rate of diabetic children.

  7. Innovative Perspective: Gadolinium-Free Magnetic Resonance Imaging in Long-Term Follow-Up after Kidney Transplantation

    Mick J. M. van Eijs


    Full Text Available Since the mid-1980s magnetic resonance imaging (MRI has been investigated as a non- or minimally invasive tool to probe kidney allograft function. Despite this long-standing interest, MRI still plays a subordinate role in daily practice of transplantation nephrology. With the introduction of new functional MRI techniques, administration of exogenous gadolinium-based contrast agents has often become unnecessary and true non-invasive assessment of allograft function has become possible. This raises the question why application of MRI in the follow-up of kidney transplantation remains restricted, despite promising results. Current literature on kidney allograft MRI is mainly focused on assessment of (sub acute kidney injury after transplantation. The aim of this review is to survey whether MRI can provide valuable diagnostic information beyond 1 year after kidney transplantation from a mechanistic point of view. The driving force behind chronic allograft nephropathy is believed to be chronic hypoxia. Based on this, techniques that visualize kidney perfusion and oxygenation, scarring, and parenchymal inflammation deserve special interest. We propose that functional MRI mechanistically provides tools for diagnostic work-up in long-term follow-up of kidney allografts.

  8. Early hemispherectomy in catastrophic epilepsy: a neuro-cognitive and epileptic long-term follow-up.

    Lettori, D; Battaglia, D; Sacco, A; Veredice, C; Chieffo, D; Massimi, L; Tartaglione, T; Chiricozzi, F; Staccioli, S; Mittica, A; Di Rocco, C; Guzzetta, F


    The authors report their experience about a neuro-cognitive and epileptic long-term follow-up of children with catastrophic epilepsy treated with hemispherectomy in the first 5 years of life. Nineteen children with resistant epilepsy that significantly interfered with their neuro-cognitive development underwent hemispherectomy within 5 years of life (mean: 2 years, 3 months; range: 5 months to 5 years). All patients were assessed before surgery and after, at least at the end of the follow-up (mean: 6 years and 6 months; range: 2-11 years and 2 months) with a full clinical examination including motor ability and functional status evaluation as well as behaviour observation, neuroimaging and an ictal/interictal prolonged scalp video-EEG. A seizure-free outcome was obtained in 73.7% of patients. Gross motility generally improved and cognitive competence did not worsen, with an evident progress in two cases. Consistently with previous reports, evolution was worse in cortical dysplasia than in progressive or acquired vascular cerebropathies. The excellent epileptic outcome and the lack of developmental deterioration in comparison with other more aged series seem to suggest a possible better evolution in earlier surgery treatment. To confirm this suggestion, however, further experience with larger series is needed.

  9. Long-term Survival After Stereotactic Radiosurgery of Brain Metastases: A Case Series with 10-year Follow-up.

    Ampil, Federico; Ellika, Shehanaz; Nanda, Anil; Vora, Moiz


    Patients with brain metastases (BRM) generally have a poor prognosis with infrequent long-term outcomes. Four patients treated by stereotactic radiosurgery (SRS) for BRM between 2000 and 2010 with a minimum follow-up of 10 years are described. The mean age was 43.5 years, and these individuals exhibited good performance status at the time of diagnosis of intracranial disease. BRM was solitary or multiple, and the primary malignant tumor originated from the thyroid gland, lung, mediastinum or large intestine. Progression of the original and secondary tumors subsequent to diagnosis and SRS was not observed. Radioimaging of the brain obtained 9 years later in one of the patients who was asymptomatic at follow-up revealed white matter changes; BRM in this individual was treated by tumor resection and cranial irradiation prior to SRS. We contend that extended longevity is not precluded when standard management of BRM is practiced in selected cases. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  10. Long term follow up of clinical outcome between patellar resurfacing and nonresurfacing in total knee arthroplasty: Chinese experience

    Feng Bin; Weng Xisheng; Lin Jin; Jin Jin; Qian Wenwei; Wang Wei; Qiu Guixing


    Background The long term outcome of patellar resurfacing in Chinese has not been well described.This study evaluated more than 10-year clinical outcomes and survivorship of patellar resurfacing or nonresurfacing in total knee arthroplasty.Methods From January 1993 to December 2002,265 patients accepted total knee arthroplasty in Department of Orthopaedic Surgery,Peking Union Medical College Hospital.Among them,226 patients (246 knees) were successfully followed up,with 176 knees for patellar resurfacing and 70 knees for nonresurfacing.The survivorship of total knee arthroplasty between two groups and the hospital for special surgery knee score (HSS),patellar score,patellar related complication and radiological results were studied at the latest follow-up.Results The HSS knee score increased from 55.9±12.2 preoperatively to 92.0±10.9 postoperatively for patellar resurfacing group and from 56.6±9.9 to 94.2±11.4 for nonresurfacing group after average 11.4-year follow-up.Patellar score increased from 13.93±2.42 preoperatively to 28.33±2.20 for resurfacing group and from 13.55±2.73 to 27.8±2.37 for nonresurfacing group.There was no statistically significant difference for both HSS score,patellar score between the two groups with higher rate of anterior knee pain for nonresurfacing group.Patellar nonresurfacing had higher lateral subluxation than resurfacing group according to radiological evaluation.Patients with rheumatoid arthritis had 5.5 fold patellar related complication than patients with osteoarthritis.The 10-year survival rate was not statistically significant different between the two groups (P=0.12).Conclusions There was no significant difference of long-term clinical outcome and survivorship between patellar resurfacing and nonresurfacing.Patellar nonresurfacing can be advisable during primary total knee arthroplasty especially in Chinese patients with osteoarthritis.Selective patellar resurfacing for patients with rheumatoid arthritis can achieve

  11. Long-term follow-up of long and flat bone eosinophilic granulomas managed only with biopsy.

    Erol, Bülent; Sofulu, Ömer; Topkar, Mert Osman; Çalışkan, Emrah; Türköz, Hüseyin Kemal


    We evaluated long-term clinical and radiological follow-up results of patients with long and flat bone eosinophilic granulomas managed only with biopsy. Seventeen patients [11 male, 6 female; average age 8.5 years (range: 3.5 to 14 years)] with long and flat bone eosinophilic granulomas were followed after biopsy. Involved bones were femur (5), tibia (3), humerus (2), ulna (1), pelvis (3), scapula (1) and clavicle (1). After confirmation of diagnosis by biopsy, no further surgical intervention was performed. Clinical follow-up was done with preoperative and postoperative MSTS and VAS scores. The healing process was followed with periodic radiographs. Limb-length discrepancy, deformity, and lesion progression or recurrence were recorded. Average follow-up was 65 months (range: 28 to 115 months). Average preoperative MSTS score was 45% (range: 30 to 56.6%), while postoperative 6, 12 and 24 months scores were measured as 76% (range: 70 to 83.3%), 88% (range: 73.3 to 93.3%) and 94% (range: 86.6 to 100%) respectively. Average VAS score, which was 8.4 (range: 6 to 10) preoperatively, had a tendency to decrease postoperatively, and was measured as 3.5 (range: 2 to 5), 2.2 (range: 1 to 3.5) and 1.1 (range: 0 to 2) at 3, 6, and 12 months. Even though the majority of lesions demonstrated complete radiographic healing at 12 months, the healing process extended to 24 months for flat bones. No patients experienced limb-length discrepancy or deformity. All lesions regressed following biopsy and no recurrence was seen. Eosinophilic granuloma has a spontaneous healing potential, and confirming the diagnosis by biopsy is sufficient to obtain good functional and radiological results without any further intervention.

  12. Steroid injection and needle aponeurotomy for Dupuytren disease: long-term follow-up of a randomized controlled trial.

    McMillan, Catherine; Binhammer, Paul


    To compare long-term outcomes and retreatment rates for patients with Dupuytren disease who underwent needle aponeurotomy (NA) combined with a series of triamcinolone acetonide injections or underwent NA alone as part of a prior randomized controlled trial. During this follow-up study, 44 of 47 participants in the original study were examined as needed between 6 and 53 months from their initial procedure. Those who had not been reassessed within 18 months of the original NA were asked to return for follow-up. The average total active extension deficit (TAED) of previously treated joints was compared between groups 7 to 12, 13 to 24, 25 to 36, and 37 to 48 months following treatment. Timing of retreatment (if performed) was recorded. Forty-four participants returned for assessment an average of 4.8 times over 53 months. Mean TAED was significantly less in needle aponeurotomy triamcinolone injection patients at 6 months and between 13 and 24 months. Sixty-two percent of NA group patients and 30% of needle aponeurotomy triamcinolone injection patients returned for a second treatment on the same digit(s) (retreatment). This difference was not significant. Mean time to retreatment and mean TAED immediately prior to retreatment did not differ significantly between groups. Kaplan-Meier survival estimates demonstrated a significantly higher percentage of NA group patients expected to return for retreatment by 24 but not by 36 months. Younger age, more than one joint treated at the initial NA, and TAED severity throughout the follow-up period were associated with earlier retreatment. Serial triamcinolone injections combined with NA was associated with lower TAED for up to 24 months. A larger study would more accurately quantify the potential benefits of combining triamcinolone injections with NA for treatment of Dupuytren disease. Therapeutic III. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. 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

    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


    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

  14. Long-term follow-up of jaw osteomyelitis associated with bisphosphonate use in a tertiary-care center.

    Pigrau-Serrallach, Carlos; Cabral-Galeano, Evelyn; Almirante-Gragera, Benito; Sordé-Masip, Roger; Rodriguez-Pardo, Dolors; Fernandez-Hidalgo, Nuria; Larrosa-Escartín, Nieves; Bescos-Atín, Socorro; Pahissa-Berga, Albert


    This study reviews our experience in bisphosphonate-associated jaw osteomyelitis (BJOM), focusing on the incidence, etiology, treatment, and long-term outcome. Retrospective review of the clinical histories adult patients diagnosed with BJOM (1995-2008) in a tertiary hospital. BJOM was found in 30 of 132 (22.7%) consecutive patients with jaw osteomyelitis. The percentage of BJOM cases increased from 8.7% (4/46) in 1995-2005 to 30.2% (26/86) in 2005-2008. Symptoms appeared in a median of 2.5 years after intravenous use, and 4.5 years after oral exposure. Viridans group streptococci were isolated in 83.3% of cases. Actinomyces spp. was found in 16 (39.0%) of 41 bone histologies. All included patients received a median of 6 months of appropiate antibiotic therapy and a surgical procedure (debridament and/or sequestrectomy). Thirteen of 27 cases (48.1%) with long-term follow-up (median 22 months, IQR 25-75 17-28) failed. Clinical failure defined as, persistent infection or relapse, was more frequent in patients receiving intravenous than oral bisphosphonates (11/16 [68.8%] vs. 2/11 [18.2%]; P < .05) and in cases with Actinomyces spp. (7/10 [70.0%] vs6/17 [35.3%]; P = .08). Bisphosphonate therapy is now a frequent cause of JO. BJOM is difficult to cure and relapses are common, particularly in patients exposed to intravenous bisphosphonates. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  15. Long-term follow-up of children and adoles-cents with primary sclerosing cholangitis and autoimmune sclerosing cholangitis

    Vratislav Smolka; Eva Karaskova; Oksana Tkachyk; Kvetoslava Aiglova; Jiri Ehrmann; Kamila Michalkova; Michal Konecny; Jana Volejnikova


    BACKGROUND: Sclerosing cholangitis (SC) is a chronic cho-lestatic hepatobiliary disease with uncertain long-term prog-nosis in pediatric patients. This study aimed to evaluate long-term results in children with SC according to the types of SC. METHODS: We retrospectively followed up 25 children with SC over a period of 4-17 years (median 12). The diagnosis of SC was based on biochemical, histological and cholangio-graphic ifndings. Patients fuliflling diagnostic criteria for probable or deifnite autoimmune hepatitis at the time of diag-nosis were deifned as having autoimmune sclerosing cholangi-tis (ASC); other patients were included in a group of primary sclerosing cholangitis (PSC). The incidence of the following complications was studied: obstructive cholangitis, portal hy-pertension, advanced liver disease and death associated with the primary disease. RESULTS: Fourteen (56%) patients had PSC and 11 (44%) had ASC. Patients with ASC were signiifcantly younger at the time of diagnosis (12.3 vs 15.4 years,P=0.032) and had higher IgG levels (22.7 vs 17.2 g/L,P=0.003). The mentioned compli-cations occurred in 4 (16%) patients with SC, exclusively in the PSC group: one patient died from colorectal cancer, one patient underwent liver transplantation and two patients, in whom severe bile duct stenosis was present at diagnosis, were endoscopically treated for acute cholangitis. Furthermore, two other children with ASC and 2 children with PSC had elevated aminotransferase levels. The 10-year overall survival was 95.8% in all patients, 100% in patients without complicated liver disease, and 75.0% in patients with complications. CONCLUSION: In children, ASC is a frequent type of SC, whose prognosis may be better than that in patients with PSC.

  16. Risk and fate of residual interatrial shunting after transcatheter closure of patent foramen ovale: a long term follow up study

    Hammerstingl C


    Full Text Available Abstract Background Percutaneous transcatheter closure of patent foramen ovale (PFO in cryptogenic stroke is an alternative to medical therapy. There is still debate on different outcome for each currently available device. The impact of residual shunting after PFO-clo- sure on recurrent arterial embolism is unknown. Aims (i To evaluate the prevalence of residual interatrial shunting after device- closure of PFO, (ii to identify risk factors predicting residual interatrial shunting after device implantation, and (iii to investigate the outcome of patients after PFO-closure during long- term follow- up (FU. Methods and results Between 2000- 2005 PFO-closure was performed in 124 patients using four different devices: Amplatzer PFO-(n = 52, CardioSeal (n = 33, Helex (n = 23 and Premere (n = 16 occluder. All patients underwent serial contrast-enhanced transesophageal echocardiography (TEE for 24 months after PFO- closure; clinical FU was at minimum 5 years up to 9.75 years (mean 6.67 ± 1.31 years. Overall-closure rate was 87% at 2 years, device-specific closure time curves differed significantly (p-logrank = 0.003. Independent risk factors for residual-shunting were implantation of a Helex occluder (hazard ratio [HR] 12.6, 95% confidence interval [CI] 2.6- 57.4, p = 0.002, PFO- canal- lengths (HR 1.2, 95%CI 1.1- 1.3, p = 0.004 and extend of atrial-septal-aneurysm (HR 1.1, 95%CI 0.9- 1.3; p = 0.05. 4 (3.2% arterial embolic events occurred during a FU-period of 817.2 patient-years, actuarial annual thromboembolic-risk was 0.49%. All ischemic events were not related to residual PFO-shunting or device-related thrombus- formation. Conclusion Success rates of PFO- closure are mainly dependent on occluder-type, extend of concomitant atrial-septum-aneurysm and PFO-canal- length. Importantly, residual shunting after PFO-closure was not associated with recurrence of arterial embolism during long-term follow-up.

  17. High mortality among children with gastroschisis after the neonatal period: A long-term follow-up study.

    Risby, Kirsten; Husby, Steffen; Qvist, Niels; Jakobsen, Marianne S


    During the last decades neonatal outcomes for children born with gastroschisis have improved significantly. Survival rates >90% have been reported. Early prenatal diagnosis and increased survival enforce the need for valid data for long-term outcome in the pre- and postnatal counseling of parents with a child with gastroschisis. Long-term follow-up on all newborns with gastroschisis at Odense University Hospital (OUH) from January 1 1997-December 31 2009. Follow-up included neonatal chart review for neonatal background factors, including whether a GORE(®)DUALMESH was used for staged closure, electronic questionnaires, interview and laboratory investigations. Cases were divided into complex and simple cases according to the definition by Molik et al. (2001). Survival status was determined by the national personal identification number registry. Because of the consistency of the registration, survival status was obtained from all children participating in the study. A total of 71 infants (7 complex and 64 simple) were included. Overall seven out of the 71 children (9.9%, median age: 52days (25-75% percentile 0-978days) had died at the time of follow-up. Three died during the neonatal period and four died after the neonatal period. Parenteral nutrition (PN) induced liver failure and suspected adhesive small bowel obstruction were the causes of deaths after the neonatal period. Overall mortality was high in the "complex" group compared to the simple group (3/7 (42.9%) vs 4/64 (6.3%), p = 0.04). Forty (62.5%) of the surviving children consented to participate in the follow-up. A total of 12 children had had suspected adhesive small bowel obstruction. Prevalence of small bowel obstruction was not related to the number of operations needed for neonatal closure of the defect. Staged closure was done in 5/12 (41.7%) who developed small bowel obstruction vs 11/35 (31.43%) without small bowel obstruction, p=0.518. A GORE(®)DUALMESH was used in 16 children (22.5%). Of these

  18. Long-term follow-up of patients after acute kidney injury: patterns of renal functional recovery.

    Etienne Macedo

    Full Text Available BACKGROUND AND OBJECTIVES: Patients who survive acute kidney injury (AKI, especially those with partial renal recovery, present a higher long-term mortality risk. However, there is no consensus on the best time to assess renal function after an episode of acute kidney injury or agreement on the definition of renal recovery. In addition, only limited data regarding predictors of recovery are available. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: From 1984 to 2009, 84 adult survivors of acute kidney injury were followed by the same nephrologist (RCRMA for a median time of 4.1 years. Patients were seen at least once each year after discharge until end stage renal disease (ESRD or death. In each consultation serum creatinine was measured and glomerular filtration rate estimated. Renal recovery was defined as a glomerular filtration rate value ≥60 mL/min/1.73 m2. A multiple logistic regression was performed to evaluate factors independently associated with renal recovery. RESULTS: The median length of follow-up was 50 months (30-90 months. All patients had stabilized their glomerular filtration rates by 18 months and 83% of them stabilized earlier: up to 12 months. Renal recovery occurred in 16 patients (19% at discharge and in 54 (64% by 18 months. Six patients died and four patients progressed to ESRD during the follow up period. Age (OR 1.09, p<0.0001 and serum creatinine at hospital discharge (OR 2.48, p = 0.007 were independent factors associated with non renal recovery. The acute kidney injury severity, evaluated by peak serum creatinine and need for dialysis, was not associated with non renal recovery. CONCLUSIONS: Renal recovery must be evaluated no earlier than one year after an acute kidney injury episode. Nephrology referral should be considered mainly for older patients and those with elevated serum creatinine at hospital discharge.

  19. Pregnancy-associated spinal osteoporosis treated with bisphosphonates: long-term follow-up of maternal and infants outcome.

    Vujasinovic-Stupar, Nada; Pejnovic, Nada; Markovic, Ljiljana; Zlatanovic, Maja


    Pregnancy-associated spinal osteoporosis (PPSO) is a rare condition characterized by severe back pain occurring near the end of the first pregnancy or shortly afterward. The aim of this report is to present a 12-year follow-up of a patient with PPSO. Also, the outcomes of patient's two pregnancies and her infants after long-term treatment with bisphosphonates are assessed. A young woman was referred to our tertiary care hospital aged 30 years, due to intense pain in thoracic and lumbar region that started during the last month of her first pregnancy and got worse after delivery. Bone mineral density (BMD) measurement, clinical, and biochemical parameters were performed. Extremely low lumbar spine BMD, L2-L4: 0.627 g/cm(2), T-score -4.8, Z-score -4.3, 52% young adult indicated severe osteoporosis. Cyclical treatment with etidronate and then pamidronate was started, and a substantial increase in the BMD and the reduction in back pain intensity were observed. An increase in BMD of 44.8% over baseline was observed after 12 years of follow-up. Her two pregnancies were uneventful, and no neonatal adverse effects were observed. Control DXA scan in her girl child aged 6.8 years revealed low BMD at the lumbar spine. As PPSO seems to be an underdiagnosed severe disease, caution is recommended if back pain occurs in the last trimester or early post-partum period. Although pre-pregnancy use of bisphosponates does not pose a substantial fetal risk, their use in women of childbearing age might best be done only when strong clinical indications exist.

  20. Breast Implant–Associated Anaplastic Large-Cell Lymphoma: Long-Term Follow-Up of 60 Patients

    Miranda, Roberto N.; Aladily, Tariq N.; Prince, H. Miles; Kanagal-Shamanna, Rashmi; de Jong, Daphne; Fayad, Luis E.; Amin, Mitual B.; Haideri, Nisreen; Bhagat, Govind; Brooks, Glen S.; Shifrin, David A.; O'Malley, Dennis P.; Cheah, Chan Y.; Bacchi, Carlos E.; Gualco, Gabriela; Li, Shiyong; Keech, John A.; Hochberg, Ephram P.; Carty, Matthew J.; Hanson, Summer E.; Mustafa, Eid; Sanchez, Steven; Manning, John T.; Xu-Monette, Zijun Y.; Miranda, Alonso R.; Fox, Patricia; Bassett, Roland L.; Castillo, Jorge J.; Beltran, Brady E.; de Boer, Jan Paul; Chakhachiro, Zaher; Ye, Dongjiu; Clark, Douglas; Young, Ken H.; Medeiros, L. Jeffrey


    Purpose Breast implant–associated anaplastic large-cell lymphoma (ALCL) is a recently described clinicopathologic entity that usually presents as an effusion-associated fibrous capsule surrounding an implant. Less frequently, it presents as a mass. The natural history of this disease and long-term outcomes are unknown. Patients and Methods We reviewed the literature for all published cases of breast implant–associated ALCL from 1997 to December 2012 and contacted corresponding authors to update clinical follow-up. Results The median overall survival (OS) for 60 patients was 12 years (median follow-up, 2 years; range, 0-14 years). Capsulectomy and implant removal was performed on 56 of 60 patients (93%). Therapeutic data were available for 55 patients: 39 patients (78%) received systemic chemotherapy, and of the 16 patients (28%) who did not receive chemotherapy, 12 patients opted for watchful waiting and four patients received radiation therapy alone. Thirty-nine (93%) of 42 patients with disease confined by the fibrous capsule achieved complete remission, compared with complete remission in 13 (72%) of 18 patients with a tumor mass. Patients with a breast mass had worse OS and progression-free survival (PFS; P = .052 and P = .03, respectively). The OS or PFS were similar between patients who received and did not receive chemotherapy (P = .44 and P = .28, respectively). Conclusion Most patients with breast implant–associated ALCL who had disease confined within the fibrous capsule achieved complete remission. Proper management for these patients may be limited to capsulectomy and implant removal. Patients who present with a mass have a more aggressive clinical course that may be fatal, justifying cytotoxic chemotherapy in addition to removal of implants. PMID:24323027

  1. Long-term follow-up study on the safety of deep brain stimulation for treating Parkinson's disease

    Xi WU


    Full Text Available Objective To evaluate the safety of deep brain stimulation (DBS for treating Parkinson's disease (PD under long-term follow-up and modify the surgical procedure. Methods A total of 362 PD patients underwent DBS, and almost 613 electrodes were implanted into these patients. Both surgical and hardware-related complications of DBS were retrospectively analyzed. Results Perioperative complications included postoperative confusion or delirium in 21 cases (5.80%, intracranial hemorrhage in 4 cases (1.10%; 2 asymptomatic cortical microhemorrhage and 2 basal ganglia trajectory microhemorrhage, generalized tonic-clonic seizures (GTCS in 2 cases (0.55% , urinary tract infection in 4 cases (1.10% , pulmonary infection in 7 cases (1.93%, implantable pulse generator (IPG hematoma in 11 cases (3.04%, IPG seroma in 3 cases (0.83%. All these patients were cured. They were followed-up for 12-146 months (median 34 months. Hardware-related complications included infection of incisional wound and/or skin erosion (9 cases, 2.49% , extension wire fracture caused by IPG displacement (one case, 0.28% , IPG shifting to abdomen due to fixation wire fracture (one case, 0.28%, slightly migrated electrode due to fall (one case, 0.28%, and discomfort about occipital incision (one case, 0.28%. Conclusions The overall risk of both surgical and hardware-related adverse events of DBS for treating PD is acceptably low. DOI: 10.3969/j.issn.1672-6731.2015.10.005

  2. Long-term follow-up of MCL patients treated with single-agent ibrutinib: updated safety and efficacy results

    Blum, Kristie A.; Martin, Peter; Goy, Andre; Auer, Rebecca; Kahl, Brad S.; Jurczak, Wojciech; Advani, Ranjana H.; Romaguera, Jorge E.; Williams, Michael E.; Barrientos, Jacqueline C.; Chmielowska, Ewa; Radford, John; Stilgenbauer, Stephan; Dreyling, Martin; Jedrzejczak, Wieslaw Wiktor; Johnson, Peter; Spurgeon, Stephen E.; Zhang, Liang; Baher, Linda; Cheng, Mei; Lee, Dana; Beaupre, Darrin M.; Rule, Simon


    Ibrutinib, an oral inhibitor of Bruton tyrosine kinase, is approved for patients with mantle cell lymphoma (MCL) who have received one prior therapy. We report the updated safety and efficacy results from the multicenter, open-label phase 2 registration trial of ibrutinib (median 26.7-month follow-up). Patients (N = 111) received oral ibrutinib 560 mg once daily, and those with stable disease or better could enter a long-term extension study. The primary end point was overall response rate (ORR). The median patient age was 68 years (range, 40-84), with a median of 3 prior therapies (range, 1-5). The median treatment duration was 8.3 months; 46% of patients were treated for >12 months, and 22% were treated for ≥2 years. The ORR was 67% (23% complete response), with a median duration of response of 17.5 months. The 24-month progression-free survival and overall survival rates were 31% (95% confidence interval [CI], 22.3-40.4) and 47% (95% CI, 37.1-56.9), respectively. The most common adverse events (AEs) in >30% of patients included diarrhea (54%), fatigue (50%), nausea (33%), and dyspnea (32%). The most frequent grade ≥3 infections included pneumonia (8%), urinary tract infection (4%), and cellulitis (3%). Grade ≥3 bleeding events in ≥2% of patients were hematuria (2%) and subdural hematoma (2%). Common all-grade hematologic AEs were thrombocytopenia (22%), neutropenia (19%), and anemia (18%). The prevalence of infection, diarrhea, and bleeding was highest for the first 6 months of therapy and less thereafter. With longer follow-up, ibrutinib continues to demonstrate durable responses and favorable safety in relapsed/refractory MCL. The trial is registered to as #NCT01236391. PMID:26059948

  3. Recurrent optic neuritis: clues from a long-term follow up study of recurrent and bilateral optic neuritis patients

    Asli Kurne


    Full Text Available Asli Kurne1, Rana Karabudak1, Gul Yalcin-Cakmakli1, Yasemin Gursoy-Ozdemir1, Pinar Aydin3, Ayse Ilksen-Colpak1, Sevda Lule2, Tulay Kansu11Department of Neurology, 2Institute of Neurological Sciences and Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey; 3Special Eye Clinic, Ankara, TurkeyBackground and aim: Optic neuritis (ON can be recurrent, with unilateral or bilateral presentation. Diagnosis of recurrent cases may be challenging. In this study long-term follow-up of recurrent and/or bilateral ON patients is reported in an effort to guide differential diagnosis and treatment.Methods: The study included 474 optic neuropathy patients. Of these, 70 patients with recurrent unilateral or bilateral, and nonrecurrent bilateral ON were assessed. The characteristics of each ON attack, laboratory and magnetic resonance imaging (MRI findings, associated diseases and response to treatment were noted for each patient. Most of the patients were reevaluated in the outpatient clinic. Seven patients were investigated for neuromyelitis optica (NMO-immunoglobulin G (IgG seropositivity.Results: Forty-seven patients had recurrent unilateral ON and 23 had bilateral ON. Mean follow-up was 7.55 years. Final diagnoses for recurrent unilateral group were multiple sclerosis (MS (n = 29, chronic relapsing inflammatory optic neuritis (CRION (n = 11, NMO (n = 4, or autoimmune thyroid disease (n = 3; and for bilateral ON group, MS (n = 4, vasculitis (n = 13, postinfectious ON (n = 4, and sarcoidosis (n = 2. Three patients were positive for NMO antibodies.Conclusion: Based on the data collected, we conclude when recurrent ON causes moderate to severe visual loss in the absence of cranial MRI findings typical of MS, other diagnoses should be considered, including NMO.Keywords: optic neuritis, recurrent, bilateral, multiple sclerosis, neuromyelitis optica

  4. Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study.

    Heijer, M. den; Seynaeve, C.; Timman, R.; Duivenvoorden, H.J.; Vanheusden, K.; Tilanus-Linthorst, M.; Menke-Pluijmers, M.B.; Tibben, A.


    PURPOSE: To explore the course of psychological distress and body image at long-term follow-up (6-9 years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. METHODS:

  5. Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study.

    Heijer, M. den; Seynaeve, C.; Timman, R.; Duivenvoorden, H.J.; Vanheusden, K.; Tilanus-Linthorst, M.; Menke-Pluijmers, M.B.; Tibben, A.


    PURPOSE: To explore the course of psychological distress and body image at long-term follow-up (6-9 years) after prophylactic mastectomy and breast reconstruction (PM/BR) in women at risk for hereditary breast cancer, and to identify pre-PM risk factors for poor body image on the long-term. METHODS:

  6. The long-term prediction of return to work following serious accidental injuries: A follow up study

    Sensky Tom


    Full Text Available Abstract Background Considerable indirect costs are incurred by time taken off work following accidental injuries. The aim of this study was to predict return to work following serious accidental injuries. Method 121 severely injured patients were included in the study. Complete follow-up data were available for 85 patients. Two weeks post trauma (T1, patients rated their appraisal of the injury severity and their ability to cope with the injury and its job-related consequences. Time off work was assessed at one (T2 and three years (T3 post accident. The main outcome was the number of days of sick leave taken due to the accidental injury. Results The patients' appraisals a of the injury severity and b of their coping abilities regarding the accidental injury and its job-related consequences were significant predictors of the number of sick-leave days taken. Injury severity (ISS, type of accident, age and gender did not contribute significantly to the prediction. Conclusions Return to work in the long term is best predicted by the patients' own appraisal of both their injury severity and the ability to cope with the accidental injury.

  7. Long-term follow-up of metil aminolevulinate (MAL)-PDT in difficult-to-treat cutaneous Bowen's disease.

    Cavicchini, Stefano; Serini, Stefano Maria; Fiorani, Roberta; Girgenti, Valentina; Ghislanzoni, Massimo; Sala, Francesco


    Bowen's disease (BD) is a form of intraepidermal squamous cell carcinoma, which is clinically characterized by gradually enlarging, well-demarcated erythematous plaques with irregular borders and surface crusting or scaling, affecting primarily the elderly. BD often presents with lesions difficult to treat with standard therapy as surgery, cryosurgery, or 5-fluorouracil (5-FU) for the risk of significantly poor cosmetic outcome, failure rate, and adverse events, related mainly to the age of the patients. Topical PDT with methyl aminolevulinate (MAL) represents a valid and approved therapy for BD lesions in many cases, especially for lesions located at poor healing sites or for large patches of disease, due to its high efficacy coupled with good tolerability and tissue-sparing attitude. In this study, we sought to investigate the efficacy, safety, and cosmetic outcome of MAL-PDT in a series of patients with BD lesions which were challenging to treat for clinical, surgical, and patient-related reasons, such as size of the lesion, difficult surgical approach for anatomical sites, or age of patients and request of the best cosmetic result. We also performed a long-term follow-up to assess recurrence rates and eventual late-onset adverse events.

  8. Spinal cord lesions in patients with neuromyelitis optica: a retrospective long-term MRI follow-up study

    Krampla, Wolfgang; Hruby, Walter [SMZ-Ost Donauspital, Department of Radiology, Vienna (Austria); Aboul-Enein, Fahmy; Jecel, Julia; Kristoferitsch, Wolfgang [SMZ-Ost Donauspital, Department of Neurology, Vienna (Austria); Lang, Wilfried [Hospital of Barmherzige Brueder, Department of Neurology, Vienna (Austria); Fertl, Elisabeth [Krankenanstalt Rudolfstiftung, Department of Neurology, Vienna (Austria)


    Neuromyelitis optica (NMO) is characterised by a particular pattern of the optic nerves and the spinal cord. Long-term MRI follow-up studies of spinal NMO lesions are rare, or limited by short observation periods. In nine patients with definite NMO or recurrent longitudinally extensive transverse myelitis (LETM) with NMO-IgG serum antibodies, repeated MRI examinations of the spine were carried out over a period of up to 11 years and evaluated regarding the changes over time in this retrospective study. In eight patients spinal cord lesions were located centrally, involving the grey and white matter. In the first examination after clinical onset changes resembled a stroke of the anterior spinal artery in two patients. Symmetrical signal alterations within the grey matter were observed. In one patient this pattern was transient, but it remained in the other. During the chronic stage, either a variable degree of spinal cord atrophy and high signal alterations, or almost complete remission of the lesions, was observed. Spinal MRI of patients with NMO myelitis can resemble a stroke. MRI of acute NMO stages did not allow a prediction of the clinical outcome. To a variable degree, NMO left behind typical defects which correlated with the clinical outcome. (orig.)

  9. Long-term follow-up of a female with congenital adrenal hyperplasia due to P450-oxidoreductase deficiency.

    Bonamichi, Beatriz D S F; Santiago, Stella L M; Bertola, Débora R; Kim, Chong A; Alonso, Nivaldo; Mendonca, Berenice B; Bachega, Tania A S S; Gomes, Larissa G


    P450 oxidoreductase deficiency (PORD) is a variant of congenital adrenal hyperplasia that is caused by POR gene mutations. The POR gene encodes a flavor protein that transfers electrons from nicotinamide adenine dinucleotide phosphate (NADPH) to all microsomal cytochrome P450 type II (including 21-hydroxylase, 17α-hydroxylase 17,20 lyase and aromatase), which is fundamental for their enzymatic activity. POR mutations cause variable impairments in steroidogenic enzyme activities that result in wide phenotypic variability ranging from 46,XX or 46,XY disorders of sexual differentiation, glucocorticoid deficiency, with or without skeletal malformations similar to Antley-Bixler syndrome to asymptomatic newborns diagnosed during neonatal screening test. Little is known about the PORD long-term evolution. We described a 46,XX patient with mild atypical genitalia associated with severe bone malformation, who was diagnosed after 13 years due to sexual infantilism. She developed large ovarian cysts and late onset adrenal insufficiency during follow-up, both of each regressed after hormone replacement therapies. We also described a late surgical approach for the correction of facial hypoplasia in a POR patient.

  10. ["True neurologic thoracic outlet syndrome" -- anatomical features and electrophysiological long-term follow-up of lateral thenar atrophy].

    Hug, U; Jung, F J; Guggenheim, M; Wedler, V; Burg, D; Künzi, W


    Atrophies of the intrinsic muscles of the hand are considered to be a typical symptom of the "true neurologic" form of thoracic outlet syndrome (TOS). The classical form of this entity was described as early as 1970, consisting of a cervical rib or a prolonged transverse process of C7, complete with a fibrous band to the first thoracic rib, resulting in atrophy of the intrinsic muscles of the hand. All our TOS patients presenting with such atrophy displayed anatomical findings consistent with this definition. Based on this observation, the TOS classification currently in clinical use, which differentiates between "disputed" and "true neurologic" subgroups of the neurologic form, is reviewed. In all cases of "true neurologic TOS" with atrophy of the intrinsic muscles of the hand, the lateral thenar muscles are affected first. We present the electrophysiological long-term results of such thenar atrophies of seven patients with eight operated extremities after brachial plexus decompression. The amplitude of the neurographically measured potential over the opponens pollicis and the abductor pollicis brevis muscle, respectively, was defined as quantitative parameter for muscles atrophy. Neither distinct reinnervation nor progressive denervation was evident in any of the cases after a follow-up period, on average, of more than five years post surgery. These findings are in conflict with clinical observations reporting a major postoperative improvement of the motor deficits.

  11. Long-term follow-up of patients with spontaneous clearance of hepatitis C: does viral clearance mean cure?

    Iqbal, M


    Up to 40% of patients with hepatitis C virus (HCV) antibodies are negative for HCV RNA at initial evaluation. If there is a risk of viral re-activation, long term follow-up is required with attendant financial, psychological and medical implications. We investigated the risk of re-activation in the Irish anti-D cohort. Information was obtained from the national hepatitis C database which includes data on patients infected by anti-D immunoglobulin in two large outbreaks, 1977-9 and 1991-94. As part of a screening programme, starting in 1994, 64,907 females exposed to anti-D immunoglobulin were evaluated. Three hundred and forty-seven were found to be antibody positive but HCV RNA negative at initial assessment. 93% had subsequent RNA tests. There was no evidence of HCV recurrence in patients whose infection resolved spontaneously. It appears that two initial sequential negative results for HCV RNA are sufficient to confirm spontaneous viral clearance and probable cure of hepatitis C virus infection.

  12. A Dual Expandable Stent for Treatment of Malignant Colorectal Obstruction: Long-Term Follow-Up Results

    Son, Won Young; Kang, Hee; Jung, Gyoo Sik [Dept. of Radiology, Kosin University College of Medicine, Gospel Hospital, Busan (Korea, Republic of)


    To analyze the long-term results and to evaluate the efficacy of a dual expandable stent for the treatment of malignant colorectal strictures. Under the fluoroscopic guidance, stents were placed in 60 patients with malignant colorectal strictures. A dual stent consists of two stents, the outer stent was placed into the stricture which was followed by coaxial placement of the inner bare stent. Technical and clinical success rates, complications, patient survival and stent patency during the follow-up period were evaluated in this study. Stent placement was technically successful in 57 of 60 patients (95%). Of them, obstructive symptoms resolved within two days in 12/12 (100%) patients in the preoperative group and in 36/45 (80%) patients in the palliative group. Complications associated with this procedure were perforation (n = 5), migration (n = 3), and tumor overgrowth (n = 2). Each of the six patients in the preoperative group underwent conventional laparotomy and laparoscopic surgery, respectively. The mean interval between stent insertion and surgery was nine days. In the palliative group, the median survival was 159 days (mean; 235) and the median patency of stent was 116 days (mean; 185). 1-month, 3-month, 6-month, 12-month and 24-month stent patency were 75%, 60%, 27%, 13% and 7%, respectively. Insertion of a dual expandable nitinol stent into malignant colorectal obstruction is a safe and effective procedure for the palliative treatment of malignant colorectal obstruction. This procedure is also effective for preoperative decompression.

  13. Costochondral graft construction/reconstruction of the ramus/condyle unit: long-term follow-up.

    Perrott, D H; Umeda, H; Kaban, L B


    This is a retrospective study of 26 patients (seven growing and 19 non-growing) who received costochondral grafts (n = 33) for construction or reconstruction of the ramus/condyle unit (RCU). Facial appearance, jaw motion, occlusion, contour, and linear growth changes were documented preoperatively, immediately postoperatively, and long-term (> 1 year). Average follow-up was 48.6 months for growing and 46.4 months for nongrowing patients. Facial asymmetry and malocclusion were successfully corrected in all patients except for those with hemifacial microsomia, where partial correction was most common. For the growing patients mean change in RCU length (n = 8) during the observation period was +3.1 mm on the constructed/reconstructed side and +3.2 mm on the unoperated side. For nongrowing patients, mean change in the RCU length (n = 25) was -5.7 mm for the reconstructed side. Three patients developed lateral contour overgrowth of the articulating surface; no patients developed clinically significant linear overgrowth with malocclusion. The results of this study indicate that a costochondral graft may be used successfully to construct/reconstruct the RCU and that linear overgrowth of the graft does not appear to be a clinical problem with the method described in this paper.

  14. Long-term follow-up studies of Gamma Knife surgery for patients with neurofibromatosis Type 2.

    Sun, Shibin; Liu, Ali


    The aim of this study was to evaluate long-term clinical outcomes after Gamma Knife surgery (GKS) for patients with neurofibromatosis Type 2 (NF2) and the role of GKS in the management of NF2. From December 1994 through December 2008, a total of 46 patients (21 male, 25 female) with NF2 underwent GKS and follow-up evaluation for at least 5 years at the Gamma Knife Center of the Beijing Neurosurgical Institute. GKS was performed using the Leksell Gamma Knife Models B and C. The mean age of the patients was 30 years (range 13-59 years). A family history of NF2 was found for 9 (20%) patients. The NF2 phenotype was thought to be Wishart for 20 (44%) and Feiling-Gardner for 26 (56%) patients. Among these 46 patients, GKS was performed to treat 195 tumors (73 vestibular schwannomas and 122 other tumors including other schwannomas and meningiomas). For vestibular schwannomas, the mean volume was 5.1 cm(3) (median 3.6 cm(3), range 0.3-27.3 cm(3)), the mean margin dose was 12.9 Gy (range 10-14 Gy), and the mean maximum dose was 27.3 Gy (range 16.2-40 Gy). For other tumors, the mean volume was 1.7 cm(3) (range 0.3-5.5 cm(3)), the mean margin dose was 13.3 Gy (range 11-14 Gy), and the mean maximum dose was 26.0 Gy (range 18.0-30.4 Gy). The median duration of follow-up was 109 months (range 8-195 months). For the 73 vestibular schwannomas that underwent GKS, the latest follow-up MR images demonstrated regression of 30 (41%) tumors, stable size for 31 (43%) tumors, and enlargement of 12 (16%) tumors. The total rate of tumor control for bilateral vestibular schwannomas in patients with NF2 was 84%. Of the 122 other types of tumors that underwent GKS, 103 (85%) showed no tumor enlargement. The rate of serviceable hearing preservation after GKS was 31.9% (15/47). The actuarial rates for hearing preservation at 3 years, 5 years, 10 years, and 15 years were 98%, 93%, 44%, and 17%, respectively. Of the 46 patients, 22 (48%) became completely bilaterally deaf, 17 (37%) retained

  15. Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up: a long-term prospective cohort study

    Lamberts, M.P.; Oudsten, B.L. den; Keus, F.; Vries, J. de; Laarhoven, C.J.H.M. van; Westert, G.P.; Drenth, J.P.H.; Roukema, J.A.


    BACKGROUND: Up to 41% of patients report pain after cholecystectomy and in most studies follow-up for these symptoms did not exceed 5 years. The episodic nature of abdominal pain associated with symptomatic cholelithiasis warrants long-term follow-up studies. We assessed which patient and surgical f

  16. Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up : A long-term prospective cohort study

    Lamberts, M.P.; den Oudsten, B.L.; Keus, F.; de Vries, J.; van Laarhoven, C.J.H.M.; Westert, G.P.; Drenth, J.P.H.; Roukema, J.A.


    Background Up to 41 % of patients report pain after cholecystectomy and in most studies follow-up for these symptoms did not exceed 5 years. The episodic nature of abdominal pain associated with symptomatic cholelithiasis warrants long-term follow-up studies. We assessed which patient and surgical f

  17. Heart rate reduction for 36 months with ivabradine reduces left ventricular mass in cardiac allograft recipients: a long-term follow-up study

    Doesch AO


    Full Text Available Andreas O Doesch,1 Susanne Mueller,1 Christian Erbel,1 Christian A Gleissner,1 Lutz Frankenstein,1 Stefan Hardt,1 Arjang Ruhparwar,2 Philipp Ehlermann,1 Thomas Dengler,3 Hugo A Katus1 1Department of Cardiology, 2Department of Cardiovascular Surgery, University of Heidelberg, Heidelberg, 3SLK Plattenwald Hospital, Bad Friedrichshall, Germany Background: Due to graft denervation, sinus tachycardia is a common problem after heart transplantation, underlining the importance of heart rate control without peripheral effects. However, long-term data regarding the effects of ivabradine, a novel If channel antagonist, are limited in patients after heart transplantation. Methods: In this follow-up analysis, the resting heart rate, left ventricular mass indexed to body surface area (LVMI, tolerability, and safety of ivabradine therapy were evaluated at baseline and after 36 months in 30 heart transplant recipients with symptomatic sinus tachycardia versus a matched control group. Results: During the study period, ivabradine medication was stopped in three patients (10% of total. Further analysis was based on 27 patients with 36 months of drug intake. The mean patient age was 53.3±11.3 years and mean time after heart transplantation was 5.0±4.8 years. After 36 months, the mean ivabradine dose was 12.0±3.4 mg/day. Resting heart rate was reduced from 91.0±10.7 beats per minute before initiation of ivabradine therapy (ie, baseline to 81.2±9.8 beats per minute at follow-up (P=0.0006. After 36 months of ivabradine therapy, a statistically significant reduction of LVMI was observed (104.3±22.7 g at baseline versus 93.4±18.4 g at follow-up, P=0.002. Hematologic, renal, and liver function parameters remained stable during ivabradine therapy. Except for a lower mycophenolate mofetil dose at follow-up (P=0.02, no statistically significant changes in immunosuppressive drug dosage or blood levels were detected. No phosphenes were observed during 36 months of

  18. Performance of the "house doctor". Effect of physician-to-patient ratio on follow up in long-term care facilities.

    Sloan, J P; Buchanan, B.


    Do physicians with many patients in a long-term care facility provide more timely follow up of their drug orders than those with only a few? We reviewed 60 charts at random in three intermediate care facilities. Physician practices fell into two distinct groups. Those with more than 17 patients followed up sooner than those with fewer than six. We recommend a "house doctor" model of care for patients whose follow up is poor.

  19. Genetic determinants of long-term changes in blood lipid concentrations: 10-year follow-up of the GLACIER study.

    Tibor V Varga


    Full Text Available Recent genome-wide meta-analyses identified 157 loci associated with cross-sectional lipid traits. Here we tested whether these loci associate (singly and in trait-specific genetic risk scores [GRS] with longitudinal changes in total cholesterol (TC and triglyceride (TG levels in a population-based prospective cohort from Northern Sweden (the GLACIER Study. We sought replication in a southern Swedish cohort (the MDC Study; N = 2,943. GLACIER Study participants (N = 6,064 were genotyped with the MetaboChip array. Up to 3,495 participants had 10-yr follow-up data available in the GLACIER Study. The TC- and TG-specific GRSs were strongly associated with change in lipid levels (β = 0.02 mmol/l per effect allele per decade follow-up, P = 2.0 × 10(-11 for TC; β = 0.02 mmol/l per effect allele per decade follow-up, P = 5.0 × 10(-5 for TG. In individual SNP analysis, one TC locus, apolipoprotein E (APOE rs4420638 (β = 0.12 mmol/l per effect allele per decade follow-up, P = 2.0 × 10(-5, and two TG loci, tribbles pseudokinase 1 (TRIB1 rs2954029 (β = 0.09 mmol/l per effect allele per decade follow-up, P = 5.1 × 10(-4 and apolipoprotein A-I (APOA1 rs6589564 (β = 0.31 mmol/l per effect allele per decade follow-up, P = 1.4 × 10(-8, remained significantly associated with longitudinal changes for the respective traits after correction for multiple testing. An additional 12 loci were nominally associated with TC or TG changes. In replication analyses, the APOE rs4420638, TRIB1 rs2954029, and APOA1 rs6589564 associations were confirmed (P ≤ 0.001. In summary, trait-specific GRSs are robustly associated with 10-yr changes in lipid levels and three individual SNPs were strongly associated with 10-yr changes in lipid levels.

  20. Long-term follow-up of rituximab plus first-line mitoxantrone, chlorambucil, prednisolone and interferon-alpha as maintenance therapy in follicular lymphoma.

    Herold, Michael; Scholz, Christian W; Rothmann, Frank; Hirt, Carsten; Lakner, Volker; Naumann, Ralph


    The randomised, controlled OSHO#39 study showed promising results using first-line mitoxantrone, chlorambucil and prednisolone (MCP) chemotherapy plus rituximab in patients with advanced symptomatic follicular lymphoma (FL) in need of therapy. The aim of this long-term follow-up was to investigate whether clinical benefits are maintained after up to 9 years of observation. Following the 4-year follow-up of OSHO#39, 77 FL patients who received rituximab plus MCP (R-MCP) and 52 patients who received MCP (129 patients alive and not previously censored in total) were followed for 5 additional years in this prospective, non-interventional, observational study. For the efficacy analysis, data were jointly analysed with OSHO#39 data (FL intention-to-treat population: 105 patients R-MCP, 96 MCP). Patients not included in the 5-year follow-up were censored. For surviving patients, median follow-up was 102 months (R-MCP) and 87 months (MCP). Although median overall survival (OS) was not yet reached, OS was longer for patients with R-MCP compared with MCP (p = 0.0057), with 8-year-survival rates of 76.1 versus 55.9%. Further time-to-event data were substantially longer for the R-MCP group than for MCP alone: median progression-free survival (PFS) was 93.4 versus 34.9 months, and median event-free survival (EFS) 89.6 versus 26.5 months. Unplanned subanalyses of patients with and without interferon maintenance showed improved PFS and EFS without an impact on OS. The addition of rituximab to first-line MCP chemotherapy improves clinical outcomes in advanced FL patients and translates into long-term OS benefits. R-MCP remains a promising standard option for this patient group.

  1. Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up: a long-term prospective cohort study.

    Lamberts, Mark P; Den Oudsten, Brenda L; Keus, Frederik; De Vries, Jolanda; van Laarhoven, Cornelis J H M; Westert, Gert P; Drenth, Joost P H; Roukema, Jan A


    Up to 41% of patients report pain after cholecystectomy and in most studies follow-up for these symptoms did not exceed 5 years. The episodic nature of abdominal pain associated with symptomatic cholelithiasis warrants long-term follow-up studies. We assessed which patient and surgical factors were associated with absence of pain and patient-reported success of surgery after ≥ 5 years of follow-up. Patients of ≥ 18 years of age with symptomatic cholelithiasis, classified as ASA I or II, who had previously returned a preoperative questionnaire were sent a questionnaire consisting of the gastrointestinal quality of life index (GIQLI) and patient ratings of current versus presurgical abdominal symptoms and of surgery result. Logistic regression analysis was performed to determine associations. Questionnaires were sent to 197 patients and returned by 126 (64.0%) patients (73.8 % female, mean age at surgery 47.5 ± 12.2 years) at a mean of 10.0 ± 1.0 years after cholecystectomy. Absence of abdominal pain was reported by 60.3% of the patients. Patients classified as ASA II as opposed to ASA I were less likely to report absence of pain (OR 0.41, 95% CI 0.17-0.99). A positive rating of long-term postsurgical versus presurgical abdominal symptoms was given by 89.7% of the patients and 90.5% considered the cholecystectomy result to be good. No variables were significantly associated with these latter two outcome measures. We found a high patient-reported surgery success rate after >5 years of follow-up after cholecystectomy despite residual abdominal pain in some of these patients. None of the patient and surgery-related characteristics were consistently associated with all three outcome measures. This discrepancy between patient' outcomes highlights the need for realistic expectations prior to cholecystectomy.

  2. Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden.

    Cecilia Dhejne

    Full Text Available CONTEXT: The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment. OBJECTIVE: To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. DESIGN: A population-based matched cohort study. SETTING: Sweden, 1973-2003. PARTICIPANTS: All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males in Sweden, 1973-2003. Random population controls (10:1 were matched by birth year and birth sex or reassigned (final sex, respectively. MAIN OUTCOME MEASURES: Hazard ratios (HR with 95% confidence intervals (CI for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]. RESULTS: The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8-4.3 than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8-62.9. Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9-8.5 and psychiatric inpatient care (aHR 2.8; 95% CI 2.0-3.9. Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls. CONCLUSIONS: Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.

  3. Health promotion and information provision during long-term follow-up for childhood cancer survivors: A service evaluation.

    Mayes, Jonathan; Brown, Morven C; Davies, Nicola; Skinner, Roderick


    Health promotion is an important component of long-term follow-up (LTFU) care for childhood cancer survivors (CCS). However, little information exists about how survivors perceive their own health promotion needs. As part of a service evaluation, 51 CCS who had previously attended the LTFU clinic took part in a single semistructured interview to seek their views on information they had received regarding late adverse effects (LAEs) of treatment, the purpose of LTFU, and the provision of health promotion information. Although most (93%) CCS were satisfied with the information received about LAEs, 37% desired further details. Over half (59%) believed that the purpose of LTFU was to screen for LAEs, whereas 31% felt that it was to check for relapse. No survivor reported health promotion to be an aim of LTFU; only 14% of CCS expected to receive healthy lifestyle advice, and fewer than 10% wanted dietary and physical activity advice. Most (88%) CCS felt that their hospital-based health care professional was best placed to give healthy lifestyle advice, but there was no consensus about the optimum timing for health promotion. CCS varied in their knowledge, needs, and wishes regarding LTFU care. The results of this evaluation strongly indicate that the profile of health promotion needs to be raised within our service and identifies issues that may be pertinent to similar services. Further research is needed to understand the views of CCS regarding health promotion and lifestyle behaviors, with the aim of tailoring and improving the delivery of effective health education to CCS.

  4. Metabolic Health in Childhood Cancer Survivors: A Longitudinal Study in a Long-Term Follow-Up Clinic.

    Gunn, Harriet M; Emilsson, Hanna; Gabriel, Melissa; Maguire, Ann M; Steinbeck, Katharine S


    Childhood cancer survivors (CCS) are at increased risk of metabolic dysfunction as a late effect of cancer treatment. However, pediatric metabolic syndrome (MetS) lacks a unified definition, limiting the diagnosis of MetS in CCS. This study evaluated individual metabolic health risk factors and potential areas for intervention in this at-risk population. This single center, retrospective observational longitudinal study evaluated the metabolic health of all CCS attending an oncology long-term follow-up clinic at a university hospital in Sydney, Australia (January 2012-August 2014). Participants were 276 CCS (52.2% male; mean age 18.0 years; range 6.8-37.9 years), at least 5 years disease free with a broad spectrum of oncological diagnoses. Primary metabolic health risk factors included raised body mass index, hypertension, and hypertransaminasemia. Participants treated with cranial radiotherapy (n = 47; 17.0% of cohort) had additional biochemical variables analyzed: fasting glucose/insulin, HDL/LDL cholesterol, and triglycerides. Hypertension was common (19.0%), with male sex (p < 0.01) and being aged 18 years or above (p < 0.01) identified as risk factors. Cranial irradiation was a risk factor for overweight/obesity (47.8% in cranial radiotherapy-treated participants vs. 30.4%; p = 0.02). Hypertransaminasemia was more prevalent among participants treated with radiotherapy (15.6% vs. 7.3%; p = 0.03), and overweight/obese participants (17.6% vs. 8.2%; p = 0.04). Metabolic health risk factors comprising MetS are common in CCS, placing this population at risk of premature adverse cardiovascular consequences. Proactive surveillance and targeted interventions are required to minimize these metabolic complications, and a unified definition for pediatric MetS would improve identification and monitoring.

  5. The Outcome of a Long-Term Follow-up of Pancreatic Function after Recovery from Acute Pancreatitis

    Tomas Symersky


    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.

  6. Stigma and quality of life at long-term follow-up after surgery for epilepsy in Uganda.

    Fletcher, Anita; Sims-Williams, Helen; Wabulya, Angela; Boling, Warren


    Epilepsy is a worldwide health problem with a 10-fold greater prevalence in the developing world. Commonly, the seizure focus is in the temporal lobe, and seizures in about 30% of people with epilepsy are intractable to medication. For these individuals, surgery for intractable temporal lobe epilepsy (iTLE) is more effective than medication alone and may be the only option for cure. Intractable temporal lobe epilepsy is associated with elevated morbidity and mortality, reduced quality of life (QOL), and associated stigma particularly occurring in the developing world. Individuals with intractable epilepsy who participated in an earlier Uganda pilot study were selected for the current study based on their undergoing previous surgery for iTLE or having comparable seizure type who did not have surgery. At long-term follow-up, 10 who underwent surgery for iTLE in addition to 9 patients with focal dyscognitive type epilepsy who did not have surgery were evaluated in the current study. Tests were administered to look at various outcome parameters: seizure severity, QOL, stigma, and self-esteem. Stigma and self-esteem were additionally evaluated in the parent/caregiver. Seventy-percent of surgical resection patients were seizure-free at 8 years postsurgery. The QOLIE-31 scores were higher in surgical patients. Child/patient and parent/proxy surveys identified lower stigma in seizure-free patients. The results suggest that surgery for iTLE is an effective treatment for epilepsy in the developing world and provides an opportunity to reduce stigma and improve QOL.

  7. Long-Term Follow-Up of Desmoid Fibromatosis Treated with PF-03084014, an Oral Gamma Secretase Inhibitor.

    Villalobos, Victor Manuel; Hall, Francis; Jimeno, Antonio; Gore, Lia; Kern, Kenneth; Cesari, Rossano; Huang, Bo; Schowinsky, Jeffrey T; Blatchford, Patrick Judson; Hoffner, Brianna; Elias, Anthony; Messersmith, Wells


    Desmoid fibromatosis is a fibroblastic neoplasm driven by aberrations within the WNT pathway, exhibiting mutations in β-catenin or APC. We review the long-term follow-up of patients in a phase I study treated with an oral gamma secretase inhibitor, PF-03084014. PF-03084014 was administered orally at doses ranging from 20 to 330 mg twice daily. Tumor assessments were performed using computed tomography/magnetic resonance imaging (CT/MRI) within 4 weeks of study entry, and every other cycle through cycle 9. After cycle 9, patients were evaluated as clinically indicated. Seven patients with desmoid fibromatosis were treated between December 2009 and December 2016 at the University of Colorado. Five patients (71.4%, 95% confidence interval [CI] 29.0-96.3%) achieved a partial response (PR), with a mean time to achieving response of 11.9 months (95% CI 2.5-21.4 months). All patients who achieved a PR continue to maintain responses between 47.9 and 73+ months. Four patients stopped treatment yet remain free of progression between 11 and 53+ months. One patient had PFS of 42+ months, with a 17% decrease in the target lesion. A biopsy performed at the end of the study showed decreased tumoral cellularity compared with previous biopsies. Effective treatment doses ranged from 80 to 330 mg administered orally twice daily. PF-03084014 was effective in treating desmoid tumors, with an objective response rate of 71.4% (95% CI 29.0-96.3%) in this small cohort of patients. PF-03084014 exhibits promising activity, even at relatively low doses (80 mg twice daily), with high tolerability leading to prolonged disease control even after therapy discontinuation.

  8. Chronic fatigue in 812 testicular cancer survivors during long-term follow-up: increasing prevalence and risk factors.

    Sprauten, M; Haugnes, H S; Brydøy, M; Kiserud, C; Tandstad, T; Bjøro, T; Bjerner, J; Cvancarova, M; Fosså, S D; Oldenburg, J


    Chronic fatigue (CF) has been reported to be slightly more prevalent in testicular cancer survivors (TCSs) than in the general population. In this study, we wished to explore possible determinants of CF in TCSs median 12 (survey I) and 19 years (survey II) after treatment, in particular the relation to late effects after treatment. Overall, 812 TCSs treated between 1980 and 1994 provided blood samples (testosterone and luteinizing hormone) and completed questionnaires at survey I (1998-2002) and survey II (2007-2008). Hormone levels were categorized according to quartile thresholds for decadal age groups of controls. Associations between CF and possible risk factors, including the Hospital Anxiety and Depression Scale (HADS), treatment, physical activity, hormone levels, neurotoxicity, and comorbidity, were analyzed by logistic regression. Prevalence of CF increased from 15% at survey I to 27% at survey II (P < 0.001). At survey II, risk for CF was increased three- to four-fold for high levels of neuropathy compared with no neuropathy, and two- to three-fold for high levels of Raynaud-like phenomena, and having testosterone levels in the lowest quartile, while being moderately and highly physically active, had a protective effect. Risk for CF in TCSs with higher levels of HADS-Anxiety and HADS-Depression was increased two- to five-fold, respectively. The increasing prevalence of CF in TCSs is a novel finding. Lifestyle interventions, early detection and treatment of depression and anxiety, and possibly testosterone substitution might reduce the risk of CF. Extended long-term follow-up seems to be important. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email:

  9. Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases.

    Mirzaali, Mikaeil; Dooley, Maureen; Wynne, Dylan; Cooter, Nina; Lee, Lorraine; Haworth, Peter; Saha, Romi; Gainsborough, Nicola; Hildick-Smith, David


    Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke.

  10. Health effects following long-term exposure to thorium dusts. A fourteen-year follow-up study in China

    Chen Xingan; Cheng Younge; Zhen Rong [Ministry of Public Health, Beijing (China). Lab. of Industrial Hygiene


    A fourteen-year follow-up study was carried out at Baiyan Obo Rare-earth Iron Mine in China. It has been operating for forty one years. It's ore contains ThO2 at a percentage of 0.04. The purpose of this study is to investigate the possible health effects of 2903 dust-inhaled miners following long-term exposure to thorium dusts. An electrostatic collection system was used to measure the exhaled thoron activity of each examinee, through simple calculation, each examinee's thorium lung burden obtained. Health status was ascertained through questionnaire, physical examination and clinical laboratory tests. An epidemiological study on the mortality rates of lung cancers of the dust-inhaled miners and internal controls was also carried out. Results showed that the highest thorium lung burden for 1158 measurements of 638 miners was at a value of 11.11 Bq, one tenth of the maximum thorium lung burden. In a ten-year investigation on the four haematological parameters and four hepatic parameters of 638 exposed miners, no adverse effects were observed. The incidence of severe breathlessness, lung function tests, pneumoconiosis of stage O{sup +} and the concentration of ceruloplasmin in the serum of high thorium lung burden group are much higher than that of low thorium lung burden group. However, owing to the concentration of SiO2 (10%) are much higher than that of the ThO2 (0.04%) in the dust, the disorders of respiratory tract are mainly due to the fibrogenic effects of SiO2, Epidemiology study showed that both the SMRs of the dust-inhaled miners and the dust-free miners are all greater than one (5.15 vs. 2.30). The SMR of the dust miners was much higher than that of the controls. However, there was no statistic significant difference between these two SMRs (X{sup 2}=3.75 P>0.05). This means that the high SMR of the dust-inhaled miners was not solely due to the long-term inhaled thorium and short-lived thoron daughters. Because of very high percentage of smokers

  11. Long-term follow-up after accidental gamma irradiation from a {sup 192}Ir source in Bangladesh

    Mollah, A.S.; Begum, A.; Begum, R. [Bangladesh Atomic Energy Commission, Dhaka (Bangladesh)


    A industrial radiographer was accidentally over -exposed to high dose of ionizing radiation from an {sup 192}Ir source pellet during radiograph y of weld-joints in gas pipe-lines on June 10, 1985 in Bangladesh. The source, housed in a portable exposure assembly, had an activity of about 1850 GBq. A guide -tube was used to control the transfer of the source from safe storage position to the exposure position and vice versa. For radiography, the ti p of the guide tube was to be fixed to the weld -joint while the source was cranked to the exposure position. Following the elapse of the preset exposure time the source had to be cranked back to the safe stor age position. This procedure was to be repeated for each radiographic exposure. Symptoms of high radiation exposure occurred immediately after the accident and skin erythema developed leading to progressive tissue deteriorations. Biological effects such as mild vomiting, malaise, nausea and diarrhea occurred within a short period after the accident. Skin erythema, swelling and tenderness of the palmar surfaces and the tips of the thumbs, index fingers and middle fingers of the both hands accompanied by severe pain and inflammation developed within 7 days of the mishap. The inflammatory changes characterized by redness and bullae spread over the affected fingers with severe pain and agony within a few days. The finger -tips developed abscesses with enormous pus formation and the affected finger nails fell off. He also developed toothache. At this stage a medical practitioner made some surgical dressings and prescribed antibiotics. During the first six months the most serious health disorder was local necroses of the skin and the deep layers of the palmar side of the affected fingers with sharply delineated injuries. The clinical findings were consistent with those reported elsewhere under similar accident conditions. The consequences of this over-exposure are being followed up to assess the long-term effects of

  12. Endovascular management of patients with coronary artery disease and diabetic foot syndrome:A long-term follow-up

    Gianluca Rigatelli; Paolo Cardaioli; Fabio dell'Avvocata; Massimo Giordan; Giovanna Lisato; Francesco Mollo


    Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients.Methods We retrospectively included 220 diabetic patients (78.5±15.8 years,107 females,all with Fontaine III or IV class) who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010.Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease (CAD) and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions.Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure (TcPO2) before and after the procedure were performed as well as stressechocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly.Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography.In the rest of 126 patients,combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients.Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients.For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients (77.7%) and contralateral cross-over in 40/220 patients (18.8%) and popliteal retrograde+femoral antegrade in 10/220 patients (4.5%).Balloon angioplasty was performed in 252 legs (32 patients had bilateral disease):the procedure was successful in 239/252 legs with an immediate success rate

  13. Long-term evolution of slipped capital femoral epiphysis treated by in situ fixation: a 26 years follow-up of 11 hips

    Jérôme Murgier


    Full Text Available Slipped capital femoral epiphysis (SFCE may lead to femoro acetabular impingement and long-term function impairment, depending on initial displacement and treatment. There are several therapeutic options which include in situ fixation (ISF. The objective of this study was to evaluate long-term functional and radiographic outcomes of patients with SFCE treated with ISF. We conducted a single-center, retrospective study evaluating the clinical and radiographic outcomes of SCFE in situ fixation with a mean follow-up of 26 years (10- 47. Analysis of preoperative and last follow up radiographs was performed. The functional status of the hip was evaluated according to the Oxford hip score-12 and the radiographic osteoarthritis stage was rated according to Tönnis classification. Signs of femoro acetabular impingement were sought. Ten patients (11 hips were included. The average initial slip was 33.5° (10-62. At final follow up, the average Oxford hip score was 19.3 (12-37, it was good for groups who had a small initial slip (16.7 or moderate (17 and fair for the severe group (27. Average Tönnis grade was 1.3 (0- 3. The average alpha angle was 65.3° (50- 80°. Femoro acetabular impingement was likely in 100% of patients with severe slip, in 50% of patients with moderate slip and in 33% of patients with a slight slip. In situ fixation generated poor functional results, substantial hip osteoarthritis and potential femoro acetabular impingement in moderate to severe SCFE’s. However, in cases with minor displacement, functional and radiographic results are satisfactory. The cut off seems to be around 30° slip angle, above which other treatment options should be considered.

  14. Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up.

    Iwasaki, Motoki; Kawaguchi, Yoshiharu; Kimura, Tomoatsu; Yonenobu, Kazuo


    The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course. The authors reviewed data obtained in 92 patients who underwent cervical laminoplasty between 1982 and 1990. Three patients were lost to follow up, 25 patients died within 10 years of surgery, and 64 patients were followed for more than 10 years. Results were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. The recovery rate was calculated using the Hirabayashi method. The mean neurological recovery rate during the first 10 years after surgery was 64%, which declined to 60% at the last follow-up examination (mean follow up 12.2 years). Late neurological deterioration occurred in eight patients (14%) from 5 to 15 years after surgery. The most frequent causes of late deterioration were degenerative lumbar disease (three patients), thoracic myelopathy secondary to ossification of the ligamentum flavum (two patients), or postoperative progression of OPLL at the operated level (two patients). Postoperative progression of the ossified lesion was noted in 70% of the patients, but only two patients (3%) were found to have related neurological deterioration. Additional cervical surgery was required in one patient (2%) because of neurological deterioration secondary to progression of the ossified ligament. The authors performed a multivariate stepwise analysis, and found that factors related to better clinical results were younger age at operation and less severe preexisting myelopathy. Younger age at operation, as well as mixed and continuous types of OPLL, was highly predictive of progression of OPLL. Postoperative progression of kyphotic deformity was observed in 8% of the patients, although it did not cause neurological deterioration. When the incidence of surgery-related complications and

  15. Late occurrence of granular dystrophy in bilateral keratoconus: Penetrating keratoplasty and long-term follow-up

    Varsha M Rathi


    Full Text Available We report a rare case of keratoconus with granular dystrophy with a follow-up of two decades, documenting the sequential presentation of two diseases confirmed by histology and genetic studies. A 13-year-old boy was diagnosed in 1988 with keratoconus in both eyes (BE based on slit-lamp biomicroscopy findings of corneal ectasia in BE accompanied by Fleischer′s ring, Vogt′s striae, a small, old, healed hydrops. The left eye (LE had central corneal thinning and scar in the central area involving the mid and posterior stroma secondary to healed hydrops. Penetrating keratoplasty (PKP was advised. The boy was lost to follow-up till 1991 and presented with white, dot-like opacities in the central cornea in the RE only, suggestive of granular corneal dystrophy. Similar findings of white, dot-like opacities were noted in the LE in 1995 and the patient subsequently underwent PKP in BE. Histopathology of corneal buttons confirmed the presence of patchy, crystal-like orange deposits, which stained bright red with Masson′s trichrome. Mutational analysis of the TGFBI gene in patient′s DNA revealed a heterozygous mutation corresponding to a change in Arg555Trp in the keratoepithelin protein. Granular dystrophy recurred after 8 years in the RE.

  16. Long-term and ultra long-term blood pressure variability during follow-up and mortality in 14,522 patients with hypertension.

    Hastie, Claire E; Jeemon, Panniyammakal; Coleman, Holli; McCallum, Linsay; Patel, Rajan; Dawson, Jesse; Sloan, William; Meredith, Peter; Jones, Gregory C; Muir, Scott; Walters, Matthew; Dominiczak, Anna F; Morrison, David; McInnes, Gordon T; Padmanabhan, Sandosh


    Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be an independent cardiovascular risk predictor. The implication of this variability in hypertension clinical practice is unclear. BPV as average real variability (ARV) was calculated in 14,522 treated patients with hypertension in 4 time frames: year 1 (Y1), years 2 to 5 (Y2-5), years 5 to 10 (Y5-10), and years >10 (Y10+) from first clinic visit. Cox proportional hazards models for cause-specific mortality were used in each time frame separately for long-term BPV, across time frames based on ultra long-term BPV, and within each time frame stratified by mean BP. ARV in systolic blood pressure (SBP), termed ARV(SBP), was higher in Y1 (21.3±11.9 mm Hg) in contrast to Y2-5 (17.7±9.9 mm Hg), Y5-10 (17.4±9.6 mm Hg), and Y10+ (16.8±8.5 mm Hg). In all time frames, ARV(SBP) was higher in women (Phypertensive individuals at high risk, especially those with BP within the normal range.

  17. Mechanical cardiac remodeling and new-onset atrial fibrillation in long-term follow-up of subjects with chronic Chagas' disease

    P.R. Benchimol-Barbosa


    Full Text Available Atrial fibrillation (AF affects subjects with Chagas' disease and is an indicator of poor prognosis. We investigated clinical, echocardiographic and electrocardiographic variables of Chagas' disease in a long-term longitudinal study as predictors of a new-onset AF episode lasting >24 h, nonfatal embolic stroke and cardiac death. Fifty adult outpatients (34 to 74 years old, 62% females staged according to the Los Andes classification were enrolled. During a follow-up of (mean ± SD 84.2 ± 39.0 months, 9 subjects developed AF (incidence: 3.3 ± 1.0%/year, 5 had nonfatal stroke (incidence: 1.3 ± 1.0%/year, and nine died (mortality rate: 2.3 ± 0.8%/year. The progression rate of left ventricular mass and left ventricular ejection fraction was significantly greater in subjects who experienced AF (16.4 ± 20.0 g/year and -8.6 ± 7.6%/year, respectively than in those who did not (8.2 ± 8.4 g/year; P = 0.03, and -3.0 ± 2.5%/year; P = 0.04, respectively. In univariate analysis, left atrial diameter ≥3.2 cm (P = 0.002, pulmonary arterial hypertension (P = 0.035, frequent premature supraventricular and ventricular contraction counts/24 h (P = 0.005 and P = 0.007, respectively, ventricular couplets/24 h (P = 0.002, and ventricular tachycardia (P = 0.004 were long-term predictors of AF. P-wave signal-averaged ECG revealed a limited long-term predictive value for AF. In chronic Chagas' disease, large left atrial diameter, pulmonary arterial hypertension, frequent supraventricular and ventricular premature beats, and ventricular tachycardia are long-term predictors of AF. The rate of left ventricular mass enlargement and systolic function deterioration impact AF incidence in this population.

  18. Long-term follow-up in two cases of intracranial Rosai–Dorfman Disease complicated by incomplete resection and recurrence

    Rivera, Diones; Pérez-Castillo, Miguelina; Fernández, Belkis; Stoeter, Peter


    Background: Although intracranial Rosai–Dorfman disease is a principally benign lymphohistiocytosis, some patients run a relapsing or progressive course. However, reports about long-term follow-up are extremely rare. Case Description: In two patients, initial tumor resection was incomplete or followed by recurrences over 3 years, which finally subsided after application of chemotherapy, and patients remained tumor-free for more than 7 years thereafter. Conclusion: Up to now there is no agreement on how to treat complicated cases of intracranial Rosai–Dorfman disease; our good experience with adjuvant chemotherapy and long-term follow-up will contribute to treatment planning in complicated cases. PMID:24778918

  19. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia

    J.W.A. Burger (Jacobus); R.W. Luijendijk; W.C.J. Hop (Wim); J.A. Halm (Jens); E.G. Verdaasdonk; J. Jeekel (Hans)


    textabstractOBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking.


    M. E. Tsanyan; S K Soloviev; A. V. Torgashina; E N Aleksandrova; S G Radenska-Lopovok; E. V. Nikolaeva; E L Nasonov


    Objective. To evaluate the efficacy and safety of rituximab (RTM) treatment in the long-term follow-up of patients with systemic lupus erythematosus (SLE) refractory to standard therapy. Material and methods. RTM therapy was prescribed to 97 SLE patients with high disease activity and insufficient effica- cy of using high doses of glucocorticoids (GC) and cytostatics. The median follow-up time (25th; 75th percentiles) was 18 [12; 36] months. The most common clinical manifestations of SLE incl...

  1. Primary Infrarenal Aortic Stenting With or Without Iliac Stenting for Isolated and Aortoiliac Stenoses: Single-Centre Experience With Long-Term Follow-Up

    Tapping, C. R.; Ahmed, M.; Scott, P. M.; Lakshminarayan, R.; Robinson, G. J.; Ettles, D. F.; Shrivastava, V., E-mail: [Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Department of Radiology (United Kingdom)


    The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 {+-} 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 {+-} -0.15 (right) and 0.61 {+-} -0.16 (left). After the procedure they were 0.86 {+-} -0.07 (right) and 0.90 {+-} -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic

  2. Practices and barriers in long-term living kidney donor follow-up: a survey of U.S. transplant centers.

    Mandelbrot, Didier A; Pavlakis, Martha; Karp, Seth J; Johnson, Scott R; Hanto, Douglass W; Rodrigue, James R


    Many have called for more comprehensive follow-up of living kidney donors, both for the donor's benefit and to establish a high-quality database of donor outcomes. United Network for Organ Sharing currently requires transplant centers to report donor follow-up information at several time points after donation, but little is known about how frequently this information is obtained, or which barriers exist to compliance with United Network for Organ Sharing requirements. To assess practices and barriers in providing follow-up care to living donors, we sent a questionnaire to all program directors at U.S. transplant centers. Few transplant centers are currently seeing donors for long-term follow-up. Many centers recommend that donor follow-up care be provided by primary care physicians, but follow-up information is rarely received from primary care physicians. The main barriers to collecting more complete information are donor inconvenience, costs, and lack of reimbursement to the transplant center for providing follow-up care. Significant changes are required to improve long-term donor follow-up by U.S. transplant centers.

  3. Failure pattern implications following external beam irradiation of prostate cancer: long-term follow-up and indications of cure.

    Hanlon, A L; Hanks, G E


    The purpose of this study was to present patterns and risk of biochemical failure following external beam irradiation of prostate cancer and to make comparisons to a published modern radical prostatectomy series. Between January 1987 and December 1994, 328 men were treated definitively at Fox Chase Cancer Center for localized prostate cancer using conventional or three-dimensional conformal radiotherapy. The median biochemical follow-up was 6.4 years, with all patients having at least 5 years follow-up. Two prognostic patient groups were established on the basis of proportional hazards modeling that considered treatment and presenting tumor characteristics. For each of the two prognostic groups, biochemical failure and hazard functions were estimated using the ASTRO consensus definition of failure and life table methodology. Failure risk comparisons were made to modern published radical prostatectomy series. Multivariate analysis demonstrated the independent predictive power of pretreatment PSA level, palpation stage, Gleason score, and dose. Thus, the favorable prognosis group, Group I, consisted of 83 patients who were treated with a dose level > or = 74 Gy and who presented with PSA levels or = 20 ng/ml, T2B/T3 tumor, Gleason score 7-10, dose tapering to a low rate at 4 years with no failures observed after 6 years. Differences in patterns of failure by prognostic group show maximum risk of failure at 24 months (median, 31 months) for Group I, and 12 to 36 months (median, 22 months) for Group II. Group II reaches low levels of risk at 6 years, in contrast to 4 years for the patients with a more favorable prognosis. We concluded that patients treated with external beam radiation alone show little risk of failure after 4 to 6 years. This result suggests that the 5-year bNED control rate approximates the eventual cure rate of prostate cancer.

  4. Presentation and long-term follow-up of refractory celiac disease: comparison of type I with type II.

    Malamut, Georgia; Afchain, Pauline; Verkarre, Virginie; Lecomte, Thierry; Amiot, Aurélien; Damotte, Diane; Bouhnik, Yoram; Colombel, Jean-Frédéric; Delchier, Jean-Charles; Allez, Matthieu; Cosnes, Jacques; Lavergne-Slove, Anne; Meresse, Bertrand; Trinquart, Ludovic; Macintyre, Elizabeth; Radford-Weiss, Isabelle; Hermine, Olivier; Brousse, Nicole; Cerf-Bensussan, Nadine; Cellier, Christophe


    Refractory celiac disease (RCD) was recently subdivided into 2 subtypes (RCD I and II) based on a normal or abnormal phenotype of intraepithelial lymphocytes (IELs), respectively. It is not clear, however, if these 2 entities differ in their presentation at diagnosis or long-term outcome. We compared the clinical and biological characteristics of RCD I and RCD II at diagnosis, the risk of developing an overt lymphoma, and the predictive factors of survival. Medical files of 14 patients with RCD I and 43 with RCD II were analyzed retrospectively. Predictive factors of overt lymphoma and survival were studied in univariate and multivariate analyses. At diagnosis, malnutrition, ulcerative jejunitis, and lymphocytic gastritis were more common in patients with RCD II than RCD I (PRCD I and 16 with RCD II. In the univariate analysis, abnormal IEL phenotype and increased age at diagnosis of RCD were predictive factors for overt lymphoma. Abnormal IEL phenotype (PRCD I and 44% with RCD II. RCD II has a much more severe presentation and prognosis than patients with RCD I; RCD II survive 5 years after diagnosis. Abnormal IEL phenotype is a predictive factor but not a necessary condition for the development of overt lymphoma.

  5. A long-term follow up study of a birth cohort of boxer dogs in The Netherlands : genetic and environmental risk factors for diseases

    Hagen, Marjan Antonia Elisabeth van


    This thesis describes the long-term follow up of a birth cohort of boxer dogs to study disease incidence, mortality, as well as genetic and environmental risk factors in a purebred dog population in The Netherlands. During the last decades, both the number of genetic disorders and the disease rate o

  6. Clinical Presentation, Long-Term Follow-Up, and Outcomes of 1001 Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Patients and Family Members

    Groeneweg, Judith A.; Bhonsale, Aditya; James, Cynthia A.; Te Riele, Anneline S.; Dooijes, Dennis; Tichnell, Crystal; Murray, Brittney; Wiesfeld, Ans C P; Sawant, Abhishek C.; Kassamali, Bina; Atsma, Douwe E.; Volders, Paul G.; De Groot, Natasja M.; De Boer, Karin; Zimmerman, Stefan L.; Kamel, Ihab R.; van der Heijden, JF; Russell, Stuart D.; Cramer, MJ; Tedford, Ryan J.; Doevendans, Pieter A.; van Veen, AAB; Tandri, Harikrishna; Wilde, Arthur A.; Judge, Daniel P.; Van Tintelen, J. Peter; Hauer, Richard N. W.; Calkins, Hugh


    Background Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a progressive cardiomyopathy. We aimed to define long-term outcome in a transatlantic cohort of 1001 individuals. Methods and Results Clinical and genetic characteristics and follow-up data of ARVD/C index-patients (n=4

  7. 75 FR 77880 - Proposed Collection; Comment Request; GuLF Worker Study: Gulf Long-Term Follow-Up Study for Oil...


    ... excessive heat, and possibly to stress due to widespread economic and lifestyle disruption. Exposures range... HUMAN SERVICES National Institutes of Health Proposed Collection; Comment Request; GuLF Worker Study: Gulf Long-Term Follow-Up Study for Oil Spill Clean-Up Workers and Volunteers SUMMARY: Under...

  8. A long-term follow up study of a birth cohort of boxer dogs in The Netherlands : genetic and environmental risk factors for diseases

    Hagen, Marjan Antonia Elisabeth van


    This thesis describes the long-term follow up of a birth cohort of boxer dogs to study disease incidence, mortality, as well as genetic and environmental risk factors in a purebred dog population in The Netherlands. During the last decades, both the number of genetic disorders and the disease rate o

  9. Long-term follow-up of a randomised controlled trial of azathioprine/methylprednisolone versus cyclophosphamide in patients with proliferative lupus nephritis

    Arends, Suzanne; Grootscholten, Cecile; Derksen, Ronald H. W. M.; Berger, Stefan P.; de Sevaux, Ruud G. L.; Voskuyl, Alexandre E.; Bijl, Marc; Berden, Jo H. M.


    Objectives The objectives of this study are to analyse the long-term follow-up of a randomised controlled trial of induction treatment with azathioprine/methylprednisolone (AZA/MP) versus high-dose intravenous cyclophosphamide (ivCY) in patients with proliferative lupus nephritis (LN) and to evaluat

  10. Long-term follow-up of a randomised controlled trial of azathioprine/methylprednisolone versus cyclophosphamide in patients with proliferative lupus nephritis.

    Arends, S.; Grootscholten, C.; Derksen, R.H.W.M.; Berger, S.P.; Sevaux, R.G.L. de; Voskuyl, A.E.; Bijl, M. van der; Berden, J.H.M.


    OBJECTIVES: The objectives of this study are to analyse the long-term follow-up of a randomised controlled trial of induction treatment with azathioprine/methylprednisolone (AZA/MP) versus high-dose intravenous cyclophosphamide (ivCY) in patients with proliferative lupus nephritis (LN) and to evalua

  11. Long-term follow-up after mesh removal and selective neurectomy for persistent inguinal postherniorrhaphy pain

    Bischoff, J M; Enghuus, Casper Nørskov; Werner, M U;


    PURPOSE: Persistent inguinal pain, influencing daily activities, is seen in about 5 % of patients following inguinal herniorrhaphy. Surgical treatment of patients with persistent postherniorrhaphy pain has been associated with pain relief and improvement in functional status. However, the detailed...... long-term outcome effects remain to be clarified. The aim of this study was to determine the long-term effects of mesh removal and selective neurectomy in patients with persistent postherniorrhaphy pain after previous open repair. METHODS: The study consecutively included 54 inguinal postherniorrhaphy...

  12. Long-term effects of preventive cognitive therapy in recurrent depression : a 5.5-year follow-up study

    Bockting, Claudi L H; Spinhoven, Philip; Wouters, Luuk F; Koeter, Maarten W J; Schene, Aart H


    OBJECTIVE: Major depressive disorder (MDD) was projected to rank second on a list of 15 major diseases in terms of burden in 2030. A crucial part of the treatment of depression is the prevention of relapse/recurrence in high-risk groups, ie, recurrently depressed patients. The long-term preventive e

  13. Long-term follow-up of peptidergic and nonpeptidergic reinnervation of the epidermis following sciatic nerve reconstruction in rats

    Kambiz, S.; Duraku, L.S.; Baas, M.; Nijhuis, T.H.; Cosgun, S.G.; Hovius, S.E.; Ruigrok, T.J.; Walbeehm, E.T.


    OBJECT: Peripheral nerve injuries are a commonly encountered clinical problem and often result in long-term functional deficits. The current gold standard for transected nerves is an end-to-end reconstruction, which results in the intermittent appearance of neuropathic pain. METHODS: To improve our

  14. Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis : the Dutch national register

    Prince, F H M; Twilt, M; ten Cate, R; van Rossum, M A J; Armbrust, W; Hoppenreijs, E P A H; van Santen-Hoeufft, M; Koopman-Keemink, Y; Wulffraat, N M; van Suijlekom-Smit, L W A


    OBJECTIVE: We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis (JIA) subtypes. METHODS: At baseline we collected patient and disease characteristics of all Dutch patients wi

  15. Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis : the Dutch national register

    Prince, F. H. M.; Twilt, M.; ten Cate, R.; van Rossum, M. A. J.; Armbrust, Wineke; Hoppenreijs, E. P. A. H.; van Santen-Hoeufft, M.; Koopman-Keemink, Y.; Wulffraat, N. M.; van Suijlekom-Smit, L. W. A.


    Objective: We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis (JIA) subtypes. Methods: At baseline we collected patient and disease characteristics of all Dutch patients wi

  16. Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis: the Dutch national register

    Prince, F.H.M.; Twilt, M.; ten Cate, R.; van Rossum, M.A.J.; Armbrust, W.; Hoppenreijs, E.P.A.H.; van Santen-Hoeufft, M.; Koopman-Keemink, Y.; Wulffraat, N.M.; van Suijlekom-Smit, L.W.A.


    OBJECTIVE: We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis (JIA) subtypes. METHODS: At baseline we collected patient and disease characteristics of all Dutch patients wi

  17. Active Middle Ear Implantation: Long-term Medical and Technical Follow-up, Implant Survival, and Complications

    Zwartenkot, J.W.; Mulder, J.J.S.; Snik, A.F.M.; Cremers, C.W.R.J.; Mylanus, E.A.M.


    OBJECTIVE: To evaluate the long-term medical and technical results, implant survival, and complications of the semi-implantable vibrant soundbridge (VSB), otologics middle ear transducer (MET), and the otologics fully implantable ossicular stimulator (FIMOS). STUDY DESIGN: Retrospective cohort study

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

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


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

  19. Long-term follow-up of lung and heart transplant recipients with pre-transplant malignancies

    Sigurdardottir, Vilborg; Bjortuft, Oystein; Eiskjær, Hans


    Concern regarding recurrence of pre-transplant (Tx) malignancy has disqualified patients from Tx. Because this has been poorly studied in lung and heart Tx recipients our aim was to investigate the influence of pre-Tx malignancy on post-Tx recurrence and long-term survival, focusing on pre...

  20. CKD and hypertension during long-term follow-up in children and adolescents previously treated with extracorporeal membrane oxygenation

    A.J.M. Zwiers (Alexandra); H. IJsselstijn (Hanneke); J.M. van Rosmalen (Joost); S.J. Gischler (Saskia); S.N. de Wildt (Saskia); D. Tibboel (Dick); K. Cransberg (Karlien)


    markdownabstract__Abstract__ Background and objectives Many children receiving extracorporeal membrane oxygenation develop AKI. If AKI leads to permanent nephron loss, it may increase the risk of developing CKD. The prevalence of CKD and hypertension and its predictive factors during long-term foll

  1. Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot.

    Oosterhof, T.; Meijboom, F.J.; Vliegen, H.W.; Hazekamp, M.G.; Zwinderman, A.H.; Bouma, B.J.; Dijk, A.P.J. van; Mulder, B.J.M.


    AIMS: To analyse the long-term outcomes after pulmonary valve replacement (PVR) in patients with a previous correction for tetralogy of Fallot. METHODS AND RESULTS: In a retrospective study, 158 adult patients with a diagnosis of tetralogy of Fallot, who had undergone a PVR after initial total

  2. Long-term follow-up of post hematopoietic stem cell transplantation for Hurler syndrome: Clinical, biochemical, and pathological improvements

    Eriko Yasuda


    In conclusion, this long-term post-HSCT observation should shed light on a new aspect of therapeutic effect associated with skeletal pathology and GAG levels as a biomarker, indicating that HSCT is a primary choice at an early stage for not only CNS but also skeletal system in combination of appropriate surgical procedures.

  3. Long-term safety of umbilical cord mesenchymal stem cells transplantation for systemic lupus erythematosus: a 6-year follow-up study.

    Wang, Dandan; Niu, Lingying; Feng, Xuebing; Yuan, Xinran; Zhao, Shengnan; Zhang, Huayong; Liang, Jun; Zhao, Cheng; Wang, Hong; Hua, Bingzhu; Sun, Lingyun


    The aim of this study is to assess the long-term safety of allogeneic umbilical cord mesenchymal stem cells (UC MSCs) transplantation for patients with refractory systemic lupus erythematosus (SLE). Nine SLE patients, who were refractory to steroid and immunosuppressive drugs treatment and underwent MSCs transplantation in 2009, were enrolled. One million allogeneic UC MSCs per kilogram of body weight were infused intravenously at days 0 and 7. The possible adverse events, including immediately after MSCs infusions, as well as the long-term safety profiles were observed. Blood and urine routine test, liver function, electrocardiogram, chest radiography and serum levels of tumor markers, including alpha fetal protein (AFP), cancer embryo antigen (CEA), carbohydrate antigen 155 (CA155) and CA199, were assayed before and 1, 2, 4 and 6 years after MSCs transplantation. All the patients completed two times of MSCs infusions. One patient had mild dizzy and warm sensation 5 min after MSCs infusion, and the symptoms disappeared quickly. No other adverse event, including fluster, headache, nausea or vomit, was observed. There was no change in peripheral white blood cell count, red blood cell count and platelet number in these patients after followed up for 6 years. Liver functional analysis showed that serum alanine aminotransferase, glutamic-oxalacetic transaminase, total bilirubin and direct bilirubin remained in normal range after MSCs infusions. No newly onset abnormality was detected on electrocardiogram and chest radiography. Moreover, we found no rise of serum tumor markers, including AFP, CEA, CA125 and CA199, before and 6 years after MSCs infusions. Our long-term observational study demonstrated a good safety profile of allogeneic UC MSCs in SLE patients.

  4. Stabilization of the proximal ulnar stump in the Sauvé-Kapandji procedure by using the extensor carpi ulnaris tendon: long-term follow-up studies.

    Minami, Akio; Iwasaki, Norimasa; Ishikawa, Jun-Ichi; Suenaga, Naoki; Kato, Hiroyuki


    The Sauvé-Kapandji procedure is considered a useful treatment option for distal radioulnar disorders. Postoperative instability of the proximal ulnar stump and radioulnar convergence, however, may be symptomatic. We modified the Sauvé-Kapandji procedure by stabilizing the proximal ulnar stump with a half-slip of the extensor carpi ulnaris tendon. We previously reported on 13 patients with this procedure at an average follow-up period of 35 months; the patients had satisfactory clinical results and improved stability of the proximal ulnar stump as shown by x-ray examination. In this article we address the question of whether those clinical and radiographic results noted at an average follow-up period of 35 months after surgery were maintained at later follow-up examinations. We re-examined 12 of the 13 original patients and compared their initial follow-up results with their current results after an average follow-up period of 95 months. The results of this series after 95 months of follow-up evaluation were similar to the results at 35 months. The results presented in this article suggest that the clinical radiographic results at the 35-month follow-up examination were maintained in the long-term 95-month follow-up evaluation despite the finding that the hole in the proximal ulnar stump had broken in 3 wrists at follow-up examination. Therapeutic, Level IV.

  5. Successful treatment of giant basal cell carcinoma with topical imiquimod 5% cream with long term follow-up

    M Chun-Guang


    Full Text Available The use of the topical Imiquimod 5% cream offers a noninvasive, nonsurgical, and an effective option for the treatment of primary small (5 cm BCC with topical Imiquimod 5% cream are rare. We present our experience in the treatment of two giant tumors (6 × 8 cm 2 , 5.2 × 4.2 cm 2 of BCC on the face with Imiquimod 5% cream, 2 to 3 days/week for 12 weeks. Both the tumors were cured with clinical and pathological evidence, one with 6-year follow-up and the other with 3.5-year follow-up.

  6. Long-term efficacy follow-up on two cryolipolysis case studies: 6 and 9 years post-treatment.

    Bernstein, Eric F


    Cryolipolysis is a noninvasive esthetic procedure that utilizes controlled cooling to reduce subcutaneous fat. Clinical studies have established its safety, efficacy, and tolerability for fat reduction in a variety of areas including the abdomen, flanks, thighs, submental area, arms, back, and chest. Because of obvious esthetic concerns, long-term unilateral studies leaving an untreated flank, thigh, or arm are not performed, but serve as ideal controls for weight gain or loss or re-distribution of fat for other reasons. This article follows two patients previously documented in a case report to demonstrate their ongoing treatment efficacy at 6 and 9 years after treatment. Clinical photographs of the treated flanks and untreated contralateral controls demonstrate long-term durability in these two subjects. © 2016 The Author. Journal of Cosmetic Dermatology Published by Wiley Periodicals, Inc.

  7. A 20-year follow-up study on the effects of long-term exposure to thorium dust

    陈兴安; 程永娥; 肖慧娟; 冯国栋; 邓芸辉; 冯志良; 陈莲; 韩轩茂; 杨英杰; 董智华; 甄荣


    Objective The purpose of this study is to investigate the possible effects of long-term exposure to dust containing thorium and thoron progeny dust-exposed miners. Methods A negative, high voltage, exhaled thoron progeny measurement system was used to estimate the miners' thorium lung burden. Results The highest thorium lung burden of 638 miners was 11.11 Bq. The incidence of stage 0+ pneumoconiosis was higher among dust-exposed miners. Lung cancer mortality of the dust-exposed miners was significantly higher than that of controls (P<0.005). Conclusion There is a difference in cancer rates between those who have long-term exposure to dust containing thorium (in which carcinogenic ThO2 and SiO2 exist) and thoron progeny and those who have not.



    Two hundred and forty-four outpatients with gonarthrosis were examined. The time course of arthrosonographic (the height of the articular cartilage, the volume of intraarticular effusion, the width of the joint cleft, and the degree of osteophytosis) changes were estimated during longterm Teraflex therapy and in control patients. The long-term (3-year) Teraflex therapy was shown to have a restraining impact on the processes of articular cartilage degradation and the progression of artic...

  9. Long-term follow-up of trauma patients before and after implementation of a Physician-Staffed Helicopter

    S. Funder, Kamilla; Rasmussen, Lars S.; Lohse, Nicolai


    Introduction: The first Danish Helicopter Emergency Medical Service (HEMS) was introduced May 1st2010. The implementation was associated with lower 30-day mortality in severely injured patients. Theaim of this study was to assess the long-term effects of HEMS on labour market affiliation and mort...... reduction in time on socialtransfer payments. No significant differences were found in involuntary early retirement rate, long-termmortality, or work ability....

  10. Sporadic late-onset nemaline myopathy with MGUS: long-term follow-up after melphalan and SCT.

    Voermans, Nicol C.; Benveniste, Olivier; Minnema, Monique C.; Lokhorst, Henk; Lammens, Martin; Meersseman, Wouter; Delforge, Michel; Kuntzer, Thierry; Novy, Jan; Pabst, Thomas; Bouhour, Françoise; Romero, Norma; Leblond, Veronique; Bergh, Peter van den; Vekemans, Marie-Christiane


    OBJECTIVE Sporadic late-onset nemaline myopathy (SLONM) is a rare, late-onset myopathy that progresses subacutely. If associated with a monoclonal gammopathy of unknown significance (MGUS), the outcome is unfavorable: the majority of these patients die within 1 to 5 years of respiratory failure. This study aims to qualitatively assess the long-term treatment effect of high-dose melphalan (HDM) followed by autologous stem cell transplantation (SCT) in a series of 8 patients with SLONM-MGUS...

  11. Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients.

    Isaacs, Albert M; Bezchlibnyk, Yarema B; Yong, Heather; Koshy, Dilip; Urbaneja, Geberth; Hader, Walter J; Hamilton, Mark G


    OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994-2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1-230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p hydrocephalus. The overall ETV success rate when it was the primary treatment modality for adult hydrocephalus was approximately 87%, and 99% of patients experience symptomatic

  12. Longitudinal changes in seizure outcomes after resection of cerebral cavernous malformations in patients presenting with seizures: a long-term follow-up of 46 patients.

    Kim, Jiha; Kim, Chi Heon; Chung, Chun Kee


    Seizure is the most common presentation in patients with cerebral cavernous malformations (CCMs). Although many articles have documented seizure outcomes after resection of CCM, few have conducted long-term follow-ups; thus, the fluctuating seizure outcomes have been neglected. The purpose of this study is to describe long-term postoperative seizure outcomes in patients with CCM and to compare seizure outcomes between patients with sporadic seizures and those with chronic seizures. Forty-six patients with CCM presenting with seizures underwent surgery. The male-to-female ratio was 1:1, and the average age at initial seizure onset was 27.6 years. The mean preoperative seizure duration was 42.7 months. Patients were divided into two groups: a chronic group (N = 20) and a sporadic group (N = 26) according to seizure frequency and duration. The mean postoperative follow-up duration was 96.3 months, and the postoperative seizure outcomes were checked annually based upon Engel's classification. After the first year of follow-up, 80.8 % of the sporadic group and 75.0 % of the chronic group were evaluated as Engel class I. These rates increased to 100.0 % and 90.0 %, respectively, at the eighth year of follow-up. Overall, 29 (63.0 %) of the 46 patients experienced changes in seizure outcomes over the follow-up period. Despite their delayed improvements, the chronic group showed less favorable outcomes throughout follow-up (p = 0.025). Long-term follow-up is indispensable for accurately assessing postoperative seizure outcomes because these outcomes change continuously. We recommend earlier surgery to achieve seizure-free status in patients with CCM. However, even in the chronic group, surgery is recommended, considering the overall delayed improvement.

  13. Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis.

    Jong, Z. de; Munneke, M.; Kroon, H.M.; Schaardenburg, D. van; Dijkmans, B.A.; Hazes, J.M.; Vliet Vlieland, T.P.M.


    The aims of this study were to describe rheumatoid arthritis patients' compliance with continued exercise after participation in a 2-year supervised high-intensity exercise program and to investigate if the initially achieved effectiveness and safety were sustained. Data were gathered by follow-up o

  14. Rate of disease progression during long-term follow-up of patients with late-onset Pompe disease

    Van der Beek, N. A. M. E.; Hagemans, M. L. C.; Reuser, A. J. J.; Hop, W. C. J.; Van der Ploeg, A. T.; Van Doorn, P. A.; Wokke, J. H. J.

    To determine the rate of disease progression in patients with late-onset Pompe disease, we collected longitudinal data on pulmonary function and skeletal muscle strength in 16 patients whose symptoms had started in childhood or adulthood. The mean duration of follow-up was 16 years (range 4-29

  15. Long-term follow-up after iodine-131 treatment for Plummer's disease (autonomous goiter)

    Wiener, J.D.


    A follow-up study is presented in 88 patients treated with I-131 for Plummer's disease (localized autonomous thyroid function, either multifocal or as a solitary nodule) one to 17 years before the present study. Studies included clinical examination, scintigraphy, and function tests. One patient was hypothyroid, seven were marginally hyperthyroid, and five still received low dose antithyroid drugs. Of 75 euthyroid patients, the thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) was absent in 16 (generally with scintigraphic evidence of autonomous function), subnormal in 20, and normal in 39. A single autonomous nodule prior to treatment was found relatively frequently in males and in patients with a normal TRH test at follow-up. Most goiters had become smaller and one third of all solitary nodules could not be detected anymore. Autonomous function at follow-up was probably due to residual rather than recurrent disease in most, if not all, cases. It is concluded that I-131 therapy is at least as satisfactory as partial thyroidectomy in the treatment of Plummer's disease; lifelong follow-up was not found to be necessary.

  16. A long-term follow-up study of serum lipid levels and coronary heart disease in the elderly

    李健斋; 陈曼丽; 王抒; 董军; 曾平; 侯鲁维


    Background It is still controversial whether or not the correlation between lipid abnormality and coronary heart disease (CHD) becomes weaker in the elderly, and whether patients above 80 years old still benefit from lipid management for the secondary prevention of CHD. The purpose of this study is to assess the correlation between hyperlipidemia and the risk of CHD events in the elderly, and to determine if it is appropriate to use lipid-lowering drugs in those aged above 80, as prescribed by the recommended guidelines for lipid management.Methods One thousand two hundred and eleven retirees, mainly males (92%), aged 70±9 years, were enrolled in this study. Lifestyle habits and medical history were recorded via questionnaires. During the period 1986 -2000, all subjects participated in an annual physical examination with a blood chemistry survey. The mean follow-up period was 11.2 years. Subjects with incidental illnesses, especially cardiovascular diseases, were diagnosed or treated promptly. Serum lipid parameters, including total cholesterol (TC), Iow and high-density lipoprotein cholesterol (LDL-C and HDL-C) and triglyceride (TG) levels were analyzed according to standardization of lipid and lipoprotein measurements. The association between lipid levels and the prevalence of acute myocardial infarction (AMI) or coronary death was analyzed statistically. Results Lipid abnormalities occurred in 2/3 of the 1211 subjects. The most common lipid disorder was high TC and high LDL-C, which was much more prevalent than high TG. Among the subjects, 51.6% had TC levels above 5.2 mmol/L. Mean TC and LDL-C reached peak levels in the 65-74 age group without significant decrease until ages over 90. The cumulative total number of deaths due to various causes was 397 in the 15-year follow-up period, with the mortality rate in the high lipid group slightly lower than that in the normal lipid group (30.6% vs 35. 3% ), although the difference was not significant (P=0

  17. Rasch modelling to deal with changes in the questionnaires used during long-term follow-up of cohort studies: a simulation study

    Alexandra Rouquette


    Full Text Available Abstract Background A specific measurement issue often occurs in cohort studies with long-term follow-up: the substitution of the classic instruments used to assess one or several factors or outcomes studied by new, more reliable, more accurate or more convenient instruments. This study aimed to compare three techniques to deal with this issue when the substituted instrument is a questionnaire measuring a subjective phenomenon: one using only the items shared by the different questionnaires over time, i.e. computation of the raw score; the two others using every item, i.e. computation of the standardised score or estimation of the latent variable score using the Rasch model. Methods Two hundred databases were simulated, corresponding to longitudinal 10-item questionnaire data from three trajectory groups of subjects for the subjective phenomenon of interest (“increasing”, “stable-low” or “stable-high” mean trajectory over time. Three copies of these databases were generated and the subjects’ responses to some items were removed at some collection times leading to a number of shared items over time varying from 4 to 10 in the 800 datasets. The performances of Latent Class Growth Analysis (LCGA applied to the raw score, the standardised score or the latent variable score were studied on these databases according to the number of shared items over time. Results Surprisingly, LCGA applied to the latent variable score estimate did not perform as well as LCGA applied to the standardised score, where it was the most efficient whatever the number of shared items. However, the proportions of correctly classified subjects by LCGA applied to the latent variable score were more balanced across trajectory groups. Conclusions The use of the standardised score to deal with questionnaire changes over time was more efficient than the raw score and also, surprisingly, than the latent variable score. LCGA applied to the raw score was the least

  18. Educational achievement among long-term survivors of congenital heart defects: a Danish population-based follow-up study

    Olsen, Morten; Hjortdal, Vibeke E; Mortensen, Laust Hvas;


    Background: Congenital heart defect patients may experience neurodevelopmental impairment. We investigated their educational attainments from basic schooling to higher education. Patients and methods: Using administrative databases, we identified all Danish patients with a cardiac defect diagnosis...... of educational attainment was reduced among long-term congenital heart defect survivors....... and controls born at term and without extracardiac defects or chromosomal anomalies. Results: We identified 2986 patients. Their probability of completing compulsory basic schooling was approximately 10% lower than that of control individuals (adjusted hazard ratio=0.79, ranged from 0.75 to 0.82 0.79; 95...

  19. Long-term effectiveness of a school-based primary prevention program for anorexia nervosa: A 7-to 8-year follow-up.

    Adametz, Luise; Richter, Felicitas; Strauss, Bernhard; Walther, Mario; Wick, Katharina; Berger, Uwe


    This is the first study to evaluate the long-term effectiveness of a school-based prevention program in Germany. The aim is to determine the long-term effects of the primary prevention program PriMa (Primary prevention of anorexia nervosa in preadolescent girls) on disordered eating and body self-esteem from childhood to young adulthood. PriMa was conducted and successfully evaluated in a quasi-experimental pre-post design with a control group from 2007 to 2008 consisting of 11-13year old girls (N=1508) from Thuringian schools in Germany. Seven to eight years after the intervention, the same cohort (mean age 19.8years) was invited to complete an online survey. Disordered eating (EAT-26), body self-esteem (FBeK) and BMI were assessed via self-report. The response rate at seven-to-eight-year follow-up was very low (7%). Data of N=100 girls were analyzed. Concerning changes in disordered eating, results revealed no significant long-term effect of PriMa seven to eight years after the intervention. During this time, disordered eating remained stable without a significant increase or decrease. Regarding changes in body self-esteem, group courses differed significantly from each other. The results revealed a significant main effect of group, indicating significant differences in changes of body self-esteem between the intervention and the control group. Following the analysis of these changes of body self-esteem over time, it was found that the intervention group revealed an increase of body self-esteem after program participation and remained stable over time. By contrast, the control group revealed a decrease of body self-esteem over time. Long-term intervention effects of PriMa could be found for body self-esteem but not for disordered eating. The findings suggest that PriMa prevented a decrease of body self-esteem from childhood to young adulthood. For a broader dissemination it is necessary to implement prevention programs consistently in school settings. In order to

  20. Diffusion tensor imaging for long-term follow-up of corticospinal tract degeneration in amyotrophic lateral sclerosis

    Jacob, S.; Ehrenreich, H. [Max-Planck-Institute for Experimental Medicine, Georg-August-University, Hermann-Rein-Strasse 3, 37075, Goettingen (Germany); Departments of Neurology and Psychiatry, Georg-August-University, Goettingen (Germany); Finsterbusch, J.; Frahm, J. [Biomedizinische NMR Forschungs GmbH, Max-Planck-Institute for Biophysical Chemistry, Georg-August-University, Goettingen (Germany); Weishaupt, J.H. [Departments of Neurology and Psychiatry, Georg-August-University, Goettingen (Germany); Khorram-Sefat, D. [Department of Neuroradiology, Georg-August-University, Goettingen (Germany)


    Amyotrophic lateral sclerosis (ALS) is a predominantly clinical and electromyographic diagnosis. Conventional MRI reveals atrophy of the motor system, particularly the pyramidal tract, in the advanced stages but does not provide a sensitive measure of disease progression. Three patients with different principal symptoms of ALS, i.e., with predominant involvement of the upper (UMN) or lower (UMN) motor neurons, or bulbar disease, respectively, underwent serial clinical examination including lung function tests, conventional MRI, and diffusion tensor imaging (DTI). MRI demonstrated changes in of the pyramidal tract without measurable variation on follow-up. The patient with UMN involvement showed remarkable progressive loss of diffusion anisotropy in the pyramidal tract. DTI might be useful, together with clinical follow-up, as an objective morphological marker in therapeutic trials. (orig.)

  1. [Long-term follow up of patients surgically treated for pyelo-ureteral disease by the Anderson-Hynes technique].

    Polito, M; Galosi, A B; Minardi, D; Nonni, M; Cinti, P; Riccardi, A


    A series of 48 patients with hydronephrosis (mean age 31 yrs.) underwent on Anderson-Hynes pyeloplasty. Assessment was carried out in 30 pts. after a mean observation time of 90 months, with a minimum 5 years follow-up. Clinical examination, laboratory investigations, renal ultrasonography, urography and renal scan were performed pre-operatively and at follow-up. There was one patient with evidence of stenosis in the ureteropelvic junction; one patient developed urinary leakage post-operatively and required surgical correction. All patients had symptoms pre-operatively and no one had symptoms post-operatively. Four patients had calcolosis associated, postoperatively all pts. were stone free; four years later one patient developed litiasis. We observed that the results of surgical intervention in hydronephrosis are excellent especially in patients aged less than 30 years.

  2. Management of fused supernumerary teeth in children using guided tissue regeneration: long-term follow up of 2 cases.

    Olsen, Christopher B; Johnston, Timothy; Desai, Mala; Peake, Gregory G


    Surgical separation of supernumerary teeth fused to permanent incisor teethhas typically given rise to residual post surgical periodontal defects, induding loss of attachment and deep periodontal pocketing with persistent inflammation. Other complications include devitalisation of the retained tooth section, ankylosis, external and replacement resorption. A unique technique of using guided tissue regeneration has been successfully employed to promote periodontal healing, after 2 cases of surgical removal of a supernumerary tooth fused to a permanent maxillary lateral incisor tooth. In the first case, a 2-stage guided tissue regeneration technique was completed with a nonresorbable Gor-Tex membrane, and was followed up after 9 years. The second case was completed using a resorbable Vicryl membrane, in a single-stage guided tissue regenerative technique; and was followed up after 5 years.

  3. Sporadic late-onset nemaline myopathy with MGUS: long-term follow-up after melphalan and SCT.

    Voermans, Nicol C; Benveniste, Olivier; Minnema, Monique C; Lokhorst, Henk; Lammens, Martin; Meersseman, Wouter; Delforge, Michel; Kuntzer, Thierry; Novy, Jan; Pabst, Thomas; Bouhour, Françoise; Romero, Norma; Leblond, Veronique; Bergh, Peter van den; Vekemans, Marie-Christiane; van Engelen, Baziel G; Eymard, Bruno


    Sporadic late-onset nemaline myopathy (SLONM) is a rare, late-onset myopathy that progresses subacutely. If associated with a monoclonal gammopathy of unknown significance (MGUS), the outcome is unfavorable: the majority of these patients die within 1 to 5 years of respiratory failure. This study aims to qualitatively assess the long-term treatment effect of high-dose melphalan (HDM) followed by autologous stem cell transplantation (SCT) in a series of 8 patients with SLONM-MGUS. We performed a retrospective case series study (n = 8) on the long-term (1-8 years) treatment effect of HDM followed by autologous SCT (HDM-SCT) on survival, muscle strength, and functional capacities. Seven patients showed a lasting moderate-good clinical response, 2 of them after the second HDM-SCT. All of them had a complete, a very good partial, or a partial hematologic response. One patient showed no clinical or hematologic response and died. This case series shows the positive effect of HDM-SCT in this rare disorder. Factors that may portend an unfavorable outcome are a long disease course before the hematologic treatment and a poor hematologic response. Age at onset, level and type of M protein (κ vs λ), and severity of muscle weakness were not associated with a specific outcome. This study provides Class IV evidence that for patients with SLONM-MGUS, HDM-SCT increases the probability of survival and functional improvement. © 2014 American Academy of Neurology.

  4. Change in muscle strength over time in spinal muscular atrophy types II and III. A long-term follow-up study

    Werlauff, U; Vissing, J; Steffensen, B F


    Whether muscle strength deteriorates with time in spinal muscular atrophy (SMA) types II and III is still debated. We present a long-term follow-up study on muscle strength in 30 patients with SMA types II and III. Median follow-up time was 17 years. Median number of assessments was four. All...... patients were assessed by Manual Muscle Testing (MMT), Brooke upper limb scale and EK scale. There was a difference in muscle strength of the upper limbs from first to last assessment in SMA II (p...

  5. Intensive point-of-care ultrasound training with long-term follow-up in a cohort of Rwandan physicians.

    Henwood, Patricia C; Mackenzie, David C; Rempell, Joshua S; Douglass, Emily; Dukundane, Damas; Liteplo, Andrew S; Leo, Megan M; Murray, Alice F; Vaillancourt, Samuel; Dean, Anthony J; Lewiss, Resa E; Rulisa, Stephen; Krebs, Elizabeth; Raja Rao, A K; Rudakemwa, Emmanuel; Rusanganwa, Vincent; Kyanmanywa, Patrick; Noble, Vicki E


    We delivered a point-of-care ultrasound training programme in a resource-limited setting in Rwanda, and sought to determine participants' knowledge and skill retention. We also measured trainees' assessment of the usefulness of ultrasound in clinical practice. This was a prospective cohort study of 17 Rwandan physicians participating in a point-of-care ultrasound training programme. The follow-up period was 1 year. Participants completed a 10-day ultrasound course, with follow-up training delivered over the subsequent 12 months. Trainee knowledge acquisition and skill retention were assessed via observed structured clinical examinations (OSCEs) administered at six points during the study, and an image-based assessment completed at three points. Trainees reported minimal structured ultrasound education and little confidence using point-of-care ultrasound before the training. Mean scores on the image-based assessment increased from 36.9% (95% CI 32-41.8%) before the initial 10-day training to 74.3% afterwards (95% CI 69.4-79.2; P < 0.001). The mean score on the initial OSCE after the introductory course was 81.7% (95% CI 78-85.4%). The mean OSCE performance at each subsequent evaluation was at least 75%, and the mean OSCE score at the 58-week follow up was 84.9% (95% CI 80.9-88.9%). Physicians providing acute care in a resource-limited setting demonstrated sustained improvement in their ultrasound knowledge and skill 1 year after completing a clinical ultrasound training programme. They also reported improvements in their ability to provide patient care and in job satisfaction. © 2016 John Wiley & Sons Ltd.

  6. [Requirements for long-term follow-up on efficacy and safety of advanced therapy medicinal products. Risk management and traceability].

    Klug, B; Reinhardt, J; Schröder, C


    Advanced therapy medicinal products (ATMPs) are an innovative treatment option. To promote timely access of the innovative medicinal product and to safeguard public health, new elements have been introduced into legislation. A key element of the ATMP regulation is the requirement for long-term follow-up on safety and efficacy of patients enrolled in clinical trials with ATMPs, which is beyond the routine requirements on pharmacovigilance. For gene therapy medicinal products, a guideline on long-term follow-up, which lays down the technical requirements, is available. A further key element of the ATMP regulation is the traceability of the starting materials used to manufacture the ATMP. A common European coding system is imperative to ensure the traceability of starting materials, especially across the borders of European Member States.

  7. Ameloblastic fibrosarcoma of the upper jaw: Report of a rare case with long-term follow-up

    Maryam Khalili


    Full Text Available Ameloblastic fibrosarcoma (AFS is a rare malignant mixed odontogenic tumor which is usually considered as the malignant counterpart of ameloblastic fibroma. Only mesenchymal component represents sarcomatous alterations and ameloblast-like epithelial nest remains bland in AFS. Here, we report a case of AFS in a 26-year-old man in the maxilla, which was regarded as an uncommon location for this tumor. After 2 years follow up, no evidence of recurrence was noted. We also emphasize on comprehensive clinical, radiographic, and histopathologic evaluation of such patients rather than immunohistochemical staining to make an accurate diagnosis.

  8. Ameloblastic fibrosarcoma of the upper jaw: Report of a rare case with long-term follow-up.

    Khalili, Maryam; Shakib, Pouyan Amini


    Ameloblastic fibrosarcoma (AFS) is a rare malignant mixed odontogenic tumor which is usually considered as the malignant counterpart of ameloblastic fibroma. Only mesenchymal component represents sarcomatous alterations and ameloblast-like epithelial nest remains bland in AFS. Here, we report a case of AFS in a 26-year-old man in the maxilla, which was regarded as an uncommon location for this tumor. After 2 years follow up, no evidence of recurrence was noted. We also emphasize on comprehensive clinical, radiographic, and histopathologic evaluation of such patients rather than immunohistochemical staining to make an accurate diagnosis.

  9. The diverse impact of advance care planning: a long-term follow-up study on patients' and relatives' experiences

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine;


    : A qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis. SETTING/PARTICIPANTS: 3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating...... issues being 'tucked away'. CONCLUSIONS: The study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual...

  10. A Questionnaire-based Long-term Follow-up of Photorefractive Keratectomy for Low to High Myopia

    Vestergaard, Anders; Hjortdal, Jesper; Ivarsen, Anders;

    (0 to 2.5), negative (>2.5 to 5), positive (>5 to 7.5) and very positive (>7.5 to 10). No neutral responses were allowed in this categorisation. Patients were prior to surgery informed that there were no guaranties of spectacle independence, and that long-term side-effects were not known. This study...... in quality of life, mean score was 7.3 ± 2.5 and 89% felt an improvement in quality of life after PRK. Thirty-nine percent had problems or many problems with backlight glare, and 48% with nighttime glare. Eleven percent had problems or many problems with halos around light sources in daylight and 40...

  11. Long-Term Survival after Stroke: 30 Years of Follow-Up in a Cohort, the Copenhagen City Heart Study

    Boysen, G.; Marott, J.L.; Gronbaek, M.


    died before the end of 2007. The National Register of Causes of Death provided cause of death. Survival in stroke patients was compared with survival in participants in the Copenhagen City Heart Study who did not suffer a stroke, and with survival in the general Danish population. Cox regression...... in the Copenhagen City Heart Study who experienced a first-ever stroke from 1978 to the end of 2001 were followed to the end of 2007. Stroke events were validated using the World Health Organization's definition of stroke. Linkage to the Danish Civil Registration System enabled identification of participants who......-stroke controls. Long-term survival improved steadily over time. Life expectancy after stroke increased up to 4 years from 1978 to the end of 2001, exceeding the increase of life expectancy in the general population. Slightly longer survival was found in women than in men when adjusted for age at stroke onset...

  12. Long-term follow-up of children who underwent severe hypospadias repair using an online survey with validated questionnaires.

    Fraumann, Sarah A; Stephany, Heidi A; Clayton, Douglass B; Thomas, John C; Pope, John C; Adams, Mark C; Brock, John W; Tanaka, Stacy T


    Few studies of hypospadias repair in childhood have used validated questionnaires to investigate outcomes of cosmesis, urinary function, and sexual function in adulthood. We sought to investigate long-term outcomes in adult patients who had undergone severe hypospadias repair as children using an existing web-based application available to multiple institutions in order to develop an online patient survey of previously validated questionnaires. Patients aged 18 years or older who underwent severe hypospadias repair between 1992 and 1997 at our institution were contacted to complete an online survey. Through medical chart reviews, we analyzed the location of meatus, type of repair, and complications. The online survey included questions about penile appearance, and validated questionnaires to assess urinary and sexual function. Of 58 patients who met the inclusion criteria, we contacted 19, and 13 completed the survey. Fifty-nine percent had complications, with an average of 2.2 procedures per patient. Most (85.0%) were satisfied with penile appearance, although 38.0% had residual penile curvature. Hypospadias patients had mean lower orgasmic function than normal controls. Mean scores for urinary function and other domains of sexual function were similar to normal controls. Although the majority of adult patients were satisfied with the outcomes of penile appearance, urinary function, and sexual function, our online survey suggests decreased lower orgasmic function as measured by validated questionnaire. An online survey accessible to multiple institutions with validated questionnaires may facilitate assessment of long-term hypospadias results. Copyright © 2014 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  13. Long-term follow-up data may help manage patient and parent expectations for pediatric patients undergoing thyroidectomy.

    Morris, Lilah F; Waguespack, Steven G; Warneke, Carla L; Ryu, Haengrang; Ying, Anita K; Anderson, Barbara J; Sturgis, Erich M; Clayman, Gary L; Lee, Jeffrey E; Evans, Douglas B; Grubbs, Elizabeth G; Perrier, Nancy D


    We investigated the incidence and impact of postoperative complications in children who underwent total thyroidectomy (TTx). The records of all pediatric patients undergoing TTx (2001-2011) at our institution were retrospectively reviewed for the occurrence of biochemical hypothyroidism (thyroid-stimulating hormone >10 mIU/mL), laboratory assessments, and medication nonadherence. The 74 patients (median age, 12.5 years) had thyroid cancer (differentiated, n = 39; medullary, n = 16) or benign pathology (n = 19; 16 with multiple endocrine neoplasia type 2A). The median postoperative follow-up was 3.2 years; 46 patients (62%) had ≥ 1 year follow-up. Forty-one percent had ≥ 1 period of medication nonadherence; this was not associated with age at TTx (P = .30). Non-treatment-related hypothyroidism occurred in 33% of patients during postoperative year (POY) 1. The number of POY1 laboratory assessments among the 30% of patients with parathyroid dysfunction was more than twice that among patients with normal parathyroid function (median assessments per year 8 vs 3; P pediatric patients were unable to fully adhere to postoperative medication regimens, and non-treatment-related hypothyroidism was common. Postoperative hypoparathyroidism doubled the number of laboratory assessments obtained. These data may help families better prepare for TTx sequelae. Copyright © 2012 Mosby, Inc. All rights reserved.

  14. Long Term Follow-Up of a Successful Lower Limb Replantation in a 3-Year-Old Child

    Akbar Jaleel Zubairi


    Full Text Available Replantation of the lower extremity has controversial indications but nevertheless it may be considered in carefully selected patients who present early and are expected to show good functional recoveries. Here we present a successful replantation in a 3-year-old boy who has made excellent recovery with no functional deficit evident at 12 years of follow-up. He sustained a traumatic amputation at the level of distal tibia when he fell of a “Qing Qi” (motorcycle rickshaw. Replantation was attempted at 8 hours cold ischemia time with the tibia shortened 4 cm and all tendons, vessels, and nerves repaired. Patient required a second procedure during the same hospital stay for skin coverage. Patient made good recovery with ambulation without support at 6 months, less than 3 cm limb length discrepancy, plantar and dorsiflexion power 4/5, and recovery of sensation over the foot. Now at 12 years of follow-up patient has a normal gait and has integrated into society with no functional deficit. Considering the functional outcome of our case, replantation should be attempted whenever possible and feasible especially in children.

  15. Valvular Abnormalities Detected by Echocardiography in 5-Year Survivors of Childhood Cancer: A Long-Term Follow-Up Study

    Pal, Helena J. van der, E-mail: [Department of Medical Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Dijk, Irma W. van [Department of Radiation Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Geskus, Ronald B. [Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Kok, Wouter E. [Department of Cardiology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Koolen, Marianne; Sieswerda, Elske [Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Oldenburger, Foppe; Koning, Caro C. [Department of Radiation Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Leeuwen, Flora E. van [Department of Epidemiology, Netherlands Cancer Institute, Amsterdam (Netherlands); Caron, Huib N.; Kremer, Leontien C.; Dalen, Elvira C. van [Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands)


    Purpose: To determine the prevalence of valvular abnormalities after radiation therapy involving the heart region and/or treatment with anthracyclines and to identify associated risk factors in a large cohort of 5-year childhood cancer survivors (CCS). Methods and Materials: The study cohort consisted of all 626 eligible 5-year CCS diagnosed with childhood cancer in the Emma Children's Hospital/Academic Medical Center between 1966 and 1996 and treated with radiation therapy involving the heart region and/or anthracyclines. We determined the presence of valvular abnormalities according to echocardiograms. Physical radiation dose was converted into the equivalent dose in 2-Gy fractions (EQD{sub 2}). Using multivariable logistic regression analyses, we examined the associations between cancer treatment and valvular abnormalities. Results: We identified 225 mainly mild echocardiographic valvular abnormalities in 169 of 545 CCS (31%) with a cardiac assessment (median follow-up time, 14.9 years [range, 5.1-36.8 years]; median attained age 22.0 years [range, 7.0-49.7 years]). Twenty-four CCS (4.4%) had 31 moderate or higher-graded abnormalities. Most common abnormalities were tricuspid valve disorders (n=119; 21.8%) and mitral valve disorders (n=73; 13.4%). The risk of valvular abnormalities was associated with increasing radiation dose (using EQD{sub 2}) involving the heart region (odds ratio 1.33 per 10 Gy) and the presence of congenital heart disease (odds ratio 3.43). We found no statistically significant evidence that anthracyclines increase the risk. Conclusions: Almost one-third of CCS treated with potentially cardiotoxic therapy had 1 or more asymptomatic, mostly mild valvular abnormalities after a median follow-up of nearly 15 years. The most important risk factors are higher EQD{sub 2} to the heart region and congenital heart disease. Studies with longer follow-up are necessary to investigate the clinical course of asymptomatic valvular abnormalities

  16. Ginkgo Biloba Extract and Long-Term Cognitive Decline: A 20-Year Follow-Up Population-Based Study

    Amieva, Hélène; Meillon, Céline; Helmer, Catherine; Barberger-Gateau, Pascale; Dartigues, Jean François


    Background Numerous studies have looked at the potential benefits of various nootropic drugs such as Ginkgo biloba extract (EGb761®; Tanakan®) and piracetam (Nootropyl®) on age-related cognitive decline often leading to inconclusive results due to small sample sizes or insufficient follow-up duration. The present study assesses the association between intake of EGb761® and cognitive function of elderly adults over a 20-year period. Methods and Findings The data were gathered from the prospective community-based cohort study ‘Paquid’. Within the study sample of 3612 non-demented participants aged 65 and over at baseline, three groups were compared: 589 subjects reporting use of EGb761® at at least one of the ten assessment visits, 149 subjects reporting use of piracetam at one of the assessment visits and 2874 subjects not reporting use of either EGb761® or piracetam. Decline on MMSE, verbal fluency and visual memory over the 20-year follow-up was analysed with a multivariate mixed linear effects model. A significant difference in MMSE decline over the 20-year follow-up was observed in the EGb761® and piracetam treatment groups compared to the ‘neither treatment’ group. These effects were in opposite directions: the EGb761® group declined less rapidly than the ‘neither treatment’ group, whereas the piracetam group declined more rapidly (β = −0.6). Regarding verbal fluency and visual memory, no difference was observed between the EGb761® group and the ‘neither treatment’ group (respectively, β = 0.21 and β = −0.03), whereas the piracetam group declined more rapidly (respectively, β = −1.40 and β = −0.44). When comparing the EGb761® and piracetam groups directly, a different decline was observed for the three tests (respectively β = −1.07, β = −1.61 and β = −0.41). Conclusion Cognitive decline in a non-demented elderly population was lower in subjects who reported using EGb761® than in

  17. Ginkgo biloba extract and long-term cognitive decline: a 20-year follow-up population-based study.

    Hélène Amieva

    Full Text Available BACKGROUND: Numerous studies have looked at the potential benefits of various nootropic drugs such as Ginkgo biloba extract (EGb761®; Tanakan® and piracetam (Nootropyl® on age-related cognitive decline often leading to inconclusive results due to small sample sizes or insufficient follow-up duration. The present study assesses the association between intake of EGb761® and cognitive function of elderly adults over a 20-year period. METHODS AND FINDINGS: The data were gathered from the prospective community-based cohort study 'Paquid'. Within the study sample of 3612 non-demented participants aged 65 and over at baseline, three groups were compared: 589 subjects reporting use of EGb761® at at least one of the ten assessment visits, 149 subjects reporting use of piracetam at one of the assessment visits and 2874 subjects not reporting use of either EGb761® or piracetam. Decline on MMSE, verbal fluency and visual memory over the 20-year follow-up was analysed with a multivariate mixed linear effects model. A significant difference in MMSE decline over the 20-year follow-up was observed in the EGb761® and piracetam treatment groups compared to the 'neither treatment' group. These effects were in opposite directions: the EGb761® group declined less rapidly than the 'neither treatment' group, whereas the piracetam group declined more rapidly (β = -0.6. Regarding verbal fluency and visual memory, no difference was observed between the EGb761® group and the 'neither treatment' group (respectively, β = 0.21 and β = -0.03, whereas the piracetam group declined more rapidly (respectively, β = -1.40 and β = -0.44. When comparing the EGb761® and piracetam groups directly, a different decline was observed for the three tests (respectively β = -1.07, β = -1.61 and β = -0.41. CONCLUSION: Cognitive decline in a non-demented elderly population was lower in subjects who reported using EGb761® than in those who did


    M. E. Tsanyan


    Full Text Available Objective. To evaluate the efficacy and safety of rituximab (RTM treatment in the long-term follow-up of patients with systemic lupus erythematosus (SLE refractory to standard therapy. Material and methods. RTM therapy was prescribed to 97 SLE patients with high disease activity and insufficient effica- cy of using high doses of glucocorticoids (GC and cytostatics. The median follow-up time (25th; 75th percentiles was 18 [12; 36] months. The most common clinical manifestations of SLE included nephritis (62%, skin lesion (33%, and lesion of the nervous system (22.7%. The clinical assessment of the SLE activity was carried out using the SLEDAI-2K activity index. In assessing the therapy efficacy, the following concepts were used: the partial response (PR, complete response (CR, and flare. Flare was classified as moderate (MF and severe (SF using the SLE flare index (SFI. Results. Immediately after RTM therapy, depletion of B-cells was determined in 78% of the patients with SLE. During the 6-year follow-up, the effect of RTM therapy was achieved in 84% of the patients after repeated courses of RTM (CR – 56%, PR – 28%. In total, flares were observed in 24 (24.7% patients; the median interval from RTM administration to flare was 12 [12; 24] months. In the long-term follow-up, the decline in the SLEDAI-2K index, normalization of laboratory test values, and the decrease in the daily GC dose were noted. Most patients tolerated well both the first and repeated courses of RTM therapy. Conclusion. According to the results of the long-term follow-up, RTM therapy is a highly effective method to treat SLE patients with the ineffectiveness of previously conducted standard therapy with GC and cytostatics. Good tolerance of RTM treatment has been noted; no increase in risk of infectious complications or adverse reactions has been found. 

  19. Depigmentation with Q-switched Nd:YAG laser in universal vitiligo: a long-term follow-up study of 4 years.

    Majid, Imran; Imran, Saher


    Q-switched (QS) lasers are used for depigmentation in universal vitiligo, but there is limited data on long-term results after laser treatment. This study was conducted to assess the safety and long-term follow-up results of QS Nd:YAG laser treatment in combination with need-based topical depigmentation therapy for universal vitiligo. A retrospective study was performed on patients with universal vitiligo who had received QS Nd:YAG laser treatment from 2010 to 2013. All patients were contacted and called for follow-up. Patients who reported were assessed clinically and information regarding adverse effects and relapse (repigmentation) in the follow-up period were obtained. Any need for topical depigmenting creams or other interventions and overall satisfaction to treatment were also documented. Records of 34 patients were retrieved, out of whom 28 cases reported for the follow-up visit. Duration of follow-up ranged from 2 to 5 years (mean, 2.78). No long-term adverse effects were reported and the majority of patients were highly satisfied with treatment. Satisfactory results with >90% clearance of pigment was reported by 89.3% (25/28) of patients, out of whom 72% (18/25) had retained the therapeutic effect with the use of sunscreens with/without intermittent topical depigmentation therapies. In seven cases, partial to complete relapse was observed. QS Nd:YAG laser is an effective tool for treating residual pigmentation in universal vitiligo, and the therapeutic effect can be maintained in most cases with regular sunscreen use and need-based topical therapies.

  20. Long-term Bone Remodeling in HA-coated Stems: A Radiographic Review of 208 Total Hip Arthroplasties (THAs) with 15 to 20 Years Follow-up.

    Boldt, Jens G; Cartillier, Jean-Claude; Machenaud, Alain; Vidalain, Jean-Pierre


    We present a prospective study focused on radiographic long-term outcomes and bone remodeling at a mean of 17.0 years (range: 15 to 20) in 208 cementless fully HA-coated femoral stems (Corail, DePuy International Ltd, Leeds, UK). Total hip replacements in this study were performed by three members of the surgeon design group between 1986 and 1991. Radiographic evaluation focused on periprosthetic osteolysis, bone remodeling, osseous integration, subsidence, metaphyseal or diaphyseal load transfer, and femoral stress shielding. The radiographs were digitized and examined with contrast-enhancing software for analysis of the trabecular architecture. Radiographic signs of aseptic stem loosening were visible in two cases (1%). Three stems (1.4%) showed metaphyseal periprosthetic osteolysis in four of seven Gruen zones associated with eccentric polyethylene wear awaiting metaphyseal bone grafting and cup liner exchange. One stem (0.5%) was revised due to infection. No stem altered in varus or valgus alignment more than two degrees, and mean subsidence was 0.1 mm (range: 0 to 2 mm) after a mean of 17.0 years. A total of 5 stems (2.4%) required or are awaiting revision surgery. Trabecular orientation and micro-anatomy suggested main proximal load-transfer patterns in all except 3 cases (98.6%). Combined metaphyseal and diaphyseal osseointegration and bone remodeling were visible in 100 stems (48%). Diaphyseal stress shielding and cortical thickening were observed in 3 stems (1.4%). Other radiographic features are discussed in depth. This long-term study of 208 fully HA-coated Corail stems showed satisfactory osseointegration and fixation in 203 cases (97.6%) after a mean of 17.0 years follow-up. Stem failures were associated with extreme eccentric polyethylene wear.

  1. A statistically compiled test battery for feasible evaluation of knee function after rupture of the Anterior Cruciate Ligament – derived from long-term follow-up data


    Purpose Clinical test batteries for evaluation of knee function after injury to the Anterior Cruciate Ligament (ACL) should be valid and feasible, while reliably capturing the outcome of rehabilitation. There is currently a lack of consensus as to which of the many available assessment tools for knee function that should be included. The present aim was to use a statistical approach to investigate the contribution of frequently used tests to avoid redundancy, and filter them down to a proposed comprehensive and yet feasible test battery for long-term evaluation after ACL injury. Methods In total 48 outcome variables related to knee function, all potentially relevant for a long-term follow-up, were included from a cross-sectional study where 70 ACL-injured (17–28 years post injury) individuals were compared to 33 controls. Cluster analysis and logistic regression were used to group variables and identify an optimal test battery, from which a summarized estimator of knee function representing various functional aspects was derived. Results As expected, several variables were strongly correlated, and the variables also fell into logical clusters with higher within-correlation (max ρ = 0.61) than between clusters (max ρ = 0.19). An extracted test battery with just four variables assessing one-leg balance, isokinetic knee extension strength and hop performance (one-leg hop, side hop) were mathematically combined to an estimator of knee function, which acceptably classified ACL-injured individuals and controls. This estimator, derived from objective measures, correlated significantly with self-reported function, e.g. Lysholm score (ρ = 0.66; pbattery, based on a solid statistical approach, includes assessments which are all clinically feasible, while also covering complementary aspects of knee function. Similar test batteries could be determined for earlier phases of ACL rehabilitation or to enable longitudinal monitoring. Such developments, established on a well

  2. Long-Term Follow-Up of Bimaxillary Osteomyelitis Associated with Autosomal Dominant Osteopetrosis: A Case Report.

    Kulyapina, A; Verdaguer Martin, J; Navarro Cuellar, C; Navarro Vila, C


    Osteopetrosis (OP) is a rare metabolic bone disease characterized by a generalized increase in skeletal mass. The disease is characterized by increased susceptibility to develop osteomyelitis of the jaws. We report a case of clinical and radiological progression of bimaxillary osteomyelitis in a patient with autosomal dominant OP. The patient presented non simultaneous osteomyelitis in both upper and lower jaws with time interval of 10 years. The osteomyelitis of maxilla resulted in oroantral fistula formation and required surgical closure with Bichat fat pad flap. The mandibular osteomyelitis resulted in sequestra formation and pathological fracture and required multiple debridement procedures. Both maxillary and mandibular osteomyelitic foci were persistent and healing required more than 2 years. The case confirms the possibility of development of non simultaneous bimaxillary osteomyelitis in patients with OP. The case enhances the need of close follow- up and preventive measures in patients with OP.

  3. Long-Term Follow-Up of the Postoperative Macular Fold following the Vitreoretinal Surgery with Air Tamponade

    Ali Osman Saatci


    Full Text Available A 64-year-old male who had a macula-on superior bullous retinal detachment in OD underwent scleral buckling, 20-gauge-pars plana vitrectomy, internal drainage of subretinal fluid with perfluorocarbon fluid, 360° endolaser and perflourocarbon-fluid-air exchange surgery. Patient sat upright immediately after the surgery for the night. At the first postoperative morning although the retina was attached, there was a macular fold extending toward the temporal retinal periphery. Patient denied further surgery. During the follow-up, retinal fold gradually became less visible and it could be noticeable only by fundus autoflorescence imaging at the sixth postoperative year with a subtle epiretinal membrane formation on the optical coherence tomographic section.

  4. In situ repair of a primary Brucella-infected abdominal aortic aneurysm: long-term follow-up.

    Goudard, Yvain; Pierret, Charles; de La Villéon, Bruno; Mlynski, Amélie; de Kerangal, Xavier


    Infected aortic aneurysms represent 0.85 to 1.3% of aortic aneurysms. Most often, the implicated bacteria species are Salmonella sp., Staphylococcus sp. and Streptococcus sp. Brucella-related infected aortic aneurysms are very rare. Most often, they result from endocarditis or from a local septic focus. Combined treatment by antibiotics and surgery is the standard for infectious aneurysms. In the absence of formal factual data, the surgical treatment is still discussed in the literature, especially since endovascular treatments have been in full expansion. We are reporting the case of a female patient presenting with a Brucella-related infra-renal abdominal aortic aneurysm, without primitive infectious source (area) or identified endocarditis. Surgical treatment with in situ prosthetic replacement and omentoplasty in association with adapted antibiotics allowed a favorable outcome with an excellent result after an 8-year follow up.

  5. Myasthenia gravis and thymus: long-term follow-up screening of thymectomized and non-thymectomized patients

    Paulo Jose Lorenzoni


    Full Text Available Thymoma screening is recommended at the onset of myasthenia gravis (MG or when patients with MG present with clinical deterioration or a progressive increase of anti-acetylcholine receptor antibody. However, it is unknown if it is necessary to repeat the screening of thymoma at fixed intervals, even in the absence of MG deterioration, when the initial screening is negative. We analyzed the recurrence rate and incidence of new thymoma in a series of patients with well-controlled MG. The sample consisted of 53 patients, aged 17 to 72 years, and the follow-up varied between 75 and 472 months. The chest computerized tomography detected thymus abnormalities in eight patients at the initial screening and no abnormalities in all patients at a second screening after five years. The findings of this study support the classical opinion that screening for thymoma should be recommended only if there is clinical deterioration due to the disease.

  6. Long-Term Follow-Up of Intravitreal Ranibizumab for the Treatment of Choroidal Neovascularization due to Choroidal Osteoma

    Zenith H.Y. Wu


    Full Text Available Choroidal osteoma is an uncommon benign osseous intraocular tumor that typically affects young adult women. Choroidal neovascularization (CNV is one of the complications that can develop in eyes with choroidal osteoma. We present a case of CNV secondary to choroidal osteoma treated with intravitreal ranibizumab. A 57-year-old lady presented with painless loss of vision with a right-eye visual acuity of 20/800. Fundus examination showed a well-demarcated yellowish peripapillary choroidal osteoma with associated retinal and subretinal hemorrhage due to CNV. Three intravitreal ranibizumab injections at monthly intervals were given and her visual acuity improved to 20/30 following treatment. After 1.2 years of follow-up, the right eye visual acuity was maintained at 20/30 with no evidence of CNV recurrence. Our findings suggest that intravitreal ranibizumab may be an effective therapeutic option for treating CNV secondary to choroidal osteoma.

  7. Long-term follow-up among Danish transfusion recipients identified in the national hepatitis C lookback

    Just, Søren Andreas; Grau, Katrine; Georgsen, Jørgen;


    BACKGROUND: In 1996, a national lookback study was performed in Denmark identifying 1018 patients exposed to hepatitis C virus (HCV) by transfusion before 1991. The objective of this study was to describe morbidity and mortality during extended follow-up among patients in the Danish HCV lookback......-exposed recipients alive in 1996, 124 (53.9%) had chronic hepatitis C, 43 (18.7%) were not infected, and 63 (27.4%) had incomplete HCV data. In 2009, 121 (52.6%) were still alive a median of 21.8 years after transfusion. The mortality rate among the HCV-exposed recipients followed from 1996 was 4.9 per 100 person...

  8. Outcomes of Patients Initially Treated with Intravitreal Bevacizumab for Central Retinal Vein Occlusion: Long-Term Follow-Up.

    Bajric, Jasmina; Bakri, Sophie J


    To assess outcomes of visual acuity (VA) and central retinal thickness (RT) in patients with macular edema (ME) secondary to central retinal vein occlusion (CRVO) who were initially treated with bevacizumab and followed for up to four years. In this observational case series, 51 patients with non-ischemic and ischemic CRVO who had initial treatment with bevacizumab were included. Main outcome measures were VA and RT at one year, with follow-up of up to four years. Mean VA improved from 20/214 at baseline to 20/107 at one year (p = 0.0009) and this improvement was maintained clinically at four years. RT decreased from 595 μm to 339 μm at one year (p = 0.0027) and this was maintained at four years. Patients who received bevacizumab as initial therapy for ME from CRVO maintained VA and RT improvement for up to four years.

  9. Cardiovascular and metabolic characteristics 40 years after hypertensive pregnancies: a long-term follow-up study of mothers.

    Collén, Anna-Clara; Hellgren, Margareta; Gustafsson, Helena; Johansson, Magnus C; Manhem, Karin


    Maternal cardiovascular morbidity is increased after hypertensive pregnancies (HTP). The pathways from complicated pregnancies to future cardiovascular disease are complex. The aim of the present study was to test the hypothesis that different cardiovascular mechanisms are changed in women who experienced HTP four decades earlier in comparison to women with normotensive pregnancies. One hundred and five women (50 with hypertensive and 55 with normal pregnancies) were examined with anthropometric measurements; office blood pressure, ambulatory blood pressure and central blood pressure, pulse wave velocity, augmentation index, intimal-media thickness, echocardiography and laboratory measurements. In addition another 204 women were followed-up by a questionnaire regarding their pregnancy 40 years ago, as well as their present health status and medications. Women with HTP had more often diagnosed hypertension when compared with women with normal pregnancies (50 vs. 31%, respectively; P = 0.046), but the groups did not differ in any blood pressure levels. HTP were associated with higher pulse wave velocity (8.8 m/s vs. 7.8 m/s, P = 0.021), and higher levels of P-glucose (5.7 mmol/l vs. 5.2 mmol/l, P = 0.022), P-HbA1c (4.4% vs. 4.2%, P = 0.010) and noradrenaline (2.45 mmol/l vs. 2.11 mmol/l, P = 0.040) when compared with normotensive pregnancies. Women followed up with a questionnaire reported deteriorated cardiovascular health compared to women attending the clinical investigations of the study. HTP are associated with impairment in vascular function and metabolic status 40 years postpartum despite well controlled blood pressure levels.

  10. Tumor shrinkage assessed by volumetric MRI in the long-term follow-up after stereotactic radiotherapy of meningiomas

    Astner, Sabrina T.; Theodorou, Marilena; Dobrei-Ciuchendea, Mihaela; Kopp, Christine; Molls, Michael [Dept. of Radiotherapy and Radiooncology, Klinikum rechts der Isar, Technical Univ. of Munich (Germany); Auer, Florian [Dept. of Neuroradiology, Klinikum rechts der Isar, Technical Univ. of Munich (Germany); Grosu, Anca-Ligia [Dept. of Radiotherapy, Univ. Hospital Freiburg (Germany)


    Purpose: To evaluate tumor volume reduction in the follow-up of meningiomas after fractionated stereotactic radiotherapy (FSRT) or linac radiosurgery (RS) by using magnetic resonance imaging (MRI). Patients and Methods: In 59 patients with skull base meningiomas, gross tumor volume (GTV) was outlined on contrast-en-hanced MRI before and median 50 months (range 11-92 months) after stereotactic radiotherapy. MRI was performed as an axial three-dimensional gradient-echo T1-weighted sequence at 1.6 mm slice thickness without gap (3D-MRI). Results were compared to the reports of diagnostic findings. Results: Mean tumor size of all 59 meningiomas was 13.9 ml (0.8-62.9 ml) before treatment. There was shrinkage of the treated meningiomas in all but one patient. Within a median volumetric follow-up of 50 months (11-95 months), an absolute mean volume reduction of 4 ml (0-18 ml) was seen. The mean relative size reduction compared to the volume before radiotherapy was 27% (0-73%). Shrinkage measured by 3D-MRI was greater at longer time intervals after radiotherapy. The mean size reduction was 17%, 23%, and 30% (at < 24 months, 24-48 months, and 48-72 months). Conclusion: By using 3D-MRI in almost all patients undergoing radiotherapy of a meningioma, tumor shrinkage is detected. The data presented here demonstrate that volumetric assessment from 3D-MRI provides additional information to routinely used radiologic response measurements. After FSRT or RS, a mean size reduction of 25-45% can be expected within 4 years. (orig.)

  11. Treatment of focal hyperhidrosis with botulinum toxin type A: long-term follow-up in 61 patients.

    Schnider, P; Moraru, E; Kittler, H; Binder, M; Kranz, G; Voller, B; Auff, E


    The blocking action of botulinum toxin type A (BTX-A) on cholinergically innervated sweat glands has been used successfully to treat patients with focal hyperhidrosis. To investigate the long-term efficacy and safety of intradermal injections of BTX-A. We performed an open-label study in 61 patients treated over a period of 3 years for axillary or palmar hyperhidrosis. A total dose of 400 mU BTX-A (Dysport) was injected into both axillae or 460 mU BTX-A (Dysport) into both palms. The injections were repeated after relapse. Objective quantification of sweat production was performed using digitized ninhydrin-stained sheets. Four weeks after BTX-A treatment the median reduction in sweat production was 71% compared with baseline (P production by the patients using a visual analogue scale (0, no sweating; 100, the most severe sweating) showed a significant reduction in both the axillary (P BTX-A in patients with axillary and palmar hyperhidrosis are as effective as first treatments.

  12. Long-term follow-up of trauma patients before and after implementation of a Physician-Staffed Helicopter

    Funder, K.S.; Rasmussen, Lars S.; Lohse, Nicolai


    .00 post-HEMS; corresponding to ahazard ratio (HR) of 0.72 (95% confidence interval (CI) 0.44–1.17; p = 0.18). The HR of involuntary earlyretirement was 0.79 (95% CI 0.44–1.43; p = 0.43). The prevalence of reduced work ability after three yearswere 21.4% vs. 17.7%, odds ratio (OR) = 0.78 (CI 0.53–1.14; p...... = 0.20). The proportions of patients on socialtransfer payments at least half the time during the three-year period were 30.5% vs. 23.4%, OR = 0.68 (CI0.49–0.96; p = 0.03). HR for mortality was 0.92 (CI 0.62–1.35; p = 0.66). Conclusions: The implementation of HEMS was associated with a significant......Introduction: The first Danish Helicopter Emergency Medical Service (HEMS) was introduced May 1st2010. The implementation was associated with lower 30-day mortality in severely injured patients. Theaim of this study was to assess the long-term effects of HEMS on labour market affiliation...

  13. Results of surgical treatment for cervicobrachial neuralgia. A retrospective study of 122 patients with long-term follow-up.

    Perrin, G; Lapras, C; Goutelle, A


    Surgical nerve root decompression is rarely needed in the treatment of cervicobrachial neuralgia. In patients with prolonged and resistant pain or neurological deficits, or when signs of associated spinal cord suffering have been found, various surgical procedures can be used, but is most cases the disco-arthro-radicular conflict can be solved by the anterior approach with or without bone graft. This review of long-term résults in a series of 122 patients operated upon and re-examined more than 3 years later shows that the radicular symptoms were relieved in 95% of the cases. Evaluation of anatomical results did not reveal any instability or aggravation of discarthrosis at the site of surgery. However, in 30% of the cases disc degeneration was increased in the over- and underlying levels but without recurrence of clinical symptoms; 4% of the patients in this series were reoperated upon for this aggravated or de novo disc disease. The authors underline the importance of a thorough radioanatomical examination not only to decide whether or not a "soft hernia" or an arthrotic hypertrophy should be operated, but also to evaluate the extent of the decompressive operation to be performed.

  14. Maintenance of remission with infliximab in inflammatory bowel disease: Efficacy and safety long-term follow-up


    AIM: To evaluate the safety and efficacy of a longterm therapy with infliximab in Crohn's disease (CD) and ulcerative colitis (UC) patients retrospectively.METHODS: The medical charts of 50 patients (40 CD and 10 UC), who received after a loading dose of 3 infliximab infusions scheduled re-treatments every 8 wk as a maintenance protocol, were reviewed.RESULTS: Median (range) duration of treatment was 27 (4-64) mo in CD patients and 24.5 (6-46) mo in UC patients. Overall, 32 (80%) CD and 9 (90%) UC patients showed a sustained clinical response or remission throughout the maintenance period. Three CD patients shortened the interval between infusions. Eight (20%) CD patients and 1 UC patient underwent surgery for flare up of disease. Nine out of 29 CD and 4 out of 9 UC patients, who discontinued infliximab scheduled treatment, are still relapse-free after a median of 16 (5-30) and 6.5 (4-16) mo following the last infusion,respectively. Ten CD patients (25%) and 1 UC patient required concomitant steroid therapy during maintenance period, compared to 30 (75%) and 9 (90%) patients at enrolment. Of the 50 patients, 16 (32%) experienced at least 1 adverse event and 3 patients (6%) were diagnosed with cancer during maintenance treatment.CONCLUSION: Scheduled infliximab strategy is effective in maintaining long-term clinical remission both in CD and UC and determines a marked steroid sparing effect.Long-lasting remission was observed following infliximab withdrawal.

  15. A 50-year follow up of the long-term consequences of childhood plumbism. 1. Neurobehavior among survivors

    White, R.; Gendzler, R.D.; Hu, H.; Potter, N.

    The long-term health effects of childhood lead poisoning are incompletely explored. The authors identified a group of subjects for whom it was documented during 1930-1942 that they had lead poisoning. With the assistance of public records, survivors who reside in Massachusetts were traced. Thirty-three were successfully recruited to participate in this portion of the study. Twenty age-, sex-, and town-of-residence matched control subjects were recruited and studied simultaneously. All subjects were given a battery of neuropsychological tests, including tasks known to be sensitive to lead or robust in the face of lead exposure from prior occupational and environmental studies. The battery assessed a wide range of psychological functions, including visuospatial abilities, attention and executive function, reasoning, short-term memory, and mood. All tests known to be sensitive to brain damage and/or effects of lead were performed less effectively by the group of plumbism subjects than by controls. The equivalence of the two groups on tests known to be insensitive to lead and on the mood scales argues against subject performance bias. These results support the hypothesis that a history of childhood plumbism is associated with longstanding cognitive deficits. The pattern of test findings is consistent with the hypothesis that lead affects limbic and frontal system function in the brain.

  16. Anterior Skull Base Defects Reconstructed Using Three-Layer Method: 78 Consecutive Cases with Long-Term Follow-Up.

    Geyik, Murat; Erkutlu, Ibrahim; Alptekin, Mehmet; Gezgin, Inan; Mizrak, Ayse; Dokur, Mehmet; Gok, Abdulvahap


    Objectives Anterior skull base defects are potentially lethal and surgical treatment must be performed as soon as possible. The purpose of this study was to evaluate whether our technique is effective or not in long-term period. Design Retrospective chart review of all patients whose data were entered into the Hospital Registry System between 1995 and 2015. Setting/Participants This study was performed at the Gaziantep University School of Medicine, Gaziantep, Turkey, in 2015 and included 78 patients who in the past 20 years underwent three-layer reconstruction surgery for anterior skull base defects at the same university. Main Outcome Measures Among the patients, defects repaired by transcranial approach had the lowest recurrence rate. Overall, successful repair was achieved in 100% of the patients. Results Pure transbasal approach was used as a single procedure on 71 (91%) patients. Combined approaches were used in seven (9%) cases. The extended transbasal approach was combined with a transfacial approach in four patients and with a pterional approach in three patients. Conclusion We encourage the use of three-layer reconstruction and recommend free fascia lata grafts and galeal flaps with vascularized pedicle as sealing material of choice in all types of cases such as tumor and trauma.

  17. Smith-Magenis syndrome with West syndrome in a 5-year-old girl: a long-term follow-up study.

    Hino-Fukuyo, Naomi; Haginoya, Kazuhiro; Uematsu, Mitsugu; Nakayama, Tojo; Kikuchi, Atsuo; Kure, Shigeo; Kamada, Fumiaki; Abe, Yu; Arai, Natsuko; Togashi, Noriko; Onuma, Akira; Tsuchiya, Shigeru


    Smith-Magenis syndrome is characterized by multiple congenital anomalies and mental retardation caused by the heterozygous deletion of chromosomal region 17p11.2. We present a long-term follow-up study of a girl with Smith-Magenis syndrome and West syndrome. West syndrome became apparent at 7 months of age. Since then, mental retardation, particularly in terms of language development, became increasingly more obvious. The patient's spasms and hypsarrhythmia disappeared after a course of adrenocorticotropic hormone therapy, but focal seizures reappeared at the age of 3 years and 3 months. Her craniofacial dysmorphia and mental retardation became increasingly evident compared to her condition at the onset of West syndrome. Chromosome analysis detected the characteristic 17p deletion, which was then confirmed via fluorescent in situ hybridization analysis. This is the second report of a patient with Smith-Magenis syndrome and West syndrome; taken together, these results suggest that Smith-Magenis syndrome may be a further cause of West syndrome.

  18. A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan

    Chung Chi-Hsiang


    Full Text Available Abstract Background Previous follow-up studies of repeated self-harm show that the cumulative risk of repeated self-harm within one year is 5.7%–15%, with females at greatest risk. However, relatively few studies have focused on the Far East. The objective of this study was to calculate the cumulative risk of repeated self-harm over different lengths of follow-up time (3 months, 6 months, and 1–8 years, to determine factors influencing repeated self-harm and to explore the interaction between gender and self-harm methods. Methods We used self-harm patient who hospitalized due to first-time self-harm between 2000 and 2007 from 1,230 hospitals in Taiwan. Hospitalization for repeated self-harm among members of this cohort was tracked after 3 months, 6 months, and 1–8 years. Tracking continued until December 31, 2008. We analyzed the cumulative risk and risk factors of repeated self-harm by using negative binomial regression. Results Of the 39,875 individual study samples, 3,388 individuals (8.50% were found to have repeatedly self-harmed. The cumulative risk of repeated self-harm within three months was 7.19% and within one year was 8%. Within 8 years, it was 8.70%. Females were more likely to repeatedly self-harm than males (RR = 1.21, 95% CI = 1.15–1.76. The main method of self-harm was solid or liquid substances (RR = 1.88, 95% CI = 1.23–2.04 or cutting or piercing (RR = 1.36, 95% CI = 1.02–1.82, and in patients with psychiatric disorders were more likely to self-harm (RR = 1.61, 95% CI = 1.48–1.75. Conclusions The key time for intervention for repeated self-harm is within three months. Appropriate prevention programs should be developed based on gender differences.

  19. Long-term follow-up of seven patients with ophthalmopathy not associated with thyroid autoimmunity: heterogeneity of autoimmune ophthalmopathy

    McCorquodale T


    smokers (eight out of 13 versus none out of seven.Conclusions: Earlier studies suggesting that patients with EGD eventually develop thyroid dysfunction have not been confirmed here, although follow-up continues, and the possibility that such patients have had thyroid autoimmunity in the past, or that they will develop it in the future cannot be excluded. Overall, it is likely that the ophthalmopathy associated with Graves' hyperthyroidism is the same disease as that observed in patients – such as those reported here – in whom thyroid dysfunction and thyroid autoimmunity are not present during the period of follow-up. The role of autoimmunity against the TSH-r in euthyroid patients with ophthalmopathy has not been proven and the significance of the orbital antibodies is unclear.Keywords: ophthalmopathy, thyroid eye disease, collagen XIII, calsequestrin, euthyroid Graves' disease

  20. Long-term follow-up of renal transplant patients with renal artery stenosis treated by percutaneous angioplasty

    Peregrin, Jan H. [Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 14021 Prague 4 (Czech Republic)], E-mail:; Stribrna, Jarmila [Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 14021 Prague 4 (Czech Republic); Lacha, Jiri [Department of Nephrology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 14021 Prague 4 (Czech Republic); Skibova, Jelena [Statistical Department, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 14021 Prague 4 (Czech Republic)


    Purpose of the study: To evaluate if renal angioplasty (PTRA) in patients with transplanted kidney and renal artery stenosis (TRAS) can have long-term effect on hypertension and renal function. Materials and methods: Within a 24-year time period, 58 PTRAs in 55 adults (three times Re-PTRA) with transplanted kidney were performed. The group included 34 males and 21 females, average age 41 {+-} 10.6 (18-72) years. After exclusion of 7 technical failures, 51 PTRAs were followed at 1 week, 6 months and 1-3 years after PTRA. Hypertension improvement was defined as mean arterial pressure (MAP) decrease of at least 15% from the pre-PTRA value. Graft function was evaluated by serum creatinine (Scr) and creatinine clearance (Ccr) levels, and the improvement was defined as a 20% change. Clinical FU was 3 years. Results: PTRA technical success was 88.4%. In 51 kidney recipients at the end of FU, blood pressure improved in 65.2% of patients (MAP decreased from 123 {+-} 13.1 to 107 {+-} 12.1 mmHg), but no patient remained normotensive medication free. Graft function improved in 44.8% of patients and was stabilized in 20.7% of them (average Ccr before PTRA: 0.48 {+-} 0.29, after PTRA: 0.78 {+-} 47 ml/s). PTRA complications were observed in 25.5% of procedures, most often with no clinical sequel. Thirty days mortality was 1.8% (one patient). Conclusions: PTRA results in kidney recipients are valuable mainly in preserving graft function.

  1. Long-term follow-up results of combination therapy of surgery and gamma knife on pituitary tumor

    Ikeda, Hidetoshi; Yoshimoto, Takashi; Shirokura, Hideshi [Tohoku Univ., Sendai (Japan). School of Medicine


    Usefulness of the combination therapy for invasive pituitary tumor with surgery and gamma knife (GK) was evaluated on 17 cases followed for >2 years. Tumors involved ACTH cell adenoma, GH cell adenoma, mixed GH and PRL, purihormonal adenoma, gonadotrophic cell adenoma, GH cell adenoma and null cell adenoma, which were divided into I and II group since adverse effects by GK on the normal pituitary tissues could be evaluated according to tumor growth and abnormal hormone secretion. Irradiation was carried out to make the marginal dose of around 30 (15-35) Gy and center dose of 25-70 Gy on the gland, and marginal dose of <10 Gy on optic nerve. After GK, follow-up was done by pituitary hormone values, tests for sight and visual field and MRI examination. Hypopituitarism was seen in 67% with 100% remission of Cushing`s disease. MRI revealed that the adenoma changed to fibrosis (type 1) with increasing Gd-enhancement or to cystic necrosis (type 2) without Gd-enhancement. Values for GH, cortisol and ACTH turned to normal ones. Thus the combination therapy was found useful. (K.H.)

  2. Long term follow-up of patients with Cushing's disease treated by interstitial irradiation

    Sandler, L.M.; Richards, N.T.; Carr, D.H.; Mashiter, K.; Joplin, G.F.


    The first 86 patients with Cushing's disease treated with interstitial irradiation (by needle implantation) as the sole therapy were reviewed. In the 82 patients who were reassessed 1 yr after treatment 63 (77%) achieved remission. This study comprises the outcome and complications in the 54 patients who had a remission and whom we were able to follow. The follow-up period ranged from 3-26 yr (mean, 10.5) from the time of remission. No instance of clinical or radiological relapse has occurred. Of these 54 patients, yttrium-90 alone was used in 32, of whom 12 (37%) required corticosteroid or T4 replacement therapy in a mean time of 3.5 months; in 7 of these 12 we elected to give an ablative dose. Gold-198 alone was used in 15 patients, of whom 7 (47%) developed hypopituitarism in a mean time of 76 months. Both isotopes were used in 7 patients. A diurnal serum cortisol rhythm was found in 28 of the 31 patients who were not receiving corticosteroid therapy. In 5 of the 7 patients with an initially abnormal pituitary fossa, serial radiological studies revealed remodelling in 3. There have been no complications in the last 17 years. Pituitary implantation with yttrium-90 is an effective alternative to transsphenoidal hypophysectomy, with a high remission rate, no recurrence (as yet), no operative complications, and avoidance of hormone replacement in the majority.

  3. Noninvasive Transcutaneous Monitoring in Long-Term Follow-Up of Patients With Thromboangiitis Obliterans Treated With Intravenous Iloprost.

    Melillo, Elio; Grigoratos, Chrysanthos; Sanctis, Francesco De; Spontoni, Paolo; Nuti, Marco; Dell'Omodarme, Matteo; Ferrari, Mauro; Balbarini, Alberto


    We evaluated the effectiveness of intravenous iloprost (IVI) in outpatients with thromboangiitis obliterans (TAO) and lower limb noninvasive transcutaneous monitoring (TCM) at follow-up (FU). Ten consecutive patients with TAO underwent IVI therapy. Transcutaneous oxygen (TcPo 2) and carbon dioxide (TcPco 2) determination and laser Doppler flowmetry (LDF) were performed before and after IVI at 3, 6, and 12 months of FU. Clinical response was positive in 7 patients, whereas 3 nonresponders underwent a second IVI cycle with 1 showing a late positive clinical response. After 12 months of FU, all patients were alive without amputations. Supine and dependent TcP2 levels significantly improved (P < .005). Hallux LDF values showed significant change with the maximal hyperemic test at 44°C (P < .005). Forefoot maximal hyperemic test at 44°C LDF (P < .005) and improved venous arterial reflex (P < .05) showed statistically significant time evolution. We demonstrated some degree of IVI effectiveness and evaluated TCM in patients with TAO.

  4. [A 8-year-forgotten ureteral stent after kidney transplantation: treatment and long-term follow-up].

    Lasaponara, Fedele; Dalmasso, Ettore; Santià, Silvia; Sedigh, Omidreza; Bosio, Andrea; Pasquale, Giovanni; Segoloni, Giuseppe P; Fontana, Dario


    Forgotten indwelling ureteral stents can cause significant urological complications. Only few cases are reported after kidney transplantation. We present a case of a 39-year-old woman, transplanted in 1993 and referred to our Transplant Center 8 years later, because of a serious urinary tract infection with renal function impairment. Abdominal CT scan showed pyelonephritis and hydronephrosis in the transplanted kidney and the presence of a calcific ureteral stent, which had been forgotten in situ for 8 years. The stent was removed, but it was impossible to replace it with a new stent both retrogradely and anterogradely, because of a tight obstruction of the mid ureter. So a uretero-ureteral anastomosis with up urinary tract was performed. No intra- or post-operative complications occurred. At 9 years' follow-up, the patient shows an optimal renal function, with no urinary tract infection. A forgotten ureteral stent in a transplanted kidney can cause a lot of complications and can lead to graft loss. The prosthesis may cause an irreversible ureteral damage, so, as in our experience, forgetting a ureteral stent can result in a complex surgery.

  5. Clinico-MRI study of hemispheric disorder in long-term follow-up cases of multiple system atrophy

    Konagaya, Masaaki; Miwa, Shigeru; Matsuoka, Yukihiko [Suzuka National Hospital, Mie (Japan); Konagaya, Yoko


    Twelve cases of multiple system atrophy (MSA) were studied for clinical and MRI findings of the cerebral hemispheric involvement. The subjects consisted of five olivopontocerebellar atrophy (OPCA) type and seven striatonigral degeneration (SND) type. The age at onset was 56.7{+-}8.0 (M{+-}SD) years, duration of illness at the first MRI study 3.2{+-}1.1 years, duration of illness at the last study 8.1{+-}2.2 years, and the following up duration 4.9{+-}2.0 years. The grasping phenomenon was observed in 70% of the cases examined, snout reflex in 80%, slowness of verbal response in 88%, and decrease of spontaneous speech in 100%. Three cases finally fell into the state of mutism. Three out of ten cases were categorized as dementia by HDS-R (Hasegawa Dementia Scale-Revised) test. Besides the progression of the pontocerebellar atrophy and putaminal changes, MRI study revealed progressive frontal lobe atrophy in most cases. At six years after the onset, SND type showed significantly higher incidence of conspicuous frontal lobe atrophy and dilatation of the Sylvian fissure than OPCA type. Cerebral ventricular dilatation was common feature, and atrophy of the temporal and occipital lobes were observed in several cases. We indicated the possible involvement of the cerebral hemisphere, especially the frontal lobe, and higher nervous function in MSA. (author)

  6. Segmental odontomaxillary dysplasia: report of a series of 5 cases with long-term follow-up.

    Whitt, Joseph C; Rokos, James W; Dunlap, Charles L; Barker, Bruce F


    We report a series of 5 cases of segmental odontomaxillary dysplasia (SOMD) with follow-up periods ranging from 8 to 21 years, bringing the total number of reported cases to 45. SOMD is a sporadic, mesoectodermal dysplasia that presents early in life, possibly as early as in utero and exhibits male gender predominance (1.7:1.0). Its features include enlargement of the soft tissue and/or bone of 1 hemimaxilla that may produce mild facial asymmetry. Subsequent growth of the affected area is proportional to that of the unaffected hemimaxilla. Sclerotic radiographic bone changes and dental developmental abnormalities are also present. The dense bone, which often exhibits a radiographic vertical orientation of the trabecular bone pattern, is typically associated with delayed eruption of the teeth. Congenitally missing premolar teeth (either or both) is a common feature of this condition that is of significant diagnostic value. Although ipsilateral cutaneous findings have been reported in 23%, our cases exhibited none. Computed tomographic imaging demonstrated extensive involvement of the maxillary bone, including the lateral wall and floor of the maxillary sinus and the hard palate. The affected bone presents no impediment to either orthodontic tooth movement or to the successful osteointegration of dental implants. The cause of SOMD is unknown; the clues to the cause of this unusual phenotypic expression are buried in the intricacies of developmental biology within the first branchial arch. Copyright © 2011 Mosby, Inc. All rights reserved.

  7. Long-term effects of STN DBS on mood: psychosocial profiles remain stable in a 3-year follow-up

    Brücke Thomas


    Full Text Available Abstract Background Deep brain stimulation of the subthalamic nucleus significantly improves motor function in patients with severe Parkinson's disease. However, the effects on nonmotor aspects remain uncertain. The present study investigated the effects of subthalamic nucleus deep brain stimulation on mood and psychosocial functions in 33 patients with advanced Parkinson's disease in a three year follow-up. Methods Self-rating questionnaires were administered to 33 patients prior to surgery as well as three, six, twelve and 36 months after surgery. Results In the long run, motor function significantly improved after surgery. Mood and psychosocial functions transiently improved at one year but returned to baseline at 36 months after surgery. In addition, we performed cluster and discriminant function analyses and revealed four distinct psychosocial profiles, which remained relatively stable in the course of time. Two profiles featured impaired psychosocial functioning while the other two of them were characterized by greater psychosocial stability. Conclusion Compared to baseline no worsening in mood and psychosocial functions was found three years after electrode implantation. Moreover, patients can be assigned to four distinct psychosocial profiles that are relatively stable in the time course. Since these subtypes already exist preoperatively the extent of psychosocial support can be anticipatory adjusted to the patients' needs in order to enhance coping strategies and compliance. This would allow early detection and even prevention of potential psychiatric adverse events after surgery. Given adequate psychosocial support, these findings imply that patients with mild psychiatric disturbances should not be excluded from surgery.

  8. Long term follow-up and outcome of liver transplantation from hepatitis B surface antigen positive donors

    Ballarin, Roberto; Cucchetti, Alessandro; Russo, Francesco Paolo; Magistri, Paolo; Cescon, Matteo; Cillo, Umberto; Burra, Patrizia; Pinna, Antonio Daniele; Di Benedetto, Fabrizio


    Liver transplant for hepatitis B virus (HBV) currently yields excellent outcomes: it allows to rescue patients with an HBV-related advanced liver disease, resulting in a demographical modification of the waiting list for liver transplant. In an age of patient-tailored treatments, in liver transplantation as well the aim is to offer the best suitable graft to the patient who can benefit from it, also expanding the criteria for organ acceptance and allocation. With the intent of developing strategies to increase the donor pool, we set-up a multicenter study involving 3 Liver Transplant Centers in Italy: patients undergoing liver transplantation between March 03, 2004, and May 21, 2010, were retrospectively evaluated. 1408 patients underwent liver transplantation during the study period, 28 (2%) received the graft from hepatitis B surface antigen positive (HBsAg)-positive deceased donors. The average follow-up after liver transplantation was 63.7 mo [range: 0.1-119.4; SD ± 35.8]. None Primary non-function, re-liver transplantation, early or late hepatic artery thrombosis occurred. The 1-, 3- and 5-year graft and patient survival resulted of 85.7%, 82.1%, 78.4%. Our results suggest that the use of HBsAg-positive donors liver grafts is feasible, since HBV can be controlled without affecting graft stability. However, the selection of grafts and the postoperative antiviral therapy should be managed appropriately.

  9. Extracranial metastasizing solitary fibrous tumors (SFT) of meninges: histopathological features of a case with long-term follow-up.

    Gessi, Marco; Gielen, Gerrit H; Roeder-Geyer, Eva-Dorette; Sommer, Clemens; Vieth, Michael; Braun, Veit; Kuchelmeister, Klaus; Pietsch, Torsten


    Extrapleural solitary fibrous tumors are uncommon mesenchymal neoplasms frequently observed in middle-aged adults and are classified, according to the WHO classification of soft tissue tumors, as part of the hemangiopericytoma tumor group. However, these two entities remain separated in the WHO classification of tumors of the central nervous system. In fact, meningeal solitary fibrous tumors are believed to be benign lesion and only in a minority of cases local relapses have been described, although detailed survival clinical studies on solitary fibrous tumors of meninges are rare. In contrast to hemangiopericytoma, which frequently shows distant extracranial metastases, such an event is exceptional in patients with meningeal solitary fibrous tumors and has been clinically reported in a handful of cases only and their histopathological features have not been investigated in detail. In this report, we describe the detailed clinico-pathological features of a meningeal solitary fibrous tumor presenting during a 17-year follow-up period, multiple intra-, extracranial relapses and lung metastases.


    Rafael M. LAURINO NETO


    Full Text Available Context It is unclear whether health-related quality of life (HRQL is sustained in a long-term follow-up of morbidly obese patients who underwent Roux-en-Y gastric bypass (RYGB. Objective This study aims to analyze the HRQL changes following RYGB in short and long-term follow-up. Methods We compared the health-related quality of life among three separate patient groups, using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36. Group A - 50 preoperative morbidly obese patients; Group B - 50 RYGB patients 1-2 years post-surgery; Group C - 50 RYGB patients more than 7 years post-surgery. Results The groups were similar for gender, age and body mass index before surgery. We observed that physical functioning, social function, emotional role functioning and mental health scales did not vary between the three groups. The physical role functioning scale was unchanged in the short-term and decreased compared to the preoperative scale in the long-term follow-up. Bodily pain improved after the operation but returned to the initial level after 7 years. The vitality and general health perceptions improved after the operation and maintained these results after 7 years compared with the preoperative perceptions. Conclusions RYGB improved health-related quality of life in three SF-36 domains (bodily pain, general health perceptions and vitality in the short-term and two SF-36 domains (general health perceptions and vitality in the long-term.

  11. Long-term follow-up of kidney allografts in patients with sickle cell hemoglobinopathy Transplante renal na anemia falciforme

    João R. Friedrisch


    Full Text Available Although sickle cell anemia and sickle cell disease produce a variety of functional renal abnormalities they uncommonly cause end stage renal failure. Renal transplantation has been a successful alternative for the treatment of the rare terminal chronic renal failure with outcomes comparable with non-sickle recipients. This approach, however, has not been often described on patients with renal failure associated with SC hemoglobinopathy. Here we report the outcomes of two patients with chronic renal failure due to SC hemoglobinopathies who underwent renal transplantation. At the time of the transplantation they were both severely anemic and had frequent vasoocclosive pain crises. Both patients evolved with good allograft function, near normal hematological parameters, and very rare pain crisis, thirteen and eight years after transplant. These cases illustrate that terminal renal failure due to SC hemoglobinopathy can be successfully managed by renal transplantation and satisfactory long-term results are achievable not only in terms of renal allograft function but also of their hematological condition.Embora a anemia falciforme e as síndromes falciformes freqüentemente causem várias alterações funcionais renais, não é comum a insuficiência renal terminal. Nestes casos, o transplante renal é uma alternativa que se acompanha de resultados comparáveis aos obtidos em receptores sem hemoglobinopatias. Esta estratégia terapêutica tem sido, no entanto, pouco relatada para portadores de hemoglobinopatia SC. Este relato descreve a evolução de dois pacientes portadores de hemoglobinopatia SC que foram submetidos ao transplante renal. No momento do transplante ambos apresentavam severa anemia e crises dolorosas freqüentes. Os pacientes evoluíram com boa função do enxerto, parâmetros hematológicos quase normais e praticamente assintomáticos do ponto de vista da hemoglobinopatia, treze e oito anos após o transplante. Estes casos ilustram

  12. Cardiovascular morbidity and mortality in surgically treated hyperthyroidism - a nation-wide cohort study with a long-term follow-up.

    Ryödi, Essi; Salmi, Jorma; Jaatinen, Pia; Huhtala, Heini; Saaristo, Rauni; Välimäki, Matti; Auvinen, Anssi; Metso, Saara


    Previous studies suggest that patients with hyperthyroidism remain at an increased risk of cardiovascular morbidity even after restoring euthyroidism. The mechanisms of the increased risk and its dependency on the different treatment modalities of hyperthyroidism remain unclear. The aim of this long-term follow-up study was to compare the rate of hospitalizations for cardiovascular causes and the mortality in hyperthyroid patients treated surgically with an age- and gender-matched reference population. A population-based cohort study was conducted among 4334 hyperthyroid patients (median age 46 years) treated with thyroidectomy in 1986-2007 in Finland and among 12,991 reference subjects. Firstly, the hospitalizations due to cardiovascular diseases (CVD) were analysed until thyroidectomy. Secondly, the hazard ratios for any new hospitalization due to CVDs after the thyroidectomy were calculated in Cox regression analysis adjusted with the prevalent CVDs at the time of thyroidectomy. The risk of hospitalization due to all CVDs started to increase already 5 years before the thyroidectomy, and by the time of the operation, it was 50% higher in the hyperthyroid patients compared to the controls (P hyperthyroidism. Despite the increased CVD morbidity among the patients, there was no difference in cardiovascular mortality. The present study shows that hyperthyroidism increases the risk of hospitalization due to CVDs and the risk is sustained up to two decades after effective surgical treatment. However, there was no excess CVD mortality in the middle-aged patient cohort studied. © 2013 John Wiley & Sons Ltd.

  13. Effect of coumarins started before coronary angioplasty on acute complications and long-term follow-up: a randomized trial.

    ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Ernst, S M; Verheugt, F W; Plokker, H W


    Coronary angioplasty frequently creates a thrombogenic surface, with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. The objective of this open, randomized trial was to assess the clinical effect of coumarins started before coronary angioplasty and continued for 6 months. Before coronary angioplasty, 530 patients were randomly assigned to aspirin plus coumarins and 528 patients to aspirin alone. At the start of the angioplasty, the mean international normalized ratio was 2.7+/-1.1; during follow-up, it was 3.0+/-1.1. At 30 days, the composite end point of death, myocardial infarction, target-lesion revascularization, and stroke was observed in 18 patients (3.4%) treated with aspirin plus coumarin compared with 34 patients (6.4%) treated with aspirin alone (relative risk, 0.53; 95% CI, 0.30 to 0.92). At 1 year, these figures were 14.3% and 20.3%, respectively (relative risk, 0.71; 95% CI, 0.54 to 0.93). The incidence of major bleeding and false aneurysm during hospitalization was 3.2% and 1.0%, respectively (relative risk, 3.39; 95% CI, 1.26 to 9.11). The benefit of coumarins was observed in both stented and nonstented patients. Coumarins in addition to aspirin started before PTCA and continued for 6 months was more effective than aspirin alone in the prevention of acute and late complications after coronary angioplasty. This benefit was accompanied by a small but significant increase in bleeding complications.

  14. Endoscopic mucosal resection of flat and sessile colorectal adenomas: Our experience with long-term follow-ups

    Grgov Saša


    Full Text Available Bacground/Aim. Endoscopic mucosal resection (EMR or mucosectomy is a removing method of flat or sessile lesions, laterally spreading tumors and carcinoma of the colon or the rectum limited to mucosa or the surface part of the submucosa. The aim of the study was to estimate the efficacy and safety of EMR in removing flat and sessile colorectal adenomas. Methods. This prospective study involved 140 patients during the period of 8 years. A total of 187 colorectal adenomas were removed using the EMR method “inject and cut with snare”. Results. The approximate size of mucosectomised adenomas was 13.6 mm (from 8 mm to 60 mm. There was a total of 48 (25.7% flat adenomas and 139 (74.3% sessile adenomas, (p < 0.01. Using “en bloc” and “piecemeal” resection, 173 (92.5% and 14 (7.5% of colorectal adenomas were removed, respectively. In all the cases, a complete removal of colorectal adenomas was achieved. Two (1.4% patients had adenoma removal with intramucosal carcinoma each. In the average follow-up period of 21.2 ± 17.8 months, 2 (1.4% patients had adenoma relapse after EMR. Considering complications, there was bleeding in 1 (0.7% patient with a big rectum adenoma removed with EMR. Furthermore, one (0.7% patient had a postcoagulation syndrome after cecal adenoma was removed by EMR. Conclusion. EMR is an efficient, safe and minimally invasive technique of removing flat and sessile adenomas in the colon and the rectum, with a very low percentage of adenoma recurrence over a long period of monitoring.

  15. Hypofractionated stereotactic radiotherapy for low grade glioma at McGill University: long-term follow-up.

    Roberge, D; Souhami, L; Olivier, A; Leblanc, R; Podgorsak, E


    Small, well-defined, unresectable low-grade gliomas are attractive targets for stereotactic irradiation. Fractionated stereotactic irradiation of these targets has the theoretical benefit of increased normal tissue sparing beyond that provided by the physical characteristics of stereotactic radiosurgery. From July 1987 to November 1992, 21 patients were treated for low-grade glioma at our institution using a hypofractionated regimen of stereotactic radiotherapy. All patients had well-circumscribed, < 40 mm tumors. No patient had had prior radiotherapy. All lesions were histologically proven WHO grade I or II glial tumors. Lesions involved sensitive brain structures and were deemed unresectable. A typical dose of 42 Gy was delivered in 6 fractions over a two-week period using rigid immobilization and a linac-based dynamic stereotactic radiosurgical technique. Patients had a median age of 23 years (9-74) and were predominantly female (60%). Median tumor diameter was 20 mm. With a median follow-up for living patients of 13.3 years, the actuarial 5, 10, and 15-year overall survival rates are 76%, 71%, and 63%, respectively. Treatment was acutely well tolerated although three patients experienced late post-therapy complications. Our results and those of 241 patients treated in nine other institutional series are reviewed. Despite some examples of favorable short-term outcomes, all reported series are highly selected and thus likely biased. The data regarding the use of SRS is limited and, in our opinion, insufficient to claim a clear therapeutic advantage to SRS in the initial management of low-grade glioma. Our own results with hypofractionated stereotactic radiotherapy are similar to those expected with standard therapy.

  16. Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up

    Pia Allegri


    Full Text Available Pia Allegri1, Antonio Mastromarino1, Piergiorgio Neri21Uveitis Center, Ophthalmological Department of Lavagna Hospital, Genova, Italy; 2Uveitis Unit, The Eye Clinic, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Ancona, ItalyAbstract: Curcumin has been successfully applied to treat inflammatory conditions in experimental research and in clinical trials. The purpose of our study is to evaluate the efficacy of an adjunctive-to-traditional treatment with Norflo tablets (curcumin-phosphatidylcholine complex; Meriva administered twice a day in recurrent anterior uveitis of different etiologies. The study group consisted of 106 patients who completed a 12-month follow-up therapeutic period. We divided the patients into three main groups of different uveitis origin: group 1 (autoimmune uveitis, group 2 (herpetic uveitis, and group 3 (different etiologies of uveitis. The primary end point of our work was the evaluation of relapses frequency in all treated patients, before and after Norflo treatment, followed by the number of relapse in the three etiological groups. Wilcoxon signed-rank test showed a P < 0.001 in all groups. The secondary end points were the evaluation of relapse severity and of the overall quality of life. The results showed that Norflo was well tolerated and could reduce eye discomfort symptoms and signs after a few weeks of treatment in more than 80% of patients. In conclusion, our study is the first to report the potential therapeutic role of curcumin and its efficacy in eye relapsing diseases, such as anterior uveitis, and points out other promising curcumin-related benefits in eye inflammatory and degenerative conditions, such as dry eye, maculopathy, glaucoma, and diabetic retinopathy.Keywords: curcumin, anterior recurrent uveitis, phosphatidylcholine-bound-curcumin (Meriva

  17. Primary Whipple disease of the brain: case report with long-term clinical and MRI follow-up

    Peregrin J


    Full Text Available Jan Peregrin,1 Hana Malikova2,3 1Department of Neurology, 2Department of Radiology, Na Homolce Hospital, 3Second Faculty of Medicine, Institute of Anatomy, Charles University, Prague, Czech Republic Abstract: Whipple disease (WD is a rare systemic disorder caused by the bacteria Tropheryma whipplei. In its classic form, it manifests with gastrointestinal problems including diarrhea, abdominal pain, and weight loss. However, various other systems can be affected, including the central nervous system (CNS. Even more rarely, the CNS is primarily affected without gastrointestinal symptoms and with a negative small bowel biopsy. The incidence of primary CNS WD is unknown. We report the case of a young female with the primary CNS form of WD. In this report, we highlight the main clinical features and diagnostic procedures that lead to the diagnosis and comment on the treatment and clinical response. We stress the importance of neuroimaging and brain biopsy. A unique feature of this case is that the patient has been followed up for 12 years. At the time of diagnosis, no neurological manifestations were detected, although a tumor-like lesion in the right temporal lobe and hypothalamic infiltration were present on magnetic resonance imaging (MRI. The first neurological manifestations developed 2 years later despite recommended antibiotic treatment, with cognitive impairment developing more than 10 years later. According to the MRI findings and clinical course, the disease was active for several years when multiple lesions on MRI appeared despite antibiotic therapy. In the discussion, we compare the present case with similar cases previously reported and we elaborate on the similarities and discrepancies in clinical features, diagnostic procedures, results, and treatment options. Keywords: central nervous system, brain biopsy, antibiotic treatment


    Cornelius, Jack R; Salloum, Ihsan M; Ferrell, Robert; Douaihy, Antoine B; Hayes, Jeanie; Kirisci, Levent; Horner, Michelle; Daley, Dennis C


    This study compared the acute phase (12-week) and the long-term (1 year) efficacy of fluoxetine versus placebo for the treatment of the depressive symptoms and the cannabis use of youth with comorbid major depressive disorder (MDD) and an cannabis use disorder (CUD)(cannabis dependence or cannabis abuse). We hypothesized that fluoxetine would demonstrate efficacy in the acute phase trial and at the 1-year follow-up evaluation. Data is also provided regarding the prevalence of risky sexual behaviors in our study sample. We recently completed the first double-blind placebo-controlled study of fluoxetine in adolescents and young adults with comorbid MDD/CUD. A total of 70 persons participated in the acute phase trial, and 68 of those persons (97%) also participated in the 1-year follow-up evaluation. Results of the acute phase study have already been presented (Cornelius, Bukstein, et al., 2010), but the results of the 1 year follow-up assessment have not been published previously. All participants in both treatment groups also received manual-based cognitive behavioral therapy (CBT) and motivation enhancement therapy (MET) during the 12-week course of the study. The 1-year follow-up evaluation was conducted to assess whether the clinical improvements noted during the acute phase trial persisted long term. During the acute phase trial, subjects in both the fluoxetine group and the placebo group showed significant within-group improvement in depressive symptoms and in cannabis-related symptoms. However, no significant difference was noted between the floxetine group and the placebo group on any treatment outcome variable during the acute phase trial. End of study levels of depressive symptoms were low in both the fluoxetine group and the placebo group. Most of the clinical improvements in depressive symptoms and for cannabis-related symptoms persisted at the 1-year follow-up evaluation. Fluoxetine did not demonstrate greater efficacy than placebo for treating either

  19. A Randomized Multicenter Trial Comparing Autologous Chondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years.

    Knutsen, Gunnar; Drogset, Jon Olav; Engebretsen, Lars; Grøntvedt, Torbjørn; Ludvigsen, Tom C; Løken, Sverre; Solheim, Eirik; Strand, Torbjørn; Johansen, Oddmund


    The management of cartilage and osteochondral lesions in the knee remains problematic and controversial. Our group reported the 2-year and 5-year results of a randomized controlled trial comparing autologous chondrocyte implantation (ACI) and microfracture in patients with focal femoral cartilage injuries. The objective of the present study was to report the long-term results. Eighty patients with a single symptomatic chronic cartilage defect on the femoral condyle without general osteoarthritis were included in the study at the time of the index operation (January 1999 to February 2000). We used the International Cartilage Repair Society (ICRS), Lysholm, Short Form-36 (SF-36), and Tegner forms to collect data at the time of inclusion and at follow-up evaluations. Standing weight-bearing radiographs were evaluated for evidence of osteoarthritis according to the method described by Kellgren and Lawrence. For the long-term follow-up in 2014, we used the Synaflexer frame to standardize the radiographs. The operation was considered to have failed if a reoperation was performed because of symptoms from a lack of healing of the treated defect. At the long-term follow-up evaluation, no significant differences between the treatment groups were detected with respect to the results on the clinical scoring systems. At the 15-year evaluation, there were 17 failures in the ACI group compared with 13 in the microfracture group. We observed that more total knee replacements were needed in the ACI group than in the microfracture group (6 compared with 3). The surviving patients in both groups, i.e., those who had not had a failure, had significant improvement in the clinical scores compared with baseline. Fifty-seven percent of the surviving patients in the ACI group and 48% of such patients in the microfracture group had radiographic evidence of early osteoarthritis (a Kellgren and Lawrence grade of ≥2); the difference was not significant. The survivors in both groups improved

  20. CT-guided radiofrequency ablation of osteoid osteoma and osteoblastoma: Clinical success and long-term follow up in 77 patients

    Rehnitz, Christoph, E-mail: [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Sprengel, Simon David, E-mail: [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Lehner, Burkhard, E-mail: [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Ludwig, Karl, E-mail: [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Omlor, Georg, E-mail: [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Merle, Christian, E-mail: [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Kauczor, Hans-Ulrich, E-mail: [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Ewerbeck, Volker, E-mail: [Department of Orthopaedic Surgery, University of Heidelberg, Schlierbacher Landstr. 200a, D-69118 Heidelberg (Germany); Weber, Marc-Andre, E-mail: [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany)


    The purpose of this study was to retrospectively evaluate long-term success of CT-guided radiofrequency ablation (RFA) in patients with osteoid osteoma (OO) and osteoblastoma (OB) including tumors in critical locations. Eighty-one CT-guided RFA procedures were performed in 77 patients with OO (65 patients) and OB (12) including 6 spinal and 15 intra/periarticular tumors. Procedural techniques included multiple needle positions, three-dimensional access planning, as well as, thermal protection techniques. Long-term success was assessed using a questionnaire including, among others, several VAS (visual analogue scale) scores. All patients completed 3-6 months follow-up, overall response to the questionnaire was 64/77 (83.1%). Primary success rate was 74/77 (96.1%) of all patients. Retreatment with RFA in 3 patients resulted in a secondary success rate of 77/77 (100%). Long-term follow-up (mean, 38.5 months; range, 3-92) revealed a highly significant (p < 0.001) reduction of all assessed limitation scores reaching normal or almost normal values. One major complication, a cannula break leading to a secondary short hospital stay, occurred. In conclusion, RFA is a safe and effective long-lasting treatment of OO and OB. Advanced procedural techniques aid treating tumors in critical locations and in the coverage of larger tumors. Besides night pain, RFA also greatly improves other factors negatively affecting the quality of life.

  1. Long term follow-up of Cushing's disease treated with reserpine and pituitary irradiation followed by subtotal adrenalectomy

    Murayama, Masanori; Yasuda, Keigo; Minamori, Yoshiaki; Mercado-Asis, L.B.; Morita, Hiroyuki; Miura, Kiyoshi (Gifu Univ. (Japan). Faculty of Medicine); Yamakita, Noriyoshi


    Subtotal adrenalectomy was given to 10 adult patients with Cushing's disease, concurrently with or following therapeutic regimen by long term reserpine administration and pituitary irradiation. In the present study, we describe long term follow-up results. Two patients died after the operation due to acute adrenal crisis and pneumonia, respectively. The other 8 patients achieved clinical and biochemical remissions and were followed for long term. Three patients relapsed 9, 14 or 17 years after achieving remission, two patients developed hypopituitarism 12 or 20 years after and one died of cerebral vascular accident at 64 years, 5 years after the remission. The remaining 2 patients maintained remission for 10 or 18 years, respectively. During the remission periods of 0.5 to 20 years with a mean of 10.1[+-]6.7 years, 6 of 7 patients examined by 1 mg overnight dexamethasone test showed normal suppressibility of plasma cortisol. Provocative tests of plasma GH by 1-arginine infusion and/or insulin-induced hypoglycemia were performed in 6 patients in the early remission period. All of 5 patients in the arginine infusion test and 3 of 5 in the insulin-induced hypoglycemia test showed normal responses. Furthermore, to facilitate prediction of long term response or failure to our therapeutic regimen, long term reserpine administration and pituitary irradiation, pretreatment clinical and biochemical characteristics were analyzed retrospectively in 3 divided groups; the present 10 patients treated with reserpine and pituitary irradiation followed by subtotal adrenalectomy, 11 patients achieving long term remission treated by our regimen alone, and 7 patients failed with our regimen alone. There were no significant factors predictive of response to our regimen. (author).

  2. Long-term follow-up of a randomized controlled trial comparing acceptance and commitment therapy and standard cognitive behavior therapy for anxiety and depression.

    Forman, Evan M; Shaw, Jena A; Goetter, Elizabeth M; Herbert, James D; Park, Jennie A; Yuen, Erica K


    The present study represents one of the first comparisons of the long-term effectiveness of traditional cognitive behavior therapy (i.e., Beckian cognitive therapy; CT) and acceptance and commitment therapy (ACT). One hundred thirty-two anxious or depressed outpatients were randomly assigned to receive either CT or ACT, and were assessed at posttreatment (n=90) and at 1.5-year (n=91) follow-up. As previously reported, the two treatments were equivalently effective at posttreatment according to measures of depression, anxiety, overall (social/occupational/symptom-related) functioning, and quality of life. However, current results suggest that treatment gains were better maintained at follow-up in the CT condition. Clinical significance analyses revealed that, at follow-up, one-third more CT patients were in the clinically normative range in terms of depressive symptoms and more than twice as many CT patients were in the normative range in terms of functioning levels. The possible long-term advantage of CT relative to ACT in this population is discussed. Copyright © 2012. Published by Elsevier Ltd.

  3. Mid- and long-term effects of family constellation seminars in a general population sample: 8- and 12-month follow-up.

    Hunger, Christina; Weinhold, Jan; Bornhäuser, Annette; Link, Leoni; Schweitzer, Jochen


    In a previous randomized controlled trial (RCT), short-term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid- and long-term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3-day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ-45.2) at 8- and 12-month follow-up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals' experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8-month follow-up, p = .000; d = 0.40 at 12-month follow-up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants' experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid- and long-term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed. © 2014 Family Process Institute.

  4. Design of a long-term follow-up effectiveness, immunogenicity and safety study of women who received the 9-valent human papillomavirus vaccine

    Luxembourg, Alain; Kjaer, Susanne K; Nygard, Mari


    -26years of age. A long-term follow-up (LTFU) study has been initiated as an extension of the Phase III clinical study to assess effectiveness of the 9vHPV vaccine up to at least 14years after the start of vaccination. It includes participants from Denmark, Norway and Sweden and uses national health...... design: it is an extension of a Phase III clinical study and also has elements of an epidemiological study (i.e., endpoints based on standard clinical practice; surveillance using searches from health registries); it uses a control chart method to determine whether vaccine effectiveness may be waning...... medicinal products when long-term outcomes need to be assessed, there is no control group, or outcomes are rare....

  5. Long-term follow-up after epilepsy surgery in infancy and early childhood--a prospective population based observational study.

    Reinholdson, Jesper; Olsson, Ingrid; Edelvik, Anna; Hallböök, Tove; Lundgren, Johan; Rydenhag, Bertil; Malmgren, Kristina


    To describe 2-year and long-term outcomes (five or ten years) after resective epilepsy surgery in children operated before the age of four years. This prospective, population based, longitudinal study is based on data from the Swedish National Epilepsy Surgery Register 1995-2010. The following variables were analysed: seizure frequency, antiepileptic drug treatment (AED), neurological deficits, type of operation, histopathological diagnosis and perioperative complications. During the study period 47 children under four years had resective surgery. A majority had seizure onset within the first year of life, and the median age at surgery was two years and one month. Two thirds had neurodevelopmental abnormalities. Temporal lobe resection, frontal lobe resection and hemispherotomy predominated. A majority had malformations of cortical development. There was one major perioperative complication. At the 2-year follow-up, 21/47 children (45%) were seizure free, eight of whom were off medication. At the long-term follow-up, 16/32 (50%) were seizure-free and 11 of them off medication. Another ten (31%) had ≥75% reduction in seizure frequency. Fourteen children (44%) had sustained seizure freedom from surgery to the long-term follow-up. This is the first prospective, population based, longitudinal study to show that a favourable seizure outcome is achievable in a majority of infants and young children undergoing resective epilepsy surgery and that the improvements are consistent over time. Many can also stop taking AEDs. The findings emphasise the importance of early referral to epilepsy surgery evaluation in cases of medically intractable epilepsy in infants and young children. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  6. Weight Changes in Patients with Differentiated Thyroid Carcinoma during Postoperative Long-Term Follow-up under Thyroid Stimulating Hormone Suppression

    Seo Young Sohn


    Full Text Available BackgroundThere are limited data about whether patients who receive initial treatment for differentiated thyroid cancer (DTC gain or lose weight during long-term follow-up under thyroid stimulating hormone (TSH suppression. This study was aimed to evaluate whether DTC patients under TSH suppression experience long-term weight gain after initial treatment. We also examined the impact of the radioactive iodine ablation therapy (RAIT preparation method on changes of weight, comparing thyroid hormone withdrawal (THW and recombinant human TSH (rhTSH.MethodsWe retrospectively reviewed 700 DTC patients who underwent a total thyroidectomy followed by either RAIT and levothyroxine (T4 replacement or T4 replacement alone. The control group included 350 age-matched patients with benign thyroid nodules followed during same period. Anthropometric data were measured at baseline, 1 to 2 years, and 3 to 4 years after thyroidectomy. Comparisons were made between weight and body mass index (BMI at baseline and follow-up.ResultsSignificant gains in weight and BMI were observed 3 to 4 years after initial treatment for female DTC but not in male patients. These gains among female DTC patients were also significant compared to age-matched control. Women in the THW group gained a significant amount of weight and BMI compared to baseline, while there was no increase in weight or BMI in the rhTSH group. There were no changes in weight and BMI in men according to RAIT preparation methods.ConclusionFemale DTC patients showed significant gains in weight and BMI during long-term follow-up after initial treatment. These changes were seen only in patients who underwent THW for RAIT.

  7. Lessons Learned Through the Follow-up of the Long-Term Effects of Over-Exposure to an Ir192 Industrial Radiography Source in Bangladesh

    Jalil, A.; Rabbani, G.; Hossain, M. K.; Alam, M. K.; Koddus, A.


    An industrial radiographer was accidentally over-exposed while taking the radiograph of weld-joints of gas pipe-lines in 1985 in Bangladesh. Symptoms of high radiation exposure occurred immediately after the accident and skin erythema developed leading to progressive tissue deterioration. The consequences of this over-exposure is being followed up to assess the long-term effects of ionizing radiation on the victim. Progressive tissue deteriorations have already led to multiple surgeries and successive amputations of the finger-tips so far. Lessons learned from this accident are also reported in this paper.

  8. Long-term efficacy of plasma-derived hepatitis B vaccine among Chinese children: a 12-year follow-up study


    @@ INTRODUCTION To evaluate long-term efficacy of a plasma-derived hepatitis B vaccine and provide evidence for decision-making on the vaccine booster doses, we conducted a prevalent follow-up study to examine serologic changes in hepatitis markers and vaccine efficacy in 350 children from the original cohort of 513 children who participated in a randomized, double-blind and placebo-controlled trial on a plasma-derived hepatitis B vaccine in Longan County, Guangxi Autonomous Region, China, in 1982.

  9. Successful treatment of life-threatening Evans syndrome due to antiphospholipid antibody syndrome by rituximab-based regimen: a case with long-term follow-up.

    Rückert, A; Glimm, H; Lübbert, M; Grüllich, C


    An association of antiphospholipid antibody syndrome with antibodies directed against either phospholipids or plasma proteins strongly suggest that B-cell dysfunction may be involved in its pathogenesis. Antiphospholipid antibody syndrome with autoimmune cytopenias shows a poor response rate to conventional treatment with anticoagulants, glucocorticosteroids, immunosuppressive agents, intravenous immunoglobulin or plasmapheresis. We report a case of life-threatening antiphospholipid antibody syndrome with Evans syndrome receiving successful multimodal treatment including anti-CD20 monoclonal antibody rituximab with long-term follow-up.

  10. The challenges of long-term follow-up data collection in non-commercial, academically-led breast cancer clinical trials: the UK perspective.

    Kilburn, Lucy S; Banerji, Jane; Bliss, Judith M


    Improved survival rates in early breast cancer and the chronic nature of disease relapse result in a large cohort of patients being available for long-term follow-up (LTFUP) in randomised controlled trials. Whilst of recognised scientific value to assess long-term treatment-related sequelae, the volume of this activity can be challenging for trialists and participating sites, and comes at a considerable cost to research funders and the National Health Service (NHS). A National Cancer Research Institute Breast Clinical Studies Group supported project aimed to characterise UK LTFUP data collection procedures in order to propose improvements. Protocols and case report forms for UK non-commercial National Institute for Health Research portfolio early breast cancer randomised controlled trials were reviewed and a questionnaire sent to associated participating NHS sites. Responders were asked to give opinions on issues with follow-up and LTFUP data collection procedures and to suggest potential improvements to practice. Results were used to inform design of a proposed standard LTFUP case report form. Thirty-four trials, involving eight Clinical Trials Units were eligible for inclusion in the review. All trials requested follow-up at least annually up to 5 years, with two-thirds requesting LTFUP after that time point. Information relating to efficacy endpoints was captured for all trials via case report forms; however, precise detail on recording of recurrence, second malignancies and death varied. Separately, questionnaires were returned from 66 NHS sites. Main concerns identified included difficulties in identifying all adverse events from hospital notes, volume of work, bureaucratic data management practices in Clinical Trials Units and perceptions of prioritisation of recruitment over follow-up. Variation has existed with respect to detail of LTFUP information requested for UK trials. Improved communication, simplification and standardisation of data and associated

  11. Long-term follow-up of allograft reconstruction of segmental defects of the humeral head associated with posterior dislocation of the shoulder.

    Martinez, Angel Antonio; Navarro, Evelio; Iglesias, Daniel; Domingo, Javier; Calvo, Angel; Carbonel, Ignacio


    The purpose of this study is to report the long-term follow-up result of allograft reconstruction of segmental defect of the humeral head associated with posterior dislocation of the shoulder. Six men underwent operative management of defects of the humeral head involving 40% of the articular surface, following posterior dislocation of the humeral head. The period of time between dislocation and surgery ranged from 7 to 8 weeks. The defect in the head was filled with an allogeneic segment of humeral head contoured to restore the spherical shape. All the patients returned to their occupation 4 months later. All the cases were evaluated clinically and by radiographs and computed tomography (CT) scan at a mean of 122 (96-144) months after the operative procedure. Three men had no complaints of pain, instability, clicking or catching, whereas three had pain, clicking, catching and stiffness. The three patients with good clinical result showed also good radiographic result. The computed tomography (CT) confirmed incorporation of the allograft and no osteoarthrosis. Another patient had a good clinical and radiographic result until the eighth postoperative year. At 8-year follow-up examination, this patient developed shoulder osteoarthrosis and he had pain and stiffness. He needed an arthroplasty 10 years after the operation. The other two patients developed collapse of the graft and osteoarthrosis that were yet evident at 4-year follow-up. These patients required a shoulder arthroplasty 8 years after the procedure. We conclude that the treatment of segmental defects of the humeral head associated with posterior dislocations of the shoulder by allograft reconstruction has a good long-term follow-up result in 50% of the patients.

  12. Prognostic Significance of Immunoreactive Neutrophil Elastase in Human Breast Cancer: Long-Term Follow-Up Results in 313 Patients

    Miwa Akizuki


    Full Text Available OBJECTIVE: We have measured the concentration of immunoreactive neutrophil elastase (ir-NE in the tumor extracts of 313 primary human breast cancers. Sufficient time has elapsed, and we are now ready to analyze its prognostic value in human breast cancer. METHODS: ir-NE concentration in tumor extracts was determined with an enzyme-linked immunosorbent assay that enables a rapid measurement of both free-form ir-NE and the α1-protease inhibitor-complexed form of ir-NE. We analyzed the prognostic value of this enzyme in human breast cancer in univariate and multivariate analyses. RESULTS: Patients with breast cancer tissue containing a high concentration of ir-NE had poor survival compared to those with a low concentration of ir-NE at the cutoff point of 9.0 µg/100 mg protein (P = .0012, which had been previously determined in another group of 49 patients. Multivariate stepwise analysis selected lymph node status (P= .0004; relative risk = 1.46 and ir-NE concentration (P= .0013; relative risk = 1.43 as independent prognostic factors for recurrence. CONCLUSIONS: Tumor ir-NE concentration is an independent prognostic factor in patients with breast cancer who undergo curative surgery. This enzyme may play an active role in tumor progression that leads to metastasis in human breast cancer.

  13. Obesity, ethnicity, and quality of life among breast cancer survivors and women without breast cancer: the long-term quality of life follow-up study.

    Connor, Avonne E; Baumgartner, Richard N; Pinkston, Christina M; Boone, Stephanie D; Baumgartner, Kathy B


    The purpose of this study was to examine the relationship between obesity and quality of life (QOL) among Hispanic and non-Hispanic white breast cancer survivors and population-based controls from the 'Long-Term Quality of Life Study'--a 12- to 15-year follow-up study of breast cancer cases/survivors and controls from New Mexico (n = 451). Using multiple linear regressions, obesity measures [body mass index (BMI) ≥ 30 kg/m(2)] at baseline and follow-up interview were modeled with composite scores for physical and mental health from the SF-36 Quality of Life Survey. Interaction between ethnicity and BMI and change in BMI were evaluated. All models were adjusted for age, ethnicity, Charlson Index, depression, fatigue, and physical activity. Baseline obesity (β = -6.58, p = 0.04) was significantly associated with decreased mental health among survivors, but not among controls. Obesity at baseline and follow-up were significantly associated with decreased physical health among survivors (baseline β = -10.51, p = 0.004; follow-up β = -7.16, p = 0.02) and controls (baseline β = -11.07, p breast cancer survivors and controls and the impact of obesity on the mental and physical aspects of QOL.

  14. The role of BRAF V600E mutation as a potential marker for prognostic stratification of papillary thyroid carcinoma: a long-term follow-up study.

    Daliri, Mahdi; Abbaszadegan, Mohammad Reza; Bahar, Mostafa Mehrabi; Arabi, Azadeh; Yadollahi, Mona; Ghafari, Azar; Taghehchian, Negin; Zakavi, Seyed Rasoul


    Abstract Papillary carcinoma is the most prevalent malignancy of thyroid gland, and its incidence has been recently increased. The BRAF(V600E) mutation is the most frequent genetic alteration in papillary thyroid carcinoma (PTC). The role of BRAF(V600E) mutation as a potential prognostic factor has been controversially reported in different studies, with short-term follow-up. In this study, we evaluated the role of BRAF(V600E) mutation as a potential marker for prognostic stratification of patients with PTC in long-term follow-up. We studied 69 PTC patients with a mean follow-up period of 63.9 months (median: 60 m). The BRAF(V600E) mutation was analyzed by PCR-single-strand conformational polymorphism and sequencing. The correlation between the presence or absence of the BRAF(V600E) mutation, clinicopathological features and prognosis of PTC patients were studied. The BRAF(V600E) mutation was found in 28 of 69 (40.6%) PTC patients, and it was significantly more frequent in older patients (p papillary thyroid cancer in northeast of Iran. The BRAF(V600E) mutation was associated with older age and advanced tumor stage but was not correlated with incomplete response during follow-up.

  15. Phosphocalcium ceramics are efficient in the management of severe acetabular loss in revision hip arthroplasties. A 22 cases long-term follow-up study.

    Schwartz, C; Vautrin, M


    Management of bone loss in revision total hip replacement remains a challenge. To eliminate any immunological or infectious problem and so to try to improve the long-term results obtained with allografts, the authors used synthetic ceramics as bone substitutes since 1995. We reviewed 13 of the patients of our study, we previously reported in 2005 (Schwartz and Bordei in Eur J Orthop Surg Traumatol 15: 191 2005), which was a prospective cohort of thirty-two cases of acetabular revision reconstruction, with a mean follow-up of 14.4 years yet (from 9 to 16 years). Clinical results were assessed according to Oxford scale and Postel and Merle d'Aubigne (PMA) scale. Since 2005, no specific complications were noted. The average PMA functional hip score was 14.9 (vs. 9.2 before revision) at follow-up over 9 years. Nine patients still alive in 2013 were seen again by a surgeon, which was not the operator, with a mean follow-up of 15.3 years: Their Oxford average score was 40.3. Radiological assessment affirmed a good integration of the substitutes in bone without any edging in all cases. A progressive invasion of the ceramics by bone can be seen on the X-ray. We conclude that about 15 years of average delay, which is a significant follow-up in orthopedic surgery, the outcomes without specific complications are satisfactory and allow one to go with these materials in total hip revision surgery.

  16. Long Term Analysis for the BAM device

    Bonino, D.; Gardiol, D.


    Algorithms aimed at the evaluation of critical quantities are based on models with many parameters, which values are estimated from data. The knowledge, with high accuracy, of these values and the control of their temporal evolution are important features. In this work, we focus on the latter subject, and we show a proposed pipeline for the BAM (Basic Angle Monitoring) Long Term Analysis, aimed at the study of the calibration parameters of the BAM device and of the Basic Angle variation, searching for unwanted trends, cyclic features, or other potential unexpected behaviours.

  17. Long term follow-up in a patient with papillary glioneuronal tumor Seguimento tardio de paciente com tumor papilar glioneuronal

    Guilherme Borges


    Full Text Available We report a case of a young female patient with a rare and recently described form of brain tumor. This patient had a history of headache, hemiparesis and motor simple partial seizures. Her investigation revealed a brain tumor involving the left frontal and parietal lobes. The radiological images showed a cystic mass with multiple nodular masses and a rim of contrast enhancement extending from the right parietal cortex to the ipsilateral ventricle and corpus callosum. The patient underwent gross resection of the lesion and the histological analysis of the surgical specimen revealed a pseudopapillary structure formed by delicate vessels intermixed with a fibrillary pattern and bordered by intense astrocytic reaction with Rosenthal fibers. These features correspond to the recently described mixed neuronal-glial neoplasm, the papillary glioneuronal tumor. The patient has been followed for five years since the surgical treatment, without evidence of tumor recurrence, confirming the indolent behavior of this type of tumor.Relatamos o caso de uma jovem paciente com um tumor cerebral raro e recentemente descrito. Essa paciente apresentou-se com queixas de cefaléia, hemiparesia e crises epiléticas parciais simples. Sua investigação revelou um tumor cerebral envolvendo os lobos frontal e parietal esquerdos. As imagens radiológicas mostraram uma massa cística com massas nodulares múltiplas e reforço anelar de contraste estendendo do córtex parietal direito aos ventrículo lateral e corpo caloso ipsilaterais. A paciente se submeteu à ressecção do tumor e a análise histológica da lesão revelou uma estrutura pseudopapilar formada por vasos delicados entremeados com um padrão fibrilar e emoldurada por intensa reação astrocítica com fibras de Rosenthal. Essas características correspondem a uma forma de neoplasia mista glial-neuronal recentemente descrita, o tumor papilar glioneuronal. A paciente está em seguimento desde a cirurgia sem evid

  18. Patients’ follow-up using biomechanical analysis of rehabilitation exercises

    Bruno Bonnechère


    Full Text Available Thanks to the evolution of game controllers video games are becoming more and more popular in physical rehabilitation. The integration of serious games in rehabilitation has been tested for various pathologies. Parallel to this clinical research, a lot of studies have been done in order to validate the use of these game controllers for simple biomechanical evaluation. Currently, it is thus possible to record the motions performed by the patients during serious gaming exercises for later analysis. Therefore, data collected during the exercises could be used for monitoring the evolution of the patients during long term rehabilitation. Before using the parameters extracted from the games to assess patients’ evolution two important aspects must be verified: the reproducibility of measurement and a possible effect of learning of the task to be performed. Ten healthy adults played 9 sessions of specific games developed for rehabilitation over a 3-weeks period. Nineteen healthy children played 2 sessions to study the influence of age. Different parameters were extracted from the games: time, range of motion, reaching area. Results of this study indicates that it is possible to follow the evolution of the patients during the rehabilitation process. The majority of the learning effect occurred during the very first session. Therefore, in order to allow proper regular monitoring, the results of this first session should not be included in the follow-up of the patient.

  19. Whole Lung Lavage Treatment of Chinese Patients with Autoimmune Pulmonary Alveolar Proteinosis:A Retrospective Long-term Follow-up Study

    Yu-Yue Zhao; Hui Huang; Yong-Zhe Liu; Xin-Yu Song; Shan Li; Zuo-Jun Xu


    Background:Pulmonary alveolar proteinosis (PAP) is a rare lung disease,the most common type of which is autoimmune PAP.The gold standard therapy for PAP is whole lung lavage (WLL).Few studies have reported the optimal technique with which to evaluate the response to WLL.In this study,we aimed to identify parameters with which to assess the need for repeat WLL during a long-term 8-year follow-up.Methods:We conducted a retrospective analysis of 120 patients with autoimmune PAP with 80 of whom underwent WLL.Physiologic,serologic,and radiologic features of the patients were analyzed during an 8-year follow-up after the first WLL treatment.Results:Of the 40 patients without any intervention,39 patients either achieved remission or remained stable and only one died of pulmonary infection.Of the 56 patients who underwent WLL for 1 time,55 remained free from a second WLL and 1 patient died of cancer.Twenty-four required additional treatments after their first WLL.The baseline PaO2 (P =0.000),PA-aO2 (P =0.000),shunt fraction rate (P =0.00 1),percent of predicted normal diffusing capacity of the lung for carbon monoxide (DLCO%Pred) (P =0.016),6-min walk test (P =0.013),carcinoembryonic antigen (CEA) (P =0.007),and neuron-specific enolase (NSE) (P =0.003) showed significant differences among the three groups.The need for a second WLL was significantly associated with PaO2 (P=0.000),CEA (P =0.050),the 6-minute walk test (P =0.026),and DLCO%Pred (P =0.041).The DLCO%Pred on admission with a cut-offvalue of42.1% (P =0.001) may help to distinguish whether patients with PAP require a second WLL.Conclusions:WLL is the optimal treatment method for PAP and provides remarkable improvements for affected patients.The DLCO%Pred on admission with a cut-off value of 42.1% may distinguish whether patients with PAP require a second WLL.

  20. Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in Russia: an observational study (EPICOR-RUS study).

    Ruda, Mikhail Ya; Averkov, Oleg V; Khomitskaya, Yunona V


    This study sought to describe the short- and long-term (up to 2 years) antithrombotic management patterns in a real-life setting for patients hospitalized for an acute coronary syndrome (ACS) event, and to document clinical outcomes. EPICOR-RUS was a multicenter (34 centers), prospective, observational, longitudinal cohort study conducted across Russia on antithrombotic management in hospitalized (within 24 hours of symptom onset) ACS patients with 2 year follow-up. NCT01373957. A total of 600 ACS patients (71.1% male, mean age 60 years) were enrolled; 599 were included for analysis. Diagnosis comprised STEMI (n = 375, 62.6%), NSTEMI (n = 147, 24.5%), and unstable angina (UA) (n = 77, 12.9%). Percutaneous coronary intervention (PCI) was conducted in 64.3% of patients with STEMI (with or without thrombolysis), 36.7% with NSTEMI, and 58.4% with UA. There was undertreatment with dual antiplatelet therapy (DAPT) for STEMI, NSTEMI, and UA: 14.7%, 25.9% and 16.9% of patients, respectively, were not receiving DAPT during hospitalization, and 10.1%, 21.8% and 16.9% at discharge. Post-discharge, of the STEMI group, only 72.4% of patients who were managed by PCI and 39.8% of conservatively treated patients received DAPT at 12 months. The respective figures in the NSTEMI group were 77.3% and 26.4%. In the STEMI cohort the cumulative incidence of all-cause mortality was 3.2% at 1 year and 5.1% at 2 years of follow-up; in the NSTEMI cohort this was 2.7% and 4.8%, respectively. There were no deaths by 12 months and one death by 24 months (1.3%) in the UA population. Despite evidence-based guidelines for the management of ACS, the real-world setting in Russia shows discrepancies in clinical practice, highlighting the need for improvements for the optimal management of high-risk patients with ACS.

  1. Higher physiopathogenicity by Fasciola gigantica than by the genetically close F. hepatica: experimental long-term follow-up of biochemical markers.

    Valero, M Adela; Bargues, M Dolores; Khoubbane, Messaoud; Artigas, Patricio; Quesada, Carla; Berinde, Lavinia; Ubeira, Florencio M; Mezo, Mercedes; Hernandez, Jose L; Agramunt, Veronica H; Mas-Coma, Santiago


    Fascioliasis is caused by Fasciola hepatica and F. gigantica. The latter, always considered secondary in human infection, nowadays appears increasingly involved in Africa and Asia. Unfortunately, little is known about its pathogenicity, mainly due to difficulties in assessing the moment a patient first becomes infected and the differential diagnosis with F. hepatica. A long-term, 24-week, experimental study comparing F. hepatica and F. gigantica was made for the first time in the same animal model host, Guirra sheep. Serum biochemical parameters of liver damage, serum electrolytes, protein metabolism, plasma proteins, carbohydrate metabolism, hepatic lipid metabolism and inflammation were analysed on a biweekly basis as morbidity indicators. Serum anti-Fasciola IgG, coproantigen and egg shedding were simultaneously followed up. rDNA and mtDNA sequencing and the morphometric study by computer image analysis system (CIAS) showed that fasciolids used fitted standard species characteristics. Results demonstrated that F. gigantica is more pathogenic, given its bigger size and biomass but not due to genetic differences which are few. Fasciola gigantica shows a delayed development of 1-2 weeks regarding both the biliary phase and the beginning of egg shedding, with respective consequences for biochemical modifications in the acute and chronic periods. The higher F. gigantica pathogenicity contrasts with previous studies which only reflected the faster development of F. hepatica observed in short-term experiments. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail:

  2. A long-term follow-up of serum myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) in patients with Graves disease treated with propylthiouracil.

    Ishii, Reiko; Imaizumi, Misa; Ide, Akane; Sera, Nobuko; Ueki, Ikuko; Horie, Ichiro; Ando, Takao; Usa, Toshiro; Ejima, Eri; Ashizawa, Kiyoto; Eguchi, Katsumi


    Propylthiouracil (PTU) is known to induce myeloperoxidase antineutrophil cytoplasmic antibodies (MPO-ANCA) in patients with Graves disease (GD). Previously, we showed that serum MPO-ANCA were frequently seen in patients with GD treated with PTU. In this study, we analyzed 13 patients with positive MPO-ANCA examining a long-term clinical consequence of these patients as well as antibody titers during 5.6 +/- 3.0 years. PTU therapy was continued in 8 patients and discontinued in 5 patients. Antibody titers decreased in 7 of 8 patients who discontinued PTU therapy but remained positive in 5 patients 5 years after PTU withdrawal. The initial MPO-ANCA levels were significantly higher in those antibody titers remained positive for longer than 5 years (n=5) than in those titers turned to be negative within 5 years after PTU withdrawal (n=3) (203 +/- 256 EU and 22 +/- 2 EU, respectively, P=0.04), but there were no significant differences in age, gender, duration of PTU therapy or dosage of PTU. Among 5 patients who continued PTU therapy, 2 patients with initially low MPO-ANCA titers turned to having negative antibody. No patients had new symptoms or signs of vasculitis throughout the follow-up periods. The long-term follow-up study suggests that higher MPO-ANCA levels remain positive for years after PTU withdrawal but are rarely associated with vasculitis.

  3. Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity. Long-term follow-up in eight Bernese Mountain Dogs.

    Samoy, Y C A; de Bakker, E; Van Vynckt, D; Coppieters, E; van Bree, H; Van Ryssen, B


    The purpose of this study was to investigate the long-term treatment results of fragmented coronoid process (FCP) in joints with a radio-ulnar step greater than 3 mm. Treatment of these patients only consisted of fragment removal, without correction of the incongruity. The eight Bernese Mountain Dogs (11 joints) included in this study showed obvious clinical signs of elbow disease and were diagnosed with severe elbow incongruity and concomitant FCP in the time period from 1999-2003. At that time, elbow radiography, computed tomography, and arthroscopy were performed. The mean follow-up period was 5.6 years. The follow-up consisted of a telephone questionnaire combined with a clinical and radiographic re-evaluation at our clinic. The questionnaire revealed that all dogs were either free of lameness or only lame following heavy exercise. One dog sporadically required medication after heavy exercise. The owner satisfaction rate was 100%. The clinical re-evaluation did not reveal any signs of pain or lameness in all cases. Range-of- motion was decreased in nine of the 11 elbows. Radiographs revealed an increase in severity of osteoarthritis in every case.In this case series, arthroscopic fragment removal without treatment of incongruity was demonstrated to be a valuable treatment option and may provide a satisfactory long-term outcome.

  4. Thin-Section Computed Tomography Manifestations During Convalescence and Long-Term Follow-Up of Patients with Severe Acute Respiratory Syndrome (SARS).

    Wu, Xiaohua; Dong, Dawei; Ma, Daqing


    BACKGROUND SARS is not only an acute disease, but also leads to long-term impaired lung diffusing capacity in some survivors. However, there is a paucity of data regarding long-term CT findings in survivors after SARS. The aim of this study was to assess the changes in lung function and lung thin-section computed tomography (CT) features in patients recovering from severe acute respiratory syndrome (SARS), especially the dynamic changes in ground-glass opacity (GGO). MATERIAL AND METHODS Clinical and radiological data from 11 patients with SARS were collected. The serial follow-up thin-section CTs were evaluated at 3, 6, and 84 months after SARS presentation. The distribution and predominant thin-section CT findings of lesions were evaluated. RESULTS The extent of the lesions on the CT scans of the 11 patients decreased at 6 and 84 months compared to 3 months. The number of segments involved on 84-month follow-up CTs was less than those at 6 months (PSARS, GGO and intralobular and interlobular septal thickening were the main thin-section CT manifestation. Intralobular and interlobular septal thickening predominated over GGO at 84 months.

  5. Long-term immigrant adaptation: eight-year follow-up study among immigrants from Russia and Estonia living in Finland.

    Jasinskaja-Lahti, Inga


    This study was a longitudinal investigation of the three different dimensions of long-term immigrant adaptation (i.e., psychological, sociocultural, and socioeconomic adaptation) and the relationships between them in an 8-year follow-up with panel data. The 282 respondents were immigrants in Finland, born between 1961 and 1976, coming from the former Soviet Union. The results suggest that the adaptation of these immigrants has developed favourably. In 8 years, the respondents had improved their Finnish language skills and their position in the labour market. No differences were observed in their levels of psychological well-being between the two assessments. Of the three adaptation dimensions assessed, sociocultural adaptation, measured as proficiency in understanding, speaking, reading, and writing Finnish, turned out to be the most significant predictor of the two other long-term outcomes of immigrant adaptation (i.e., socioeconomic and psychological). In particular, the better the initial command of the Finnish language, the better were their socioeconomic and psychological adaptation outcomes after 8 years of residence. These results demonstrate the importance of parallel and longitudinal assessments of the different outcomes of immigrant adaptation in order to address which particular dimensions of adaptation are most critical in the beginning of acculturation in terms of determining positive development and long-term immigrant adaptation. This study was supported by City of Helsinki Urban Facts. The author gratefully acknowledges the assistance of Anniina Lahtinen and Riku Perhoniemi in the data collection, and in addition, Riku Perhoniemi for the preliminary data analysis, and advice on the Amos analyses. Cette étude longitudinale a examiné trois différentes dimensions de l'adaptation à long-terme de l'immigré (i.e., adaptation psychologique, socio-culturelle et socio-économique) et de la relation entre elles dans un suivi de 8 ans avec des données de

  6. Neurocognitive and clinical predictors of long-term outcome in adolescents at ultra-high risk for psychosis: a 6-year follow-up.

    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.

  7. Does cisplatin-based chemotherapy effect on blood lipid levels of patients with germ cell testicular tumor in long-term follow-up?

    Koc, Gokhan; Divrik, Taner Rauf; Unlu, Nuri; Bulut, Volkan; Zorlu, Ferruh


    Cisplatin-based chemotherapy is widely used in the treatment for germ cell testicular tumors. However, long-term complications of this treatment have gained importance, and hypercholesterolemia is one of these. In some studies, hypercholesterolemia is reported following the cisplatin-based chemotherapy. In this study, we evaluated the relationship of cisplatin-based chemotherapy and blood lipid levels in long-term survivors of patients with germ cell testicular tumors. A total of 89 testicular cancer patients were evaluated between December 1989 and December 2001. Of these, while 39 received cisplatin-based chemotherapy (Group 1), the remaining control group of 50 testicular cancer patients (Group 2) had no adjuvant treatment. The patients in both groups had at least 5-year follow-up and had no known cardiovascular disease. Fasting lipid profiles were obtained including total cholesterol, triglyceride, low- and high-density lipoprotein and very low-density lipoprotein. These values were compared with the normal range, and the statistical difference between the two groups was evaluated. Student's t test was used for continuous variables, and P chemotherapy in germ cell testicular tumors did not have long-term negative effect on blood lipid levels.

  8. Long-term follow-up clinical courses of cerebellar hemangioblastoma in von hippel-lindau disease : two case reports and a literature review.

    Lee, Seung Hwan; Park, Bong Jin; Kim, Tae Sung; Lim, Young Jin


    Although cerebellar hemangioblastomas are histopathologically benign, they yield a degree of malignant clinical behavior in long-term follow-up. We present two cases of long-term progression of renal cell carcinoma, which had been diagnosed as renal cysts during treatment for cerebellar hemangioblastoma. A 14-year-old male with von Hippel-Lindau disease was admitted for a cerebellar hemangioblastoma with multiple spinal hemangioblastomas and a renal cyst. After primary total resection of the cerebellar hemangioblastoma, the patient required two further surgeries after 111 and 209 months for a recurrent cerebellar hemangioblastoma. Furthermore, he underwent radical nephrectomy as his renal cyst had progressed to renal cell carcinoma 209 months after initial diagnosis. A 26-year-old male presented with multiple cerebellar hemangioblastomas associated with von Hippel-Lindau disease and accompanied by multiple spinal hemangioblastomas and multiple cystic lesions in the liver, kidney, and pancreas. He underwent primary resection of the cerebellar hemangioblastoma in association with craniospinal radiation for multiple intracranial/spinal masses. Unexpectedly, a malignant glioma developed 83 months after discovery of the cerebellar hemangioblastoma. At the same time, renal cell carcinoma, which had developed from an initial renal cyst, was diagnosed, and a radical nephrectomy was performed. In the view of long term clinical course, cerebellar hemangioblastoma associated with von Hipple-Lindau disease may redevelop even after primary total resection. In addition, associated lesions such as renal cysts may also progress to malignancy after the passing of a sufficient length of time.

  9. Longitudinal Long-term Magnetic Resonance Imaging and Clinical Follow-up After Single-Row Arthroscopic Rotator Cuff Repair: Clinical Superiority of Structural Tendon Integrity.

    Heuberer, Philipp R; Smolen, Daniel; Pauzenberger, Leo; Plachel, Fabian; Salem, Sylvia; Laky, Brenda; Kriegleder, Bernhard; Anderl, Werner


    The number of arthroscopic rotator cuff surgeries is consistently increasing. Although generally considered successful, the reported number of retears after rotator cuff repair is substantial. Short-term clinical outcomes are reported to be rarely impaired by tendon retears, whereas to our knowledge, there is no study documenting long-term clinical outcomes and tendon integrity after arthroscopic rotator cuff repair. To investigate longitudinal long-term repair integrity and clinical outcomes after arthroscopic rotator cuff reconstruction. Case series; Level of evidence, 4. Thirty patients who underwent arthroscopic rotator cuff repair with suture anchors for a full-tendon full-thickness tear of the supraspinatus or a partial-tendon full-thickness tear of the infraspinatus were included. Two and 10 years after initial arthroscopic surgery, tendon integrity was analyzed using magnetic resonance imaging (MRI). The University of California, Los Angeles (UCLA) score and Constant score as well as subjective questions regarding satisfaction with the procedure and return to normal activity were used to evaluate short- and long-term outcomes. At the early MRI follow-up, 42% of patients showed a full-thickness rerupture, while 25% had a partial rerupture, and 33% of tendons remained intact. The 10-year MRI follow-up (129 ± 11 months) showed 50% with a total rerupture, while the other half of the tendons were partially reruptured (25%) or intact (25%). The UCLA and Constant scores significantly improved from preoperatively (UCLA total: 50.6% ± 20.2%; Constant total: 44.7 ± 10.5 points) to 2 years (UCLA total: 91.4% ± 16.0% [ P integrity important goals of future research efforts.

  10. Family-focused cognitive behaviour therapy versus psycho-education for adolescents with chronic fatigue syndrome: long-term follow-up of an RCT.

    Lloyd, Samantha; Chalder, Trudie; Rimes, Katharine A


    The aim of this study was to investigate the long term efficacy of family-focused cognitive behaviour therapy (CBT) compared with psycho-education in improving school attendance and other secondary outcomes in adolescents with chronic fatigue syndrome (CFS). A 24 month follow-up of a randomised controlled trial was carried out. Participants received either 13 one-hour sessions of family-focused CBT or four one-hour sessions of psycho-education. Forty-four participants took part in the follow-up study. The proportion of participants reporting at least 70% school attendance (the primary outcome) at 24 months was 90% in CBT group and 84% in psycho-education group; the difference between the groups was not statistically significant (OR = 1.29, p = 0.80). The proportion of adolescents who had recovered in the family-focused CBT group was 79% compared with 64% in the psycho-education, according to a definition including fatigue and school attendance. This difference was not statistically significant (Fisher's exact test, p = 0.34). Family-focused CBT was associated with significantly better emotional and behavioural adjustment at 24 month follow-up compared to psycho-education, as reported by both adolescents (F = 6.49, p = 0.02) and parents (F = 4.52, P = 0.04). Impairment significantly decreased in both groups between six and 24 month follow-ups, with no significant group difference in improvement over this period. Gains previously observed for other secondary outcomes at six month follow-up were maintained at 24 month follow-up with no further significant improvement or group differences in improvement. In conclusion, gains achieved by adolescents with CFS who had undertaken family-focused CBT and psycho-education generally continued or were maintained at two-year follow-up. The exception was that family-focused CBT was associated with maintained improvements in emotional and behavioural difficulties whereas psycho-education was associated with

  11. Long-Term Outcomes of Posterior Lumbar Interbody Fusion Using Stand-Alone Ray Threaded Cage for Degenerative Disk Disease: A 20-Year Follow-Up

    Medrano, Belen G.; Noriega, David C.


    Study Design Retrospective study. Purpose To analyze outcomes of posterior lumbar interbody fusion (PLIF) stand-alone cages. Overview of Literature PLIF for degenerative disk disease using stand-alone cages has lost its popularity owing to implant-related complications and pseudoarthrosis. Methods We analyzed the records of 45 patients (18 women, 27 men), operated between January 1994 and December 1996, with a mean follow-up of 18 years 3 months (20 years 3 months–22 years 3 months). Clinical outcomes were measured using visual analogue score (VAS), Oswestry disability index (ODI), Odom's criteria, and radiological measurements of fusion rate, Cobb angle, and implant-related complications conducted at the preoperative evaluation, hospital discharge, 12-month follow-up, and final follow-up. Results Preoperative mean VAS (back) was 6.9 and VAS (radicular) was 7.2, with mean improvements (p Pseudoarthrosis was observed in five patients (11.1%), of whom, three (6.6%) required re-operation. Preoperative disk height was 9.23 mm, which increased to 13.33 mm in the immediate postoperative evaluation and was maintained at 10.0 mm at the final follow-up (p <0.05). The preoperative mean L1–S1 Cobb angle was 34.7°, which changed to 44.7° in the immediate postoperative evaluation and dropped to 39.7° at the final follow-up (p <0.005). Conclusions PLIF stand-alone cages were associated with good clinical outcomes. Although the fusion rate was excellent, maintenance of disk heights and a lordotic alignment were not achieved in the long term. PMID:27994787

  12. Long-term follow-up of nipple-sparing mastectomy without radiotherapy: a single center study at a Japanese institution.

    Sakurai, Teruhisa; Zhang, Ning; Suzuma, Takaomi; Umemura, Teiji; Yoshimura, Goro; Sakurai, Takeo; Yang, Qifeng


    Recent reports have suggested that nipple-sparing mastectomy (NSM) is a potential alternative to mastectomy (MT). The aim of our study was to investigate the oncological and technical outcomes of NSM compared with MT using long-term follow-up data. A total of 932 patients between April 1985 and March 2004 were enrolled in our study. Among them, 788 patients received NSM, whereas 144 patients received the routine mastectomy. The median follow-up time was 78 months. No significant difference in the probability of local recurrence between the NSM cohort and the MT cohort was found (8.2 vs. 7.6 %, p = 0.81). The rate of nipple-areola complex (NAC) relapse was low (3.7 %), and all of the nipple and/or areola recurrence cases were treated with NAC removal. Furthermore, nipple and/or areola recurrence was associated with a significantly better prognosis than that of skin flap recurrences and local lymph node recurrences. For the 21-year disease-free survival and the 21-year overall survival, no significant difference between the NSM and MT cohorts was observed. There was no occurrence of nipple necrosis in our trial. This was the first study to investigate the long-term follow-up of NSM in a large Japanese population. We reported the NSM could be performed without nipple necrosis and is oncologically as safe as mastectomy without radiotherapy. Therefore, we suggest that NSM without radiotherapy is a potential alternative to mastectomy for breast cancer patients for both outcome and aesthetic benefits.

  13. Individualized nutrition intervention is of major benefit to colorectal cancer patients: long-term follow-up of a randomized controlled trial of nutritional therapy.

    Ravasco, Paula; Monteiro-Grillo, Isabel; Camilo, Maria


    In our published randomized trial in colorectal cancer, group 1 (n = 37) received individualized nutritional counseling and education about regular foods, group 2 (n = 37) received dietary supplements and consumed their usual diet of regular foods, and group 3 (n = 37) consumed their usual diet of regular foods. Neither group 2 nor group 3 received individualized counseling. Early nutritional counseling during radiotherapy was highly effective at reducing acute radiotherapy toxicity and improving nutritional intake/status and quality of life (QoL). Efficacy persisted for 3 mo after the intervention. The objective was to perform long-term follow-up in survivors of that clinical trial to specifically evaluate survival, late toxicity, QoL, and nutritional variables. Medical data were collected from patients' records, and prescheduled interviews were conducted by dietitians for individualized evaluations. Analyses and comparisons between groups (adjusted for stage) were performed after a median follow-up of 6.5 (range: 4.9-8.1) y. Patients complied with the Radiotherapy Department's follow-up protocol. Nutritional deterioration was higher (P group 2 > group 1 (P group 1 (P < 0.001). QoL was worse in groups 3 and 2 than in group 1: group 3 ≃ group 2 < group 1 (P < 0.002). Worse radiotherapy toxicity, QoL, and mortality were associated with deteriorated nutritional status and intake (P < 0.001). Likewise, depleted intake, nutritional status, and QoL predicted shorter survival and late toxicity (HR: 8.25; 95% CI: 2.74, 1.47; P < 0.001). This study conveys novel information about the effectiveness of nutrition at improving long-term prognosis in colorectal cancer. Overall, the data indicate that early individualized nutritional counseling and education during radiotherapy is valuable for patients.

  14. Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction.

    Chadwick, C; Whitehouse, S L; Saxby, T S


    Flexor digitorum longus transfer and medial displacement calcaneal osteotomy is a well-recognised form of treatment for stage II posterior tibial tendon dysfunction. Although excellent short- and medium-term results have been reported, the long-term outcome is unknown. We reviewed the clinical outcome of 31 patients with a symptomatic flexible flat-foot deformity who underwent this procedure between 1994 and 1996. There were 21 women and ten men with a mean age of 54.3 years (42 to 70). The mean follow-up was 15.2 years (11.4 to 16.5). All scores improved significantly (p Foot and Ankle Society (AOFAS) score improved from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up. The mean pain component improved from 12.3 to 35.2 (20 to 40). The mean function score improved from 35.2 to 45.6 (30 to 50). The mean visual analogue score for pain improved from 7.3 to 1.3 (0 to 6). The mean Short Form-36 physical component score was 40.6 (sd 8.9), and this showed a significant correlation with the mean AOFAS score (r = 0.68, p = 0.005). A total of 27 patients (87%) were pain free and functioning well at the final follow-up. We believe that flexor digitorum longus transfer and calcaneal osteotomy provides long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction. ©2015 The British Editorial Society of Bone & Joint Surgery.

  15. Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

    Jung, Hyun Kyung; Moon, Hee Jung; Kim, Min Jung; Kim, Eun Kyung [Dept. of Diagnostic Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)


    To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3) 2 cm or larger on the basis of excisional biopsy and long-term follow-up. We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US)-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35) or breast ultrasonography (n=20). Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor), and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146), 6.8% (10/146), and 1.4% (2/146), respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1%) were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor). US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6%) enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

  16. Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

    Hyun Kyung Jung


    Full Text Available Purpose: To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3 2 cm or larger on the basis of excisional biopsy and long-term follow-up. Methods: We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35 or breast ultrasonography (n=20. Results: Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor, and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146, 6.8% (10/146, and 1.4% (2/146, respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1% were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor. Conclusion: US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6% enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

  17. Prophylactic efficacy of fluoxetine, escitalopram, sertraline, paroxetine, and concomitant psychotherapy in major depressive disorder: outcome after long-term follow-up.

    Peselow, Eric D; Tobia, Gabriel; Karamians, Reneh; Pizano, Demetria; IsHak, Waguih William


    The acute efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of major depressive disorder (MDD) is well established; however their role in longer-term prevention of recurrence remains unconfirmed. This study aims at examining: the prophylactic efficacy of four commonly used SSRIs in MDD in a naturalistic setting with long-term follow-up, the effect of concomitant cognitive behavioral therapy (CBT), and the predictors of outcome. In a prospective cohort study, 387 patients who either remitted or responded following treatment with four different SSRIs-fluoxetine, escitalopram, sertraline and paroxetine-were followed up over several years. During an average follow-up period of 34.5 months, 76.5% of patients experienced MDD recurrence. Escitalopram and fluoxetine showed a numerically higher prophylactic efficacy than paroxetine and sertraline but the difference was statistically insignificant. The prophylactic efficacy for SSRI-only treatment was limited, with a recurrence rate of 82.0%, compared to 59.0% of patient recurrence rate in concomitant Cognitive Behavioral Therapy (CBT). The relatively small size of the CBT group and the lack of randomization may undermine the extrapolation of its findings to clinical practice. Nevertheless, the study preliminary data may help in defining the clinical utility of antidepressants and CBT in the prophylaxis from MDD recurrence.

  18. Long-term validity of biological markers of psychopathy and criminal recidivism: follow-up 6-8 years after forensic psychiatric investigation.

    Stalenheim, E Gunilla


    This study is a follow-up investigation of a forensic psychiatric sub-population 6-8 years after forensic psychiatric evaluation. The aim was to examine the long-term validity of biological markers of psychopathy and antisocial behavior over time. Data on criminal records were obtained at follow-up from the National Council for Crime Prevention. Basic data included findings of psychiatric and psychological assessments, as well as values for serum triiodothyronine (T3) and free thyroxin (FT4), and platelet monoamine oxidase (MAO) activity, all obtained during the forensic psychiatric examination. Criminal recidivists at follow-up had higher serum T3 levels than non-recidivists, and much higher values than normal controls, while their levels of free T4 were lower. The T3 levels in criminal recidivists correlated to psychopathy- and aggression-related personality traits as measured by the Karolinska Scale of Personality. In violent recidivists, a remarkably high correlation was noted between T3 levels and Irritability and Detachment, traits that have previously been linked to the dopaminergic system. Stepwise multiple regression analyses confirmed the relationships of T3 levels and platelet MAO activity with personality traits in criminal recidivists. The predictive validity of biological markers of psychopathy, T3 and platelet MAO, measured during forensic psychiatric investigation, is stable over time. The results indicate chronic alterations of the hypothalamic-pituitary-thyroid axis in this group of subjects.

  19. Long-term follow-up of non-calcified pulmonary nodules (<10 mm) identified during low-dose CT screening for lung cancer

    Slattery, Michael M.; Logan, P.M.; Lee, Michael J. [Beaumont Hospital, Department of Radiology, Dublin (Ireland); Foley, Claire; Kenny, Dermot [Beaumont Hospital, Clinical Research Centre, RCSI, Dublin (Ireland); Costello, Richard W. [Beaumont Hospital, Respiratory Division, Dublin (Ireland)


    To assess the long-term stability of small (<10 mm) non-calcified pulmonary nodules (NCNs) in high-risk subjects initially screened for lung cancer using low-dose chest computed tomography (LDCCT). A total of 449 subjects initially underwent screening with serial LDCCT over a 2-year period. Participants identified as having NCNs {>=}10 mm were referred for formal lung cancer workup. NCNs <10 mm diameter were followed in accordance with the study protocol. Seven years after baseline screening, subjects with previously documented NCNs <10 mm, which were unchanged in size after the 2-year follow-up period, were re-imaged using LDCCT to assess for interval nodule growth. Eighty-three subjects with previously documented stable NCNs <10 mm underwent LDCCT at 7 years. NCNs were unchanged in 78 subjects and had decreased in size in 4 subjects. There was interval growth of an NCN (from 6 mm to 9 mm) in one subject re-imaged at 7 years, but this nodule has remained stable in size over a further 2-year follow-up period. Non-calcified pulmonary nodules <10 mm in size that are unchanged in size or smaller after 2 years of follow-up with LDCCT are most likely benign. (orig.)

  20. Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up.

    Liu, Congcong; Lin, Li; Wang, Weixing; Lv, Guohua; Deng, Youwen


    OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a

  1. Aortic valve replacement with autologous pericardium: long-term follow-up of 15 patients and in vivo histopathological changes of autologous pericardium.

    Liu, Xiaohong; Han, Lin; Song, Zhigang; Tan, Mengwei; Gong, Dejun; Xu, Zhiyun


    The study aimed to assess the long-term follow-up of patients with an autologous pericardial aortic valve (APAV) replacement and to analyse in vivo histopathological changes in implanted APAVs. From 1996 to 1997, 15 patients (mean age, 34 years) underwent aortic valve replacement with the glutaraldehyde-treated autologous pericardium. All patients were followed up after discharge. The excised APAVs were processed for haematoxylin-eosin, Victoria blue-van Gieson and immunohistochemical staining. The mean clinical follow-up was 11.43 ± 4.50 years. APAV-related in-hospital and late mortalities were both 0%. Five (33%) patients required reoperation because of a prolapse of the right coronary cusp (n = 1), infective endocarditis (n = 1) or fibrocalcific degeneration (n = 3). Freedom from endocarditis, fibrocalcific degeneration and reoperation at the end of follow-up was 93, 80 and 67%, respectively. The remaining 10 patients were alive and well with a mean New York Heart Association class of 1.10 ± 0.32 and normally functioning aortic valves (peak pressure gradient: 7.70 ± 3.41 mmHg; mean pressure gradient: 1.79 ± 0.64 mmHg). Histopathology revealed that (i) a thin factor VIII-positive layer (endothelialization) was found on all non-endocarditis APAVs; (ii) pericardial cells in all APAVs were positive for α-smooth muscle actin (myofibroblast phenotype) and some cells in the fibrocalcific APAVs were positive for alkaline phosphatase (osteoblast phenotype) and (iii) an elastic band was found in 3 cases (in vivo >9 years). APAV replacement is a procedure with a low mortality. APAVs adapt to new environmental demands by producing an elastic band and by endothelialization, whereas myofibroblast/osteoblast transdifferentiation seems to be responsible for the fibrocalcification of APAVs.

  2. Long-Term Treatment Outcome in Adult Male Prisoners With Attention-Deficit/Hyperactivity Disorder: Three-Year Naturalistic Follow-Up of a 52-Week Methylphenidate Trial.

    Ginsberg, Ylva; Långström, Niklas; Larsson, Henrik; Lindefors, Nils


    Despite high rates of attention-deficit/hyperactivity disorder (ADHD) among adult lawbreakers, particularly the long-term effects of ADHD pharmacotherapy remain unclear, not the least because of ethical challenges with preventing control subjects in randomized controlled trials from receiving medication over prolonged time. We followed up adult male prisoners with ADHD who completed a 5-week randomized, double-blind, placebo-controlled trial followed by a 47-week open-label extension of osmotic-release oral system methylphenidate in a Swedish high-security prison from 2007 to 2010 ( NCT00482313). Twenty-five trial completers were prospectively followed up clinically 1 year (24/25, 96% participated fully or in part) and 3 years (20/25, 80% participation) after trial regarding ADHD symptoms (observer and self-reports), psychosocial functioning, substance misuse, and criminal reoffending. Methylphenidate-related improvements in ADHD symptoms and psychosocial functioning obtained during the 52-week trial were maintained at 1- and 3-year follow-ups. Specifically, after 3 years, 75% (15/20) of the respondents had been released from prison, and 67% of these (10/15) had employment, usually full time. In contrast, nonmedicated respondents at the 3-year follow-up (5/20) reported more ADHD symptoms, functional impairment, and substance misuse compared with currently medicated respondents (15/20). Further, 40% of the respondents self-reported reoffending, indicating a substantially lower relapse rate than expected (70%-80%).In summary, although these observations need validation from new and larger samples, positive effects were maintained after 4 years of methylphenidate treatment. Most study completers were employed and had no relapse in substance misuse or criminality. These results suggest that motivational support and continued medication are important for improved outcome in adult criminal offenders with ADHD.

  3. Late presentation of an anomalous left coronary artery from the pulmonary artery treated with conservative surgical management with long-term cardiac magnetic resonance imaging follow-up

    Gouda, Pishoy; Gouda, John; Butler, Craig; Welsh, Robert C


    Anomalous origin of the left coronary artery from the pulmonary artery is rare congenital abnormality that most commonly presents in childhood and is associated with a high mortality. In the elderly, patients may present acutely with arrhythmias or signs of ischemia or with vague chronic presentations of shortness of breath and fatigue. In the high-risk elderly population, it is unclear as to whether conservative surgical management by means of suture ligation of the left coronary artery is associated with positive long-term outcomes. We present a case of a 69-year-old patient diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, which was treated with conservative surgical management and followed up for 15 years with cardiovascular magnetic resonance imaging, with positive outcomes.

  4. Liver remnant regeneration in donors after living donor liver transplantation. Long-term follow-up using CT and MR imaging

    Klink, T. [INSELSPITAL - Bern University Hospital (Switzerland). Diagnostic, Interventional, and Pediatric Radiology; University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Diagnostic and Interventional Radiology; Simon, P. [Merciful Brethren Hospital, Trier (Germany). Dept. of Radiology, Neuroradiology, Sonography and Nuclearmedicine; University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Diagnostic and Interventional Radiology; Knopp, C.; Ittrich, H.; Adam, G.; Koops, A. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Diagnostic and Interventional Radiology; Fischer, L. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Hepatobiliary Surgery and Transplant Surgery


    Purpose: To assess liver remnant volume regeneration and maintenance, and complications in the long-time follow-up of donors after living donor liver transplantation using CT and MRI. Materials and Methods: 47 donors with a mean age of 33.5 years who donated liver tissue for transplantation and who were available for follow-up imaging were included in this retrospective study. Contrast-enhanced CT and MR studies were acquired for routine follow-up. Two observers evaluated pre- and postoperative images regarding anatomy and pathological findings. Volumes were manually measured on contrast-enhanced images in the portal venous phase, and potential postoperative complications were documented. Pre- and postoperative liver volumes were compared for evaluating liver remnant regeneration. Results: 47 preoperative and 89 follow-up studies covered a period of 22.4 months (range: 1 - 84). After right liver lobe (RLL) donation, the mean liver remnant volume was 522.0 ml (± 144.0; 36.1%; n = 18), after left lateral section (LLS) donation 1,121.7 ml (± 212.8; 79.9%; n = 24), and after left liver lobe (LLL) donation 1,181.5 ml (± 279.5; 72.0%; n = 5). Twelve months after donation, the liver remnant volume were 87.3% (RLL; ± 11.8; n = 11), 95.0% (LS; ± 11.6; n = 18), and 80.1% (LLL; ± 2.0; n = 2 LLL) of the preoperative total liver volume. Rapid initial regeneration and maintenance at 80% of the preoperative liver volume were observed over the total follow-up period. Minor postoperative complications were found early in 4 patients. No severe or late complications or mortality occurred. Conclusion: Rapid regeneration of liver remnant volumes in all donors and volume maintenance over the long-term follow-up period of up to 84 months without severe or late complications are important observations for assessing the safety of LDLT donors. (orig.)

  5. Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study

    Nannini C


    1 and group 2 was 22 ± 1 months and 21 ± 1.6 months, respectively.Conclusion: Remission of ankylosing spondylitis is possible in at least 50% of patients treated with etanercept 50 mg weekly. After halving of the etanercept dose, remission is maintained in a high percentage of patients during long-term follow-up, with important economic implications.Keywords: ankylosing spondylitis, anti-tumor necrosis factor, etanercept, remission, dose reduction

  6. A 7-year, single-center research and long term follow-up of graft patency of robotic total arterial off-pump coronary artery bypass grafting

    Guo-peng LIU


    Full Text Available Objective  The aim of the study was to explore the long-term benefits of coronary artery bypass grafting (CABG. Methods  From January 2007 to November 2014, 240 patients (187 males and 53 females, average age 59 years received robotic off-pump CABG assisted with da Vinci Surgical System (Intuitive Surgical, USA in our center. Totally endoscopic coronary artery bypass (totally robot-assisted TECAB, n=100 or mini-thoracotomy direct coronary artery bypass (free of internal mammary artery, IMA, by robot, MIDCAB, n=140 grafting was performed. Patients were followed-up regularly, and their graft patency was assessed every 6 months by coronary angiography or 64-multi-slide CT angiography. Results  All the procedures were completed successfully without conversion to median sternotomy or cardiopulmonary bypass , there was no operative mortality. 237 unilateral IMA grafts (98.7% and 3 bilateral IMA grafts (1.3% were used. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%. In the follow-up of 41.1±12.9 months, no death, stroke or myocardial infarction occurred. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MIDCAB over 3 years (up to 91 months after surgery. Conclusions  Robotic off-pump CABG using IMA grafts is a safe and effective surgery method in selected patients. The long-term outcome and patency of IMA grafts are excellent. DOI: 10.11855/j.issn.0577-7402.2016.06.15

  7. Rationale and design of a long term follow-up study of women who did and did not receive HPV 16/18 vaccination in Guanacaste, Costa Rica.

    Gonzalez, Paula; Hildesheim, Allan; Herrero, Rolando; Katki, Hormuzd; Wacholder, Sholom; Porras, Carolina; Safaeian, Mahboobeh; Jimenez, Silvia; Darragh, Teresa M; Cortes, Bernal; Befano, Brian; Schiffman, Mark; Carvajal, Loreto; Palefsky, Joel; Schiller, John; Ocampo, Rebeca; Schussler, John; Lowy, Douglas; Guillen, Diego; Stoler, Mark H; Quint, Wim; Morales, Jorge; Avila, Carlos; Rodriguez, Ana Cecilia; Kreimer, Aimée R


    The Costa Rica Vaccine Trial (CVT) was a randomized clinical trial conducted between 2004 and 2010, which randomized 7466 women aged 18 to 25 to receive the bivalent HPV-16/18 vaccine or control Hepatitis-A vaccine. Participants were followed for 4 years with cross-over vaccination at the study end. In 2010 the long term follow-up (LTFU) study was initiated to evaluate the 10-year impact of HPV-16/18 vaccination, determinants of the immune response, and HPV natural history in a vaccinated population. Herein, the rationale, design and methods of the LTFU study are described, which actively follows CVT participants in the HPV-arm 6 additional years at biennial intervals (3 additional study visits for 10 years of total follow-up), or more often if clinically indicated. According to the initial commitment, women in the Hepatitis-A arm were offered HPV vaccination at cross-over; they were followed 2 additional years and exited from the study. 92% of eligible CVT women accepted participation in LTFU. To provide underlying rates of HPV acquisition and cervical disease among unvaccinated women to compare with the HPV-arm during LTFU, a new unvaccinated control group (UCG) of women who are beyond the age generally recommended for routine vaccination was enrolled, and will be followed by cervical cancer screening over 6 years. To form the UCG, 5000 women were selected from a local census, of whom 2836 women (61% of eligible women) agreed to participate. Over 90% of participants complied with an interview, blood and cervical specimen collection. Evaluation of comparability between the original (Hepatitis-A arm of CVT) and new (UCG) control groups showed that women's characteristics, as well as their predicted future risk for cervical HPV acquisition, were similar, thus validating use of the UCG. LTFU is poised to comprehensively address many important questions related to long-term effects of prophylactic HPV vaccines.

  8. Long-term follow-up after comprehensive rehabilitation of persons with epilepsy, with emphasis on participation in employment or education.

    Wedlund, Ewa Wadhagen; Nilsson, Lena; Erdner, Anette; Tomson, Torbjörn


    The objective of this study was to describe the current situation of patients with epilepsy after rehabilitation with emphasis on employment and education and to investigate if clinical factors at admission were associated with increase in employment or education. All patients that participated in a comprehensive rehabilitation were eligible. Data were collected from medical records at admission, during rehabilitation, at discharge and from a structured telephone interview at follow-up 1-17 years after admission. In total, 124 patients participated in the follow-up. Participation in employment or education improved from admission to follow-up in 38 patients. In univariable analysis, active epilepsy with tonic-clonic seizures at admission was significantly associated with increased participation in employment or education at follow-up, so was decreased frequency of tonic-clonic seizures from admission to follow-up. The significance of the associations disappeared in adjusted multivariable analysis. Participation in employment or education was improved for many patients at follow-up.

  9. Beta-interferon, retinoids and tamoxifen in metastatic breast cancer: long-term follow-up of a phase II study.

    Recchia, Francesco; Sica, Gigliola; Candeloro, Giampiero; Necozione, Stefano; Bisegna, Roberta; Bratta, Massimo; Rea, Silvio


    Based on a series of in vitro data, including the additive and/or synergistic antiproliferative effect of interferon and tamoxifen on breast cancer cell lines, and on clinical reports, we designed a pilot phase II study to test the activity and toxicity of simultaneous administration of beta-interferon (beta-IFN), retinoids (R) and tamoxifen (TAM) as a salvage therapy in a group of patients with metastatic breast cancer (MBC). Herein we describe the outcome of this cohort of patients after a median follow-up of 150 months. Sixty-five stage IV breast cancer patients, 13 pre-treated with hormones, 38 with chemotherapy and 15 with both, received, as a salvage therapy, TAM, beta-IFN and R. Among 65 evaluable patients, 36 achieved a clinical response (55.5%) (95% c.i. 42-67.7%). Toxicity was moderate and mainly hepatic. Median progression-free and overall survival, which did not show any statistically significant difference in patients with different estrogen and progesterone receptor content, were 43 months and 47.9 months, respectively. In conclusion, the study shows that long-term treatment with TAM, beta-IFN and R in MBC is feasible, has moderate toxicity and seems to give a long-term benefit, irrespective of the receptorial status.

  10. [Immunomodulatory treatment with beta-interferon in patients with cervical intraepithelial neoplasia and human papillomavirus infection: long-term follow-up].

    Cazorla, E; Urgal, A; Córdoba, J; Boldó, A; Marín, M; Sánchez Gutiérrez, M; Molina, J M; Llixiona, J


    The aim of this study was to evaluate the long-term efficacy of beta-interferon treatment in the management of cervical intraepithelial neoplasia associated with human papillomavirus (HPV) infection in a selected group of patients. Thirty-nine patients who had histologically proven cervical intraepithelial neoplasia I or II with concurrent HPV infection were administered 27,000,000 IU of intramuscular beta-interferon. Periodical controls were carried out based on Papanicolaou smears and/or colposcopic examination and DNA HPV determination was performed by hybridation test, for a maximum of 8 years' follow-up. An initial complete response rate of 75% was obtained, with a recurrence rate of 25%, cervical intraepithelial neoplasia with late manifestation was of higher grade. Treatment interruption due to side-effects was not necessary. Associated viral infections appeared to be a recurrence risk factor, but not smoking or parity. While immunomodulatory treatment with beta-interferon has good long-term results in cervical intraepithelial neoplasia I/II treatment, wider randomized studies are required to obtain conclusive results.

  11. Long-term physical workload in middle age and disability pension in men and women: a follow-up study of Swedish cohorts.

    Kjellberg, Katarina; Lundin, Andreas; Falkstedt, Daniel; Allebeck, Peter; Hemmingsson, Tomas


    The study investigates the association between level of long-term physical workload in middle age and disability pension (DP) before 61 years of age with adjustments made for early life factors, level of education, and psychosocial working conditions. Associations with DP overall, DP due to musculoskeletal disorders and DP due to psychiatric disorders were examined. The study is based on cohorts of 21,809 Swedish men and women born in 1948 and 1953, with data on physical workload estimated with a job exposure matrix based on occupational titles in 1985 and 1990 and follow-up data on diagnosis-specific DP in the years 1991-2009. Data on paternal education and intelligence were collected in primary school. Data on level of education were taken from administrative records. Data on psychosocial working conditions were estimated with a job exposure matrix based on occupational titles in 1990. Long-term exposure to high physical workload measured 5 years apart at around age 40 was strongly associated with DP due to musculoskeletal disorders up to the age of 61 among both men (HR 5.44, 95 % CI 3.35-8.84) and women (HR 3.82, CI 95 % 2.88-5.08). For women, the association between high physical load and overall DP was also significantly increased (HR 2.33, CI 95 % 1.92-2.82). The increased risks remained but were clearly attenuated after adjustments for fathers' education, IQ in childhood, achieved education and level of control at work. Exposure to high physical workload is associated with long-term risk of DP due to musculoskeletal disorders, even though adjustments for early life factors, level of education and psychosocial working conditions clearly attenuated the risks.

  12. Percutaneous Excision of a Benign Breast Mass Using Ultrasound-guided, Vacuum-assisted Core Biopsy:A Review of 197 Cases with Long Term Follow-up

    Yoon, Hoi Soo; Han, Heon; Kim, Sam Soo; Jeon, Yong Hwan; Lee, Ji Won; Kim, Hyoung Rae [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of); Moon, Jin Hee; Lee, Hyun; Koh, Sung Hye [Hallym University College of Medicine, Chuncheon (Korea, Republic of); Kim, Sun Mi [Bundang Seoul National University Hospital, Seoul (Korea, Republic of)


    To assess long term results of excising benign masses using ultrasound (US)-guided, vacuum-assisted core biopsy (Mammotome). We enrolled 163 patients (197 masses) receiving US guided excision using vacuum-assisted core biopsy and follow-up sonography in this retrospective study. The masses were category 3 as determined by ultrasound imaging according to the Breast Imaging Reporting and Data System (BI-RADS) (n=145) or pathologically confirmed as benign masses by a previous core-needle biopsy although category 4a and 4b (n =