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Sample records for infundibuloneurohypophysitis long-term follow-up

  1. Long-term follow-up of newborn screening patients.

    PubMed

    Berry, Susan A; Lloyd-Puryear, Michele A; Watson, Michael S

    2010-12-01

    New technology in newborn screening permits clinicians to approach strategies for defining optimal treatments for newborn-screened conditions. The Health Resources and Services Administration Maternal and Child Health Bureau, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Centers for Disease Control and Prevention have all established initiatives for long-term follow-up assessment of children identified after newborn screening. In October 2008, an inaugural meeting of the National Institute of Child Health and Human Development-sponsored National Coordinating Center Long-Term Follow-Up Data Collection Work Group brought together partners from Health Resources and Services Administration-sponsored Regional Genetics Collaboratives to review pilot projects undertaken to promote systematic long-term follow-up for children with inborn errors of metabolism identified by newborn bloodspot screening. Beginning with these projects, the goal of this meeting was to provide a foundation for national planning for a common data set to be used for long-term follow-up. This supplement summarizes these initial projects. PMID:21150374

  2. Long-term follow-up of pediatric trachyonychia.

    PubMed

    Kumar, Monique G; Ciliberto, Heather; Bayliss, Susan J

    2015-01-01

    Pediatric trachyonychia is an acquired nail disease that can cause distress to families. It is a poorly understood disease, and long-term follow-up data are lacking. We present an institutional review of 11 children with isolated pediatric trachyonychia followed over time. Children with the diagnosis of pediatric trachyonychia were identified and invited to participate. Pictures were taken on follow-up and a questionnaire was answered. Exclusion criteria include having another diagnosis at the initial visit that causes nail dystrophy. Eleven patients with the diagnosis of pediatric trachyonychia were available for follow-up. The mean age of appearance was 2.7 years (range 2-7 yrs) and the average follow-up was 66 months (range 10-126 mos). Nine patients were treated with potent topical corticosteroids, one used only petrolatum, and one took vitamin supplements. One patient was found to have an additional skin and hair diagnosis of alopecia areata on follow-up. On follow-up, 82% noted improvement of the nails, whereas 18% noted no change. A majority of cases of pediatric trachyonychia are isolated and improve with time, regardless of treatment. PMID:25556756

  3. Long-term follow-up of patients with candiduria.

    PubMed

    Revankar, S G; Hasan, M S; Revankar, V S; Sobel, J D

    2011-02-01

    Candiduria is commonly encountered in hospitalized patients, particularly those with indwelling urinary catheters. While risk factors and therapy are well described in previous studies, little is known about long-term outcomes and recurrence rates of candiduria. We studied 188 patients with candiduria in a retrospective chart review at a single institution from January 1999 to December 2000. Data were collected regarding risk factors and underlying disease, therapy, follow-up cultures until December 2003, and mortality. Ninety-one patients with at least one follow-up culture >1 month after the initial culture (range 2-48) were available for further study. In this group, patients receiving antifungal therapy for asymptomatic candiduria were paradoxically more likely to have subsequent positive urine cultures than patients who never received antifungal therapy. Six patients developed candidemia during follow-up, although in none was this considered to represent a consequence of candiduria. Mortality rate at the end of the follow-up period (mean of 18 months) was 43%, including one death attributed to candidemia. Therapy for candiduria does not appear to reduce candiduria recurrence rates through 48 months of follow-up and little evidence of treatment benefit was identified. PMID:20857164

  4. Long-term Follow-up After Bariatric Surgery

    PubMed Central

    Puzziferri, Nancy; Roshek, Thomas B.; Mayo, Helen G.; Gallagher, Ryan; Belle, Steven H.; Livingston, Edward H.

    2015-01-01

    IMPORTANCE Bariatric surgery is an accepted treatment for obesity. Despite extensive literature, few studies report long-term follow-up in cohorts with adequate retention rates. OBJECTIVE To assess the quality of evidence and treatment effectiveness 2 years after bariatric procedures for weight loss, type 2 diabetes, hypertension, and hyperlipidemia in severely obese adults. EVIDENCE REVIEW MEDLINE and Cochrane databases were searched from 1946 through May 15, 2014. Search terms included bariatric surgery, individual bariatric procedures, and obesity. Studies were included if they described outcomes for gastric bypass, gastric band, or sleeve gastrectomy performed on patients with a body mass index of 35 or greater, had more than 2 years of outcome information, and had follow-up measures for at least 80% of the initial cohort. Two investigators reviewed each study and a third resolved study inclusion disagreements. FINDINGS Of 7371 clinical studies reviewed, 29 studies (0.4%, 7971 patients) met inclusion criteria. All gastric bypass studies (6 prospective cohorts, 5 retrospective cohorts) and sleeve gastrectomy studies (2 retrospective cohorts) had 95% confidence intervals for the reported mean, median, or both exceeding 50% excess weight loss. This amount of excess weight loss occurred in 31% of gastric band studies (9 prospective cohorts, 5 retrospective cohorts). The mean sample-size–weighted percentage of excess weight loss for gastric bypass was 65.7% (n = 3544) vs 45.0% (n = 4109) for gastric band. Nine studies measured comorbidity improvement. For type 2 diabetes (glycated hemoglobin <6.5% without medication), sample-size–weighted remission rates were 66.7% for gastric bypass (n = 428) and 28.6% for gastric band (n = 96). For hypertension (blood pressure <140/90 mm Hg without medication), remission rates were 38.2% for gastric bypass (n = 808) and 17.4% for gastric band (n = 247). For hyperlipidemia (cholesterol <200 mg/dL, high-density lipoprotein >40 mg/dL, low-density lipoprotein <160 mg/dL, and triglycerides <200 mg/dL), remission rates were 60.4% for gastric bypass (n = 477) and 22.7% for gastric band (n = 97). CONCLUSIONS AND RELEVANCE Very few bariatric surgery studies report long-term results with sufficient patient follow-up to minimize biased results. Gastric bypass has better outcomes than gastric band procedures for long-term weight loss, type 2 diabetes control and remission, hypertension, and hyperlipidemia. Insufficient evidence exists regarding long-term outcomes for gastric sleeve resections. PMID:25182102

  5. Long term follow up after inhalation of foreign bodies.

    PubMed Central

    Davies, H; Gordon, I; Matthew, D J; Helms, P; Kenney, I J; Lutkin, J E; Lenney, W

    1990-01-01

    The long term results of treatment of inhalation of foreign bodies in a district children's hospital and in a tertiary referral centre were reviewed by clinical assessment, chest radiography, and standard four view 81mKr ventilation/99mTc macroaggregated albumin perfusion imaging (V/Q lung scan). The overall incidence in the population served by the district hospital was roughly one in 14,000/year. Of the 12 children reviewed there, three had abnormal chest radiographs and four had abnormal V/Q scans as a result of inhalation of the foreign bodies. Of 21 children treated and reviewed at the referral centre, eight had abnormal chest radiographs, and 14 had abnormal V/Q lung scans. Three factors were assessed for prognostic importance: site of impaction, initial radiographic appearance, and time before removal. A child who had inhaled a foreign body into the left lung and who had collapse/consolidation on the initial chest radiograph was at greatest risk of long term complications. These children merit close follow up. PMID:2378520

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

    PubMed

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

    2012-06-01

    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. PMID:22440534

  7. Long-term follow-up of closed hemorrhoidectomy.

    PubMed

    McConnell, J C; Khubchandani, I T

    1983-12-01

    Four hundred forty-one patients who had closed hemorrhoidectomy with local anesthesia were followed for one to seven years postoperatively to assess long-term results and patient satisfaction. Seven and one-half per cent needed further treatment of hemorrhoids, 7.7 per cent developed other anorectal or colonic pathology, and 0.5 per cent had lasting incontinence. Lateral internal sphincterotomy did not predispose to incontinence. Patient satisfaction was 92.6 per cent. PMID:6641462

  8. Long-term follow-up of vestibular neuritis.

    PubMed

    Mandalà, Marco; Nuti, Daniele

    2009-05-01

    The long-term outcome of vestibular neuritis was evaluated in 35 patients using 4 bedside tests (head impulse, head heave, head shake, vibration), the caloric test and two surveys that explored the degree of disability (Dizziness Handicap Inventory [DHI]) and the anxiety and depression levels (Hospital Anxiety and Depression Scale [HADS]). Sixty-six percent of patients showed a positive bedside clinical test or calorics abnormalities. DHI scores were significantly higher in the patients group, while HADS scores were comparable between patients and controls. Disability from vestibular neuritis is primarily due to the vestibular disturbance itself, rather than purely psychological factors. PMID:19645942

  9. Second primary lung cancer: importance of long term follow up.

    PubMed Central

    van Bodegom, P C; Wagenaar, S S; Corrin, B; Baak, J P; Berkel, J; Vanderschueren, R G

    1989-01-01

    Review of histopathological and clinical data showed that 153 patients at one hospital developed a second primary lung cancer during 1980-6, 10% of all those with lung carcinoma. There were 64 synchronous tumours (interval less than one year) and 89 metachronous tumours (interval over one year). The average interval between metachronous tumours was 6.1 years. The criteria for diagnosing a second primary lung cancer were any of the following: (1) different histological type; (2) different lobe; (3) interval between the two tumours of at least three years. The incidence of second primary tumours increases with survival, and close follow up is required for their early detection. PMID:2595619

  10. Long-term follow up of workers exposed to solvents.

    PubMed Central

    Edling, C; Ekberg, K; Ahlborg, G; Alexandersson, R; Barregrd, L; Ekenvall, L; Nilsson, L; Svensson, B G

    1990-01-01

    Long term occupational exposure to organic solvents may cause adverse effects to the central nervous system. This collaborative study between six Swedish departments of occupational medicine examines the overall prognosis in terms of working capacity, symptoms, and psychometric test performance for individuals occupationally exposed to organic solvents. After re-analyses of the data from an initial clinical investigation of 111 men, the subjects were divided into two subgroups: one group of 65 with symptoms but no impairment on the tests and one group of 46 with toxic encephalopathy (symptoms and test impairment). At least five years after the initial examination the subjects were asked to attend a re-examination that included a structured medical interview and a psychometric investigation. The results indicate that effects on the central nervous system persist even when exposure has ceased. In the group of 46 more men had stopped working and were receiving sickness or early retirement pensions. This group also had reduced activity levels with regard to everyday life, leisure activities, and education or training and more neuropsychiatric symptoms. There was no support for the view that a solvent induced toxic encephalopathy is a progressive disease comparable with presenile dementia such as Alzheimer's disease or Pick's disease. If a worker was removed from exposure when he presented symptoms without signs of impairment in intellectual function recovery was seen in most cases. PMID:2178676

  11. Career Program Completers. 1989-90 Long-Term Follow-Up Study.

    ERIC Educational Resources Information Center

    Johnson County Community Coll., Overland Park, KS. Office of Institutional Research.

    In summer 1994, a long-term follow-up study was conducted of 1989-90 graduates of career programs at Johnson County Community College (JCCC) in Kansas. A survey was mailed to 536 graduates, certificate holders, and students who left JCCC with marketable skills to assess their satisfaction with JCCC and their jobs. With telephone follow-up, a

  12. Career Program Completers, 1993-94: A Long-Term Follow-up Study.

    ERIC Educational Resources Information Center

    Conklin, Karen A.

    This long-term follow-up study, conducted in the summer of 1998 by Johnson County Community College (JCCC, Kansas) focused on graduates, certificate recipients, and students identified by career program administrators as leaving with marketable skills in 1993-94. Since first administering this type of survey in 1989, JCCC has gained a broader

  13. Statistical controversies in clinical research: long-term follow-up of clinical trials in cancer

    PubMed Central

    Cuzick, J.

    2015-01-01

    Long-term follow-up is an important unmet need for the full analysis of new treatments for cancer. Earlier detection of cancer and more effective treatment have led to many more patients surviving for more than 5 and even 10 years, so that evaluating late recurrences and side-effects is an increasingly important issue. This is particularly relevant for oestrogen receptor-positive breast cancer, where the existence of late recurrences is well documented. However, survival for other cancers, notably prostate, colorectal and cervix cancer, has dramatically increased in recent years due to screening and better treatment of early lesions. Trials of preventive therapies have an even greater need for long follow-up. Here, we review these issues and suggest ways in which provision for long-term follow-up can be improved. PMID:26433395

  14. Statistical controversies in clinical research: long-term follow-up of clinical trials in cancer.

    PubMed

    Cuzick, J

    2015-12-01

    Long-term follow-up is an important unmet need for the full analysis of new treatments for cancer. Earlier detection of cancer and more effective treatment have led to many more patients surviving for more than 5 and even 10 years, so that evaluating late recurrences and side-effects is an increasingly important issue. This is particularly relevant for oestrogen receptor-positive breast cancer, where the existence of late recurrences is well documented. However, survival for other cancers, notably prostate, colorectal and cervix cancer, has dramatically increased in recent years due to screening and better treatment of early lesions. Trials of preventive therapies have an even greater need for long follow-up. Here, we review these issues and suggest ways in which provision for long-term follow-up can be improved. PMID:26433395

  15. Long-term follow-up after callosotomy—A prospective, population based, observational study

    PubMed Central

    Stigsdotter-Broman, Lina; Olsson, Ingrid; Flink, Roland; Rydenhag, Bertil; Malmgren, Kristina

    2014-01-01

    Objective Analyze the long-term outcome of callosotomies with regard to seizure types and frequencies and antiepileptic drug treatment. Methods This longitudinal observational study is based on data from the prospective Swedish National Epilepsy Surgery Register. Thirty-one patients had undergone callosotomy in Sweden 1995–2007 and had been followed for 2 and 5 or 10 years after surgery. Data on their seizure types and frequencies, associated impairments, and use of antiepileptic drugs have been analyzed. Results The median total number of seizures per patient and month was reduced from 195 before surgery to 110 two years after surgery and 90 at the long-term follow-up (5 or 10 years). The corresponding figures for drop attacks (tonic or atonic) were 190 before surgery, 100 2 years after surgery, and 20 at the long-term follow-up. Ten (56%) of the 18 patients with drop attacks were free from drop attacks at long-term follow-up. Three of the remaining eight patients had a reduction of >75%. At long-term follow-up, four were off medication. Only one of the 31 patients had no neurologic impairment. Significance The present population-based, prospective observational study shows that the corpus callosotomy reduces seizure frequency effectively and sustainably over the years. Most improvement was seen in drop attacks. The improvement in seizure frequency over time shown in this study suggests that callosotomy should be considered at an early age in children with intractable epilepsy and traumatizing drop attacks. PMID:24372273

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

    PubMed

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

    2014-08-01

    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. PMID:24650180

  17. Management of vascular prosthetic infections: results of long-term follow-up.

    PubMed

    Zeltsman, D; Tzarnas, C D; Kerstein, M D

    1999-04-01

    An infected vascular prosthesis is a risk to life and limb, with many of the infections insidious in nature. A retrospective analysis with a minimum 49-month follow-up identified 18 patients (mean age, 61.3 years) with culture-positive infections and exposed prosthetic grafts in the infrainguinal region. All patients were managed with muscle flaps. Mean follow-up was 59 months, with a long-term salvage of infected prosthetic grafts in 16 of 18 patients; there was no loss of life or limb. Early, aggressive reconstruction of infected prosthetic grafts using a muscle flap technique saves graft, leg, and patient. PMID:10190357

  18. Long-Term Follow-up of Uterine Artery Embolization for Symptomatic Adenomyosis

    SciTech Connect

    Smeets, A. J. Nijenhuis, R. J.; Boekkooi, P. F.; Vervest, H. A. M.; Rooij, W. J. van; Lohle, P. N. M.

    2012-08-15

    Introduction: Long-term results of uterine artery embolization (UAE) for adenomyosis are largely unknown. We assess long-term outcome of UAE in 40 women with adenomyosis. Materials and methods: Between March 1999 and October 2006, 40 consecutive women with adenomyosis (22 in combination with fibroids) were treated with UAE. Changes in junction zone thickness were assessed with magnetic resonance imaging (MRI) at baseline and again at 3 months. After a mean clinical follow-up of 65 months (median 58 [range 38-129]), women filled out the uterine fibroid symptom and quality of life (UFS-QoL) questionnaire, which had additional questions on the long-term evolution of baseline symptoms and adverse events. Results: During follow-up, 7 of 40 women (18%) underwent hysterectomy. Among these 7 women, the junction zones were significantly thicker, both at baseline (mean 23 vs. 16 mm, P = 0.028) and at 3-month follow-up (mean 15 vs. 9 mm, P = 0.034). Of 33 women with preserved uterus, 29 were asymptomatic. Four patients had symptom severity scores of 50 to 85 and overall QoL scores of 60 to 66, indicating substantial clinical symptoms. There was no relation between clinical outcome and the initial presence of fibroids in addition to adenomyosis. Conclusion: In women with therapy-resistant adenomyosis, UAE resulted in long-term preservation of the uterus in the majority. Most patients with preserved uterus were asymptomatic. The only predictor for hysterectomy during follow-up was initial thickness of the junction zone. The presence or absence of fibroids in addition to adenomyosis had no relation with the need for hysterectomy or clinical outcome.

  19. Yield of Screening for Long-Term Complications Using the Children's Oncology Group Long-Term Follow-Up Guidelines

    PubMed Central

    Landier, Wendy; Armenian, Saro H.; Lee, Jin; Thomas, Ola; Wong, F. Lennie; Francisco, Liton; Herrera, Claudia; Kasper, Clare; Wilson, Karla D.; Zomorodi, Meghan; Bhatia, Smita

    2012-01-01

    Purpose The Children's Oncology Group Long-Term Follow-Up (COG-LTFU) Guidelines use consensus-based recommendations for exposure-driven, risk-based screening for early detection of long-term complications in childhood cancer survivors. However, the yield from these recommendations is not known. Methods Survivors underwent COG-LTFU Guidelinedirected screening. Yield was classified as negligible/negative (< 1%), intermediate (? 1% to < 10%), or high (? 10%). For long-term complications with high yield, logistic regression was used to identify subgroups more likely to screen positive. Results Over the course of 1,188 clinic visits, 370 childhood cancer survivors (53% male; 47% Hispanic; 69% leukemia/lymphoma survivors; median age at diagnosis, 11.1 years [range, 0.3 to 21.9 years]; time from diagnosis, 10.5 years [range, 5 to 55.8 years]) underwent 4,992 screening tests. High-yield tests included thyroid function (hypothyroidism, 10.1%), audiometry (hearing loss, 22.6%), dual-energy x-ray absorptiometry scans (low bone mineral density [BMD], 23.2%), serum ferritin (iron overload, 24.0%), and pulmonary function testing/chest x-ray (pulmonary dysfunction, 84.1%). Regression analysis failed to identify subgroups more likely to result in high screening yield, with the exception of low BMD (2.5-fold increased risk for males [P = .04]; 3.3-fold increased risk for nonobese survivors [P = .01]). Screening tests with negligible/negative (< 1%) yield included complete blood counts (therapy-related leukemia), dipstick urinalysis for proteinuria and serum blood urea nitrogen/creatinine (glomerular defects), microscopic urinalysis for hematuria (hemorrhagic cystitis, bladder cancer), ECG (anthracycline-related conduction disorder), and hepatitis B and HIV serology. Conclusion Screening tests with a high yield are appropriate for risk groups targeted for screening by the COG-LTFU Guidelines. Elimination of screening tests with negligible/negative yield should be given consideration. PMID:23091100

  20. Patterns of renal angiomyolipoma regression post embolisation on medium- to long-term follow-up

    PubMed Central

    Robinson, G J; Ettles, D F; Lakshminarayan, R

    2013-01-01

    Objective: To assess the patterns of regression of renal angiomyolipoma (AML) post embolisation and report the outcomes related to the use of different embolic materials. Methods: A retrospective review of all patients who underwent embolisation for renal AML at our institution between January 2004 and April 2012. Results: 13 patients underwent 16 episodes of embolisation. Coils were used as the primary embolisation material in 10 episodes and microspheres in 6 episodes. The size reduction rate highly correlated on CT follow-up between the two groups, with 25.6% vs 22.7% reduction at 12 months, 27.5% vs 25.1% at 24 months, 35.0% vs 33.0% at 36 months and 35.0% vs 36.8% at 48 months. During follow-up, all tumours reduced in size with one patient requiring subsequent embolisation whose tumour reduced by only 6.5% after 1 year and subsequently exhibited regrowth after 4 years. Two patients presented with rebleeding and underwent repeat embolisation. Our overall retreatment rate (23%) is well within the literature range (up to 37%). None of the patients underwent surgery. Conclusion: The majority of AML shrinkage occurs within the first year following embolisation and appears to plateau after 3 years, which could have an impact on follow-up strategy. The percentage reduction at 1 year may reflect the long-term effect of embolisation with tumours demonstrating minor size reduction more likely to relapse at long-term follow-up. Embolisation of renal AML produces durable long-term results regardless of the choice of embolic agent. Advances in knowledge: These findings provide information to guide CT follow-up of renal AML post embolisation. PMID:23392196

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

    PubMed Central

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

    2016-01-01

    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

  2. Long-term follow-up for noninvasive body contouring treatment in Asians.

    PubMed

    Chang, Shyue-Luen; Huang, Yau-Li; Lee, Mei-Ching; Chang, Chih-Hsiang; Lin, Ying-Fang; Cheng, Chun Yu; Hu, Sindy

    2016-02-01

    There are versatile modalities to achieve noninvasive fat reduction, and most of them have proven to be effective for circumferential reduction of local fat tissue, without any serious or permanent adverse effects. However, the follow-up time is short, ranging from 1 to 24weeks. Most of the patients would like to know how long will its effect last and whether there is long-term side effect or not. The aim of this study was to assess the long-term efficacy and safety of combination therapy of focused ultrasound and radio frequency for noninvasive body contouring. Thirty-two Asian subjects received three sequential combination therapies of focused ultrasound and radio-frequency treatments every 2weeks in the abdominal region and were followed up 1month and 1year after the last treatment. After a year, 5 patients were loss follow-up and 2 were pregnant. Finally, 25 healthy Asian subjects (18 females and 7 males) were enrolled in this study. Safety parameters and adverse events were recorded. The mean body weight change remained constant without a significant change 1year after treatment and was 0.1??1.2kg (p?=?0.513). The mean abdominal circumference change between 1month and 1year after the last treatment was 0.4??1.2cm and was not significant (p?=?0.169). The relationships between weight change and circumference change of the 23 patients were tested using Spearman's rho correlation coefficient. There was a correlation between weight change and circumference change (0.73; p?=?0.000). The procedure was safe without a recordable long-term adverse event. The combination therapies of nonthermally focused ultrasound and radio-frequency treatments for body contouring in the abdominal region are effective and may show positive results for at least a year if patients can maintain their body weight. The procedure is safe without recordable long-term adverse events in this study. PMID:26714982

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

    PubMed Central

    Gunenc, Uzeyir; Ozturk, Taylan; Arikan, Gul; Kocak, Nilufer

    2015-01-01

    AIM To evaluate the long-term efficacy and safety results of viscocanalostomy and phacoviscocanalostomy. METHODS The charts of 49 glaucoma patients who underwent viscocanalostomy or phacoviscocanalostomy surgery between February 1999 and August 2004 were reviewed retrospectively. Thirty-one eyes of 21 glaucoma patients who underwent filtering procedure with a postoperative follow-up of at least 5y were included in the study. Results of complete ophthalmologic examinations were recorded and statistically analyzed. Long-term surgical outcome was defined as an overall success when intraocular pressure (IOP) was found as ?20 mm Hg with or without antiglaucomatous medication at the last follow-up visit, while it was defined as a complete success when IOP was measured ?20 mm Hg without antiglaucomatous medication. RESULTS Mean age was 68.19.6y (range: 32-81y). Mean follow-up time was 101.527.3mo (range: 60-144mo). Viscocanalostomy was performed in 8 eyes (25.8%) and phacoviscocanalostomy was performed in 23 eyes (74.2%). The mean preoperative IOP was 23.17.6 mm Hg with 2.11.0 medications, while mean IOP was 16.83.8 mm Hg with 0.91.1 medication at the last follow-up visit. Both the IOP decrease and the reduction in the antiglaucomatous medication were statistically significant (P<0.001 and P<0.001). No case required further glaucoma surgery. Overall success and complete success were found as 87.1% and 51.6%, respectively. Complete success rate was statistically higher in phacoviscocanalostomy group compared with the viscocanalostomy group (P=0.031), however there was no significant difference in overall success rate between two groups (P=0.072). CONCLUSION Both viscocanalostomy and phacoviscocanalostomy provide good IOP reduction in the long-term period. PMID:26682166

  4. Long-Term Follow-Up of Patients at High Risk for Nephropathy After Contrast Exposure.

    PubMed

    Abaci, Okay; Harmankaya, Ozlem; Kocas, Betul; Kocas, Cuneyt; Bostan, Cem; Coskun, Ugur; Yildiz, Ahmet; Ersanli, Murat

    2015-07-01

    Contrast medium-induced acute kidney injury (CI-AKI) is associated with morbidity and mortality, but the long-term outcomes of patients who do not develop CI-AKI remain unknown. We assessed clinical end points during long-term follow-up in patients at high risk for nephropathy who did not develop CI-AKI. Patients (n = 135) with impaired renal function (estimated glomerular filtration rate: 30-60 mL/min/1.73 m(2)) were divided into 2 groups according to contrast media (CM) exposure. The primary end point of this study was a composite outcome measure of death or renal failure requiring dialysis. Multivariate analyses identified CM exposure to be independently associated with major adverse long-term outcomes (hazard ratio: 2.3; 95% confidence interval, 1.34-6.52; P = .018). Even when CM exposure does not cause CI-AKI in patients with impaired renal function, in the long term, primary end points occur more frequently in patients exposed to CM than in those with no CM exposure. PMID:25115554

  5. Long-term follow-up of a patient with mild tetrahydrobiopterin-responsive phenylketonuria.

    PubMed

    Cerone, R; Schiaffino, M C; Fantasia, A R; Perfumo, M; Birk Moller, L; Blau, N

    2004-02-01

    We report on the long-term follow-up of the first Italian patient with the tetrahydrobiopterin (BH4)-responsive type of phenylalanine hydroxylase deficiency (R243X/Y414C genotype). The patient was diagnosed by the newborn screening for phenylketonuria (PKU) and with a positive BH4 loading test. Introduction of BH4 (initially 10 and later 20 mg/kg/day) in addition to reduced low-phenylalanine diet resulted in therapeutic plasma phenylalanine concentrations (<340 micromol/L). Very good compliance and no side effects in this patient demonstrate the great potential of BH4 in the treatment of some patients with mild PKU. PMID:14741196

  6. [The psychological counseling in the long-term follow-up in oncology: Review and prospects].

    PubMed

    Do Nascimento-Baranger, Chlo; Rivollet, Sophie; Massoubre, Catherine

    2015-01-01

    The aim of the article is to describe psychological counseling implemented in the context of the study of the long-term follow-up in oncology (SALTO in Rhne-Alpes-Auvergne and in Gustave-Roussy). The authors address the specificity of this consultation, proposed to adults who had childhood cancer, focusing in particular on the observed psychic movements. To conclude, the authors justify the interest of a clinical approach and the necessity of such psychological consultation for these former patients became adults. PMID:25959518

  7. A Long-Term Follow-up of Pontine Hemorrhage With Hearing Loss

    PubMed Central

    Kim, Seung Ki; Kim, Ae Ryoung; Kim, Joon Yeop

    2015-01-01

    A pontine intracranial hemorrhage (ICH) evokes several neurological symptoms, due to the various nuclei and nerve fibers; however, hearing loss from a pontine ICH is rare. We have experienced a non-traumatic pontine ICH patient, with hearing loss. A 43-year-old male patient had a massive pontine hemorrhage; his brain magnetic resonance imaging revealed the hemorrhage on the bilateral dorsal pons, with the involvement of the trapezoid body. Also, profound hearing loss on the pure-tone audiogram and abnormal brainstem auditory evoked potential were noticed. Fifty-two months of long-term follow-up did not reveal any definite improvement on the patient's hearing ability. PMID:26361602

  8. MODULUS Stem for Developmental Hip Dysplasia: Long-term Follow-up.

    PubMed

    Benazzo, Francesco M; Piovani, Lucio; Combi, Alberto; Perticarini, Loris

    2015-10-01

    Between October 2001 and December 2010, 143 patients with developmental dysplasia underwent hip arthroplasty surgery using a conical stem with modular necks (MODULUS system, Lima Corporate, Villanova di San Daniele del Friuli, Italy). Thirty (21.0%) patients had both hips replaced, for a total of 173 implants. The mean age at the time of surgery was 55 years (range: 22-81 years). The mean follow-up was 87 months (range: 36-146 months); average Harris Hip Score increased from 42 (range: 23-65) preoperatively to 92 (range: 76-100) at the last follow-up. Stem revision was required in two cases. The MODULUS stem showed good long-term clinical and radiographic results, with a Kaplan-Meier survivorship of 97.6% (95% CI: 94.8-100.0%) at 8 years. PMID:25980775

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

    PubMed Central

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

    2015-01-01

    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

  10. Diastematomyelia: a surgical case with long-term follow-up.

    PubMed

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

    2015-02-01

    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

  11. Long-term follow-up of neurological manifestations in a boy with incontinentia pigmenti.

    PubMed

    Margari, Lucia; Lamanna, Anna Linda; Buttiglione, Maura; Craig, Francesco; Petruzzelli, Maria G; Terenzio, Vanessa

    2013-09-01

    Incontinentia pigmenti (IP) is an X-linked dominant genodermatosis confined to females. It is usually lethal in males. However, the survival of some males has been reported in literature. We describe a long follow-up case of a 12-year-old male with IP and a normal karyotype but a genomic deletion of the NEMO gene in the Xq28 position in the form of somatic mosaicism. The patient showed severe ophthalmic abnormalities and neurological manifestations characterised by very mild cerebellar ataxia and a history of epilepsy that was severe at the beginning with West syndrome, become moderate overtime and is now resolved. Despite these neurological manifestations, probably related to the presence of at least some mutated cells in his brain, the long-term follow-up in this patient demonstrated good neurological and cognitive outcome. PMID:23652938

  12. Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis: long-term follow-up.

    PubMed

    Hug, U; Guggenheim, M; Kilgus, M; Giovanoli, P

    2012-04-01

    Radioscapholunate arthrodesis is the treatment of choice for symptomatic, degenerative radioscapholunate osteoarthritis. We report on three patients after radioscapholunate arthrodesis with a follow-up of 22-28 years. There were no short-term postoperative complications; range of motion and strength were stable. All three patients showed radiological evidence of progressive, but clinically asymptomatic midcarpal osteoarthritis. The conversion rate for radioscapholunate to panarthrodesis of the wrist is reported at 31% with follow-ups of more than five years, invariably due to either non-union, or progressive, symptomatic midcarpal osteoarthritis. Primary excision of the distal pole of the scaphoid during radioscapholunate arthrodesis probably plays an important role in avoiding these conditions in the long-term. This measure allows a residual range of motion more than previously believed; considering that the dart thrower's motion is the physiological axis of wrist motion. PMID:22484245

  13. Long-Term Follow-Up of Percutaneous Balloon Angioplasty in Adult Aortic Coarctation

    SciTech Connect

    Paddon, Alex J.; Nicholson, Anthony A.; Ettles, Duncan F.; Travis, Simon J.; Dyet, John F.

    2000-09-15

    Purpose: To assess long-term outcomes following percutaneous transluminal angioplasty (PTA) of congenital aortic coarctation in adults.Methods: Seventeen patients underwent PTA for symptomatic adult coarctation of the aorta. Sixteen patients, with a mean age of 28 years (range 15-60 years), were reviewed at a mean interval after angioplasty of 7.3 years (range 1.5-11 years). Assessment included magnetic resonance imaging (MRI), Doppler echocardiography, and clinical examination. Current clinical measurements were compared with pre- and immediate post-angioplasty measurements.Results: At follow-up 16 patients were alive and well. The patient not included in follow-up had undergone surgical repair and excision of the coarctation segment following PTA. Mean brachial systolic blood pressure for the group decreased from 174 mmHg before angioplasty to 130 mmHg at follow-up (p 0.0001). The mean gradient had fallen significantly from 50.9 to 17.8 at follow-up (p = 0.001). The average number of antihypertensive drugs required per patient decreased from 0.56 to 0.31 (p = 0.234). No significant residual stenoses or restenoses were seen at MRI. Small but clinically insignificant residual pressure gradients were recorded in all patients using Doppler echocardiography. Complications included one transient ischemic attack at 5 days, one external iliac dissection requiring stent insertion, and a further patient who developed a false aneurysm close to the coarctation site at 12 months which subsequently required surgical excision.Conclusion: PTA of adult coarctation is safe and effective in the long term. Although primary stenting has recently been advocated in the treatment of this condition, our results suggest that PTA remains the treatment of choice.

  14. Clinical and Radiological Long-Term Follow-up After Embolization of Pulmonary Arteriovenous Malformations

    SciTech Connect

    Andersen, Poul Erik Kjeldsen, Anette D.

    2006-02-15

    The purpose was to evaluate the clinical and radiological long-term results of embolization of pulmonary arteriovenous malformations (PAVMs) and to assess the quality of life after treatment. A clinical follow-up was undertaken after 67 months (mean) in 35 consecutive patients with 106 PAVMs. Outcome parameters at follow-up were PaO{sub 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 and subjective effect of treatment on physical and social functioning. A significant rise in oxygenation of the blood after embolization was measured. In 77% of the patients symptoms improved, and 71% felt better performance. In eight patients, one of the PAVMs was found insufficiently embolized or recanalized at follow-up angiography and therefore were re-embolized. Endovascular embolization for PAVMs is effective. Clinical parameters and quality of life improved significantly. Regular clinical controls after therapy are necessary to discover insufficiently embolized, recanalized or new PAVMs.

  15. Long-term follow-up study of gastroduodenal lesions after radioembolization of hepatic tumors

    PubMed Central

    Rodrguez-Lago, Iago; Carretero, Cristina; Herriz, Maite; Subtil, Jos C; Bets, Maite; Rodrguez-Fraile, Macarena; Sola, Jess J; Bilbao, Jos I; Muoz-Navas, Miguel; Sangro, Bruno

    2013-01-01

    AIM: To evaluate the long-term natural history of the gastroduodenal lesions secondary to extrahepatic embolization with Ytrium 90 (90Y) spheres. METHODS: From September 2003 to January 2012, 379 procedures of liver radioembolization (RE) using resin microspheres loaded with 90Y were performed in our center. We have retrospectively compiled the data from 379 RE procedures performed in our center. We report a comprehensive clinical, analytical, endoscopic and histologic long-term follow-up of a series of patients who developed gastroduodenal lesions after the treatment. RESULTS: Six patients (1.5%) developed gastrointestinal symptoms and had gastrointestinal lesions as shown by upper endoscopy in the next 12 wk after RE. The mean time between RE and the appearance of symptoms was 5 wk. Only one patient required endoscopic and surgical treatment. The incidence of gastrointestinal ulcerations was 3.75% (3/80) when only planar images were used for the pre-treatment evaluation. It was reduced to 1% (3/299) when single-photon emission computed tomography (SPECT) images were also performed. The symptoms that lasted for a longer time were nausea and vomiting, until 25 mo after the treatment. CONCLUSION: All patients were free from severe symptoms at the end of follow-up. The routine use of SPECT has decreased the incidence of gastrointestinal lesions due to unintended deployment of 90Y particles. PMID:23704826

  16. Long-term clinical and radiological follow-up after laminectomy for cervical spondylotic myelopathy

    PubMed Central

    Laiginhas, Ana Rita Aleixo; Silva, Pedro Alberto; Pereira, Paulo; Vaz, Rui

    2015-01-01

    Background: The role of laminectomy in the surgical treatment of cervical spondylotic myelopathy (CSM) is established even though postoperative cervical sagittal balance changes and a risk for long-term instability have been described. The aim of the present study is to investigate its clinical efficacy and the radiological outcome in the long-term. Methods: The authors retrospectively reviewed consecutive cases of patients with CSM, who underwent cervical laminectomy between 1995 and 2010 at the Hospital So Joo (n = 106). Clinical files were consulted, and the patients reassessed in order to collect information on complaints, previous neurological deficits, surgery and its complications. Subjective and objective clinical evaluation (by three myelopathy scores) and imaging studies were undertaken in order to assess the long-term cervical sagittal curvature and presence of instability. Results: After applying exclusion criteria, 57 patients were able to complete the follow-up. A favorable statistically significant difference was obtained when comparing clinical scores. Ninety-one percent of patients were satisfied with the outcome of the surgery. Only 1 patient developed kyphosis according to Ishihara index and none according to the method of Matsumoto. Four patients developed subclinical cervical instability. No clinical-imaging correlation was found. Conclusions: If patients are properly selected cervical laminectomy without additional instrumentation is effective in offering a clinical improvement to patients with CSM with a low incidence of clinically significant radiological deterioration. PMID:26543671

  17. [Short, medium and long-term follow-up of living donors].

    PubMed

    Oppenheimer Salinas, Federico

    2010-01-01

    Live-donor kidney transplants are being done since more than fifty years ago. In recent years, a marked increase in live donations is observed, as a result of the limited availability of organs from deceased donors. Also, the use of laparoscopic nephrectomy has contributed to increase live donations. A systematic review of the literature shows that short and long-term risks of morbidity and mortality of the donor are reasonably low. Even so, an increased incidence of high blood pressure and mild proteinuria has been reported. On the contrary, no detrimental effect on renal failure is observed and the incidence of long-term chronic renal failure is lower in the donor population when compared with the incidence observed in the general population. In any case, a regular follow-up of the donors is advisable in order to prevent or early detect those medical conditions that would represent a health risk, in particular those conditions that possibly will affect renal function: hypertension, diabetes, proteinuria and obesity. It would be also necessary to establish a nation-wide scientific registry, with prospective regular data collection, that will make possible a more accurate assessment of the long-term risk of uninephrectomy and early detection of new medical information that would contribute to redefine the risk of kidney donation or to establish new requisites in the donor evaluation protocols. PMID:21183969

  18. Long-term follow-up of children with refractory immune thrombocytopenia treated with rituximab.

    PubMed

    Matsubara, Kousaku; Takahashi, Yoshiyuki; Hayakawa, Akira; Tanaka, Fumiko; Nakadate, Hisaya; Sakai, Michio; Maeda, Naoko; Oka, Toshiaki; Ishii, Eiichi; Bessho, Fumio; Morimoto, Tsuyoshi; Goto, Hiroaki; Hashii, Yoshiko; Hatakeyama, Naoki; Shirahata, Akira; Imaizumi, Masue

    2014-04-01

    Data on long-term outcomes of children with refractory immune thrombocytopenia (ITP) treated with rituximab are limited. We retrospectively analyzed the long-term effect of rituximab on 22 pediatric ITP patients (11 boys and 11 girls). Compete response (CR) (platelet count ?100 10(9)/L) and partial response (PR) (platelet count 30-99 10(9)/L) were achieved in nine (41 %) and two (9 %) patients, respectively. Of the 11 responders, eight subsequently relapsed 2-26 months after initial rituximab treatment. The 5-year relapse-free rate was 14 % (3/22, 95 % confidence interval: 0-27 %) with a median follow-up period of 6.4 years. Five initial responders with subsequent relapse and one non-responder received multiple rituximab treatments of nine courses; all patients responded to the second rituximab therapy without any significant toxicity. All eight patients who relapsed after an initial response and six of 11 non-responders achieved CR or PR with subsequent treatment, including repeated courses of rituximab, splenectomy, steroids, and other immunomodulating agents. Our findings indicated that the sustained effect of rituximab on children with refractory ITP is low, but that the long-term outcome of ITP itself is not poor. Furthermore, repeated rituximab administration may be a promising therapy for those who relapse after an initial response. PMID:24609717

  19. Long-term Fruit and Vegetable Change in Worksites: Seattle 5 A Day Follow-up

    PubMed Central

    Thompson, Beti; Bishop, Sonia; Macintyre, Jessica; McLerran, Dale; Yasui, Yutaka

    2013-01-01

    Objective To evaluate long-term change in fruit and vegetable intake following a group randomized trial of worksites. Methods Medium-sized blue-collar businesses in the Seattle metropolitan area were recruited. Intake was assessed using serial cross-sectional samples of current workforce at 3 time points. The multilevel 18-month intervention involved partnership with the companies. Long-term follow-up was at 4.4 years postbaseline. Statistical analysis used general linear models, adjusting for worksite random effects. Results Initially, 45 worksites were randomized, with 29 agreeing to participate in a new study. Fruits and vegetable intake increased, with larger sustained changes in the intervention worksites, resulting in a long-term differential change of 0.25 servings per day, 95% confidence interval (0.09 to 0.40). Conclusions Intervention sustained small effects at 4 years, including 2 years with no contact. Although effects were not large, this low-intensity intervention approach could provide an important public health model. PMID:20604696

  20. Case of cannabinoid hyperemesis syndrome with long-term follow-up

    PubMed Central

    Cha, Jae Myung; Kozarek, Richard A; Lin, Otto S

    2014-01-01

    Long-term cannabis use may be associated with attacks of severe nausea and vomiting, and a characteristic learned behavior of compulsive hot bathing, termed cannabinoid hyperemesis syndrome (CHS). Long-term follow-up and prognosis of CHS have not been reported previously. A 44-year-old Caucasian man with a long history of addiction to marijuana presented with chronic abdominal pain complicated by attacks of uncontrollable vomiting for 16 years. He had a compulsion to take scalding hot showers, as many as 15 times a day, to relieve his symptoms. All previous therapies had been ineffective. However, abstinence from marijuana led to rapid and complete resolution of all symptoms and his compulsive hot showering behavior. He has been followed for nine years, and is still doing well without recurrence of symptoms. Physicians should have a high index of suspicion for this under-recognized condition, as excellent long-term prognosis of CHS can be achieved when abstinence is maintained. PMID:25516874

  1. Oligometastases Treated With Stereotactic Body Radiotherapy: Long-Term Follow-Up of Prospective Study

    SciTech Connect

    Milano, Michael T.; Katz, Alan W.; Zhang Hong; Okunieff, Paul

    2012-07-01

    Purpose: To analyze the long-term survival and tumor control outcomes after stereotactic body radiotherapy (SBRT) for metastases limited in number and extent. Methods and Materials: We prospectively analyzed the long-term overall survival (OS) and cancer control outcomes of 121 patients with five or fewer clinically detectable metastases, from any primary site, metastatic to one to three organ sites, and treated with SBRT. Freedom from widespread distant metastasis (FFDM) was defined as metastatic disease not amenable to local therapy (i.e., resection or SBRT). Prognostic variables were assessed using log-rank and Cox regression analyses. Results: For breast cancer patients, the median follow-up was 4.5 years (7.1 years for 16 of 39 patients alive at the last follow-up visit). The 2-year OS, FFDM, and local control (LC) rate was 74%, 52%, and 87%, respectively. The 6-year OS, FFDM, and LC rate was 47%, 36%, and 87%, respectively. From the multivariate analyses, the variables of bone metastases (p = .057) and one vs. more than one metastasis (p = .055) were associated with a fourfold and threefold reduced hazard of death, respectively. None of the 17 bone lesions from breast cancer recurred after SBRT vs. 10 of 68 lesions from other organs that recurred (p = .095). For patients with nonbreast cancers, the median follow-up was 1.7 years (7.3 years for 7 of 82 patients alive at the last follow-up visit). The 2-year OS, FFDM, and LC rate was 39%, 28%, and 74%, respectively. The 6-year OS, FFDM, and LC rate was 9%, 13%, and 65%, respectively. For nonbreast cancers, a greater SBRT target volume was significantly adverse for OS (p = .012) and lesion LC (p < .0001). Patients whose metastatic lesions, before SBRT, demonstrated radiographic progression after systemic therapy experienced significantly worse OS compared with patients with stable or regressing disease. Conclusions: Select patients with limited metastases treated with SBRT are long-term survivors. Future research should address the therapeutic benefit of SBRT for these patients.

  2. DISTAL FEMORAL VARUSING FOR OSTEOARTHRITIS OF VALGUS KNEE: A LONG-TERM FOLLOW-UP

    PubMed Central

    Andrade, Marco Antônio Percope de; Gomes, Davi Coutinho Fonseca Fernandes; Portugal, André Lopes; Silva, Guilherme Moreira de Abreu e

    2015-01-01

    Objective: Assess the long-term results of distal femoral varusing osteotomy and try to establish predictive criteria that could help on selecting patients to be submitted to this technique. Methods: Fifteen patients with lateral compartment osteoarthritis and valgus deformity of the knee were submitted to distal femoral “V” varusing osteotomy fixated with lateral plate, pursuing knee alignment at 0° on the anatomical axis. The mean follow-up period was 81.4 months, ranging from 43 to 132 months. The Knee Society Rating System protocol was employed. Additional assessed variables were the following: patient age, follow-up time, and postoperative anatomical angle. Results: 11 results were regarded as excellent or good (73%) and four as fair or poor (27%). Conclusion: Distal femoral “V” varusing osteotomy constitutes a good treatment alternative for patients with lateral compartment osteoarthritis and valgus knee. The following variables have not been confirmed: patient age at the time of surgery, follow-up time, and postoperative anatomical angle as predictive factors for the results.

  3. Long-Term Follow-up After Embolization of Pulmonary Arteriovenous Malformations with Detachable Silicone Balloons

    SciTech Connect

    Andersen, Poul Erik Kjeldsen, Anette D.

    2008-05-15

    Long-term follow-up results after embolization of 13 pulmonary arteriovenous malformations in 10 patients by use of 14 detachable silicone balloons are given. Patients were followed for a mean of 99 months (range, 63-123 months) with chest x-rays and for a mean of 62 months (range, 3-101 months) with pulmonary angiography. Fifty-four percent of the balloons were deflated at latest radiographic chest film follow-up, but at pulmonary angiographic follow-up all embolized malformations were without flow irrespective of whether or not the balloons were visible. Detachable silicone balloons are not available anymore, but use of these balloons for embolization of pulmonary arteriovenous malformations has been shown to be a safe and precise method, with immediate occlusion of the feeding artery and with long-lasting occlusion, even though many balloons deflate with time, leaving a fibrotic scar replacing the pulmonary arteriovenous malformation. No case of recanalization has been discovered, and these results seem to justify a reduced number of controls of these balloon-embolized malformations.

  4. Long term follow up and retrospective study on 533 gastric cancer cases

    PubMed Central

    2014-01-01

    Background Gastric cancer (GC) is the third leading cause of cancer death in China and the outcome of GC patients is poor. The aim of the research is to study the prognostic factors of gastric cancer patients who had curative intent or palliative resection, completed clinical database and follow-up. Methods This retrospective study analyzed 533 GC patients from three tertiary referral teaching hospitals from January 2004 to December 2010 who had curative intent or palliative resection, complete clinical database and follow-up information. The GC-specific overall survival (OS) status was determined by the Kaplan-Meier method, and univariate analysis was conducted to identify possible factors for survival. Multivariate analysis using the Cox proportional hazard model and a forward regression procedure was conducted to define independent prognostic factors. Results By the last follow-up, the median follow-up time of 533 GC patients was 38.6 mo (range 6.9-100.9 mo), and the median GC-specific OS was 25.3 mo (95% CI: 23.1-27.4 mo). The estimated 1-, 2-, 3- and 5-year GC-specific OS rates were 78.4%, 61.4%, 53.3% and 48.4%, respectively. Univariate analysis identified the following prognostic factors: hospital, age, gender, cancer site, surgery type, resection type, other organ resection, HIPEC, LN status, tumor invasion, distant metastases, TNM stage, postoperative SAE, systemic chemotherapy and IP chemotherapy. In multivariate analysis, seven factors were identified as independent prognostic factors for long term survival, including resection type, HIPEC, LN status, tumor invasion, distant metastases, postoperative SAE and systemic chemotherapy. Conclusions Resection type, HIPEC, postoperative SAE and systemic chemotherapy are four independent prognostic factors that could be intervened for GC patients for improving survival. PMID:24886548

  5. The health status of Q-fever patients after long-term follow-up

    PubMed Central

    2011-01-01

    Background In the Netherlands, from 2007 to 2009, 3,522 Q-fever cases were notified from three outbreaks. These are the largest documented outbreaks in the world. Previous studies suggest that symptoms can persist for a long period of time, resulting in a reduced quality of life (QoL). The aim of this study was to qualify and quantify the health status of Q-fever patients after long-term follow-up. Methods 870 Q-fever patients of the 2007 and 2008 outbreaks were mailed a questionnaire 12 to 26 months after the onset of illness. We assessed demographic data and measured health status with the Nijmegen Clinical Screening Instrument (NCSI). The NCSI consists of three main domains of functional impairment, symptoms and QoL that are divided into eight sub-domains. The NCSI scores of Q-fever patients older than 50 years (N = 277) were compared with patients younger than 50 years (N = 238) and with norm data from healthy individuals (N = 65) and patients with chronic obstructive pulmonary disease (N = 128). Results The response rate was 65.7%. After applying exclusion criteria 515 Q-fever patients were included in this study. The long-term health status of two thirds of Q-fever patients (both younger and older than 50 years) was severely affected for at least one sub-domain. Patients scores were most severely affected on the sub-domains general QoL (44.9%) and fatigue (43.5%). Hospitalisation in the acute phase was significantly related to long-term behavioural impairment (OR 2.8, CI 1.5-5.1), poor health related QoL (OR 2.3,CI 1.5-4.0) and subjective symptoms (OR 1.9, CI 1.1-3.6). Lung or heart disease, depression and arthritis significantly affected the long-term health status of Q-fever patients. Conclusions Q-fever patients presented 12 to 26 months after the onset of illness severe -clinically relevant- subjective symptoms, functional impairment and impaired QoL. All measured sub-domains of the health status were impaired. Hospitalisation and co-morbidity were predictors for worse scores. Our data emphasise that more attention is needed not only to prevent exposure to Q-fever but also for the prevention and treatment of the long-term consequences of this zonosis. PMID:21501483

  6. Long-Term Follow-Up and Prognostic Factors for Advanced Thymic Carcinoma

    PubMed Central

    Wu, Jun-xin; Chen, Hui-qin; Shao, Ling-dong; Qiu, Su-fang; Ni, Qian-yu; Zheng, Bu-hong; Wang, Jie-zhong; Pan, Jian-ji; Li, Jin-luan

    2014-01-01

    Abstract The aim of this study was to evaluate the long-term survival outcomes in patients with advanced thymic carcinoma and identify prognostic factors influencing the survival. We retrospectively analyzed 90 consecutive patients with pathologically confirmed advanced thymic carcinoma (Masaoka III and IV) in our institute, from December 2000 to 2012. Age, sex, clinical characteristics, laboratory findings, Masaoka and tumor node metastasis staging, pathologic grade, and treatment modalities were analyzed to identify prognostic factors associated with the progress-free survival (PFS) and the overall survival (OS) rates. Statistical analysis was conducted using SPSS, version 19.0 (SPSS, Inc, Chicago, IL). A total of 73 (81.1%) male and 17 (18.9%) female patients participated in the study. The median follow-up time was 75 months (range, 20–158 months). The 5-year PFS and OS rates were 23.6% (95% confidence interval [CI], 14.6%–33.8%) and 35.7% (95% CI, 25.1%–46.4%), respectively. The multivariate Cox regression model analysis showed that factors improving the PFS were the normal lactate dehydrogenase (LDH) level (P < 0.001), Masaoka III stage (P = 0.028), and radiotherapy (RT) (P < 0.001). The LDH (P < 0.001), T stage (P < 0.001), and the pathologic grade (P = 0.047) were independently prognostic of OS. Long-term follow-up of the advanced thymic carcinoma showed poor outcomes of PFS and OS. LDH, Masaoka stage, and RT affected the PFS, and LDH, T stage, and pathologic grade seemed to affect the OS. Establishing a better staging system for predicting outcomes would be warranted. PMID:25526488

  7. Long-term follow-up of a dental faculty development program.

    PubMed

    McAndrew, Maureen; Motwaly, Suzanne; Kamens, Tracy Ellen

    2013-06-01

    Many, if not most, dental faculty members have not received formal training to be educators. However, the importance of faculty development programs in improving teaching skills, fostering career development, and reinforcing relationships with colleagues and mentors has increasingly been acknowledged. In 2005, the Excellence in Clinical Teaching Program at New York University College of Dentistry (NYUCD) was created to enhance the clinical teaching skills of NYUCD faculty members. As of spring 2009, fifty-nine faculty members had participated in eight separate cohorts. The program consists of five formal group sessions supplemented by readings, reflection papers, and a final project. This study examined the short- and long-term effectiveness of the program. Participants were asked to complete a short pre-program survey to self-assess their teaching abilities and, at the last session, a satisfaction survey. In fall 2011, forty-eight faculty members who completed the program from spring 2005 to fall 2009 and were actively teaching at least one session a week at NYUCD were asked to complete a follow-up survey asking about the long-term value of the program and their academic career progression since program completion. Thirty-three faculty members responded for a response rate of 69 percent. Ninety-seven percent of the respondents indicated they would recommend the program to their colleagues, 94 percent said program participation led to a greater likelihood of conferring with peers about teaching issues,79 percent had increased their teaching responsibilities, and 62 percent said that presenting the final project improved their presentation skills. In addition, the retention rate of those still teaching at the school (81 percent) exceeds national retention rate averages for dental faculty. This follow-up study suggests that participation in the Excellence in Clinical Teaching Program is associated with meaningful professional growth. PMID:23740908

  8. Transvaginal Aspiration of Ovarian Cysts: Long-Term Follow-up

    SciTech Connect

    Duke, D.; Colville, J.; Keeling, A.; Broe, D.; Fotheringham, T.; Lee, M.J.

    2006-06-15

    Background and purpose. Transvaginal aspiration of ovarian cysts has been advocated as a viable alternative to surgery in patients who are high-risk surgical candidates. We describe a retrospective study evaluating the results of transvaginal aspirations of benign ovarian cysts in patients at increased surgical risk, focusing on long-term follow-up for recurrence of the cyst and/or development of malignancy. Methods. Twenty-four women with ovarian cysts underwent 34 transvaginal drainages between October 1998 and December 2004. All patients were referred following diagnosis of a persistent ovarian cyst with a benign appearance on ultrasound. All patients were unsuitable candidates for surgery (history of previous pelvic surgery, n = 21; high risk for anesthesia, n = 1; and unsuitable for laparoscopy due to obesity, n = 2). Patients with a history of pregnancy, acute abdominal symptoms, or previous gynecologic malignancy were excluded. A 20G x 20 cm Chiba needle was used for transvaginal aspiration using an endocavity probe (Acuson XP, Mountain View, CA, USA; Siemens Sololine, Erlangen, Germany) and intravenous sedoanalgesia. Cysts were aspirated to dryness. Results. Long-term follow-up of patients was performed and revealed a recurrence rate of 75%. Eighty-three percent of cysts on the left and 42% of those on the right recurred. Nine of 15 (60%) patients with recurrence required further intervention. Two of 9 underwent surgical intervention only, 4 of 9 had repeat transvaginal aspiration(s) performed, and 3 of 9 had a combination of both transvaginal aspiration and surgery. No patient developed ovarian malignancy. Conclusion. Transvaginal cyst aspiration has many advantages including short hospital stay, rapid recovery, excellent patient tolerance, and a low rate of procedure-related complications. Our study demonstrates that ovarian cyst recurrence following transvaginal drainage is a more significant problem than previously documented, especially if the cyst is on the left side. However, when recurrences do occur, repeat transvaginal aspirations may be considered in the symptomatic patient.

  9. Long-Term Follow-Up of a Longitudinal Faculty Development Program in Teaching Skills

    PubMed Central

    Knight, Amy M; Cole, Karan A; Kern, David E; Barker, L Randol; Kolodner, Ken; Wright, Scott M

    2005-01-01

    Background The long-term impact of longitudinal faculty development programs (FDPs) is not well understood. Objective To follow up past participants in the Johns Hopkins Faculty Development Program in Teaching Skills and members of a comparison group in an effort to describe the long-term impact of the program. Design and Participants In July 2002, we surveyed all 242 participants in the program from 1987 through 2000, and 121 members of a comparison group selected by participants as they entered the program from 1988 through 1995. Measurements Professional characteristics, scholarly activity, teaching activity, teaching proficiency, and teaching behaviors. Results Two hundred participants (83%) and 99 nonparticipants (82%) responded. When participants and nonparticipants from 1988 to 1995 were compared, participants were more likely to have taught medical students and house officers in the last year (both P<.05). Participants rated their proficiency for giving feedback more highly (P<.05). Participants scored higher than nonparticipants for 14 out of 15 behaviors related to being learner centered, building a supportive learning environment, giving and receiving feedback, and being effective leaders, half of which were statistically significant (P<.05). When remote and recent participants from 1987 through 2000 were compared with each other, few differences were found. Conclusions Participation in the longitudinal FDP was associated with continued teaching activities, desirable teaching behaviors, and higher self-assessments related to giving feedback and learner centeredness. Institutions should consider supporting faculty wishing to participate in FDPs in teaching skills. PMID:16050881

  10. Long-term follow-up of breast cancer survivors with post-mastectomy pain syndrome.

    PubMed

    Macdonald, L; Bruce, J; Scott, N W; Smith, W C S; Chambers, W A

    2005-01-31

    Post-mastectomy pain syndrome (PMPS) is a recognised complication of breast surgery although little is known about the long-term outcome of this chronic pain condition. In 1996, Smith et al identified a prevalence rate of PMPS of 43% among 408 women in the Grampian Region, Northeast Scotland. The aim of this study was to assess long-term outcome at 7-12 years postoperatively in this cohort of women, to describe the natural history of PMPS and impact of pain upon quality of life. Chronic pain and quality of life were assessed using the McGill Pain Questionnaire (MPQ) and Short Form-36 (SF-36). Of 175 women reporting PMPS in 1996, 138 were eligible for questionnaire follow-up in 2002. Mean time since surgery was 9 years (s.d. 1.8 years). A response rate of 82% (113 out of 138) was achieved; 59 out of 113 (52%) women reported continued PMPS and 54 out of 113 (48%) women reported their PMPS had resolved since the previous survey in 1996. Quality of life scores were significantly lower in women with persistent PMPS compared to those women whose pain had resolved. However, for women with persistent PMPS, SF-36 scores had improved over time. Risk factors for persistent PMPS included younger age and heavier weight. This study found that, of women reporting PMPS in 1996, half of those surveyed in 2002 continued to experience PMPS at a mean of 9 years after surgery. PMID:15655557

  11. Long-term follow-up in toxic solitary autonomous thyroid nodules treated with radioactive iodine

    SciTech Connect

    Huysmans, D.A.; Corstens, F.H.; Kloppenborg, P.W. )

    1991-01-01

    The long-term effects of radioiodine treatment on thyroid function in patients with a toxic solitary autonomous thyroid nodule were evaluated. Fifty-two patients received a therapeutic dose of 20 mCi of iodine-131 ({sup 131}I). Duration of follow-up was 10 +/- 4 yr. Follow-up data included a biochemical evaluation of thyroid function. The failure rate (recurrent hyperthyroidism) was 2%. The incidence of hypothyroidism was 6% and was not related to the dose per gram of nodular tissue. Oral administration of 20 mCi of radioiodine is a simple and highly effective method for the treatment of patients with a toxic autonomous thyroid nodule. The risk of development of hypothyroidism is low if extranodular uptake of {sup 131}I is prevented. This can be achieved by not treating euthyroid patients, by no longer using injections of exogenous thyroid stimulating hormone in the diagnostic work-up of the patients and by always performing radioiodine imaging shortly before treatment.

  12. School-Based Interventions for Anxious Children: Long-Term Follow-Up.

    PubMed

    Lee, Susanne S; Victor, Andrea M; James, Matthew G; Roach, Lauren E; Bernstein, Gail A

    2016-04-01

    This study examined the long-term outcomes of a nonclinical sample of anxious children (N = 61) who were randomized by school to 9 weeks of group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training, or no-treatment control. Parents and children completed measures of anxiety symptoms at baseline, posttreatment, and at 3-, 6-, 12-month, 2-, and 3-year posttreatment follow-ups. Piecewise longitudinal growth curve analyses were applied to the data. When the two CBT groups were combined and compared with control, the combined treatment group showed significantly greater reduction in children's anxiety severity based on the parent ratings in the first longitudinal phase. However, on the parent Clinician Severity Rating, gains were maintained to 3 years. Child report revealed no significant differences between groups on anxiety reduction. This study maintained a small no-treatment control group during the entire follow-up period. From parental perspective only, school-based group CBT appeared to be beneficial in decreasing severity of anxiety symptoms and maintaining gains over time. PMID:26003419

  13. Short- and long-term surgical follow-up of the postbariatric surgery patient.

    PubMed

    Frank, Paul; Crookes, Peter F

    2010-03-01

    Follow-up of the large numbers of patients undergoing bariatric surgery poses problems for surgical programs and for internists who care for morbidly obese patients. Early surgical follow up is concentrated on the perioperative period to ensure healing and care for any surgical complications. It is especially important to treat persistent vomiting to avoid thiamine deficiency. Subsequently, monitoring weight loss and resolution of comorbidities assumes more importance. Identification and management of nutritional deficiencies and other unwanted consequences of surgery may become the responsibility of internists if the patient no longer attends the office of the operating surgeon. The long-term goal is to avoid weight regain and deficiencies, especially of protein, iron and vitamin B12, and calcium and vitamin D. Abdominal pain and gastrointestinal dysfunction should be investigated promptly to exclude or confirm such conditions as small bowel obstruction or gallstones. Good communication between bariatric surgeons and internal medicine specialists is essential for early and accurate identification of problems arising from bariatric surgery. PMID:20202586

  14. Long-term follow-up of surgically treated AIS patients.

    PubMed

    Hill, D; Raso, V J; Moreau, K; Moreau, M; Mahood, J

    2002-01-01

    The aim of this study was to determine the long-term changes in spine and trunk alignment in patients who have undergone scoliosis surgery. Twenty-three (16F; 7M; at age of surgery 15.7 +/- 4.9 years) patients with adolescent idiopathic scoliosis agreed to participate and had posterior-anterior radiographs and surface topography prior to derotation surgery, within 6 months of surgery, at 2 years post-operatively and 5-10 years (mean follow-up period 6.11 +/- 1.6 years) after surgery. Cobb angles, surface trunk rotations, and cosmetic scores were measured at each visit. A questionnaire assessed back appearance and pain at the 5-10 year follow-up. The results of the questionnaire were compared to 25 patients with idiopathic scoliosis who had recently undergone surgery. A paired two-tailed Student's t-test with p=0.05 was used to compare the deformity between visits. The Cobb angle and cosmetic score improved after surgery while the change in trunk rotation was insignificant (p=0.37). Between the two-year and 5-10 year review, the Cobb angle, cosmetic score, and surface trunk rotation significantly increased. Self-perception of appearance and pain were similar to the control group. Surgical correction of scoliosis is not completely maintained during adulthood although the radiographic and surface deterioration does not appear to be clinically significant. PMID:15457781

  15. Long-term follow-up of patients receiving boceprevir for treatment of chronic hepatitis C.

    PubMed

    Howe, Anita Y M; Long, Jianmin; Nickle, David; Barnard, Richard; Thompson, Seth; Howe, John; Alves, Katia; Wahl, Janice

    2015-01-01

    The durability of sustained virologic response (SVR) following boceprevir-based therapy in patients with hepatitis C virus (HCV) infection has not been reported. Furthermore, in patients receiving protease inhibitor-based therapies, development of resistance can contribute to treatment failure. The aim of the present study was to follow the clinical progression of patients treated with boceprevir after treatment in phase 2/3 clinical trials. This was a 3-year, long-term follow-up analysis of patients enrolled in boceprevir phase 2/3 studies. No treatment was administered during follow-up. Patients with SVR were assessed for durability of viral eradication. Non-SVR patients with on-treatment resistance-associated variants (RAVs) were assessed for longevity of RAVs. A total of 1148 patients (SVR, n=696; virologic failure, n=452) were enrolled in this follow-up analysis. The median duration of follow-up was approximately 3.4 years (range of 0.0-4.1 years). Overall, 3 of 696 patients with SVR had detectable HCV RNA during the follow-up period (relapse rate of 0.4% or 1.3 relapses/1000 person-years). The majority of patients who developed RAVs during the initial treatment study (228/314, 73%) reverted to wild-type (WT) within 3 years (RAVs persisted in 27% of patients). The median time for all RAVs to become undetectable was 1.11 years (95% confidence interval 1.05-1.20 years). V36M, T54A, A156S, I/V170A and V36M+R155K appeared to have a faster rate of return to WT (median times to return to WT of ⩽0.9 years); whereas, T54S, R155K, V55A and T54S+R155K had a slower rate of return to WT (median times to return to WT of approximately 1.1 years). Return to WT appeared slightly faster in patients with G1b RAVs compared to those with G1a RAVs, and in patients with previous non-response or relapse versus breakthrough or incomplete virologic response. SVR was durable in most patients treated with boceprevir. Furthermore, most RAVs present at the time of virologic failure reverted to WT over time. Time to return to WT was associated with the phenotype of RAV, presumably a reflection of the fitness of the mutant virus, suggesting that HCV RAVs are not permanently archived, but are replaced in the viral population by WT virus. PMID:25446895

  16. Long-term follow-up of patients with unexplained syncope and negative electrophysiologic study.

    PubMed

    Raviele, A; Proclemer, A; Gasparini, G; Di Pede, F; Delise, P; Piccolo, E; Feruglio, G A

    1989-02-01

    Fifty-eight patients (29 M, 29 F, mean age 60.8 +/- 16 years) with unexplained syncope at the end of a complete clinical and electrophysiological evaluation, were followed for a mean period of 36.6 +/- 20.5 months (median: 30.5 months). Structural heart disease was present in 32 patients (55.2%). The standard ECG was normal in 24 (41.4%) and showed sinus bradycardia (greater than 40 m-1) and/or first degree AV block and/or intraventricular conduction disturbances in 29 patients (50%). During follow-up, recurrences of syncope were observed in 11 of 43 untreated patients (25.6%), three of seven electrically treated patients (42.9%) and two of eight pharmacologically treated patients (25%). The cause of these recurrences was cardiac in one (1.7%), non-cardiac in 10 (17.2%) and remained undetermined in five (8.6%). Sudden death occurred in only one patient (1.7%), who was receiving chronic amiodarone therapy. These results indicate that (1) syncopal recurrences may occur in an appreciable percentage of patients with unexplained syncope and a negative electrophysiologic study during a relatively long-term follow-up, (2) syncopal recurrences, when they occur, are generally due to a non-cardiac cause, (3) sudden death is an occasional and rare event in this patient population and (4) empirical prophylactic treatment with a permanent pacemaker or antiarrhythmic drugs does not usually prevent complications during the follow-up. PMID:2924782

  17. Long-term follow-up of Fanconi anemia: clinical manifestation and treatment outcome

    PubMed Central

    Yoon, Byung Gyu; Kim, Hee Na; Han, Ui Joung; Jang, Hae In; Han, Dong Kyun; Baek, Hee Jo; Hwang, Tai Ju

    2014-01-01

    Purpose The aim of this study was to characterize Korean patients with Fanconi anemia (FA), which is a rare but very challenging genetic disease. Methods The medical records of 12 FA patients diagnosed at Chonnam National University Hospital from 1991 to 2012 were retrospectively reviewed. Results The median age at diagnosis was 6.2 years. All patients showed evidence of marrow failure and one or more physical stigmata. Chromosome breakage tests were positive in 9 out of 11 available patients. The median follow-up duration was 69.5 months. The Kaplan-Meier (KM) survival of all patients was 83.3% at 10 years and 34.7% at 20 years, respectively. Seven patients underwent 9 stem cell transplantations (SCTs). Among them, 5 were alive by the end of the study. Ten-year KM survival after SCT was 71.4% with a median follow-up of 3.4 years. All 5 patients treated with supportive treatment alone died of infection or progression at the median age of 13.5 years, except for one with short follow-up duration. Acute leukemia developed in 2 patients at 15.4 and 18.1 years of age. Among 6 patients who are still alive, 3 had short stature and 1 developed insulin-dependent diabetes mellitus. Conclusion We provide information on the long-term outcomes of FA patients in Korea. A nation-wide FA registry that includes information of the genotypes of Korean patients is required to further characterize ethnic differences and provide the best standard of care for FA patients. PMID:24778694

  18. The Sugen 5416/hypoxia mouse model of pulmonary hypertension revisited: long-term follow-up

    PubMed Central

    Hansmann, Georg; Rose, Chase; Fernandez-Gonzalez, Angeles; Scheid, Annette; Mitsialis, S. Alex; Kourembanas, Stella

    2014-01-01

    Abstract The combination of a vascular endothelial growth factor receptor antagonist, Sugen 5416 (SU5416), and chronic hypoxia is known to cause pronounced pulmonary hypertension (PH) with angioobliterative lesions in rats and leads to exaggerated PH in mice as well. We sought to determine whether weekly SU5416 injections during 3 weeks of hypoxia leads to long-term development of angioobliterative lesions and sustained or progressive PH in mice. Male C57BL/6J mice were injected with SU5416 (SuHx) or vehicle (VehHx) weekly during 3 weeks of exposure to 10% oxygen. Echocardiographic and invasive measures of hemodynamics and pulmonary vascular morphometry were performed after the 3-week hypoxic exposure and after 10 weeks of recovery in normoxia. SuHx led to higher right ventricular (RV) systolic pressure and RV hypertrophy than VehHx after 3 weeks of hypoxia. Ten weeks after hypoxic exposure, RV systolic pressure decreased but remained elevated in SuHx mice compared with VehHx or normoxic control mice, but RV hypertrophy had resolved. After 3 weeks of hypoxia and 10 weeks of follow-up in normoxia, tricuspid annular plane systolic excursion was significantly decreased, indicating decreased systolic RV function. Very few angioobliterative lesions were found at the 10-week follow-up time point in SuHx mouse lungs. In conclusion, SU5416 combined with 3 weeks of hypoxia causes a more profound PH phenotype in mice than hypoxia alone. PH persists over 10 weeks of normoxic follow-up in SuHx mice, but significant angioobliterative lesions do not occur, and neither PH nor RV dysfunction worsens. The SuHx mouse model is a useful adjunct to other PH models, but the search will continue for a mouse model that better recapitulates the human phenotype. PMID:25610598

  19. Elbow interposition arthroplasty in children and adolescents: long-term follow-up

    PubMed Central

    Rodriguez, Janeth; Oliver, Guillermo

    2007-01-01

    A long-term follow-up was made of 12 elbows operated upon between 1971 and 1986, with more than 20years follow-up, in nine males and three females, age at the time of surgery between 10 and 19years . Eight right and four left elbows were involved, and there were three aetiological causes. Seven cases were sequelae of elbow fractures, of which five were supracondylar and two were of the olecranon. There were four cases of juvenile rheumatoid arthritis and one was post-osteomyelitis. The surgical technique involved a modification made by Vainio of MacAuslands technique (wider resection of the osseous ends and total covering of the bloody surfaces) [5, 9]. After extirpating the tissue blocking the joint, we proceeded to remodel the distal humerus in a wide V shape, the proximal end of the ulnar and, if necessary, the radial head. The proximal end of the ulna was sectioned transversely. All surgery was carried out sub-periosteally. Then, an interposition material was placed in one piece and sutured over the distal humerus and cut ends of the ulna and radius. The articular ends were brought together, and the capsule was closed using equidistant stitching, as is the skin. A small compression bandage was applied, and the arm was immobilised with a collar and cuff sling, with the forearm flexed to slightly less than a right angle. In ten cases, the interposition material was fascia lata grafts; in one case, skin graft and in one case, Gelfoam graft. Early rehabilitation began when post-operative pain allowed. Follow-up ranged from 25 to 32years. Pre-surgical movement ranged between 90 and 120 of flexion and 30 and 90 of extension. Post-operative range varied between 90 and 150 of flexion. The five cases of full pre-operative ankylosis achieved between 90 and 150 of flexion and between 0 and 70 of extension. The total range of motion at the latest follow-up varied from 35 to 150. Patients who were able to perform flexion of 120 or more were considered to be excellent, those between 90 and 119 were graded good, from 60 to 89 fair and those 59 or less poor. The ability to attain a hand to mouth position requires a mobility of 120. We obtained excellent results in two patients, good results in three, fair results in four and poor results in three. The fascia lata was used in 83% of cases, obtaining excellent to good results in five patients (41%). Elbow interposition arthroplasty has its indications in children and adolescents where arthrodesis or total joint replacement cannot be performed. PMID:17308908

  20. Pediatric Bulbar and Posterior Urethral Injuries: Operative Outcomes and Long-Term Follow-Up.

    PubMed

    Trachta, Jan; Moravek, Jiri; Kriz, Jan; Padr, Radek; Skaba, Richard

    2016-02-01

    Aim The aim of this study was to analyze complications and outcomes of end-to-end urethral anastomosis performed for posttraumatic bulbar strictures or posterior urethral injuries in pediatric patients. Methods The records of 15 boys, age 18 years and below, admitted to our tertiary trauma center with urethral injuries from 1989 to 2014 were reviewed retrospectively. Out of these 15 boys, 7 were excluded (2 for iatrogenic trauma, 2 for minor straddle injuries who were not operated on, 2 for incomplete records, and 1 lost to follow-up) and 8 analyzed patients were operated for bulbar or posterior urethral injury. The mean follow-up after the operation was 4.5 years (range 0.5-10). To obtain up-to-date follow-up information, all the analyzed patients were contacted by a letter and telephone in January 2015 and asked about lower urinary tract or erectile dysfunction (ED) using the International Index of Erectile Function-5 questionnaire. Results Mean age at the time of injury was 12.3 years (range 5-17). Four patients with pelvic fracture had complete posterior urethra disruption, three patients after straddle injury developed obliterating stricture of the bulbar urethra and one patient had torn his bulbar urethra apart by a sharp hook. Except for the immediate exploration of the open perineal wound, all patients were operated via perineal approach 1 to 6 months after initial suprapubic catheter insertion. Five patients needed a cystotomy to identify the proximal urethral stump by a probe, and two patients had partial pubectomy to gain urethral length. Postoperative complications included stricture in anastomosis in six patients (all reoperated, four more than once including attempts of endoscopic internal urethrotomy). Six days after surgery, one patient developed massive external bleeding around a permanent urinary catheter due to a posttraumatic ruptured arterial aneurysm that was later stopped by urgent angiography and coil insertion. After discharge, three patients had transient stress incontinence. All patients had uroflowmetry maximum flow above 20 mL/s on their last follow-up except for two (12 and 15 mL/s). None have any lower urinary tract dysfunction symptoms in adulthood; one suffers from mild ED and two report moderate ED due to penile shortening. Conclusion Delayed end-to-end anastomosis for pediatric urethral injury is a safe operational option. However, high rate of short-term complications and reoperations should be expected. Penile shortening is one of the most severe long-term complications. PMID:26540444

  1. Long-term Success and Follow-up After Atrial Fibrillation Ablation

    PubMed Central

    Kircher, S; Hindricks, G; Sommer, P

    2012-01-01

    Atrial fibrillation (AF) is the most prevalent sustained arrhythmia in clinical practice. It is associated with significant morbidity and mortality and has been identified as an independent risk factor for ischemic stroke and thromboembolic events. Catheter ablation has become an established rhythm control therapy in patients with highly symptomatic drug-refractory AF. The definition of ablation success remains controversial since current symptom-based or intermittent electrocardiogram monitoring strategies fail to sufficiently disclose rhythm outcome. This failure is mainly related to the high incidence of asymptomatic AF recurrences, the unpredictable nature of arrhythmia relapses, and the poor correlation of symptoms and AF episodes. There is a clear correlation between the intensity of the monitoring strategy and the sensitivity for it to detect arrhythmia recurrences. Furthermore, several clinical studies assessing the long-term efficacy of catheter ablation procedures have reported late AF recurrences in patients who were initially considered responders to catheter ablation. In certain subsets of patients, precise long-term monitoring may help to guide therapy, e.g. patients in whom withdrawal of antithrombotic therapy may be considered if they are free of arrhythmia recurrences. Recently, sub-cutaneous implantable cardiac monitors (ICM) have been introduced for prolonged and continuous rhythm monitoring. The performance of a leadless ICM equipped with a dedicated AF detection algorithm has recently been assessed in a clinical trial demonstrating a high sensitivity and overall accuracy for identifying patients with AF. The clinical impact of ICM-based follow-up strategies, however, has to be evaluated in prospective clinical trials. PMID:22920479

  2. Outcomes and long term follow-up after emergent cricothyroidotomy: is routine conversion to tracheostomy necessary?

    PubMed

    Graham, David B; Eastman, Alexander L; Aldy, Kim N; Carroll, Elizabeth A; Minei, Joseph P; Brakenridge, Scott C; Phelan, Herb A

    2011-12-01

    The purpose of this study is to identify factors associated with survival after cricothyroidotomy (CRIC), and to ascertain long-term outcomes in patients simply decannulated after CRIC versus those revised to tracheostomy. All CRICs between October 1, 1995 and June 20, 2010 were reviewed. Patients were contacted by phone, visited at their last known address, or queried in the Center for Disease Control's National Death Index. DECAN were those CRICs decannulated without revision. TRACH were those revised to a tracheostomy at any point. Ninety-five CRIC patients were identified. In 94 per cent of survivors of initial admission, a Glasgow Coma Score (GCS) of 15 was noted at disposition. Cardiopulmonary resuscitation before or during CRIC performance was strongly associated with all-cause death during index admission, and increasing head Abbreviated Injury Score was associated with lower odds of a neurologically intact survival. Of survivors, 82 per cent of DECAN and 57 per cent of TRACH patients were followed-up with at medians of 48 (interquartile range 19-57) and 53 (20-119) months, respectively. DECAN occurred at a median of 4 days (2-7) whereas TRACH revision occurred at a median of 2 days (1-7). Endoscopy was performed on 36 per cent of DECAN patients and 22 per cent of TRACH patients. Two DECAN patients with acute subglottic edema/stenosis decannulated successfully on days 9 and 15 postinjury and had no problems at 54 and 91 months postinjury. At follow-up, no patient in either group had suffered a clinically evident airway complication. The need for cardiopulmonary resuscitation before or during CRIC portends poorly for neurologically intact survival. Simple decannulation is appropriate for CRIC patients when their need for airway protection has resolved. PMID:22273235

  3. Long-term follow-up of young children with brain tumors after irradiation

    SciTech Connect

    Syndikus, I.; Tait, D.; Ashley, S.

    1994-11-15

    Young children with brain tumors are at high risk of developing late sequelae after curative radiotherapy. A retrospective study was undertaken to determine the frequency and severity of neurological deficits, endocrine dysfunction, and intellectual disabilities. One hundred and fifty-six children age {ge} 3 years were treated between 1952 and 1986 with radiotherapy. Of the 57 survivors, 47 had surgery, 12 chemotherapy and 24 children received cranio-spinal radiotherapy. Late radiation side effects were assessed with a clinical examination, blood tests and an interview. The median follow-up was 13 years and the actuarial survival at 5 and 10 years was 49% and 44%, respectively. No, or only a mild, handicap was noted in 24 patients, while 21 had moderately severe and 16 severe disabilities. Children with supratentorial tumors had more abnormal neurological findings compared to those with infratentorial malignancies (p<0.001). Eighty percent of children had endocrine abnormalities, which were more marked in children with parasellar tumors (p<0.001). Twenty-one children were mentally retarded. In a multivariate analysis epilepsy emerged as the only significant variable independently associated with poor cognitive function. Long-term morbidity was found to be disabling in 58% of the surviving children. These findings encourage the development of treatment strategies designed to reduce toxity. 34 refs., 3 figs., 5 tabs.

  4. A long term follow up of 15 patients with arrhythmogenic right ventricular dysplasia.

    PubMed Central

    Blomström-Lundqvist, C; Sabel, K G; Olsson, S B

    1987-01-01

    The clinical course in 15 patients with features consistent with arrhythmogenic right ventricular dysplasia is described. At referral seven patients had abnormal physical findings, nine had abnormal electrocardiograms with non-specific right-sided abnormalities, and seven patients had increased heart size or prominent right ventricles on chest x ray. During long term follow up (mean 8.8 years, range 1.5 to 28 years) 11 patients had abnormal physical findings, 11 had electrocardiographic changes, and nine had increased heart size. Recurrent sustained right ventricular tachycardia was the most common arrhythmia (10 patients). Two patients experienced ventricular fibrillation. Seven patients suffered from over 10 episodes of ventricular tachycardia, nine required cardioversions, and 10 patients had associated serious symptoms such as syncope, severe hypotension, or cardiac arrest. Four patients required operation to correct the arrhythmia and three patients developed right heart failure. Two out of three deaths were sudden. These data suggest that in arrhythmogenic right ventricular dysplasia right ventricular abnormalities may be progressive and that the condition may affect the left ventricle. The course of the ventricular arrhythmias was highly variable and could not be predicted in individual patients. The potential for lethal ventricular arrhythmias is evident and warrants intensive diagnostic efforts to identify patients with adverse prognostic features. PMID:3676037

  5. Treatment Response and Long Term Follow-up Results of Nonspecific Interstitial Pneumonia

    PubMed Central

    Lee, Ji Yeon; Jin, Sang-Man; Lee, Byoung Jun; Chung, Doo Hyun; Jang, Bo-Gun; Park, Heae Surng; Lee, Sang-Min; Yim, Jae-Joon; Yang, Seok-Chul; Yoo, Chul-Gyu; Han, Sung Koo; Shim, Young-Soo

    2012-01-01

    The purpose of this study was to investigate the long-term clinical course of non-specific interstitial pneumonia (NSIP) and to determine which factors are associated with a response to steroid therapy and relapse. Thirty-five patients with pathologically proven NSIP were included. Clinical, radiological, and laboratory data were reviewed retrospectively. The male-to-female ratio was 7:28 (median age, 52 yr). Thirty (86%) patients responded to steroid therapy, and the median follow-up was 55.2 months (range, 15.9-102.0 months). Five patients (14%) showed sustained disease progression and three died despite treatment. In the five with sustained disease progression, NSIP was associated with various systemic conditions, and the seropositivity of fluorescent antinuclear antibody was significantly associated with a poor response to steroids (P = 0.028). The rate of relapse was 25%, but all relapsed patients improved after re-treatment. The initial dose of steroids was significantly low in the relapse group (P = 0.020). In conclusion, progression is associated with various systemic conditions in patients who show progression. A low dose of initial steroids is significantly associated with relapse. PMID:22690098

  6. Clonazepam in the treatment of epilepsy. A clinical long-term follow-up study.

    PubMed

    Bang, F; Birket-Smith, E; Mikkelsen, B

    1976-09-01

    Sixty-eight patients with various types of epileptic seizures have been treated with clonazepam (Rivotril). Fifty-four patients could be evaluated. In 44 patients, clonazepam was used as a supplement to insufficient previous medication. Ten patients received clonazepam alone. The mean duration of treatment was 2 years and 7 months. Thirty-three patients are still on clonazepam, with a mean duration of treatment of 3 years and 4 months. In 34 patients (63%) a reduction of more than 50% was seen in the seizure frequency of the only type suffered by a patient, or of one of several types. No significant decrease in antiepileptic potency with time was observed. Medication was withdrawn in a total of 21 of the 54 patients because of freedom from seizures (2 patients), lack of effect (7 patients), increased frequency of seizures (3 patients), or lack of cooperation and/or side-effects (3 patients). In 5 patients, the drug may have provoked new types of epileptic seizure. This long-term follow-up study seems to substantiate the favorable antiepileptic properties of clonazepam. PMID:824124

  7. Use of the Internet for long-term clinical follow-up.

    PubMed

    Aucar, J A; Doarn, C R; Sargsyan, A; Samuelson, D A; Odonnell, M J; DeBakey, M E

    1998-01-01

    Use of the Internet for patient-specific consultation across international boundaries has been demonstrated. This report describes the efforts of Baylor College of Medicine and NASA to conduct a telemedicine consultation with Moscow, Russia. Consultation between Russian and American physicians was performed over the Internet with a combination of real-time and store-and-forward techniques. The clinical focus involved a 65-year old Russian scientist who had undergone mitral valve replacement in the United States 5 years earlier. Development of new activity-related chest pain, dyspnea, and intermittent atrial fibrillation led to a consultation with his American cardiologist and cardiac surgeon. Real-time video was supplemented with telephone voice communication to overcome bandwidth limitations. Prior to the video link, the patient's recent history and clinical data were made available via the Internet using file transfer protocol (FTP). The patient's medications, new electrocardiographic findings, and activity status were reviewed. Specific clinical recommendations were made as a result of this telemedicine consultation. This case illustrates the technical factors, clinical implications, and confidentiality issues related to using the Internet for telemedicine consultations and demonstrates that the Internet may provide an alternative means for long-term clinical follow-up of patients. PMID:10220478

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

    PubMed Central

    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

    2012-01-01

    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 13.3%, P = 0.002), 12 (45.8% vs 16.8%, P < 0.001), 18 (52.1% vs 22.3%, P < 0.001), 24 (60.4% vs 20.9%, P < 0.001), 36 (62.5% vs 29.2%, P < 0.001), and 48 mo (66.7% vs 34.7%, P = 0.001) after surgery. CONCLUSION: Anemia was frequent after gastrectomy for early gastric cancer, with iron deficiency being the major cause. Evaluation for anemia including iron status should be performed after gastrectomy and appropriate iron replacement should be considered. PMID:23155340

  9. Long-Term Follow-Up After Endovascular Treatment of Acute Aortic Emergencies

    SciTech Connect

    Pitton, M. B. Herber, S.; Schmiedt, W.; Neufang, A.; Dorweiler, B.; Dueber, C.

    2008-01-15

    Purpose. To investigate the long-term outcome and efficacy of emergency treatment of acute aortic diseases with endovascular stent-grafts. Methods. From September 1995 to April 2007, 37 patients (21 men, 16 women; age 53.9 {+-} 19.2 years, range 18-85 years) with acute complications of diseases of the descending thoracic aorta were treated by endovascular stent-grafts: traumatic aortic ruptures (n = 9), aortobronchial fistulas due to penetrating ulcer or hematothorax (n = 6), acute type B dissections with aortic wall hematoma, penetration, or ischemia (n = 13), and symptomatic aneurysm of the thoracic aorta (n = 9) with pain, penetration, or rupture. Diagnosis was confirmed by contrast-enhanced CT. Multiplanar reformations were used for measurement of the landing zones of the stent-grafts. Stent-grafts were inserted via femoral or iliac cut-down. Two procedures required aortofemoral bypass grafting prior to stent-grafting due to extensive arteriosclerotic stenosis of the iliac arteries. In this case the bypass graft was used for introduction of the stent-graft. Results. A total of 46 stent-grafts were implanted: Vanguard/Stentor (n = 4), Talent (n = 31), and Valiant (n = 11). Stent-graft extension was necessary in 7 cases. In 3 cases primary graft extension was done during the initial procedure (in 1 case due to distal migration of the graft during stent release, in 2 cases due to the total length of the aortic aneurysm). In 4 cases secondary graft extensions were performed-for new aortic ulcers at the proximal stent struts (after 5 days) and distal to the graft (after 8 months) and recurrent aortobronchial fistulas 5 months and 9 years after the initial procedure-resulting in a total of 41 endovascular procedures. The 30-day mortality rate was 8% (3 of 37) and the overall follow-up was 29.9 {+-} 36.6 months (range 0-139 months). All patients with traumatic ruptures demonstrated an immediate sealing of bleeding. Patients with aortobronchial fistulas also demonstrated a satisfactory follow-up despite the necessity for reintervention and graft extension in 3 of 6 cases (50%). Two patients with type B dissection died due to mesenteric ischemia despite sufficient mesenteric blood flow being restored (but too late). Two suffered from neurologic complications, 1 from paraplegia and 1 from cerebral ischemia (probably embolic), 1 from penetrating ulcer, and 1 from persistent ischemia of the kidney. Five of 9 (56%) patients with symptomatic thoracic aneurysm demonstrated endoleaks during follow-up and there was an increase in the aneurysm in 1. Conclusion. Endovascular treatment is safe and effective for emergency treatment of life-threatening acute thoracic aortic syndromes. Results are encouraging, particularly for traumatic aortic ruptures. However, regular follow-up is mandatory, particularly in the other pathologies, to identify late complications of the stent-graft and to perform appropriate additional corrections as required.

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

    PubMed

    Goszcz, Halina; Szczepa?ska, ?ucja; Lech, Teresa; Groszek, Barbara

    2012-01-01

    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. PMID:23243934

  11. Flexible bronchoscopic management of benign tracheal stenosis: long term follow-up of 115 patients

    PubMed Central

    2010-01-01

    Background Management of benign tracheal stenosis (BTS) varies with the type and extent of the disease and influenced by the patient's age and general health status, hence we sought to investigate the long-term outcome of patients with BTS that underwent minimally invasive bronchoscopic treatment. Methods Patients with symptomatic BTS were treated with flexible bronchoscopy therapeutic modalities that included the following: balloon dilatation, laser photo-resection, self-expanding metal stent placement, and High-dose rate endobronchial brachytherapy used in cases of refractory stent-related granulation tissue formation. Results A total of 115 patients with BTS and various cardiac and respiratory co-morbidities with a mean age of 61 (range 40-88) were treated between January 2001 and January 2009. The underlining etiologies for BTS were post - endotracheal intubation (N = 76) post-tracheostomy (N = 30), Wegener's granulomatosis (N = 2), sarcoidosis (N = 2), amyloidosis (N = 2) and idiopathic BTS (N = 3). The modalities used were: balloon dilatation and laser treatment (N = 98). Stent was placed in 33 patients of whom 28 also underwent brachytherapy. Complications were minor and mostly included granulation tissue formation. The overall success rate was 87%. Over a median follow-up of 51 months (range 10-100 months), 30 patients (26%) died, mostly due to exacerbation of their underlying conditions. Conclusions BTS in elderly patients with co-morbidities can be safely and effectively treated by flexible bronchoscopic treatment modalities. The use of HDR brachytherapy to treat granulation tissue formation following successful airway restoration is promising. PMID:20078894

  12. Natural history of early gastric cancer: a non-concurrent, long term, follow up study

    PubMed Central

    Tsukuma, H; Oshima, A; Narahara, H; Morii, T

    2000-01-01

    BACKGROUNDControversy has arisen on the natural history of early gastric cancer (EGC). While some emphasise the effectiveness of early detection in reducing mortality from gastric cancer, others insist that EGC is a pseudo-cancer.?AIMS/PATIENTS/METHODSTo elucidate the natural history of EGC, a non-concurrent, long term, follow up study was conducted in 71patients who were diagnosed endoscopically as having EGC, which was confirmed as cancer on biopsy, but in whom surgical resection was not conducted or delayed by more than six months.?RESULTSThe natural course of EGC was observed in 56cases. Over a period of 6-137 months, 20remained in the early stage while 36progressed to the advanced stage. The proportion remaining in the early stage consistently decreased with time. Median duration of those who remained in the early stage was estimated as 44months. The cumulative five year risk for progressing to the advanced stage was 63.0%. In 38cases there was no evidence for undergoing surgical resection for gastric cancer. The cumulative five year corrected survival was estimated as 62.8% among those unresected. Hazard rate ratio for gastric cancer mortality was 0.65(p=0.34) for screening detected versus non-screening detected. Hazard rate ratio for gastric cancer mortality was 0.51,significantly lower for patients whose operations were delayed compared with those unresected.?CONCLUSIONSAlthough EGC showed a relatively long natural history in general, it progressed to the advanced stage with time and led to death from gastric cancer for the most part if left untreated.???Keywords: early gastric cancer; natural history PMID:11034575

  13. Hepatic cryosurgery for liver metastases. Long-term follow-up.

    PubMed Central

    Korpan, N N

    1997-01-01

    OBJECTIVE: The aim of this prospective study was to evaluate the applicability of cryogenic and conventional surgery in treating liver metastases (LM) with respect to intraoperative tumor reduction and survival rate. SUMMARY BACKGROUND DATA: As have been shown in animal experiments as well as in clinical investigations, cryosurgery has been used for the treatment of many benign and malignant conditions. For the first time, this report summarizes a 10-year follow-up clinical experience with cryosurgery for treatment of LM from 1983 to 1992. METHODS: One hundred twenty-three patients with LM (87 males and 36 females, a ratio 2.4:1.0; age, 41.3 +/- 12.1 years) were stratified and entered into a long-term prospective, randomized clinical trial for cryogenic surgery in group 1 (n = 63) and conventional surgical techniques in group 2 (control subjects, n = 60). Principally, a self-constructed cryogenic clamp was used for hepatic cryoresection with preliminary freezing of the margin resection by a cryosurgical system "Cryoelectronic-2" or "Cryoelectronic-4". Hepatic cryoextirpation (cryoablation) and hepatic cryodestruction were performed by means of probes of different roughly disk design from phi 5 mm to 55 mm by volume of frozen zone of 40 cm3 to 180 cm3 for approximately 7 to 32 minutes. RESULTS: In most cases in group 1 and group 2, LM were based on colorectal cancers (65% vs. 68%). The hepatic cryosurgical procedures in group 1 included cryoextirpation (29 patients, 46%), cryoresection (20 patients, 32%), and cryodestruction (14 patients, 22%) solely. Clinical and laboratory parameters showed that the curative effects were significantly higher in group 1 than in group 2. The 3-year survival rate was in group 1 and group 2 (60% vs. 51%, respectively). The 5-year survival rate was 44% in group 1 and 36% in group 2. Twelve patients (19%) versus 5 patients (8%) in group 1 and group 2, respectively, survived 10 years. The disease-free survival was in group 1 and group 2 (30% vs. 18%, respectively). During a follow-up period, recurrence in the liver was observed in 54 patients (85%) in group 1 and in 57 patients (95%) in control subjects. After a 10-year follow-up period in group 1 and group 2, 9 patients (14%) versus 3 patients (5%) remained disease free, 3 patients (4%) versus 2 patients (3%) were surviving with disease, and 51 patients (81%) versus 55 patients (92%) died. CONCLUSIONS: The data of this 10-year prospective, randomized clinical trial suggest that hepatic cryosurgery is effective in the treatment of resectable and nonresectable LM. The results show intraoperative tumor reduction (> or = 90% < or = 97%) and extended higher survival in these patients. The study indicated a 5-year and 10-year survival rate of 44% and 19% after cryosurgery, respectively. Images Figure 1. Figure 2. PMID:9065296

  14. Validation of a Multivariate Career and Educational Counseling Intervention Model Using Long-Term Follow-Up

    ERIC Educational Resources Information Center

    Greenwood, Janet I.

    2008-01-01

    In this study, the author sought to validate the effectiveness of a multivariate career and educational counseling intervention model through long-term follow-up of clients seen in private practice. Effectiveness was measured by clients' commitment to and enjoyment of their chosen career paths and the relationship of these factors to adherence to

  15. Literacy Outcomes for Students with Speech Impairment: Long-Term Follow-Up

    ERIC Educational Resources Information Center

    Leitao, Suze; Fletcher, Janet

    2004-01-01

    Background: Theoretical and empirical support now exists for the finding that many children with expressive phonological impairment experience problems in acquiring phonological awareness and early literacy skills. Few studies, however, have examined the long-term academic and literacy outcomes for this population, in particular as the

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

    PubMed

    Martinsen, Randi; Kirkevold, Marit; Sveen, Unni

    2015-02-01

    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. PMID:25565592

  17. Pediatric vocal fold immobility: natural history and the need for long-term follow-up.

    PubMed

    Jabbour, Jad; Martin, Timothy; Beste, David; Robey, Thomas

    2014-05-01

    IMPORTANCE The clinical course and outcomes of pediatric vocal fold immobility (VFI) vary widely in the literature, and follow-up in these patients varies accordingly. A better understanding of the natural history of pediatric VFI is crucial to improved management. OBJECTIVE To characterize the natural history of pediatric VFI, including symptoms and rates of resolution and surgical intervention. DESIGN, SETTING, AND PARTICIPANTS Retrospective review at an academically affiliated private pediatric otolaryngology practice in a metropolitan area of all patients seen between July 15, 2001, and September 1, 2012, with a diagnosis of complete or partial VFI. After elimination of 92 incomplete or duplicate files, 404 patient records were reviewed for demographic characteristics, etiologies, symptoms, follow-up, resolution, and interventions. Follow-up records were available for 362 patients (89.6%). MAIN OUTCOMES AND MEASURES Resolution of VFI confirmed by repeated laryngoscopy, length of follow-up, and surgical intervention rates. RESULTS Among the 404 patients, left VFI was present in 66.8%, right VFI in 7.9%, and bilateral VFI in 25.3%. Median (range) age at presentation was 2.9 (0-528.1) months. Major etiological categories included cardiac surgery in 68.8%, idiopathic immobility in 21.0%, and neurologic disease in 7.4%. At presentation, 61.4%experienced dysphonia, 54.0%respiratory symptoms, and 49.5%dysphagia. Tracheotomy was performed in 25.7%and gastrostomy in 40.8%. Median (range) duration of follow-up among the 89.6%of patients with follow-up was 17.2 (0.2-173.5) months. Resolution evidenced by laryngoscopy was found in 28.0%, with a median (range) time to resolution of 4.3 (0.4-38.7) months. In patients without laryngoscopic resolution, median follow-up was 26.0 months, and 28.9% reported symptomatic resolution. CONCLUSIONS AND RELEVANCE The natural history of pediatric VFI involves substantial morbidity, with lasting symptoms and considerable rates of surgical intervention. In this large database, the majority of patients did not experience resolution. This suggests a need for more regimented follow-up in these patients, a recommendation for which is proposed here. PMID:24626342

  18. Long-Term Follow-up Study of Children Developmentally Retarded by Early Environmental Deprivation.

    ERIC Educational Resources Information Center

    Fujinaga, Tamotsu; And Others

    This paper reports on a 14-year follow-up study of two developmentally retarded Japanese children, a brother and sister, who had been kept shut up in a small shack before being rescued (at ages 5 and 6 respectively). Following birth they consistently suffered malnutrition, maternal deprivation, social isolation from adults, language deprivation,…

  19. Long-term follow-up after iodine-131 treatment for Plummer's disease (autonomous goiter)

    SciTech Connect

    Wiener, J.D.

    1985-04-01

    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.

  20. Selective peripheral denervation for cervical dystonia: long-term follow-up

    PubMed Central

    Bergenheim, A Tommy; Nordh, Erik; Larsson, Eva; Hariz, Marwan I

    2015-01-01

    Objective 61 procedures with selective peripheral denervation for cervical dystonia were retrospectively analysed concerning surgical results, pain, quality of life (QoL) and recurrences. Methods The patients were assessed with the Tsui torticollis scale, Visual Analogue Scale (VAS) for pain and Fugl-Meyer scale for QoL. Evaluations were performed preoperatively, early postoperatively, at 6?months, then at a mean of 42 (13165) months. All patients underwent electromyogram at baseline, which was repeated in cases who presented with recurrence of symptoms after surgery. Results Six months of follow-up was available for 55 (90%) of the procedures and late follow-up for 34 (56%). The mean score of the Tsui scale was 10 preoperatively. It improved to 4.5 (p<0.001) at 6?months, and 5.3 (p<0.001) at late follow-up. VAS for pain improved from 6.5 preoperatively to 4.2 (p<0.001) at 6?months and 4 (p<0.01) at late follow-up. The Fugl-Meyer score for QoL improved from 43.3 to 46.6 (p<0.05) at 6?months, and to 51.1 (p<0.05) at late follow-up. Major reinnervation and/or change in the dystonic pattern occurred following 29% of the procedures, and led in 26% of patients to reoperation with either additional denervation or pallidal stimulation. Conclusions Selective peripheral denervation remains a surgical option in the treatment of cervical dystonia when conservative measures fail. Although the majority of patients experience a significant relief of symptoms, there is a substantial risk of reinnervation and/or change in the pattern of the cervical dystonia. PMID:25362089

  1. Desmoplastic fibroma in the proximal femur: A case report with long-term follow-up

    PubMed Central

    GONG, YU-BAO; QU, LI-MEI; QI, XIN; LIU, JIAN-GUO

    2015-01-01

    Desmoplastic fibroma of the bone is an extremely rare primary benign tumor. The present study reports a case of desmoplastic fibroma of the bone with the longest published follow-up. A 21-year-old female presented to The First Hospital of Jilin University (Changchun, Jilin, China) with thigh pain. Radiography demonstrated a lytic expansile lesion in the proximal femur. Curettage was performed, followed by use of an allogeneic graft. One month later, the patient suffered a pathological fracture and was treated with an open reduction and internal fixation. There was no recurrence of the tumor over a 28-year follow-up period. In conclusion, desmoplastic fibroma in the proximal femur is rare and an intralesional resection is strongly recommended to prevent recurrence. The disease may be misdiagnosed as a bone cyst, so the diagnosis should be confirmed with a histological examination. PMID:26622872

  2. Long-term follow-up of children conceived through assisted reproductive technology*

    PubMed Central

    Lu, Yue-hong; Wang, Ning; Jin, Fan

    2013-01-01

    Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks compared to naturally conceived (NC) children. In recent years there has been a lot of work in this field. This review will summarize what is known about the health of ART-conceived children, encompassing neonatal outcomes, birth defects, growth and gonadal developments, physical health, neurological and neurodevelopmental outcomes, psychosocial developments, risk for cancer, and epigenetic abnormalities. Most of the children conceived after ART are normal. However, there is increasing evidence that ART-conceived children are at higher risk of poor perinatal outcome, birth defects, and epigenetic disorders, and the mechanism(s) leading to these changes have not been elucidated. Continuous follow-up of children after ART is of great importance as they progress through adolescence into adulthood, and new ART techniques are constantly being introduced. PMID:23645173

  3. Long-term follow-up of successful treatment for dandy-walker syndrome (DWS)

    PubMed Central

    Lin, Jun; Liang, Guobiao; Liang, Yong; Kou, Yun

    2015-01-01

    Background: Various managements of Dandy-Walker syndrome (DWS) from open excision of the cysts to CSF diversion have been reported. However, optimal treatment for DWS remains elusive. Methods: Cyst fenestration was employed firstly, but failed 15 days after the surgery. Then a ventriculoperitoneal (VP) shunt was inserted and the patient discharged from hospital 13 days after the second surgery. During the 12-year follow-up, CT scanning, MRI, and X-radiation were performed. Results: CT scanning showed that the size of ventricular system gradually returned to normal. MRI revealed similar changes of the ventricular system, and further revealed the development of supratentorial brain. The results of X-radiation during the follow-up years showed that the peritoneal end of the shunt might be already out of the abdominal cavity. Slow refilling of the shunt valve may suggest that the shunt could be probably not functional. Conclusion: The treatment of the patient was successfully, and the abnormal cerebral ventricle system gradually recovered during the 12-year follow-up. Because the patient might be probably independent on the shunt, further choice of the shunt removal should be thinking thoroughly, considering both safety and quality of life for the patient.

  4. Long-Term Follow-Up of Adults with Gender Identity Disorder.

    PubMed

    Ruppin, Ulrike; Pfäfflin, Friedemann

    2015-07-01

    The aim of this study was to re-examine individuals with gender identity disorder after as long a period of time as possible. To meet the inclusion criterion, the legal recognition of participants' gender change via a legal name change had to date back at least 10 years. The sample comprised 71 participants (35 MtF and 36 FtM). The follow-up period was 10-24 years with a mean of 13.8 years (SD = 2.78). Instruments included a combination of qualitative and quantitative methods: Clinical interviews were conducted with the participants, and they completed a follow-up questionnaire as well as several standardized questionnaires they had already filled in when they first made contact with the clinic. Positive and desired changes were determined by all of the instruments: Participants reported high degrees of well-being and a good social integration. Very few participants were unemployed, most of them had a steady relationship, and they were also satisfied with their relationships with family and friends. Their overall evaluation of the treatment process for sex reassignment and its effectiveness in reducing gender dysphoria was positive. Regarding the results of the standardized questionnaires, participants showed significantly fewer psychological problems and interpersonal difficulties as well as a strongly increased life satisfaction at follow-up than at the time of the initial consultation. Despite these positive results, the treatment of transsexualism is far from being perfect. PMID:25690443

  5. Long-term follow-up of former world-class swimmers: evaluation of cardiovascular function.

    PubMed

    Knackstedt, Christian; Schmidt, Klaus; Syrocki, Lukas; Lang, Andreas; Bjarnason-Wehrens, Birna; Hildebrandt, Ursula; Predel, Hans-Georg

    2015-05-01

    There is some evidence that long-term high-intensity endurance training might be associated with deterioration in cardiac function and might impose a potential risk for cardiovascular events. Thus, the intention was to retrospectively evaluate the cardiac status in former endurance athletes, particularly right ventricular (RV) dimension and function, to reveal potential cardiac damage. A group of 12 former world-class swimmers (45 1.5 years) was examined 24.9 4.3 years after cessation of high-intensity endurance training. They underwent history taking, physical examination, ECG, exercise testing and echocardiography. Furthermore, functional and echocardiography data that were also available from former evaluations were included in the analysis. There was a significant decline in exercise capacity. LV function was normal with a decrease in septal thickness to 9.1 1.3 (p < 0.05) and LV diastolic diameter to 48.9 5.6 (p < 0.05). Still, there was a remaining septal hypertrophy. RV function was 55.3 4.2% and there were normal RV dimensions adjusted for body surface area. 25 years after the cessation of endurance training there was a normal RV and LV function with a normalization of almost all diameters, still there was a mild LV hypertrophy in some athletes. Consequently, no relevant long-term cardiac remodeling after intensive endurance training was depicted in this group of athletes. PMID:24510255

  6. The long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease in Vietnamese children.

    PubMed

    Liem, N T; Hau, B D; Thu, N X

    1995-04-01

    The aim of this prospective study was to evaluate the long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease in Vietnamese children. The surgical intervention was performed in three stages. Swenson's operation was performed by the same surgical team. Hirschsprung's disease was confirmed by an operative rectal biopsy. Regular out-patient attendances were made for follow-up. From January 1987 to January 1990, 69 patients including 61 boys and eight girls underwent Swenson's operation at a mean age of two years and five months (range from seven months to 14 years). There were two postoperative deaths during first 48 hours due to sepsis and two other late deaths due to severe enterocolitis (four months and six months after closure of colostomy respectively). Complications such as anastomotic leakage, anastomotic stenosis, perianal abcess, pelvic abcess did not occur. A follow-up result was obtained in 54 of 65 survivors (83%) with follow-up ranging from two to five years (mean: three years and six months). 51 of 54 children (94%) had a normal evacuation. Constipation persisted in three children (6%). Fecal soiling occurred in four children (8%) and stress urinary incontinence in one child (2%). All boys (47 children) had a normal erection. 53 patients (98%) had a normal weight growth, whereas 48 patients (89%) had a normal height growth. In conclusion, the long-term follow-up result of Swenson's operation in the treatment of Hirschsprung's disease was satisfactory. PMID:7612579

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

    PubMed Central

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

    2014-01-01

    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

  8. Atrioventricular septal defect: From embryonic development to long-term follow-up.

    PubMed

    Calkoen, Emmeline E; Hazekamp, Mark G; Blom, Nico A; Elders, Bernadette B L J; Gittenberger-de Groot, Adriana C; Haak, Monique C; Bartelings, Margot M; Roest, Arno A W; Jongbloed, Monique R M

    2016-01-01

    Atrioventricular septal defect (AVSD) covers a spectrum of heart anomalies with a common atrioventricular connection and has an incidence of 4-5.3 per 10.000 live births. About half of the AVSDs occur in patient with Down syndrome. This review provides a bench to bedside overview of AVSD. Developmental aspects, nomenclature, anatomy, and classification of AVSD are discussed. Furthermore an overview of genetic and maternal risk factors for AVSD is provided, and available literature on (fetal) diagnosis, surgical techniques and follow-up is presented. Special attention is given to differences in developmental, anatomical and prognostic factors of AVSD between non-syndromic and Down syndrome patients. PMID:26476030

  9. Long-term follow-up after purine analogue therapy in hairy cell leukaemia.

    PubMed

    Else, Monica; Dearden, Claire E; Catovsky, Daniel

    2015-12-01

    Since 2006 when we last reviewed the literature concerning the use of purine analogues in hairy cell leukaemia (HCL), results from several new and updated series have been published. Here we examine these reports and consider their implications for patient management. The two purine analogues pentostatin and cladribine remain the first-line treatments of choice for all patients with HCL. Although they have not been compared in randomised trials, they appear to be equally effective. A complete response is important for the long-term outcome and we look at how best this can be achieved. Evidence is emerging which supports the use of either purine analogue plus an anti-CD20 monoclonal antibody after relapse, though questions remain concerning the scheduling of the monoclonal antibody. Patients refractory to the purine analogues may require alternative agents. PMID:26614900

  10. Long-Term Follow-Up of Allogeneic Hematopoietic Stem Cell Transplantation for Solid Cancer.

    PubMed

    Omazic, Brigitta; Remberger, Mats; Barkholt, Lisbeth; Söderdahl, Gunnar; Potácová, Zuzana; Wersäll, Peter; Ericzon, Bo-Göran; Mattsson, Jonas; Ringdén, Olle

    2016-04-01

    We wanted to determine whether allogeneic hematopoietic stem cell transplantation (HSCT) may result in long-term survival in patients with solid cancer. HSCT was performed in 61 patients with solid cancer: metastatic renal carcinoma (n = 22), cholangiocarcinoma (n = 17), colon carcinoma (n = 15), prostate cancer (n = 3), pancreatic adenocarcinoma (n = 3), or breast cancer (n = 1). Liver transplantation was performed for tumor debulking in 18 patients. Median age was 56 years (range, 28 to 77). Donors were either HLA-identical siblings (n = 29) or unrelated (n = 32). Conditioning was nonmyeloablative (n = 23), reduced (n = 36), or myeloablative (n = 2). Graft failure occurred in 13 patients (21%). The cumulative incidence of acute graft-versus-host disease (GVHD) of grades II to IV was 47%, and that of chronic GVHD was 32%. Treatment-related mortality was 21%. At 5 years cancer-related mortality was 63%. Currently, 6 patients are alive, 2 with renal cell carcinoma, 1 with cholangiocarcinoma, and 3 with pancreatic carcinoma. Eight-year survival was 12%. Risk factors for mortality were nonmyeloablative conditioning (HR, 2.95; P < .001), absence of chronic GVHD (HR, 3.57; P < .001), acute GVHD of grades II to IV (HR, 2.90; P = .002), and HLA-identical transplant (HR, 5.00; P = .03). With none of these risk factors, survival at 6 years was 50% (n = 6). Long-term survival can be achieved in some patients with solid cancer after HSCT. PMID:26740375

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

    PubMed Central

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

    1984-01-01

    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

  12. Long term follow up of two independent patients with Schinzel-Giedion carrying SETBP1 mutations.

    PubMed

    Herenger, Yvan; Stoetzel, Corinne; Schaefer, Elise; Scheidecker, Sophie; Manire, Marie-Ccile; Pelletier, Valrie; Alembik, Yves; Christmann, Dominique; Clavert, Jean-Michel; Terzic, Joelle; Fischbach, Michel; De Saint Martin, Anne; Dollfus, Hlne

    2015-09-01

    Schinzel-Giedion syndrome (SGS, MIM #269150) is a rare syndrome characterized by severe intellectual disability, typical facial gestalt, hypertrichosis and multiple congenital malformations including skeletal, genitourinary, renal and cardiac abnormalities. The prognosis of SGS is very severe and death occurs generally within a few years after birth. In 2002, we reported 2 children with SGS with a follow-up of 3 years. They presented a very similar and particular phenotype associating distinctive facial gestalt, severe developmental delay, megacalycosis, progressive neurodegeneration, alacrimi, corneal hypoesthesia and deafness. Furthermore, temporal bone imaging revealed a tuning-fork malformation of the stapes. In 2010, Hoischen etal. identified in SGS patients pathogenic heterozygous de novo mutations in SETBP1. We sequenced SETBP1 in our patients and found the previously reported c.2608G>A (p.Gly870Ser) mutation in both children. Since 2002, one of our patients died at 6 years old and the other patient is still alive at 15 years old. Such a life expectancy has never been reported so far. We describe herein the follow up of the 2 children during 6 and 15 years respectively. This article gives further evidence of the implication of SETBP1 as the major gene of SGS, and reports the previously unseen natural evolution of the disease in a 15 years old patient. PMID:26188272

  13. Revascularisation surgery and long-term follow-up in juvenile Moyamoya syndrome: a retrospective analysis.

    PubMed

    Ulrich, Peter T; Januschek, Elke

    2011-01-01

    Due to its low incidence in Western countries, physician awareness of juvenile Moyamoya disease should be improved. The benefits of revascularisation surgery have only been proven in the juvenile version of the disease. Therefore, early revascularisation may prevent irreversible ischaemic deficits and rapidly progressive mental retardation in young patients.From 1984 to 2009, a total of 19 children (mean age 8 years, range 1-18 years, female predominance 2:1, 17/19 European white patients, 2/19 Asian origin of at least one parent) were treated for juvenile Moyamoya disease by surgical revascularisation. The leading symptoms were epilepsy (17/19), followed by transient ischaemic attacks (TIA) or prolonged reversible ischaemic neurologic deficits (PRIND) (15/19) and mental retardation (11/19). Angiography showed a clear neovascularisation in the majority of patients after indirect bypasses after 6 months. The mean follow-up was 17 years and 3 months (maximum 25 years, minimum 2 years). Two patients were lost to follow-up. In accordance with the literature, ischaemic symptoms were eliminated by the revascularisation operation in 94% of our patients with a very low rate of complications, and no lasting morbidity and mortality in any of the patients.Early diagnosis and surgical treatment seem to potentiate the benefits independently of the type of revascularisation procedure. PMID:21691986

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

    PubMed Central

    Gasparini, Giulio; Boniello, Roberto; Marianetti, Tito Matteo; Foresta, Enrico; Torroni, Andrea; Longo, Giuliana; Azzuni, Camillo; Pelo, Sandro

    2014-01-01

    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. PMID:24949422

  15. Long-term follow-up of behavioral treatment for obesity: patterns of weight regain among men and women.

    PubMed

    Kramer, F M; Jeffery, R W; Forster, J L; Snell, M K

    1989-01-01

    Maintenance of weight loss continues to be a critical concern in behavioral treatment programs. Problems with the acquisition and/or application of behavioral skills are a likely contributor to relapse. However, biological models, especially the hypothesis of a body weight setpoint, are being offered increasingly as alternative explanations for maintenance failure. Within the context of these sometimes opposing viewpoints the present study describes long-term weight outcomes for 114 men and 38 women assessed annually for 4 or 5 years following completion of a 15 week behavioral weight loss program. Although significant mean weight loss was evident at long-term follow-up, a negatively accelerating pattern of weight regain was the predominant outcome. Less than 3 percent of the subjects were at or below their posttreatment weight on all follow-up visits. Consistent sex differences were found, with women having better weight loss maintenance than men. Implications and potential future directions are discussed. PMID:2663745

  16. Social Support, Self-Efficacy for Decision Making, and Follow-up Care Use in Long-term Cancer Survivors

    PubMed Central

    Forsythe, Laura P.; Alfano, Catherine M.; Kent, Erin E.; Weaver, Kathryn E.; Bellizzi, Keith; Arora, Neeraj; Aziz, Noreen; Keel, Gretchen; Rowland, Julia H.

    2014-01-01

    Objective Cancer survivors play an important role in coordinating their follow-up care and making treatment-related decisions. Little is known about how modifiable factors like social support are associated with active participation in follow-up care. This study tests associations between social support, cancer-related follow-up care use, and self-efficacy for participation in decision making related to follow-up care (SEDM). We also identified sociodemographic and clinical factors associated with social support among long-term survivors. Methods The FOllow-up Care Use among Survivors (FOCUS) study is a cross-sectional, population based survey of breast, prostate, colon, and gynecologic cancer survivors (n=1522) 4 to 14 years post-diagnosis. Multivariable regression models were used to test associations between perceived social support (tangible and emotional/informational support modeled separately), follow-up care use (past two years), and SEDM, as well as to identify factors associated with perceived support. Results Neither support type was associated with follow-up care use (all p>0.05), although marital status was uniquely, positively associated with follow-up care use (p<0.05). Both tangible support (B for a standard deviation increase (SE)=9.75(3.15), p<0.05) and emotional/informational support (B(SE)=12.61(3.05), p<0.001) were modestly associated with SEDM. Being married, having adequate financial resources, history of recurrence, and better perceived health status were associated with higher perceived tangible and emotional support (all p<0.05). Conclusions While perceived social support may facilitate survivor efficacy for participation in decision making during cancer follow-up care, other factors, including marital satisfaction, appear to influence follow-up care use. Marital status and social support may be important factors to consider in survivorship care planning. PMID:24481884

  17. Hand and distal forearm replantation--immediate and long-term follow-up.

    PubMed

    Hegazi, M M

    2000-12-01

    Six cases of traumatic amputation of hand and/or forearm were treated by replantation over the last 20 years at this hospital. Reattachment was successful in all of the cases. Success was largely due to proper selection of cases, meticulous technique and availability of skilled manpower and technological help. Although survival of replanted part was achieved in all cases, functional success was not uniform as revealed by subjective and objective criteria used during evaluation and follow-up. Tamai method of scoring the functional aspect of a replanted part not only indicates the functional ability of a replanted part but also creates uniformity in data collection for easier comparison with other reported series. PMID:11301505

  18. Stapled versus excision haemorrhoidectomy: long-term follow up of a randomised controlled trial.

    PubMed

    Smyth, Edward F; Baker, Richard P; Wilken, Bert J; Hartley, John E; White, Tim J; Monson, John R T

    2003-04-26

    Advantages of the stapling procedure for haemorrhoids include reduced postoperative pain and shortened convalescence; however, there are few data with respect to functional and symptomatic outcome. At a dedicated clinic, we reviewed patients between Dec, 2001, and March, 2002, who had taken part in a randomised controlled trial undertaken at the unit in 1999, which compared outcomes after open or stapled haemorrhoidectomy. We noted the presence or absence of haemorrhoid specific symptoms, and assessed overall satisfaction, continence, and quality of life. Rigid sigmoidoscopy and an anorectal examination were also used to examine symptomatic recurrence and disease activity. At minimum follow-up of 33 months since surgery, both techniques seem to be equally effective. PMID:12727401

  19. A case report of acute severe paraquat poisoning and long-term follow-up

    PubMed Central

    YU, GUANGCAI; KAN, BAOTIAN; JIAN, XIANGDONG; WANG, JIERU; SUN, JING; SONG, CHENGZHEN

    2014-01-01

    In the present study, the successful management of severe paraquat (PQ) poisoning with multiple organ dysfunction syndrome is described. A 42-year-old female ingested >100 ml PQ (20% weight/volume) in an attempted suicide. After 22 h the patient was admitted to hospital with serious liver, kidney and lung damage. Comprehensive therapy that maximized poison elimination was administered, along with appropriate glucocorticoids and medication for anticoagulation and protection of the liver and kidney. The patient was successfully treated and recovered after 40 days. However, pulmonary damage was aggravated when the glucocorticoid treatment was stopped after 2 months; the lungs recovered again following systematic therapy. Subsequent to a 8-month follow-up, the patient was able to look after herself in her daily life. To the best of our knowledge, successful treatment following severe PQ poisoning is rare. PMID:24944627

  20. Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: a follow-up study.

    PubMed

    DiMauro, Jennifer; Domingues, Janine; Fernandez, Geraldine; Tolin, David F

    2013-02-01

    The short-term efficacy and effectiveness of Cognitive-Behavioral Therapy (CBT) for treating anxiety disorders in adults has been well established by a multitude of clinical studies and well-controlled randomized trials. However, though the long-term efficacy of CBT as a treatment modality is fairly well established, the degree of its long-term effectiveness has yet to be fully evaluated. Thus, the present study sought to assess both the immediate and long-term effectiveness of individually-administered CBT for the treatment of anxiety disorders in an outpatient psychological clinic. Individuals with a primary diagnosis of Panic Disorder, Social Phobia, Posttraumatic Stress Disorder, Generalized Anxiety Disorder, or Obsessive-Compulsive Disorder who had received 3 or more sessions of CBT were assessed for symptom severity and improvement prior to initiating treatment, at posttreatment, and at one-year follow-up. Symptom severity and improvement ratings were used to categorize patients as "responders" or "remitters" at posttreatment, and "maintained responders" or "maintained remitters" at follow-up. Findings demonstrated that posttreatment success as responder and remitter was significantly maintained at one-year follow-up. Additionally, pre- and posttreatment severity and posttreatment improvement scores were also predictive of maintenance. Furthermore, effect sizes were used to compare the effectiveness of CBT in the present clinical sample to research treatment outcomes demonstrated by previous efficacy studies. PMID:23262115

  1. [The long-term follow-up of patients with a congenital diaphragmatic hernia: review of the literature].

    PubMed

    Pennaforte, T; Rakza, T; Fily, A; Mur, S; Diouta, L; Sfeir, R; Aubry, E; Bonnevalle, M; Storme, L

    2013-09-01

    The increased survival rate reached in infants with congenital diaphragmatic hernia (CDH) has shown a concomitant increase in late morbidity. Many complications including pulmonary damage, cardiovascular disease, gastro-intestinal disease, failure to thrive, neurocognitive defects and musculoskeletal abnormalities have been described. Long-term pulmonary morbidity in CDH consists of obstructive and restrictive lung function impairments due to altered lung structure and prolonged ventilatory support. Long-term consequences of pulmonary hypertension are unknown. Gastro-esophageal reflux disease (GERD) is also an important contributor to overall morbidity. Failure to thrive may be caused by GERD, insufficient intake due to oral aversion and increased caloric requirements due to pulmonary morbidity. Neurological outcome is determined by an increased risk of perinatal and neonatal hypoxemia in the first days of life of CDH patients. Many studies have addressed the substantial impact of the health problems described above, on the overall well-being of CDH patients, but only a few studies focus on the health-related quality of life. Considering the scattered data indicating substantial morbidity in long-term survivors of CDH, follow-up studies that systematically assess long-term sequelae are needed. Based on such studies, a more focused approach for routine multidisciplinary follow-up programs could be established. It is the goal of the French Collaborative Network to promote exchange of knowledge, future research and development of treatment protocols. PMID:23992832

  2. Long term follow-up of intralesional laser photocoagulation (ILP) for hemangioma patients

    PubMed Central

    Chang, Cheng-Jen

    2011-01-01

    Background and Objectives: Hemangiomas remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional photocoagulation (ILP) for treatment. The objective of our study is to review the long term results of a large series of hemangiomas in patients treated by ILP. Materials (Subjects) and Methods: A retrospective review of 684 hemangiomas in patients were treated by ILP with an Nd:YAG (neodymium-yttrium-aluminium-garnet) (1064 nm) laser over a period of 10 years (January 1996January 2005). Patients ages ranged from one month to 11 years 5 months (mean, 1 year 10 months). The patient group consisted of 474 females and 210 males. Results: Patients were treated with an Nd:YAG laser delivered through a 600 m optical fiber. Laser power was set at 7 to 15 watts (W) and delivered with pulse duration of 7 to 15 seconds (s). The results showed 603 (88.6%) patients had more than 50% reduction of the volume in hemangiomas at 3 months after one treatment; and 663 (96.9%) patients had more than 50% reduction of the volume at 3 months after two treatments. Patients who had continuous ILP achieved excellent results. Conclusions: Postoperative complications have been related to photocoagulation that has been delivered too extensively or superficially, with resultant ulceration, infection, bleeding, and scarring. These complications can be avoided if this potential for harm is kept in mind. PMID:24155535

  3. The long-term course of autistic disorders: update on follow-up studies.

    PubMed

    Nordin, V; Gillberg, C

    1998-02-01

    The majority of children with autism show deviance and socially or psychiatrically handicapping conditions throughout life. Only a small proportion of those with classical childhood autism lead independent adult lives. Others, particularly those with 'high-functioning' autism and so-called Asperger syndrome will improve enough to live an independent adult life. The level of mental retardation and other comorbid conditions (such as medical syndromes and other neuropsychiatric disorders, including epilepsy) is important in predicting outcome. An IQ below 50 around school age predicts severe restriction of social and adaptive functioning in adult life. The absence of communicative speech at 5-6 years of age is indicative of a poorer long-term overall outcome. There is a clear co-variation between IQ and level of communication, but probably there is some prognostic factor in language development apart from this. Measures of flexibility and cognitive shifting abilities tend to be good predictors of social outcome in a few studies. There is a continued need for prospective, longitudinal studies of children with autism spectrum disorders, particularly in Asperger syndrome. The role of interventions of various kinds needs to be addressed in such studies. PMID:9517902

  4. Childhood to adult transition and long-term follow-up after blood and marrow transplantation.

    PubMed

    Cupit, M C; Duncan, C; Savani, B N; Hashmi, S K

    2016-02-01

    The use of hematopoietic stem cell transplantation or blood and marrow transplantation (BMT) is on the increase worldwide. With BMT's increasing utilization and increasing success, the number of BMT survivors in the United States alone is expected to surpass 500?000 by the year 2030. BMT survivors are susceptible to a host of long-term side effects and complications. The pediatric and adolescent and young adult (AYA) populations comprise an increasing proportion of BMT survivors. Though these populations are both at risk of a specific set of sequelae and faced with the additional challenge of transitioning to adult care, no previous literature has addressed their specific challenges. In this review, we illustrate with clinical vignettes the need for focused and specific survivorship clinics for pediatric/AYA BMT survivors. We then focus on the following areas pertaining to pediatric BMT survivorship and care: (1) psychological health, (2) neurocognition, (3) endocrine health, (4) infertility resources, (5) issues in transition from pediatric to adult clinicians, (6) preventative services and (7) cost of care issues. PMID:26642340

  5. Long-Term Ultrasonography Follow-Up of Thyroid Colloid Cysts at the Health Center: A Single-Center Study

    PubMed Central

    Rho, Myung Ho; Kim, Dong Wook

    2015-01-01

    Objective. No previous study has employed long-term follow-up ultrasonography (US) examinations for evaluating thyroid colloid cysts (TCCs) in the general population. This study aimed to assess the interval changes of TCCs at the health center by evaluating long-term US follow-up examinations. Methods. For evaluation of the thyroid gland at our health center from 2006 to 2010, 3692 individuals underwent 4 or more thyroid US examinations at an interval of 1 year or 2 years. We assessed the interval changes of TCCs ≥ 5 mm on US follow-up examinations. Results. Of the 3692 subjects, only 115 (3.1%) showed TCCs ≥ 5 mm on one or more thyroid US examinations. The interval changes in TCCs, as shown by the thyroid US examinations performed during the study period, were classified as follows: no interval change (n = 60), gradual increase (n = 37), gradual decrease (n = 6), positive fluctuation (n = 10), negative fluctuation (n = 0), and disappearance (n = 2). No subject reported any relevant symptom pertaining to TCCs. Conclusions. Overall, follow-up US examinations showed various interval changes in TCCs, but a majority of TCCs showed no interval change or a gradual increase in size. PMID:26579197

  6. Long-term follow-up of salvage radiotherapy in Hodgkin's lymphoma after chemotherapy failure

    SciTech Connect

    Campbell, Belinda; Wirth, Andrew . E-mail: andrew.wirth@petermac.org; Milner, Alvin; Di Iulio, Juliana; MacManus, Michael; Ryan, Gail M.

    2005-12-01

    Purpose: To evaluate the long-term results of salvage radiotherapy (SRT) for Hodgkin's lymphoma after chemotherapy failure. Methods and Materials: We reviewed 81 patients undergoing SRT for persistent or recurrent Hodgkin's lymphoma after chemotherapy; 19 also received conventional-dose salvage chemotherapy. Results: At SRT, the median patient age was 31 years. Of the 81 patients, 81% had Stage I-II, 25.9% had B symptoms, 14.8% had bulky disease, and 7.4% had extranodal disease. A less than a complete response (CR) to the last chemotherapy regimen occurred in 47%. SRT was generally limited to one side of the diaphragm, and the median dose was 36 Gy. After SRT, 75% of patients achieved a CR, with 82% retaining durable in-field control. In-field failure was associated with less than a CR to the last chemotherapy regimen (p = 0.0287). Most failures were at distant sites, with 60% in previously involved sites. The 10-year freedom from treatment failure and overall survival rates were 32.8% and 45.7%, respectively. The adverse prognostic factors for freedom from treatment failure were age >50 years (p < 0.001), B symptoms (p < 0.001), extranodal disease (p = 0.012), and less than a CR to the last chemotherapy regimen (p = 0.001). The adverse prognostic factors for overall survival were male gender (p = 0.034), age >50 years (p < 0.001), B symptoms (p = 0.002), and less than a CR to the last chemotherapy regimen (p = 0.002). Favorable cohorts had a 10-year freedom from treatment failure rate of 51% and overall survival rate of 92%. Conclusions: Salvage radiotherapy is effective for selected patients with Hodgkin's lymphoma after chemotherapy failure and should be considered for incorporation into salvage programs.

  7. Long-term follow-up of manipulative treatment in a horse with back problems.

    PubMed

    Faber, M J; van Weeren, P R; Schepers, M; Barneveld, A

    2003-06-01

    In order to objectively quantify the effect of manipulation on back-related locomotion anomalies in the horse, a recently developed kinematic measuring technique for the objective quantification of thoracolumbar motion in the horse was applied in a dressage horse that was suffering from a back problem. In this horse, clinically, a right-convex bending (scoliosis) from the 10th thoracic vertebra to the second lumbar vertebra was diagnosed. As a result, there was a marked asymmetric movement of the thoracolumbar spine. Functionally, there was severe loss of performance. Thoracolumbar motion was measured in terms of ventrodorsal flexion, lateral flexion, and axial rotation using an automated gait analysis system. Measurements were repeated before and 2 days after treatment, before the second treatment 3 weeks later, and at 4 weeks and 8 months after the second treatment to assess long-term effect. At the same time, performance of the horse was assessed subjectively by the trainer as well. Symmetry of movement improved dramatically after the first treatment. After this, there was a slight decrease in symmetry, but 8 months after the last treatment the symmetry indexes for the various joints were still considerably better than during the first (pre-treatment) measuring session. Subjectively, the trainer did not notice improvement until after measurement session 4. Between sessions 4 and 5 (at 4 weeks and 8 months after the second treatment) there was a change of trainer. The new trainer did not report any back problem, and succeeded in bringing the horse back to its former level in competition. It is concluded that manipulation had a measurable influence on the kinematics of the thoracolumbar spine. However, it is recognized that an improvement in symmetry of motion is not equivalent to clinical improvement and that other measures, such as changes in management, may be more decisive. PMID:14567510

  8. Long-term follow-up of nephrotoxicity in rats administered both melamine and cyanuric acid

    PubMed Central

    2014-01-01

    Background Melamine was recently identified as a risk factor for renal calculi following the milk powder contamination in China. However, the long-term natural history of melamine exposure and its renal effects remain unknown. We evaluated renal function and other adverse health effects using a rat model administered melamine and cyanuric aid, considering age and sex. Methods Twelve male F334/N rats each of ages 6, 10, and 26weeks (N?=?36) were equally assigned to Group M + C or controls. Group M + C rats were administered 12mg??kg-1??day-1 of melamine and cyanuric acid for 28days. Serum and urine samples and kidney sections were evaluated on day 28. Six-week-old male and female F344/N rats were administered 12mg of melamine and cyanuric acid for 28days. Body weights were measured weekly; on days 0, 28, 90, and 180 after the 28-day period of melamine and cyanuric acid administration, serum samples and kidney sections were obtained. Results Although the control group had no crystals, 6-week-old Group M + C rats had more crystals compared to the 10- and 26-week old Group M + C rats. Male rats also had significantly more crystals than females of the same age. Male rats were affected to a greater extent than females. Conclusion Younger rats experienced more severe renal failure and greater renal crystal deposition following melamine and cyanuric acid administration. However, after melamine and cyanuric acid administration cessation, crystal deposition and renal failure improved and did not cause growth arrest. Therefore, early diagnosis of melamine-associated calculi is critical. PMID:24507656

  9. Gnathic osteoblastoma: clinicopathologic review of seven cases with long-term follow-up.

    PubMed

    Rawal, Yeshwant B; Angiero, Francesca; Allen, Carl M; Kalmar, John R; Sedghizadeh, Parish P; Steinhilber, Andrew M

    2006-02-01

    The clinical, radiographic and histopathologic features of seven cases of osteoblastoma of the jaw bones were analyzed. The mandible was involved in six cases and a periosteal presentation of the tumor was noted in three cases. Six tumors were symptomatic with pain being the common presentation. The radiographic appearance of the intraosseous tumors varied from well-defined radiolucencies to poorly-defined mixed lesions. A small periosteal tumor was undetectable radiographically. Histopathologically, the tumors exhibited variation in woven bone formation, osteoblastic rimming, lesional maturation as well as interaction of the tumor with surrounding host tissue. Intraosseous tumors were managed with aggressive surgical curettage and periosteal tumors were resected and the underlying bone was curetted down to normal host bone. Follow-up of cases ranged from 2 years to 18 years with no recorded recurrences. Gnathic osteoblastomas offer a unique diagnostic challenge as they resemble other tumors of the jaws including the cementoblastoma, cemento-ossifying fibroma, cemento-osseous dysplasia and most importantly the gnathic osteosarcoma. We stress on the need to correlate the histopathologic findings with clinical and radiographic features to reach an accurate diagnosis. PMID:16129654

  10. Long-term follow-up of patients with silent ischemia during exercise radionuclide angiography

    SciTech Connect

    Breitenbuecher, A.P.; Pfisterer, M.; Hoffmann, A.; Burckhardt, D. )

    1990-04-01

    A retrospective 5 year follow-up study was performed in 140 patients with unequivocal ischemia during exercise radionuclide angiography (greater than or equal to 10% decrease in left ventricular ejection fraction or greater than or equal to 5% decrease in ejection fraction together with a distinct regional wall motion abnormality). In 84 patients (60%), ischemia during radionuclide angiography was silent (silent ischemia group), whereas 56 patients experienced angina during the test (symptomatic group). Work load and antianginal medication were similar in both groups. Critical cardiac events (unstable angina, myocardial infarction, cardiac death) occurred in 27% of patients in the silent ischemia group and 16% of those in the symptomatic group (p = NS); however, myocardial infarction or death was more frequent in patients with silent ischemia (22% versus 9%; p less than 0.05). If there was additional exercise-induced ST segment depression, the rate of critical events was further increased (p less than 0.05). The difference in critical cardiac events seemed to be influenced by the higher incidence of revascularization procedures in symptomatic patients, whereas medical therapy had no similar effect. Thus, these findings suggest that patients with documented severe ischemia should undergo left heart catheterization and revascularization irrespective of symptoms to improve their prognosis.

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

    PubMed

    Rintala, Risto J

    2016-04-01

    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. PMID:26969236

  12. Percutaneous Vertebroplasty in Multiple Myeloma: Prospective Long-Term Follow-Up in 106 Consecutive Patients

    SciTech Connect

    Anselmetti, Giovanni Carlo Manca, Antonio; Montemurro, Filippo; Hirsch, Joshua; Chiara, Gabriele; Grignani, Giovanni Carnevale Schianca, Fabrizio Capaldi, Antonio Rota Scalabrini, Delia; Sardo, Elena Debernardi, Felicino; Iussich, Gabriella; Regge, Daniele

    2012-02-15

    Purpose: Percutaneous vertebroplasty (PV) is a minimally invasive procedure involving the injection of bone cement within a collapsed vertebral body. Although this procedure was demonstrated to be effective in osteoporosis and metastases, few studies have been reported in cases of multiple myeloma (MM). We prospectively evaluated the safety and efficacy of PV in the treatment of vertebral compression fractures (VCFs) resulting from MM. Materials and Methods: PV was performed in 106 consecutive MM patients who had back pain due to VCFs, the treatment of which had failed conservative therapies. Follow-up (28.2 {+-} 12.1 months) was evaluated at 7 and 15 days as well as at 1, 3, 6, 12, 18, and every 6 months after PV. Visual analog scale (VAS) pain score, opioid use, external brace support, and Oswestry Disability Index (ODI) score were recorded. Results: The median pretreatment VAS score of 9 (range 4-10) significantly (P < 0.001) decreased to 1 (range 0-9) after PV. Median pre-ODI values of 82% (range 36-89%) significantly improved to 7% (range 0-82%) (P < 0.001). Differences in pretreatment and posttreatment use of analgesic drug were statistically significant (P < 0.001). The majority of patients (70 of 81; 86%) did not use an external brace after PV (P < 0.001). Conclusion: PV is a safe, effective, and long-lasting procedure for the treatment of vertebral compression pain resulting from MM.

  13. Long term follow-up of patients with Cushing's disease treated by interstitial irradiation

    SciTech Connect

    Sandler, L.M.; Richards, N.T.; Carr, D.H.; Mashiter, K.; Joplin, G.F.

    1987-09-01

    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.

  14. Juvenile Hemochromatosis, Genetic Study and Long-term Follow up after Therapy

    PubMed Central

    Malekzadeh, Masoud M.; Radmard, Amir Reza; Nouroozi, Alireza; Akbari, Mohammad Reza; Amini, Marzie; Navabakhsh, Behrooz; Caleffi, Angela; Pietrangelo, Antonello; Malekzadeh, Reza

    2014-01-01

    BACKGROUND Hereditary hemochromatosis (HH) is a very rare disease in Iran and reported cases are all negative for HFE mutation. We report a family affected by severe juvenile hemochromatosis (JH) with a detailed molecular study of the family members. METHODS We studied a pedigree with siblings affected by juvenile HH and followed them for 3 years. Microsatellite and gene sequencing analysis was performed for all family members. RESULTS Two siblings (the proband and his sister, aged 26 and 30 years, respectively) were found to have clinical findings of JH. The probands brother, who presented with hyperpigmentation, died of probable JH at the age of 24 years. Gene sequencing analysis showed that the proband has a homozygote c.265T>C (p.C89R) HJV mutation + a heterozygote c.884T>C (p.V295A) mutation of HFE. The affected probands sister presented with the same HJV c.265T>C (p.C89R) homozygote mutation. In addition, we found the HJV c.98-6C>G polymorphic variant in both the sister and proband (homozygote). Sequencing of hepcidin (HAMP), TfR2, and FPN revealed no mutation. CONCLUSION We have shown that molecular analysis of the HH related gene is a powerful tool for reliable diagnosis of JH and, in conjunction with magnetic resonance imaging (MRI) and noninvasive liver stiffness measurement by elastography, is adequate tool for management and follow up of HH. PMID:24872867

  15. Percutaneous closure of coronary artery fistula: long-term follow-up results

    PubMed Central

    Ilkay, Erdogan; Kacmaz, Fehmi; Ozeke, Ozcan

    2015-01-01

    Introduction Coronary artery fistula consists of abnormal congenital connections between a coronary artery and cardiac chambers, a coronary vessel or an intrathoracic vessel that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, or coronary aneurysms. Recent reports have emphasized the efficacy of percutaneous transcatheter techniques as an alternative to surgical closure, but the reported experience is relatively limited. Aim To assess angiographic outcomes in a series of 20 patients who underwent transcatheter closure of coronary artery fistula. Material and methods We evaluated all patients presenting with significant coronary artery fistula and undergoing transcatheter closure with coils and a vascular plug between March 2008 and June 2012. Results There were 20 patients (14 men; mean age: 53 8 years) with coronary artery fistula. Fistula diameter ranged from 4 to 12 mm; an average of three coils were used in the percutaneous procedure. Post-deployment angiograms demonstrated complete occlusion in all patients. The patients were followed up for 4 1.6 years. The control coronary computed tomographic angiography was performed in the sixth month and no patients had recanalization of the embolized vessel. Conclusions Percutaneous closure of coronary artery fistula is a safe and effective treatment modality. PMID:26677382

  16. Cervical spine surgery in patients with diastrophic dysplasia: Case report with long-term follow-up.

    PubMed

    Jasiewicz, Barbara; Potaczek, Tomasz; Duda, S?awomir; T?siorowski, Maciej

    2015-01-01

    Cervical kyphosis in diastrophic dysplasia (DTD) is a very dangerous deformity which may lead to compression of neural structures resulting in tetraplegia or even. Treatment of this deformity is usually surgical, but no long-term follow-up studies are presented in the literature. Authors present a case of two children with DTD who underwent anterior corpectomy due to severe cervical kyphosis. The kyphotic deformity was corrected and the normal spinal canal width was restored. The effects of the correction remained stable for respectively 6 and 10 years of the follow-up period. The unique follow-up confirms that this type of intervention leads to an effective and long lasting results. Significant cervical kyphosis in patients suffering from DTD may be treated surgically using anterior approach even in young children with a favorable and lasting results. PMID:26692703

  17. Long-term follow-up in cancer prevention trials (It ain't over 'til it's over).

    PubMed

    Cuzick, Jack

    2010-06-01

    The update of the Study of Tamoxifen and Raloxifene by Vogel et al. (beginning on p. 696 in this issue of the journal) highlights the overall importance of long-term follow-up of cancer prevention trials, which need long follow-up to fully determine agent risks and benefits. Biomarkers (e.g., reduced cervical intraepithelial neoplasia 3 after human papillomavirus vaccination) can provide an early indication of efficacy but almost never replace the cancer end point in determining the ultimate utility of an agent. Long follow-up is also important to fully determine preventive benefit, as illustrated by the tamoxifen trials, where only 60% as many treated women were needed to prevent one cancer at 10 years as at approximately 5 years, the time of the early reports. PMID:20522799

  18. Long-term follow-up for lumbar intrathecal baclofen catheters placed using the paraspinal subfascial technique.

    PubMed

    Thakur, Saumitra K; Rubin, Benjamin A; Harter, David H

    2016-03-01

    OBJECT Intrathecal baclofen (ITB) is a valuable therapeutic option for patients with spasticity and dystonia. The techniques that place an ITB pump catheter into the subcutaneous fat of a lumbar incision are well described. Because patients who require ITB often have low body fat content, they may be predisposed to catheter-related complications. The senior author used a novel technique to place the catheter in a paraspinal subfascial fashion, and the short-term results were previously published. That study demonstrated no development of hardware erosions, catheter migrations, or CSF leaks within an average follow-up of 5 months. This study followed up on those initial findings by looking at the long-term outcomes since this technique was introduced. METHODS Using the institutional review board-approved protocol, the electronic medical records were reviewed retrospectively for all patients who underwent paraspinal subfascial catheter placement by the senior author. Patients received follow-up with the surgeon at 2 weeks postoperatively and were followed routinely by their physiatrist thereafter. RESULTS Of the 43 patients identified as having undergone surgery by the senior author using the paraspinal subfascial technique between July 2010 and February 2014, 12 patients (27.9%) required reoperation. There were 5 patients (11.6%) who had complications related to the catheter or lumbar incision. No hardware erosions or CSF leaks were identified. These patients received a median follow-up of 3.0 years, with 30 of 43 patients receiving follow-up over 2.0 years. CONCLUSION This follow-up study suggests that the technique of paraspinal subfascial catheter placement translates to long-term decreases in CSF leakage and complications from erosion, infection, and also catheter malfunctions. It does not seem to affect the overall rate of complications. PMID:26588457

  19. Hepatobiliary complications of alveolar echinococcosis: A long-term follow-up study

    PubMed Central

    Graeter, Tilmann; Ehing, Franziska; Oeztuerk, Suemeyra; Mason, Richard Andrew; Haenle, Mark Martin; Kratzer, Wolfgang; Seufferlein, Thomas; Gruener, Beate

    2015-01-01

    AIM: To determine the long-term hepatobiliary complications of alveolar echinococcosis (AE) and treatment options using interventional methods. METHODS: Included in the study were 35 patients with AE enrolled in the Echinococcus Multilocularis Data Bank of the University Hospital of Ulm. Patients underwent endoscopic intervention for treatment of hepatobiliary complications between 1979 and 2012. Patients epidemiologic data, clinical symptoms, and indications for the intervention, the type of intervention and any additional procedures, hepatic laboratory parameters (pre- and post-intervention), medication and surgical treatment (pre- and post-intervention), as well as complications associated with the intervention and patients subsequent clinical courses were analyzed. In order to compare patients with AE with and without history of intervention, data from an additional 322 patients with AE who had not experienced hepatobiliary complications and had not undergone endoscopic intervention were retrieved and analyzed. RESULTS: Included in the study were 22 male and 13 female patients whose average age at first diagnosis was 48.1 years and 52.7 years at the time of intervention. The average time elapsed between first diagnosis and onset of hepatobiliary complications was 3.7 years. The most common symptoms were jaundice, abdominal pains, and weight loss. The number of interventions per patient ranged from one to ten. Endoscopic retrograde cholangiopancreatography (ERCP) was most frequently performed in combination with stent placement (82.9%), followed by percutaneous transhepatic cholangiodrainage (31.4%) and ERCP without stent placement (22.9%). In 14.3% of cases, magnetic resonance cholangiopancreatography was performed. A total of eight patients received a biliary stent. A comparison of biochemical hepatic function parameters at first diagnosis between patients who had or had not undergone intervention revealed that these were significantly elevated in six patients who had undergone intervention. Complications (cholangitis, pancreatitis) occurred in six patients during and in 12 patients following the intervention. The average survival following onset of hepatobiliary complications was 8.8 years. CONCLUSION: Hepatobiliary complications occur in about 10% of patients. A significant increase in hepatic transaminase concentrations facilitates the diagnosis. Interventional methods represent viable management options. PMID:25945006

  20. Long-term follow-up of tinnitus in patients with otosclerosis after stapes surgery.

    PubMed

    Sobrinho, Pollyanna G; Oliveira, Carlos A; Venosa, Alessandra R

    2004-01-01

    We prospectively studied 48 otosclerosis patients over a 2-year interval. Forty-four had stapedotomy, and four had stapedectomy. Demographics, clinical history, and pre- and postoperative audiometry results were recorded. A questionnaire asking about tinnitus (intensity, pitch) and including a visual analog scale quantifying the degree (1-10) of annoyance caused by the tinnitus was completed pre- and postoperatively (4-10 months and 14-48 months, respectively). Ninety-one percent of the otosclerosis patients reported the presence of tinnitus, and 39.58% reported severe disabling tinnitus (SDT; 7-10 on the visual analog scale). High-pitch (whistle) tinnitus was present in most patients, and white noise (radio static, waterfall, rain) was present in others. No patient described the tinnitus as a low-tone noise (buzzing). Ninety-one percent of patients reported tinnitus reduction or total remission after surgery. Ten of 19 patients with SDT reported complete remission of tinnitus, 7 reported improvement postoperatively, and 2 reported no change. No patient reported worsening of tinnitus. Small postoperative air-bone gaps (four tonal average) correlated with remission or reduction of tinnitus in SDT patients. Tinnitus pitch, gender, and age of patients were not related to decrease of tinnitus postoperatively. A larger preoperative air-bone gap correlated with larger reduction of tinnitus after successful surgery. A lower preoperative bone conduction level correlated with more intense tinnitus before surgery and greater reduction postoperatively. We contacted 25 patients from 14 to 48 months after surgery, and all reported that their tinnitus status had not changed since the early follow-up. Tinnitus is very prevalent in otosclerosis patients; almost one-half of patients have SDT preoperatively, and stapes surgery improves this symptom in 91% of cases. Preoperative air-bone gap and bone conduction level and a postoperative airbone gap seem to influence the degree of postoperative tinnitus reduction. PMID:15732523

  1. Atypical regressive corneal endothelial cysts in long-term confocal follow-up: a case report.

    PubMed

    Smedowski, Adrian; Wylegala, Edward; Wojcik, Lukasz; Tarnawska, Dorota

    2015-03-01

    Corneal endothelium is formed of 1 layer of mitochondria-rich cubic cells whose main role is to maintain corneal transparency. Corneal endothelial disorders represent group of both inherited and noninherited and may affect proper vision.A 36-year-old male patient with suspicion of corneal endothelial dystrophy underwent visual acuity, intraocular pressure, the basic slit-lamp examination, anterior segment optical coherence tomography (AS-OCT) (Visante, Carl Zeiss Meditec, Dublin, CA), and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III, Heidelberg, Germany). During the 3-year observation the patient reported symptoms mainly in the right eye. Slit-lamp examination revealed endothelial changes, much more pronounced in the right eye. Examination by the AS-OCT Visante showed hyperreflective dots within the right corneal endothelium. In order to assess endothelial cell morphology, analysis using corneal confocal microscopy in vivo was performed. Scans revealed presence of single endothelial deposits and severe cell changes of different morphology in both eyes. In the right eye, less pronounced changes of the polymorphic structure-polygonal guttas in different stages, linear and branched loss with "nuclear-like" formations and accompanying sediments. In the left eye, severe homomorphous polygonal "guttas-like" changes with "nuclear-like" formations were observed. Endothelial cysts' features were dynamically changing during follow-up time with different effects on the patient's clinical state.Corneal confocal microscopy allows accurate imaging of the endothelial cells and their detailed characteristics. Structural changes within the endothelial cells are not always proportional to visual acuity and slit-lamp image. The presented case is an example of an unusual corneal endothelial syndrome with probably nondystrophic background due to observed dynamic state with regressive tendency. PMID:25738472

  2. Bone marrow transplantation in adults with thalassemia: Treatment and long-term follow-up.

    PubMed

    Gaziev, Javid; Sodani, Pietro; Polchi, Paola; Andreani, Marco; Lucarelli, Guido

    2005-01-01

    Current regular blood transfusion programs and chelation treatment have considerably improved survival of patients with thalassemia, which resulted in a larger proportion of adult patients. However, disease- and treatment-related complications in these patients progress over time, causing severe morbidity and shortened life expectancy. Stem cell transplantation still remains the only cure currently available for patients with thalassemia. This study updates transplant outcomes in 107 adult patients with median age of 22 years (range, 17-35 years) who received bone marrow transplantation (BMT) from human leukocyte antigen (HLA)-identical related donors between 1988 and 1996 (group A) and describes the results of BMT in 15 adult patients with median age of 21 years (range, 17-31 years) who were treated with a new treatment protocol (Protocol 26) between 1997 and 2003 (group B). The probability of survival, event-free survival, nonrejection mortality, and rejection for group A patients were 66%, 62%, 37%, and 4%, respectively, with a median follow-up of 12 years (range, 8.3-16.2 years). Group B patients treated with the new protocol had some improvement in thalassemia-free survival (67%) and lower transplant-related mortality (27%) than that of previous protocols. However, transplant-related mortality in these high-risk patients remains elevated. Current myeloablative BMT in adult patients is characterized by higher transplant-related toxicity due to an advanced phase of disease. Although this new approach to transplant adult patients with a reduced-dose intensity-conditioning regimen has improved thalassemia-free survival, transplant-related mortality in these high-risk patients remains elevated. PMID:16339666

  3. Long-term Follow-up in Small Duct Chronic Pancreatitis

    PubMed Central

    Yekebas, Emre F.; Bogoevski, Dean; Honarpisheh, Human; Cataldegirmen, Guellue; Habermann, Christian R.; Seewald, Stefan; Link, Bjoern C.; Kaifi, Jussuf T.; Wolfram, Lars; Mann, Oliver; Bubenheim, Michael; Izbicki, Jakob R.

    2006-01-01

    Background: A pancreatic duct diameter (PDD) ranging from 4 to 5 mm is regarded as normal. The large duct form of chronic pancreatitis (CP) with a PDD >7 mm is considered a classic indication for drainage procedures. In contrast, in patients with so-called small duct chronic pancreatitis (SDP) with a PDD <3 mm extended resectional procedures and even, in terms of an ultima ratio, total pancreatectomy are suggested. Methods: Between 1992 and 2004, a total of 644 patients were operated on for CP. Forty-one prospectively evaluated patients with SDP underwent a new surgical technique aiming at drainage of the entire major PD (longitudinal V-shaped excision of the anterior aspect of the pancreas). Preoperative workup for imaging ductal anatomy included ERCP/MRCP, visualizing the PD throughout the entire gland. The interval between symptoms and therapeutic intervention varied from 12 to 120 months. Median follow-up was 83 months (range, 39117 months). A pain score as well as a multidimensional psychometric quality-of-life questionnaire was used. Results: Hospital mortality was 0%. The perioperative (30 days) morbidity was 19.6%. Postoperative, radiologic imaging showed an excellent drainage of the entire gland and the PD in all but 1 patient. Global quality-of-life index increased in median by 54% (range, 37.5%80%). Median pain score decreased by 95%. Twenty-seven patients (73%) had complete pain relief. Sixteen patients (43%) developed diabetes, while the exocrine pancreatic function was well preserved in 29 patients (78%). Conclusion: V-shaped excision of the anterior aspect of the pancreas is a secure and effective approach for SDP, achieving significant improvement in quality of life and pain relief, hereby sparing patients from unnecessary, extended resectional procedures. The deterioration of exocrine and endocrine pancreatic functions is comparable with that observed during the natural course of the disease. PMID:17122619

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

    PubMed

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

    2006-01-01

    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. PMID:17032959

  5. [Phenotypic expression variation of isovaleric acidemia in Argentinian patients. A long term follow-up].

    PubMed

    Dodelson de Kremer, R; Depetris de Boldini, C; Paschini de Capra, A; Hliba, E; Corbella, L

    1992-01-01

    In this paper we discuss the first five Argentinean patients presenting isovaleric acidemia (IVA), an alteration of leucine catabolism due to a genetic defect of isovaleryl-CoA dehydrogenase. Belonging to unrelated families, one from native (H. Fam.) and the other from Italian ancestry (M. Fam.); the patients presented the clinical pattern highly suggestive of the disease: they were siblings, had disease-free intervals, vomiting, ketoacidosis crises, "sweaty feet" odor and progression of the neurologic involvement from somnolence and stupor to profound coma. In the four children of H. Fam. the disease had a late but severe beginning; one of the girls died (N.H.). The boy from M. Fam. presented a neonatal form of clearly benign course. The disease was confirmed by gas-chromatography (GC) of volatile acids in serum and also by the typical urinary acid GC-profiles (Fig. 1, A and B); the isovalerylglycine quantitative evaluation in urinary samples collected during crises is shown in Table 1. The morphological findings in liver and brain of N.H. showed at the ultrastructural study, an extensive fatty degeneration and greatly marked mitochondrial alterations in the liver and edema, neuronal karyorrhexis and karyolysis in the brain (Fig. 2). The therapeutic protocol based on a low leucine or low protein diet and use of glycine is described. The evolutionary follow up, more than 10 years for the first case, showed a normal mental development in three of them and retardation in the first child of H. Fam., who had a late diagnosis. IVA is still valuable as a paradigm in the acquisition of a highly clinical suspicion and for its introduction in the study of genetic organic acidemias. PMID:1308904

  6. A long-term follow-up of workers exposed to beryllium

    PubMed Central

    Cotes, J E; Gilson, J C; McKerrow, C B; Oldham, P D

    1983-01-01

    ABSTRACT The relationship of features of beryllium disease to the estimated exposure to beryllium has been investigated over a 30-year period at a factory manufacturing beryllium products. The factory opened in 1952. Of the 146 men who had worked there for more than six months up to 1963, 89% were seen at that time and were followed up in 1973. The nine who continued to work in the factory and those who were engaged subsequently were examined in 1977. On each occasion a clinical interview, occupational history, chest radiograph, and assessment of lung function were carried out. The findings of the main survey were related to the beryllium content of the dust measured by mass spectrometry for 1952-60 when over 3000 determinations were made. In no part of the plant did the estimated average daily exposure exceed 2 μg m-3, and only 9% of individual determinations exceeded this level. Twenty determinations exceeded 25 μg m-3. During the period under review, four men developed the clinical, radiographic, and physiological features of beryllium disease. Two men acquired abnormal chest radiographs consistent with beryllium disease but without other features, and one developed probable beryllium disease despite the diagnosis not being confirmed at necropsy. The affected men were all exposed to beryllium oxide or hydroxide but in a wide range of estimated doses. In six the changes developed after exposure had ceased; trigger factors including patch testing may have contributed to their illness. Seventeen men recalled episodes of brief exposure to high concentrations of dust, two developed pneumonitis from which they recovered completely, and one developed chronic beryllium disease after a further 23 years' exposure. In subjects without clinical or radiographic evidence of disease no convincing evidence was obtained for any association between the lung function and the estimated exposure to beryllium. PMID:6824594

  7. Pleomorphic Xanthoastrocytoma: Natural History and Long-Term Follow-Up

    PubMed Central

    Ida, Cristiane M.; Rodriguez, Fausto J.; Burger, Peter C.; Caron, Alissa A.; Jenkins, Sarah M.; Spears, Grant M.; Aranguren, Dawn L.; Lachance, Daniel H.; Giannini, Caterina

    2015-01-01

    Prognostic significance of histological anaplasia and BRAF V600E mutation were retrospectively evaluated in 74 patients with pleomorphic xanthoastrocytoma (PXA). Median age at diagnosis was 21.5 years (31 pediatric, 43 adult) and median follow-up 7.6 years. Anaplasia (PXA-AF), defined as mitotic index ≥ 5/10HPF and/or presence of necrosis, was present in 33 cases. BRAF V600E mutation was detected in 39 (of 60) cases by immunohistochemical and/or molecular analysis, all negative for IDH1 (R132H). Mitotic index ≥ 5/ 10HPF and necrosis were associated with decreased overall survival (OS; P = 0.0005 and P = 0.0002, respectively). In all cases except two, necrosis was associated with mitotic index ≥ 5/10HPF. Patients with BRAF V600E mutant tumors had significantly longer OS compared with those without BRAF V600E mutation (P = 0.02). PXA-AF patients, regardless of age, had significantly shorter OS compared with those without (P = 0.0003). Recurrence-free survival was significantly shorter for adult PXA-AF patients (P = 0.047) only. Patients who either recurred or died ≤3 years from diagnosis were more likely to have had either PXA-AF at first diagnosis (P = 0.008) or undergone a non-gross total resection procedure (P = 0.004) as compared with patients who did not. This study provides further evidence that PXA-AF behaves more aggressively than PXA and may qualify for WHO grade III “anaplastic” designation. PMID:25318587

  8. Immunoprotection in spontaneous remission of type 1 diabetes: long-term follow-up results.

    PubMed

    Yilmaz, M T; Devrim, A S; Biyal, F; Satman, I; Arioğlu, E; Dinççag, N; Karsidağ, K; Ozden, I; Gürel, N; Sipahioğlu, F

    1993-02-01

    This prospective pilot study was undertaken to test the efficacy of oral methyl-prednisolone (MP) therapy at spontaneous remission phase of type 1 diabetes in intervening the course of the disease. Twenty-five type 1 diabetic patients who were classified as having a spontaneous remission (honeymoon) were divided into treatment and non-treatment groups on voluntary basis. Fifteen patients thus making up the treatment group (13 males and 2 females, mean age 23.8 +/- 6.2 years) received 0.7-1.0 mg/kg/day of MP p.o. for 2 weeks. The dose of the drug was then gradually diminished every week until 5 mg/day (approx. 0.1 mg/kg/day) and discontinued at 10 +/- 2 weeks. In case of hyperglycemia occurring in 12 of 15 patients due to the administration of steroid, insulin was used to normalize blood glucose levels (average 0.47 +/- 0.21 IU/kg/day). The non-treatment group (8 males and 2 females, mean age 21.8 +/- 8.9) did not receive any special medication or placebo except for insulin whenever necessary to regulate glycemia. Upon completion of protocol, all patients in treatment group displayed clinical remission with 10 still in non-insulin requiring remission for follow-up periods ranging between 16 and 91 months. The remaining 5 patients relapsed within 3-15 months of therapy. Other metabolic (including basal and stimulated C-peptide levels) and immunological indices that have spontaneously ameliorated with the occurrence of honeymoon were also maintained within normal range in the NIR patients. Meanwhile, natural remission in the non-MP-treated group terminated at 3.4 +/- 0.6 months with deterioration of all metabolic and immunological markers as well as increasing requirements for insulin. In conclusion, the spontaneous remission of the patients could be prolonged significantly by MP therapy as opposed to no therapy (P < 0.001). These results suggest that the spontaneous remission phase may be a crucial point of intervention in immunotherapy of type 1 diabetes and that randomized trials with MP at this particular phase would be worthwhile. PMID:8472630

  9. Continuing Risk of Ipsilateral Breast Relapse After Breast-Conserving Therapy at Long-Term Follow-up

    SciTech Connect

    Kreike, Bas; Hart, Augustinus A.M.; Velde, Tony van de; Borger, Jacques; Peterse, Hans; Rutgers, Emiel; Bartelink, Harry; Vijver, Marc J. van de

    2008-07-15

    Purpose: Currently, the local treatment of most patients with early invasive breast cancer consists of breast-conserving therapy (BCT). We have previously reported on the risk factors for ipsilateral breast relapse (IBR) in 1,026 patients treated with BCT after a median follow-up of 5.5 years. In the present study, we evaluated the IBR incidence and the risk factors for IBR after prolonged follow-up. Methods and Materials: We updated the disease outcome for all 1,026 patients using the clinical information collected from the medical registration of The Netherlands Cancer Institute and performed step-wise proportional hazard Cox regression analysis to identify the risk factors associated with an increased risk of IBR after BCT at long-term follow-up. Results: After a median follow-up of 13.3 years, 114 patients had developed an IBR as the first event. The IBR rate was 9.3% and 13.8%, respectively, at 10 and 15 years. Also, the increase in IBR was continuous without reaching a plateau, even after 15 years. Univariate analysis showed that involved surgical resection margins, young age, vascular invasion, and the presence and quantity of an in situ component are risk factors for IBR. Multivariate analysis showed that tumor-positive surgical resection margins (hazard ratio, 2.9; 95% confidence interval, 1.7-5.2, p = 0.0002) or the presence of vascular invasion (hazard ratio, 2.0; 95% confidence interval, 1.2-3.2, p = 0.004) is the major independent risk factor for IBR. Conclusions: The data from long-term follow-up showed a constant increase in IBR among patients treated by BCT, even after 15 years, without reaching a plateau. Involved surgical resection margins and vascular invasion were the most important risk factors for IBR.

  10. Long-Term Follow-up Observation of the Safety, Immunogenicity, and Effectiveness of Gardasil™ in Adult Women

    PubMed Central

    Luna, Joaquin; Plata, Manuel; Gonzalez, Mauricio; Correa, Alfonso; Maldonado, Ivete; Nossa, Claudia; Radley, David; Vuocolo, Scott; Haupt, Richard M.; Saah, Alfred

    2013-01-01

    Background Previous analyses from a randomized trial in women aged 24–45 have shown the quadrivalent HPV vaccine to be efficacious in the prevention of infection, cervical intraepithelial neoplasia (CIN) and external genital lesions (EGL) related to HPV 6/11/16/18 through 4 years. In this report we present long term follow-up data on the efficacy, safety and immunogenicity of the quadrivalent HPV vaccine in adult women. Methods Follow-up data are from a study being conducted in 5 sites in Colombia designed to evaluate the long-term immunogenicity, effectiveness, and safety of the qHPV vaccine in women who were vaccinated at 24 to 45 years of age (in the original vaccine group during the base study [n = 684]) or 29 to 50 years of age (in the original placebo group during the base study [n = 651]). This analysis summarizes data collected as of the year 6 post-vaccination visit relative to day 1 of the base study (median follow-up of 6.26 years) from both the original base study and the Colombian follow-up. Results There were no cases of HPV 6/11/16/18-related CIN or EGL during the extended follow-up phase in the per-protocol population. Immunogenicity persists against vaccine-related HPV types, and no evidence of HPV type replacement has been observed. No new serious adverse experiences have been reported. Conclusions Vaccination with qHPV vaccine provides generally safe and effective protection from HPV 6-, 11-, 16-, and 18-related genital warts and cervical dysplasia through 6 years following administration to 24–45 year-old women. Trial Registration Clinicaltrials.gov NCT00090220 PMID:24391768

  11. The posterior bone block procedure in posterior shoulder instability: a long-term follow-up study.

    PubMed

    Meuffels, D E; Schuit, H; van Biezen, F C; Reijman, M; Verhaar, J A N

    2010-05-01

    We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years' follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations. PMID:20436001

  12. Neuropsychiatric impairment in children with continuous spikes and waves during slow sleep: a long-term follow-up study.

    PubMed

    Margari, Lucia; Buttiglione, Maura; Legrottaglie, Anna R; Presicci, Anna; Craig, Francesco; Curatolo, Paolo

    2012-12-01

    A long-term follow-up study was conducted in patients affected by Continuous Spikes and Waves during slow Sleep (CSWS) to evaluate the long-term outcomes. Twenty-five patients (19 males, 6 females), from 2 to 16 years of age (mean age 6 years±3 SD), affected by CSWS syndrome, as defined by the International League Against Epilepsy (ILAE, 1989), were enrolled and followed for 11 years (mean duration of follow-up: 3.9 years). At the time of the appearance of CSWS, one or more neuropsychiatric disorders were present in 96% of the patients, such as behavioral problems in 54%, mental retardation in 37.5%, learning disabilities in 33%, developmental coordination disorder in 17%, language disorder in 12.5%, and pervasive developmental disorder in 8%. During the follow-up, neuropsychiatric dysfunctions remained unaltered in 52% of the patients, worsened in 24%, and improved in only 24%. Our data confirm that CSWS may be associated with a broad spectrum of neuropsychiatric disorders and may promote their worsening over time. Moreover, the findings cannot be generalized to all cases of children with CSWS because most of the children in the subgroups with no change in outcome and worse outcome had symptomatic CSWS. PMID:23159378

  13. Retrobulbar Hemodynamics and Visual Field Progression in Normal Tension Glaucoma: A Long-Term Follow-Up Study

    PubMed Central

    Kuerten, D.; Fuest, M.; Koch, E. C.; Koutsonas, A.; Plange, N.

    2015-01-01

    Purpose. Vascular risk factors are important factors in the pathogenesis of glaucoma. The purpose of this research was to investigate retrobulbar hemodynamics and visual field progression in patients with normal tension glaucoma (NTG). Patients and Methods. 31 eyes of 16 patients with NTG were included in a retrospective long-term follow-up study. Colour Doppler imaging was performed at baseline to determine various CDI parameters in the different retrobulbar vessels. The rate of visual field progression was determined using the Visual Field Index (VFI) progression rate per year (in %). To be included in the analysis, patients had at least 4 visual field examinations with a follow-up of at least 2 years. Results. Mean follow-up was 7.6 4.1 years with an average of 10 5 visual field tests. The mean MD (mean defect) at baseline was ?7.61 7.49?dB. The overall VFI progression was ?1.14 1.40% per year. A statistical significant correlation between VFI progression and the RI of the NPCA and PSV of the CRA was found. Conclusion. Long-term visual field progression may be linked to impaired retrobulbar hemodynamics in patients with NTG only to a limited degree. Interpretation of the data for an individual patient seems to be limited due to the variability of parameters. PMID:26557652

  14. PTA of Infrapopliteal Arteries: Long-term Clinical Follow-up and Analysis of Factors Influencing Clinical Outcome

    SciTech Connect

    Peregrin, Jan H. Koznar, Boris; Kovac, Josef; Lastovickova, Jarmila; Novotny, Jiri; Vedlich, Daniel; Skibova, Jelena

    2010-08-15

    This study was a retrospective analysis of patients with CLI who underwent infrapopliteal percutaneous transluminal angioplasty (PTA). The main goal was to evaluate clinical and morphological factors that influence the clinical outcome of PTA in long-term follow-up. A total of 1,445 PTA procedures were performed in 1,268 patients. Main indications for PTA included gangrene, nonhealing ulcers, or rest pain. The mean number of treated arteries was 1.77 artery/limb, and the majority of lesions were type TASC D. The technical success rate of PTA was 89% of intended-to-treat arteries. The main criterion of clinical success was functional limb salvage (LS). One-year follow-up involved 1,069 limbs. Primary and secondary 1-year LS rates were 76.1 and 84.4%, respectively. The effect of clinical and morphological parameters on the 1-year LS was that the only associated disease with an adverse effect on LS rate was DM combined with dialysis. Regarding limb preprocedural status, gangrene was clearly a negative predictor. The most important factor affecting LS was the number of patent arteries post-PTA: patients with 0, 1, 2, and 3 patent arteries had 1-year primary LS rates of 56.4, 73.1, 80.4, and 83%, respectively. Long-term follow-up of LS rates demonstrated secondary LS rates of 84.4, 78.8, and 73.3% at 1, 5, and 10 years. Every effort should be made to perform PTA for as many arteries as possible, even if TASC D type, to improve clinical outcome. Our study shows that repeat PTA is capable of keeping the long-term LS rate close to 75%.

  15. Long-term outcome of head injuries: a 23 year follow up study of children with head injuries.

    PubMed Central

    Klonoff, H; Clark, C; Klonoff, P S

    1993-01-01

    The purpose of the 23 year follow up study was to determine the relationship between trauma variables including measures of head injury and very long-term sequelae. The study included 159 individuals with a mean age 31.40 years, of whom approximately 90% were admitted to hospital with a mild head injury during childhood (mean age 7.96). Extent of head injury was determined by unconsciousness, neurological status, skull fracture, EEG, post-traumatic seizures and a composite measure. The composite measure of neurological variables was the best predictor of long-term outcome. In addition, IQ recorded in the post-acute phase was a reliable predictor of long-term outcome. Of the sample, 32.7% reported physical complaints and 17.6% reported current psychological/psychiatric problems unrelated to the head injury. Subjective sequelae (physical, intellectual and emotional) specified as due to the head injury were reported by 31% of the sample, and the sequelae were found to be related to the extent of the head injury and initial IQ. There were no discernible relationships between attribute variables including premorbid status and age with subjective sequelae. There were, however, significant relationships between subjective sequelae and objective, psychosocial measures of adaptation including educational lag, unemployment, current psychological/psychiatric problems and relationships with family members. Finally, there appeared to be continuity of complaints elicited during the five year follow up of the original project and current sequelae. The severity of the head injury was identified as the primary contributory factor in the reconstitution process and in the prediction of long term outcomes. PMID:8482963

  16. Long-term follow-up of a patient with Romberg's disease reconstructed with free groin flaps.

    PubMed

    Wakamatsu, K; Harashina, T; Nakajima, H; Okumoto, T

    1998-12-01

    Sixteen years ago the result of an operation that was performed on a 5-year-old boy with Romberg's disease was described in this journal. Nineteen years have passed since the first operation, and the authors now report the long-term follow-up. The volume of the transferred free groin flaps was maintained. Although these flaps covered the patient's atrophic tissues as vascularized tissues, these flaps could not normalize the atrophy of the surrounding tissues, especially the bone. As for the orbital content, bony atrophy was more remarkable than the other tissues. PMID:9869140

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

    PubMed

    Kan, Hester J; Hovius, Steven E R

    2012-12-01

    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. PMID:22917697

  18. [Follow-up of persons on long-term sick-leave. A cohort study in the city of Moss].

    PubMed

    Bjrndal, A

    1994-10-10

    Follow-up of people on long-term sickness leave has been a priority for central and local authorities for a number of years. In this study we have followed a cohort of such people from the city of Moss. We wanted to find out how many returned to work, and who these were. The cohort consisted of 1,975 persons. Median age was 45 years (25-75 percentile: 35-54 years). 55% were women. Median follow-up time was two years and four months. Incidence of long-term sickness leave (more than eight weeks off sick) was 4.2 per month per 1,000 persons between 16 and 66 years of age. Less than half (47%) of those who had been off sick for more than eight weeks were working at follow-up. Few people were recruited to active rehabilitation programmes; for instance new education and on-the-job training. Age, especially from 45 years and upwards, many earlier sickness leaves and diagnosis (persons with psychiatric and other diagnoses did worst) influenced the result towards inactivity. When tested by multivariate analysis these variables explained little of the total variation in re-entry to the job market. A separate study of a random sample who were offered more time and indepth counselling showed no effect on job status at follow-up. Most probably, the success or lack of success are dominated by two factors which we could not measure directly; the seriousness of the medical condition and the climate on the labour market. PMID:7998036

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

    PubMed Central

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

    2016-01-01

    Background 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. Methods 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. Results 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. Conclusions The degree of proteinuria during follow-up period is the strongest risk factor for ESKD and CRI. PMID:26978656

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

    PubMed Central

    Mikkelsen, Christina; Janarv, Per-Mats

    2014-01-01

    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. PMID:25485299

  1. Long-Term Follow-Up of the Edmonton Protocol of Islet Transplantation in the United States.

    PubMed

    Brennan, D C; Kopetskie, H A; Sayre, P H; Alejandro, R; Cagliero, E; Shapiro, A M J; Goldstein, J S; DesMarais, M R; Booher, S; Bianchine, P J

    2016-02-01

    We report the long-term follow-up of the efficacy and safety of islet transplantation in seven type 1 diabetic subjects from the United States enrolled in the multicenter international Edmonton Protocol who had persistent islet function after completion of the Edmonton Protocol. Subjects were followed up to 12 years with serial testing for sustained islet allograft function as measured by C-peptide. All seven subjects demonstrated continued islet function longer than a decade from the time of first islet transplantation. One subject remained insulin independent without the need for diabetic medications or supplemental transplants. One subject who was insulin-independent for over 8 years experienced graft failure 10.9 years after the first islet transplant. The remaining six subjects demonstrated continued islet function upon trial completion, although three had received a supplemental islet transplant each. At trial completion, five subjects were receiving insulin and two remained insulin independent, although one was treated with liraglutide. The median hemoglobin A1c was 6.3% (45?mmol/mol). All subjects experienced progressive decline in the C-peptide/glucose ratio. No patients experienced severe hypoglycemia, opportunistic infection, or lymphoma. Thus, although the rate and duration of insulin independence was low, the Edmonton Protocol was safe in the long term. Alternative approaches to islet transplantation are under investigation. PMID:26433206

  2. Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25patients

    PubMed Central

    Faber, L; Meissner, A; Ziemssen, P; Seggewiss, H

    2000-01-01

    OBJECTIVETo determine the long term outcome in patients treated with percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM).?DESIGN AND SETTINGObservational, single centre study.?PATIENTS25 patients (13women, 12men, mean (SD) age 54.7(15.0) years) with drug treatment resistant New York Heart Association (NYHA) class 2.8(0.6) symptoms attributed to a high left ventricular outflow gradient (LVOTG) and a coronary artery anatomy suitable for intervention.?INTERVENTIONPTSMA by injection of 4.1(2.6)ml of alcohol (96%) into 1.4(0.6) septal perforator arteries to ablate the hypertrophied interventricular septum.?OUTCOME MEASURESDuring in-hospital follow up, enzyme rise, the frequency of atrioventricular conduction lesions requiring permanent DDD pacing, and in-hospital mortality were assessed. Long term follow up (30(4) months, range 24-36 months) included symptoms, echocardiographic measurements of left atrial and left ventricular dimensions and function, and LVOTG.?RESULTSMean postinterventional creatine kinase rise was 780(436)U/l. During PTSMA 13patents developed total heart block, permanent pacing being necessary in five of them. One 86year old patient died from ventricular fibrillation associated with intensive treatment (?mimetic and theophylline) for coexistent severe obstructive airway disease. After three months, three patients underwent re-PTSMA because of a dissatisfactory primary result, leading to LVOTG elimination in all of them. During long term follow up, LVOTG showed sustained reduction (3(6)mmHg at rest and 12(19)mm Hg with provocation) associated with stable symptomatic improvement (NYHA class 1.2(1.0)) and without significant global left ventricular dilatation.?CONCLUSIONSPTSMA is an effective non-surgical technique for reduction of symptoms and LVOTG in HOCM. Prospective, long term observations of larger populations are necessary in order to determine the definitive significance of the procedure.???Keywords: hypertrophic obstructive cardiomyopathy; percutaneous transluminal septal myocardial ablation; left ventricular outflow tract gradient; myocardial contrast echocardiography PMID:10677415

  3. The long-term follow-up of patients with a congenital diaphragmatic hernia: a broad spectrum of morbidity.

    PubMed

    Peetsold, M G; Heij, H A; Kneepkens, C M F; Nagelkerke, A F; Huisman, J; Gemke, R J B J

    2009-01-01

    Congenital diaphragmatic hernia (CDH) is a life-threatening anomaly with a mortality rate of approximately 40-50%, depending on case selection. It has been suggested that new therapeutic modalities such as nitric oxide (NO), high frequency oxygenation (HFO) and extracorporal membrane oxygenation (ECMO) might decrease mortality associated with pulmonary hypertension and the sequelae of artificial ventilation. When these new therapies indeed prove to be beneficial, a larger number of children with severe forms of CDH might survive, resulting in an increase of CDH-associated complications and/or consequences. In follow-up studies of infants born with CDH, many complications including pulmonary damage, cardiovascular disease, gastro-intestinal disease, failure to thrive, neurocognitive defects and musculoskeletal abnormalities have been described. Long-term pulmonary morbidity in CDH consists of obstructive and restrictive lung function impairments due to altered lung structure and prolonged ventilatory support. CDH has also been associated with persistent pulmonary vascular abnormalities, resulting in pulmonary hypertension in the neonatal period. Long-term consequences of pulmonary hypertension are unknown. Gastro-esophageal reflux disease (GERD) is also an important contributor to overall morbidity, although the underlying mechanism has not been fully understood yet. In adult CDH survivors incidence of esophagitis is high and even Barrett's esophagus may ensue. Yet, in many CDH patients a clinical history compatible with GERD seems to be lacking, which may result in missing patients with pathologic reflux disease. Prolonged unrecognized GERD may eventually result in failure to thrive. This has been found in many young CDH patients, which may also be caused by insufficient intake due to oral aversion and increased caloric requirements due to pulmonary morbidity. Neurological outcome is determined by an increased risk of perinatal and neonatal hypoxemia in the first days of life of CDH patients. In patients treated with ECMO, the incidence of neurological deficits is even higher, probably reflecting more severe hypoxemia and the risk of ECMO associated complications. Many studies have addressed the substantial impact of the health problems described above, on the overall well-being of CDH patients, but most of them concentrate on the first years after repair and only a few studies focus on the health-related quality of life in CDH patients. Considering the scattered data indicating substantial morbidity in long-term survivors of CDH, follow-up studies that systematically assess long-term sequelae are mandatory. Based on such studies a more focused approach for routine follow-up programs may be established. PMID:18841373

  4. Long-Term Follow-Up of the Cheilectomy for Degenerative Joint Disease of the First Metatarsophalangeal Joint.

    PubMed

    Nicolosi, Nicole; Hehemann, Chris; Connors, James; Boike, Allan

    2015-01-01

    Cheilectomy is the surgical resection of 20% to 30% of the dorsal metatarsal head and proximal phalanx. The present retrospective study evaluated the long-term efficacy of aggressive cheilectomy to address degenerative joint disease of the first metatarsophalangeal joint. To our knowledge, this is the second longest duration study to date to evaluate the long-term efficacy of the cheilectomy procedure, with a mean follow-up period of 7.14 years (range 39 weeks to 14.87 years). The mean patient age was 55.71 ± 9.51 years, and 37 (65%) of the patients were female. Age, sex, foot type, and preoperative radiographic parameters of hallux rigidus were also evaluated and correlated. The mean percentage of success with this operation was 87.69%. Of the 58 patients, 51 (87.93%) experienced no limitations in their daily activities. Only 2 patients (3.33%) subsequently required subsequent arthrodesis. The results of the present study suggest that cheilectomy offers long-term satisfaction for patients with hallux rigidus and is an acceptable alternative to the joint destructive procedure of first metatarsophalangeal arthrodesis. PMID:25981441

  5. 75 FR 77880 - Proposed Collection; Comment Request; GuLF Worker Study: Gulf Long-Term Follow-Up Study for Oil...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-14

    ...: Gulf Long-Term Follow-Up Study for Oil Spill Clean-Up Workers and Volunteers SUMMARY: Under the... currently valid OMB control number. Proposed Collection Title: GuLF Worker Study: Gulf Long-Term Follow-Up Study for Oil Spill Clean-Up Workers and Volunteers. Type of Information Collection Request: New....

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

    PubMed Central

    Wielders, Cornelia C. H.; van Loenhout, Joris A. F.; Morroy, Gabriëlla; Rietveld, Ariene; Notermans, Daan W.; Wever, Peter C.; Renders, Nicole H. M.; Leenders, Alexander C. A. P.; van der Hoek, Wim; Schneeberger, Peter M.

    2015-01-01

    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 of this study was to validate the current follow-up strategy targeted to identify patients with chronic Q-fever. Methods A cohort of adult acute Q-fever patients, diagnosed between 2007 and 2009, for whom a twelve-month follow-up sample was available, was invited to complete a questionnaire and provide a blood sample, four years after the acute episode. Antibody profiles, determined by immunofluorescence assay in serum, were investigated with a special focus on high titres of IgG antibodies against phase I of Coxiella burnetii, as these are considered indicative for possible chronic Q-fever. Results Of the invited 1,907 patients fulfilling inclusion criteria, 1,289 (67.6%) were included in the analysis. At any time during the four-year follow-up period, 58 (4.5%) patients were classified as possible, probable, or proven chronic Q-fever according to the Dutch Q-fever Consensus Group criteria (which uses IgG phase I ≥1:1,024 to as serologic criterion for chronic Q-fever). Fifty-two (89.7%) of these were identified within the first year after the acute episode. Of the six patients that were detected for the first time at four-year follow-up, five had an IgG phase I titre of 1:512 at twelve months. Conclusions A twelve-month follow-up check after acute Q-fever is recommended as it adequately detects chronic Q-fever in patients without known risk factors. Additional serological and clinical follow-up is recommended for patients with IgG phase I ≥1:512, as they showed the highest risk to progress to chronic Q-fever. PMID:26161658

  7. Long-Term Follow-Up of Patients With Tertiary Hyperparathyroidism Treated by Resection of a Single or Double Adenoma

    PubMed Central

    Nichol, Peter F.; Starling, James R.; Mack, Eberhard; Klovning, Jason J.; Becker, Bryan N.; Chen, Herbert

    2002-01-01

    Objective To determine whether patients with tertiary hyperparathyroidism due to single- or two-gland disease undergoing limited resection have similar long-term outcomes compared with patients with hyperplasia undergoing subtotal or total parathyroidectomy. Summary Background Data Tertiary hyperparathyroidism occurs in less than 2% of patients after renal transplantation. Approximately 30% of these cases are caused by one or two hyperfunctioning glands. Nevertheless, the standard operation for this disease has been subtotal or total parathyroidectomy with autotransplantation. Methods Seventy-one patients underwent surgery for tertiary hyperparathyroidism. At the time of surgery, 19 patients who had a single or double adenoma underwent limited resection of the enlarged glands only (adenoma group). The remaining 52 patients with three- or four-gland hyperplasia had subtotal or total parathyroidectomy with implantation (hyper group). Long-term cure rates between the two groups were compared. Results In the adenoma group, 7 patients had a single adenoma and 12 underwent resection of a double adenoma. In the hyper group, 49 patients had subtotal and 3 had total parathyroidectomies. After surgery, 70 of 71 patients (99%) were cured of their hypercalcemia. The incidence of postoperative transient hypocalcemia was significantly higher in the hyper group (27% vs. 5%). No patients in either group had permanent hypocalcemia requiring long-term supplementation. With up to 16 years of follow-up, there have been no recurrences in the adenoma group, whereas three patients (6%) in the hyper group have had recurrent or persistent hyperparathyroidism. Conclusions Patients with tertiary hyperparathyroidism who underwent limited resection of a single or double adenoma only had equivalent long-term cure rates compared with patients undergoing more extensive resections. Therefore, the authors recommend in patients with tertiary hyperparathyroidism and enlargement of only one or two parathyroid glands that the resection be limited to these abnormal glands only. PMID:11981213

  8. Long-Term Follow-Up of Patients Immunized with AN1792: Reduced Functional Decline in Antibody Responders

    PubMed Central

    Vellas, Bruno; Black, R; Thal, Leon J; Fox, Nick C; Daniels, M; McLennan, G; Tompkins, C; Leibman, C; Pomfret, M; Grundman, Michael

    2009-01-01

    Background: Immunization of patients with Alzheimers disease (AD) with synthetic amyloid-? peptide (A?42) (AN1792) was previously studied in a randomized, double-blind, placebo-controlled phase 2a clinical trial, Study AN1792(QS-21)-201. Treatment was discontinued following reports of encephalitis. One year follow-up revealed that AN1792 antibody responders showed improvements in cognitive measures as assessed by the neuropsychological test battery (NTB) and a decrease in brain volume compared with placebo. Methods: A follow-up study, Study AN1792(QS-21)-251, was conducted to assess the long-term functional, psychometric, neuroimaging, and safety outcomes of patients from the phase 2a study 4.6 years after immunization with AN1792. The results were analyzed by comparing patients originally identified as antibody responders in the AN1792 phase 2a study with placebo-treated patients. Results: One hundred and fifty-nine patients/caregivers (30 placebo; 129 AN1792) participated in this follow-up study. Of the 129 AN1792-treated patients, 25 were classified in the phase 2a study as antibody responders (anti-AN1792 titers ?1:2,200 at any time after the first injection). Low but detectable, sustained anti-AN1792 titers were found in 17 of 19 samples obtained from patients classified as antibody responders in the phase 2a study. No detectable anti-AN1792 antibodies were found in patients not classified as antibody responders in the phase 2a study. Significantly less decline was observed on the Disability Assessment for Dementia scale among antibody responders than placebo-treated patients (p=0.015) after 4.6 years. Significant differences in favor of responders were also observed on the Dependence Scale (p=0.033). Of the small number of patients who underwent a follow-up MRI, antibody responders showed similar brain volume loss during the follow-up period subsequent to the AN1792 phase 2a study compared with placebo-treated patients. Conclusions: Approximately 4.6 years after immunization with AN1792, patients defined as responders in the phase 2a study maintained low but detectable, sustained anti-AN1792 antibody titers and demonstrated significantly reduced functional decline compared with placebo-treated patients. Brain volume loss in antibody responders was not significantly different from placebo-treated patients approximately 3.6 years from the end of the original study. No further cases of encephalitis were noted. These data support the hypothesis that A? immunotherapy may have long-term functional benefits. PMID:19355849

  9. Long-term follow-up of lung biodistribution and effect of instilled SWCNTs using multiscale imaging techniques

    NASA Astrophysics Data System (ADS)

    Faraj, Achraf Al; Bessaad, Amine; Cieslar, Katarzyna; Lacroix, Ghislaine; Canet-Soulas, Emmanuelle; Crmillieux, Yannick

    2010-04-01

    Due to their distinctive properties, single-walled carbon nanotubes (SWCNTs) are being more and more extensively used in nanotechnology, with prospects in nanomedicine. It would therefore appear essential to develop and apply appropriate imaging tools for detecting and evaluating their biological impacts with the prospect of medical applications or in the situation of accidental occupational exposure. It has been shown recently that raw SWCNTs with metallic impurities can be noninvasively detected in the lungs by hyperpolarized 3helium (HP-3He) MRI. Moreover raw and purified SWCNTs had no acute biological effect. The purpose of the present longitudinal study was to investigate long-term follow-up by imaging, as well as chronic lung effects. In a 3-month follow-up study, multiscale imaging techniques combining noninvasive HP-3He and proton (H) MRI to ex vivo light (histopathological analysis) and transmission electron microscopy (TEM) were used to assess the biodistribution and biological effects of intrapulmonary instilled raw SWCNTs. Specific in vivo detection of carbon nanotubes with MRI relied on their intrinsic metal impurities. MRI also has the ability to evaluate tissue inflammation by the follow-up of local changes in signal intensity. MRI and ex vivo microscopy techniques showed that granulomatous and inflammatory reactions were produced in a time and dose dependent manner by instilled raw SWCNTs.

  10. Long-term follow-up of thalamic deep brain stimulation for essential tremor – patient satisfaction and mortality

    PubMed Central

    2014-01-01

    Background Ventral intermediate thalamic nucleus (VIM) deep brain stimulation (DBS) is an effective treatment for tremor, but there is limited data on long-term efficacy and mortality after VIM-DBS. Here we report the analysis of patient satisfaction and mortality in all patients treated in our center 1996–2010 with VIM-DBS for essential tremor (ET). Methods Forty-six consecutive patients were included in this study. Medical records were reviewed, and a follow-up questionnaire was sent to all surviving patients. Results Seventy percent of all possible participants (26 patients) answered the questionnaire. Follow-up time for the responding patients was median 6.0 years (2–16). Median self-reported score on visual analogue scale of the initial postoperative effect on tremor was 8.5 (0.1–10), with a significant reduction to 7.4 (0–10) at follow-up (p = 0.001). Patients reported a median score of 10 (0–10) for overall patient satisfaction with VIM-DBS treatment. Eight patients (17%) died after median 8.9 years (0.6–15) after surgery, at median age 77.4 years (70–89). One patient (2%) committed suicide seven months after the operation. Calculated standard mortality ratio among ET patients was 1.3 (CI 0.6–2.6), similar to the general population. Conclusion We found no significant increase in mortality in this cohort of VIM-DBS operated ET patients compared to the general population in Norway. The patients reported high long-term satisfaction and continuing effect of VIM-DBS on tremor even after many years. VIM-DBS therefore seems to be an effective symptomatic long-term treatment of ET. However, one patient committed suicide. Only one other suicide has previously been reported after VIM-DBS. It is therefore still unclear whether VIM-DBS increases suicide risk. PMID:24903550

  11. Right-Side Colon Ischemia: Clinical Features, Large Visceral Artery Occlusion, and Long-Term Follow-Up

    PubMed Central

    Longstreth, George F; Hye, Robert J

    2015-01-01

    Context: Large visceral artery occlusion (LVAO) could underlie right-side colon ischemia (RSCI) but is little known. Objective: To assess patients with RSCI through long-term follow-up, including features and management of LVAO. Main Outcome Measures: Mesenteric ischemia and mortality. Design: Retrospective observational study in an integrated health care system. Results: Of 49 patients (30 women [61.2%]; mean [standard deviation] age, 69.4 [11.9] years), 19 (38.8%) underwent surgery—that is, 5 (83.3%) of 6 who developed RSCI in hospital following surgical procedures and 14 (32.6%) of 43 who had RSCI before hospitalization (p value = 0.03); overall, 5 (10.2%) died. Among 44 survivors with a median (range) follow-up of 5.19 (0.03–14.26) years, 5 (11.4%), including 3 (20.0%) of 15 operated cases, had symptomatic LVAO and underwent angioplasty and stent placement: 2 for abdominal angina that preceded RSCI, 1 for acute mesenteric ischemia 1 week after resection of RSCI, 1 for RSCI 6 weeks after resection of left-side ischemia, and 1 for abdominal angina that began 3 years after spontaneous recovery from RSCI. None had further mesenteric ischemia until death from nonintestinal disease or the end of follow-up (1.6 to 10.2 years later). Kaplan-Meier survival estimates for all 44 survivors at 1, 3, 5, and 10 years were 88.6%, 72.3%, 57.6%, and 25.9%, respectively. Thirty-one patients (70.4%) died during follow-up, 19 (61.3%) of a known cause; the 39 patients not treated for LVAO lacked mesenteric ischemia. Conclusion: Patients with RSCI may have symptomatic LVAO; therefore, we advise they undergo careful query for symptoms of abdominal angina and routine visceral artery imaging. PMID:26263388

  12. Cigarette smoking and long-term alcohol and drug treatment outcomes: a telephone follow-up at five years.

    PubMed

    Satre, Derek D; Kohn, Carolynn S; Weisner, Constance

    2007-01-01

    This prospective study examined the relationship between cigarette smoking and five-year substance abuse treatment outcomes. Of 749 individuals who began private outpatient treatment, 598 (80%) were re-interviewed by telephone at five years. At five-year follow-up, 53% reported smoking cigarettes in the prior 30 days. Smokers were less likely to be abstinent from alcohol and drugs in the prior 30 days (48.3% vs. 64.0%), and had higher Addiction Severity Index (ASI) scores in employment, alcohol, drug, psychiatric, and family/social problems; worse self-reported health; and greater self-reported depression. Findings inform understanding of long-term substance abuse treatment outcomes and potential service needs of smokers. PMID:17364419

  13. The significance of molecular studies in the long-term follow-up of children with beckwith- wiedemann syndrome.

    PubMed

    Gizewska, Maria; Wilk, Malgorzata; Patalan, Michal; Mackay, Deborah; Peregud-Pegorzelski, Jaroslow; Gawrych, Elzbieta; Walczak, Mieczyslaw; Petriczko, Elzbieta; Brodkiewicz, Andrzej

    2014-01-01

    Beckwith-Wiedemann syndrome (BWS) is a congenital disorder of imprinting caused by epimutations and mutations affecting two imprinted loci on chromosome 11p15. Its clinical features are heterogeneous, including macrosomia, macroglossia, hemihyperplasia, abdominal wall defects, neonatal hypoglycemia, and increased risk of embryonal tumors such as Wilms tumor, adrenocortical carcinoma, hepatoblastoma, and neuroblastoma. The molecular and clinical heterogeneity of BWS makes the diagnosis challenging, but essential, since different etiologies of BWS have different clinical prognoses - most crucially, patients with gain of maternal methylation at imprinting control region type 1 (ICR1) are at significant risk of Wilms tumor or hepatoblastoma. We present three cases of BWS with different symptomatology and two different molecular diagnoses. The authors emphasize the importance of molecular studies in the long-term follow-up of children with BWS, including refinement of phenotype-genotype correlation and its connection with optimal management and tumor surveillance. PMID:24911853

  14. Endovascular Exclusion of Visceral Artery Aneurysms with Stent-Grafts: Technique and Long-Term Follow-up

    SciTech Connect

    Rossi, Michele; Rebonato, Alberto Greco, Laura; Citone, Michele; David, Vincenzo

    2008-01-15

    This paper describes four cases of visceral artery aneurysms (VAAs) successfully treated with endovascular stent-grafts and discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the materials were chosen on the basis of CT angiography findings. In all cases the aneurysms were successfully excluded. In one case a splenic infarction occurred, with nonrelevant clinical findings. At 16- to 24-month follow-up three patients had patent stents and complete exclusion and shrinkage of the aneurysms. One patient died due to pancreatitis and sepsis, 16 days after successful stenting and exclusion of a bleeding pseudoaneurysm. We conclude that endovascular treatment using covered stent-grafts is a valid therapeutic option for VAAs. Multislice CT preoperative study helps in planning stent-graft positioning.

  15. Medulloblastoma: Long-term follow-up of patients treated with electron irradiation of the spinal field

    SciTech Connect

    Gaspar, L.E.; Dawson, D.J.; Tilley-Gulliford, S.A.; Banerjee, P. )

    1991-09-01

    Thirty-two patients with posterior fossa medulloblastoma underwent treatment with electron irradiation to the spinal field. The 5- and 10-year actuarial survival rates were 57% and 50%, respectively. Late complications observed in the 15 patients followed up for more than 5 years were short stature (six patients), decreased sitting-standing height ratio (four patients), scoliosis (two patients), poor school performance (seven patients), xerostomia (one patient), esophageal stricture (one patient), pituitary dysfunction (four patients), primary hypothyroidism (one patient), bilateral eighth-nerve deafness (one patient), and carcinoma of the thyroid (one patient). Complications following treatment with electrons to a spinal field are compared with reported complications following treatment with photons to the spinal field. Although short-term reactions were minimal, the authors found no difference in late complications. More sophisticated treatment planning may show such a long-term benefit in the future.

  16. Impact of gastrojejunostomy diameter on long-term weight loss following laparoscopic gastric bypass: a follow-up study

    PubMed Central

    Smith, Carter; Garren, Michael

    2016-01-01

    Background Stenosis of the gastrojejunostomy after laparoscopic Roux-en-Y gastric bypass is a common occurrence. We have previously presented data demonstrating that the use of a 25-mm circular stapler results in a decreased incidence of stenosis compared to the results of a 21-mm circular stapler (6.2 vs. 15.9%, P = 0.03). One potential drawback of the larger-diameter stapler is the possibility for impaired long-term weight loss due to decreased restriction. We sought to determine the impact of circular stapler diameter on excess weight loss up to 5 years after surgery. Methods Our initial technique for creating the gastrojejunostomy after laparoscopic gastric bypass involved the transgastric passage of a 21-mm circular stapler anvil (group 1). After a large initial experience, we switched to a 25-mm circular stapler (group 2). Follow-up data were entered prospectively into a computer database. Weight loss was recorded as percent of excess weight lost. Only patients with follow-up beyond 3 years postoperatively were eligible for inclusion. Results Group 1 consisted of 145 consecutive patients and group 2 consisted of 116 consecutive patients. There was no significant difference in weight loss between the groups at 3 (66.1 vs. 65.2%, P = 0.76, n = 134), 4 (66.4 vs. 58.6%, P = 0.1, n = 66), and 5 years after gastric bypass (62.7 vs. 57.5%, P = 0.24, n = 75). Conclusions The use of a 25-mm circular stapler in laparoscopic gastric bypass operations instead of a 21-mm stapler does not result in significantly different long-term weight loss. The 25-mm stapler is preferred with our technique. PMID:21184107

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

    PubMed Central

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

    2013-01-01

    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

  18. Long-Term Follow-Up of Cyclophosphamide Compared with Azathioprine for Initial Maintenance Therapy in ANCA-Associated Vasculitis

    PubMed Central

    Faurschou, Mikkel; Berden, Annelies; Flossmann, Oliver; Bajema, Ingeborg; Hoglund, Peter; Smith, Rona; Szpirt, Wladimir; Westman, Kerstin; Pusey, Charles D.; Jayne, David R.W.

    2014-01-01

    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 36 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 of diagnosis, participants were randomly allocated to convert to azathioprine after 36 months (the azathioprine group) or after 12 months of cyclophosphamide (the cyclophosphamide group). Patients who did not achieve a remission within 6 months were excluded. This study assessed relapses, ESRD, and death during long-term follow-up. Results Patients were allocated to the azathioprine group (n=71) and the cyclophosphamide group (n=73). Of these patients, 63 (43.8%) developed a relapse, 35 (24.3%) developed a renal relapse, 13 (9.0%) developed ESRD, and 21 (14.6%) died. Although there were worse outcomes in the azathioprine group, none were statistically significant. The subdistribution hazard ratio [sHR] for relapse was 1.63 (95% confidence interval [95% CI], 0.99 to 2.71), the composite of relapse or death hazard ratio [HR] was 1.59 (95% CI, 1.00 to 2.54), the ESRD sHR was 1.71 (95% CI, 0.56 to 5.19), and the death HR was 0.75 (95% CI, 0.32 to 1.79). Conclusions It remains uncertain whether converting to azathioprine after 36 months of induction cyclophosphamide therapy is as effective as converting after 12 months. Outcomes are still poor for this group of patients and further research is required to determine the optimal timing of maintenance therapy. PMID:24970876

  19. Uterine Artery Embolization in Patients with a Large Fibroid Burden: Long-Term Clinical and MR Follow-up

    SciTech Connect

    Smeets, Albert J. Nijenhuis, Robbert J.; Rooij, Willem Jan van; Weimar, Emilie A. M.; Boekkooi, Peter F.; Lampmann, Leo E. H.; Vervest, Harry A. M.; Lohle, Paul N. M.

    2010-10-15

    Uterine artery embolization (UAE) in patients with a large fibroid burden is controversial. Anecdotal reports describe serious complications and limited clinical results. We report the long-term clinical and magnetic resonance (MR) results in a large series of women with a dominant fibroid of >10 cm and/or an uterine volume of >700 cm{sup 3}. Seventy-one consecutive patients (mean age, 42.5 years; median, 40 years; range, 25-52 years) with a large fibroid burden were treated by UAE between August 2000 and April 2005. Volume reduction and infarction rate of dominant fibroid and uterus were assessed by comparing the baseline and latest follow-up MRIs. Patients were clinically followed at various time intervals after UAE with standardized questionnaires. There were no serious complications of UAE. During a mean follow-up of 48 months (median, 59 months; range, 6-106 months), 10 of 71 patients (14%) had a hysterectomy. Mean volume reduction of the fibroid and uterus was 44 and 43%. Mean infarction rate of the fibroid and overall fibroid infarction rate was 86 and 87%. In the vast majority of patients there was a substantial improvement of symptoms. Clinical results were similar in patients with a dominant fibroid >10 cm and in patients with large uterine volumes by diffuse fibroid disease. In conclusion, our results indicate that the risk of serious complications after UAE in patients with a large fibroid burden is not increased. Moreover, clinical long-term results are as good as in other patients who are treated with UAE. Therefore, a large fibroid burden should not be considered a contraindication for UAE.

  20. Statin Use and the Risk of Kidney Disease With Long-Term Follow-Up (8.4-Year Study).

    PubMed

    Acharya, Tushar; Huang, Jian; Tringali, Steven; Frei, Christopher R; Mortensen, Eric M; Mansi, Ishak A

    2016-02-15

    Few studies have examined long-term effects of statin therapy on kidney diseases. The objective of this study was to determine the association of statin use with incidence of acute and chronic kidney diseases after prolonged follow-up. In this retrospective cohort study, we analyzed data from the San Antonio area military health care system from October 2003 through March 2012. Statin users were propensity score matched to nonusers using 82 baseline characteristics including demographics, co-morbidities, medications, and health care utilization. Study outcomes were acute kidney injury, chronic kidney disease (CKD), and nephritis/nephrosis/renal sclerosis. Of the 43,438 subjects included, we propensity score matched 6,342 statin users with 6,342 nonusers. Statin users had greater odds of acute kidney injury (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14 to 1.48), CKD (OR 1.36, 95% CI 1.22 to 1.52), and nephritis/nephrosis/renal sclerosis (OR 1.35, 95% CI 1.05 to 1.73). In a subset of patients without co-morbidities, the association of statin use with CKD remained significant (OR 1.53, 95% CI 1.27 to 1.85). In a secondary analysis, adjusting for diseases/conditions that developed during follow-up weakened this association. In conclusion, statin use is associated with increased incidence of acute and chronic kidney disease. These findings are cautionary and suggest that long-term effects of statins in real-life patients may differ from shorter term effects in selected clinical trial populations. PMID:26742473

  1. Stereotactic LINAC-Radiosurgery for Glomus Jugulare Tumors: A Long-Term Follow-Up of 27 Patients

    PubMed Central

    El Majdoub, Faycal; Hunsche, Stefan; Igressa, Alhadi; Kocher, Martin; Sturm, Volker; Maarouf, Mohammad

    2015-01-01

    Background The optimal treatment of glomus jugulare tumors (GJTs) remains controversial. Due to the critical location, microsurgery still provides high treatment-related morbidity and a decreased quality of life. Thus, we performed stereotactical radiosurgery (SRS) for the treatment of GJTs and evaluated the long-term outcome. Methods Between 1991 and 2011, 32 patients with GJTs underwent SRS using a linear accelerator (LINAC) either as primary or salvage therapy. Twenty-seven patients (median age 59.9 years, range 28.779.9 years) with a follow-up greater than five years (median 11 years, range 5.322.1 years) were selected for retrospective analysis. The median therapeutic single dose applied to the tumor surface was 15 Gy (range 1120 Gy) and the median tumor volume was 9.5 ml (range 2.851 ml). Results Following LINAC-SRS, 10 of 27 patients showed a significant improvement of their previous neurological complaints, whereas 12 patients remained unchanged. Five patients died during follow-up due to old age or other, not treatment-related reasons. MR-imaging showed a partial remission in 12 and a stable disease in 15 patients. No tumor progression was observed. The actuarial overall survival rates after five, ten and 20 years were 100%, 95.2% and 79.4%, respectively. Conclusions Stereotactic LINAC-Radiosurgery can achieve an excellent long-term tumor control beside a low rate of morbidity in the treatment of GJTs. It should be considered as an alternative therapy regime to surgical resection or fractionated external beam radiation either as primary, adjuvant or salvage therapy. PMID:26069957

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

    PubMed

    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

    2014-01-01

    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

  3. Long-term follow-up of peripheral lymphocyte subsets in a cohort of multiple sclerosis patients treated with natalizumab

    PubMed Central

    Koudriavtseva, T; Sbardella, E; Trento, E; Bordignon, V; D'Agosto, G; Cordiali-Fei, P

    2014-01-01

    Natalizumab, an anti-alpha4 integrin monoclonal antibody inhibiting the adhesion of lymphocytes to the endothelium, is a widely accepted drug treatment for relapsingremitting multiple sclerosis (RRMS). A peripheral increase of T and B lymphocytes has already been observed as an early treatment effect. This retrospective observational study was aimed to evaluate the peripheral lymphocyte subsets during a long-term treatment follow-up. We included 23 RRMS patients treated with natalizumab for at least 2448 months who had pretreatment lymphocyte evaluation. Baseline values of lymphocyte subsets and CD4/CD8 ratio did not differ significantly from the 23 matched healthy subjects. The periodic (every 36 months) assessment of immune cell subsets was performed by flow cytometry on peripheral blood collected before drug injection. Therapy with natalizumab was confirmed to be effective during the observational period. For all patients, the increase in lymphocytes during natalizumab therapy compared to baseline at every assessment was significantly higher compared to that of overall white blood cells (21-and 13-fold, respectively, P?long-term follow-up. PMID:24387139

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

    PubMed Central

    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

    2014-01-01

    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

  5. Ophthalmological long term follow up of preterm infants: a population based, prospective study of the refraction and its development

    PubMed Central

    Holmstrom, G; el Azazi, M; Kugelberg, U

    1998-01-01

    BACKGROUNDNumerous studies have reported an increased risk of refractive errors in prematurely born infants, but only few have been long term and strictly population based.?METHODSA 3.5year ophthalmological long term follow up of 248preterm infants was performed. The infants had been included in a previous epidemiological study of retinopathy of prematurity (ROP) (birth weight ?1500grams). The incidence of refractive errors and development of refraction were studied, based on retinoscopies at 6and 30months of corrected age.?RESULTSThe overall incidence of myopia was 8% at 6months, of which 35% was transient, and 10% at 30months. Of the cryotreated infants, 30-40% were myopic at both retinoscopies. The incidence of astigmatism was 52% at 6months and 26% at 30months. Astigmatism was associated with ROP, but not with cryotreated ROP itself. Astigmatism "against the rule" was commoner than astigmatism "with the rule". Anisometropia occurred in 6.5% of the infants at 6months and in 8.4% at 30months. The incidence of anisometropia was higher in eyes with ROP, particularly in cryotreated eyes, which tended to have high and persistent anisometropia.?CONCLUSIONThe risk of refractive errors is higher in preterm infants than in infants born at term, and also prematurely born infants without ROP do run an increased risk of having myopia and anisometropia. We recommend follow up examinations with retinoscopy for all infants included in screening programmes for ROP.?? Keywords: prematurity; prospective study; retinopathy of prematurity; refraction PMID:9924330

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

    PubMed

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

    2016-04-01

    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). PMID:26825868

  7. [Unemployment among long-term sick-listed persons. From the project Evaluation of Follow-up of Long-term Sick-listed Persons].

    PubMed

    Berg, J E; Tellnes, G

    1992-01-20

    The aim of the study was to compare two subgroups of patients with long-term sickness certificate, i.e. a group who were unemployed after eight weeks of incapacity for work and a group who still had a paid job at the end of the eight weeks. 712 patients who received a medical certificate II after eight weeks of incapacity for work in 1988 were followed up for another 12-15 months by means of information collected as a routine at the local National Insurance Offices in five municipalities in Norway. Of our total sample of patients, the sub-group of unemployed persons differed in a number of ways from the group who still had a job. Among the unemployed the duration of sickness certificate was longer and there were higher frequencies of mental disorders and diseases of the nervous system/sense organs. Admission to hospital was less frequent, however, among the unemployed group than among the group who still had a job. The rate of return-to-work observed after one year of sickness certificate was lower among the unemployed. PMID:1566255

  8. Long-term follow-up of Van Nes rotationplasty in patients with congenital proximal focal femoral deficiency

    PubMed Central

    Ackman, J.; Altiok, H.; Flanagan, A.; Peer, M.; Graf, A.; Krzak, J.; Hassani, S.; Eastwood, D.; Harris, G. F.

    2015-01-01

    Van Nes rotationplasty may be used for patients with congenital proximal focal femoral deficiency (PFFD). The lower limb is rotated to use the ankle and foot as a functional knee joint within a prosthesis. A small series of cases was investigated to determine the long-term outcome. At a mean of 21.5 years (11 to 45) after their rotationplasty, a total of 12 prosthetic patients completed the Short-Form (SF)-36, Faces Pain Scale-Revised, Harris hip score, Oswestry back pain score and Prosthetic Evaluation Questionnaires, as did 12 age- and gender-matched normal control participants. A physical examination and gait analysis, computerised dynamic posturography (CDP), and timed Up & Go testing was also completed. Wilcoxon Signed rank test was used to compare each PFFD patient with a matched control participant with false discovery rate of 5%. There were no differences between the groups in overall health and well-being on the SF-36. Significant differences were seen in gait parameters in the PFFD group. Using CDP, the PFFD group had reduced symmetry in stance, and reduced end point and maximum excursions. Patients who had undergone Van Nes rotationplasty had a high level of function and quality of life at long-term follow-up, but presented with significant differences in gait and posture compared with the control group. PMID:23365028

  9. Endoscopic Papillary Balloon Dilation for Removal of Choledocholithiasis: Indications, Advantages, Complications, and Long-Term Follow-Up Results

    PubMed Central

    Chung, Joo Won

    2011-01-01

    Endoscopic papillary balloon dilation (EPBD) is an alternative method of endoscopic sphincterotomy (EST). Although concerns regarding post-procedure pancreatitis have been expressed, EPBD has come to be recognized as an effective and safe method for stone removal in specific cases. To analyze the proper indications, ideal methods, complications, and long-term follow-up results for EPBD, we reviewed articles about EPBD located through a search of the PubMed data base. We analyzed the ballooning methods, indications, results and complications of EPBD among the articles found and compared the results with those of EST. We considered the authors' own clinical experience and knowledge in developing recommendations for EPBD. EPBD showed similar efficacy and safety for the removal of choledocholithiasis to that of EST. Although large or multiple stones were difficult to remove by EPBD, it was safer and easier to apply in patients with coagulopathy or abnormal anatomy. To prevent severe pancreatitis, excessive ballooning and impractical cannulation should be avoided, and precut sphincterotomy or adjuvant prophylaxis should be considered. Due to its preservation of the sphincter of Oddi, EPBD is expected to have fewer long-term complications, such as stone recurrence, cholangitis and cholecystitis. In conclusion, EPBD appears to be safe and effective for the treatment of choledocholithiasis with proper selection of ballooning methods and patients. PMID:21461066

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

    PubMed Central

    Frimat, L.; Cassuto-Viguier, E.; Provt, 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.

    2010-01-01

    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. PMID:20706667

  11. Long-term follow-up of patients >or=60 yr old with acute myeloid leukaemia treated with intensive chemotherapy.

    PubMed

    Oberg, G; Killander, A; Bjreman, M; Gahrton, G; Grimfors, G; Gruber, A; Hast, R; Lerner, R; Liliemark, J; Mattson, S; Paul, C; Simonsson, B; Stalfelt, A-M; Stenke, L; Tidefelt, U; Udn, A-M; Bjrkholm, M

    2002-06-01

    It is still controversial how to treat elderly patients with acute myeloid leukaemia (AML), and results have been poor with most regimens. We report the long-term results of a randomised study performed by the Leukaemia Group of Middle Sweden during 1984-88 comparing two intensive chemotherapeutic drug combinations. Ninety patients >or=60-yr old with untreated AML were randomly allocated to treatment with daunorubicin, cytosine arabinoside (ara-C), and thioguanine (TAD) (43 patients) or a combination in which aclarubicin was substituted for daunorubicin (TAA) (47 patients). Forty-four patients (49%) entered complete remission (CR), 22/43 (51%) in the TAD group and 22/47 (47%) in the TAA group (ns). The CR rate in patients 70 yr 14/48 (29%) (P<0.0001). Early death within 30 d after treatment initiation was more often seen in patients >70 yr than in patients long-term follow-up >or=10 yr after inclusion of the last patient, 5/90 patients (one in the TAD group and four in the TAA group, respectively) were still alive, four in continuous complete remission and one in second complete remission. Thus, both treatment regimens appear to have similar efficacy, with a relatively high complete remission rate, and a reasonable survival as compared to other studies including some long-term survivors. However, early deaths are still numerous, particularly in patients above 70 yr of age, and the relapse rate is substantial. PMID:12225396

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

    PubMed

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

    2015-12-01

    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. PMID:25686360

  13. Subcutaneous Direct-to-Implant Breast Reconstruction: Surgical, Functional, and Aesthetic Results after Long-Term Follow-Up

    PubMed Central

    Calabrese, Claudio; Cecconi, Lorenzo; Santi, Caterina; Gjondedaj, Ulpjana; Roselli, Jenny; Nori, Jacopo; Fausto, Alfonso; Orzalesi, Lorenzo; Casella, Donato

    2015-01-01

    Abstract Background: Direct-to-implant breast reconstruction can be achieved more easily by means of soft-tissue replacement devices such as dermal matrices and synthetic meshes. The feasibility of a subcutaneous approach has been recently investigated by some studies with different devices functioning as implant support. Aim of this study is to analyze the long-term results, both objective and subjective, of a previous nonrandomized trial comparing prepectoral (subcutaneous) and retropectoral breast reconstructions. Methods: Patients enrolled in a nonrandomized prospective trial, comparing the standard retropectoral reconstruction and the prepectoral subcutaneous approach, using a titanium-coated mesh in both techniques, were followed up and evaluated for long-term results. Cases were compared in terms of the causes and rate of reinterventions, of the postoperative BREAST-Q questionnaire results, and of an objective surgical evaluation. Results: The subcutaneous group had a rate of implant failure and removal of 5.1% when compared with 0% in the retropectoral group. Aesthetic outcome was significantly better for the subcutaneous group both at a subjective and at an objective evaluation. Capsular contracture rate was 0% in the subcutaneous group. Conclusions: A higher rate of implant failure and removal, although not significant, always because of skin flaps and wound problems, should be taken into account for a careful patients selection. The subcutaneous breast reconstruction shows good long-term results. A coherent subjective and objective cosmetic advantage of this approach emerges. Moreover, no capsular contracture is evident, albeit in a relatively limited number of cases. PMID:26893999

  14. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency.

    PubMed

    Quinti, Isabella; Soresina, Annarosa; Spadaro, Giuseppe; Martino, Silvana; Donnanno, Simona; Agostini, Carlo; Claudio, Pignata; Franco, Dammacco; Maria Pesce, Anna; Borghese, Federica; Guerra, Andrea; Rondelli, Roberto; Plebani, Alessandro

    2007-05-01

    Common Variable Immunodeficiency belongs to the group of rare diseases encompassing antibody deficiency syndromes of highly variable clinical presentation and outcome. The multicenter prospective study on a cohort of 224 patients with Common Variable Immunodeficiency provides an updated view of the spectrum of illnesses which occurred at the clinical onset and over a long period of follow-up (mean time: 11 years) and information on the effects of long-term immunoglobulin treatment. The mean age at the time of diagnosis was 26.6 years. Seventy-five patients were younger than 14 years of age. The mean age at the onset of symptoms was 16.9 years. This implicates with a mean diagnostic delay of 8.9 years. Respiratory tract infections were the most prominent clinical problem observed at diagnosis and during the follow-up. Intravenous immunoglobulin administration induced a significant reduction in the incidence of acute infections, mainly acute pneumonia and acute otitis. However, a progressive increase in the prevalence of patients with chronic diseases, mainly sinusitis and lung disease, was observed in all age groups, including the pediatric population. The morbidity of Common Variable Immunodeficiency due to all associated clinical conditions increased over time despite an adequate replacement with intravenous immunoglobulins. Our data stressed the need to develop international guidelines for the prevention and therapy of chronic lung disease, chronic sinusitis, chronic diarrhoea, and chronic granulomatosis in patients with humoral immunodeficiencies. PMID:17510807

  15. [Long term follow-up of bile duct stenosis treated with interventional radiology in pediatric liver transplantation].

    PubMed

    Brun, N; Bueno, J; Prez, M; Venturi, C; Gin, C; Lloret, J; Segarra, A; Martnez Ibez, V; Charco, R

    2010-01-01

    The reported incidence of biliary strictures following pediatric liver transplantation has ranged between 5-34%, with a higher incidence in segmental grafts. Currently, percutaneous transhepatic balloon dilatation of biliary strictures is considered as the first line treatment owing to its minimal invasiveness. Between 1995-2006, 20 children who underwent liver transplantation developed biliary complications treated with interventional radiology. 16/20 developed biliary stricture, of whom 10 were treated with percutaneous transhepatic balloon dilatation. The mean age at the procedure was 6.6 years (range 8 m--14 years). The allograft types included whole (n=4), split (n=3), and reduced (n=3) livers. The procedure was performed at a mean time post-transplantation of 2.6 years. All patients are alive with a mean follow-up post-procedure of 24 months (range: 4 months-11 years). Currently, only 4 have a normal appearing biliary tree by imaging techniques and 6 developed stricture recurrence; of whom 3 developed biliary cirrhosis (2 splits, 1 reduced), one patient underwent successful rescue surgery, one was treated again percutaneously, and the remaining was lost to followup. In conclusion, treatment of percutaneous transhepatic balloon dilatation of biliary strictures is effective avoiding surgical correction. However, stricture recurrence in the medium- long term follow-up is frequent, particularly in segmental grafts. [corrected] PMID:20578568

  16. Acute gastroesophageal intussusception in a juvenile Australian shepherd dog: endoscopic treatment and long-term follow-up

    PubMed Central

    2014-01-01

    Background Canine gastroesophageal intussusception (GEI) is a rare and potentially fatal disease usually affecting puppies or young dogs < 3 months of age and of medium to large breeds. Surgical intervention has been advocated as the therapy of choice by most authors. Endoscopic treatment may offer an advantageous or alternative method of treatment. Case presentation GEI was diagnosed in a nine-week-old Australian Shepherd dog with an acute onset of vomiting and regurgitation and compatible radiographic findings on thoracic radiography. Treatment consisted of endoscopic gastric repositioning and placement of a percutaneous endoscopic gastrostomy (PEG) tube to prevent repeated dislocation of the stomach, and to allow for nutritional supplementation During a follow- up period of eight months, thoracic radiographs were obtained showing persistent esophageal dilatation in the absence of compatible clinical signs. Conclusion Endoscopic intervention is an effective, alternative in selected canine GEI- cases, allowing for rapid, minimally invasive confirmation of diagnosis and therapy. After initial treatment, radiographic long-term follow-up seems prudent even in asymptomatic patients. PMID:24885648

  17. Long-term follow-up of pediatric sickle cell disease patients with abnormal high velocities on transcranial Doppler.

    PubMed

    Bernaudin, Franoise; Verlhac, Suzanne; Coc, Lena; Lesprit, Emmanuelle; Brugires, Pierre; Reinert, Philippe

    2005-03-01

    Cerebral arteriopathy can be detected in children with sickle cell disease (SCD) by transcranial Doppler (TCD). Abnormally high velocities are predictive of high stroke risk, which can be reduced by transfusion therapy. We report the results of the screening of 291 SCD children followed in our center, including the clinical and imaging follow-up of 35 children with abnormal TCDs who were placed on transfusion therapy. We postulated that patients with normal MRA findings and abnormal TCD velocities that normalized on a transfusion program could be safely treated with hydroxyurea (HU). We report their outcome (median follow-up of 4.4 years). Of 13 patients with normalized velocities on transfusion, 10 had normal MRAs, and transfusion therapy was stopped and HU begun. Four of these ten patients redeveloped high velocities off transfusion, so currently only six remain transfusion-free. Six other transplanted patients remain transfusion-free. Abnormal TCD velocities detect a high-risk group, justifying the research for suitable transplant donors. Multicenter studies comparing HU therapy to long-term transfusion might help identify which patients can avoid transfusion and its complications while avoiding vasculopathy. PMID:15703901

  18. Revision hip arthroplasty using impacted cancellous bone and cement: a long-term follow-up study.

    PubMed

    Arumugam, Gowthaman; Nanjayan, Shashi Kumar; Quah, Conal; Wraighte, Philip; Howard, Peter

    2015-12-01

    Acetabular bone deficiency is one of the many challenging problems encountered in revision hip arthroplasty. A variety of surgical options and techniques are available including impaction bone grafting. We present our long-term experience of 68 consecutive cups in 64 patients, using impacted cancellous bone grafting with bone cement. With a mean follow-up of 10.5 year (IQR 7.5-12.9) after revision surgery, three implants had undergone further revision. Three patients had subsequent femoral peri-prosthetic fractures, and none of these three required further acetabular revision. Survival of the acetabular components was 95.5 % for all causes and 100 % for aseptic loosening as the end point, with a further four patients showing radiographic, but asymptomatic loosening. A significant correlation was found between previous revision and re-revision (early failure) (p = 0.01) as well as progression of lytic lesion and re-revision (p = 0.01). The median Harris hip score at final follow-up was 79.5 (IQR 67.9-80.4). The use of impacted morcellised allograft bone with a cemented cup is an effective technique to achieve longevity and restoration of bone stock in acetabular revision arthroplasty. Our series has shown good clinical and radiological outcome with survivorship of the prosthesis exceeding 95 % at 10 years. PMID:26399609

  19. The effect of long-term care and follow-up on complications in patients with external fixators.

    PubMed

    Cam, Rahsan; Korkmaz, Fatma Demir

    2014-02-01

    The present study aimed to determine the effect of long-term care and follow-up on complications in patients with external fixators. This study was conducted as a study research. The study sample included a total of 60 patients treated with external fixators for fractures, of whom 30 were in the control and 30 were in the study group. No intervention was made on the control group patients. The patients in the study group received external fixator pin site wound care, pin site massage and neurovascular follow-up. The study group patients were also given discharge training about external fixator pin site care two days before their discharge and were also provided with training manuals to guide their home care. Both groups were visited weekly at their homes to record their complications. Nine complications developed in eight patients (26.7%) in the study group, and 19 complications developed in 19 patients (63.3%) in the control group. Pin site infections were 11.6% of the total sample. The percentage for pin loosening, stiff joint, nerve and vessel injury and pain and swelling was 5%, 25%, 1.7% and 3.3%, respectively. PMID:24580979

  20. Long-Term Results of Anderson-Hynes Pyeloplasty in Children: How Long Follow-Up Is Necessary?

    PubMed

    Reis, Leonardo Oliveira; Ikari, Osamu; Zani, Emerson Lus; Moretti, Toms Bernardo Costa; Gugliotta, Antonio

    2015-12-01

    Purpose?After a successful pyeloplasty at 3 to 6 months, the question remains whether children need a long follow-up. Methods?The medical charts of patients with long-term follow-up (> 5 years), who underwent dismembered pyeloplasty for uretero-pelvic junction obstruction (UPJO) from May 1998 to May 2007, excluding those with bilateral UPJO, solitary kidney, associated vesicoureteral reflux or other abnormalities, and inconclusive renogram due to poor renal function, were retrospectively reviewed. Ultrasonography, differential renal function (DRF, DMSA), and renal drainage on diuretic renography (diethylene-triamine-pentaacetate technetium-99 or DTPA-Tc99) were performed at 3 and 6 months every year. Results?Complete data were available for 28 consecutive patients (28 renal unities) with 2 months to 12 years (mean age, 2.4 years) at surgery, of whom 21 (75%) were boys, 17 diagnosed prenatally (61%) and 18 unities (64.3%) were left, with median follow-up of 10.7 years. Images were graded according to the Society for Fetal Urology grading system: Grade III in 11 (49%) and grade IV in 17 (61%). All cases presented?>?10% DRF (DMSA) and obstructed DTPA-Tc99. The T1/2 (the half-time of drainage) less than 20 minutes at 3 months was found in 21 cases (75%) and less than 25 minutes in 7 cases (25%). Renal function and patency were maintained during follow-up for all units with 8% maximum fluctuation of DRF. One index case (3.6%) of renal function deterioration presented DRF fluctuation?>?8% at 3 months (from 23 to 32%) and progressive hydronephrosis and indeterminate DTPA at 6 months. Conclusions?Satisfactory diuretic renogram at 3 to 6 months after pyeloplasty with maintained renal function and stable hydronephrosis suggests no need for further follow-up and indicates no functional loss with time. More than 8% DRF fluctuation might be a significant cutoff for further intervention aiming nephron preservation. PMID:25281827

  1. Long-Term Follow-Up of the Therapeutic Outcomes for Papillary Thyroid Carcinoma With Distant Metastasis

    PubMed Central

    Lin, Jen-Der; Hsueh, Chuen; Chao, Tzu-Chieh

    2015-01-01

    Abstract Papillary thyroid carcinoma (PTC) patients with distant metastasis (DM) have variable clinical courses and therapeutic outcomes. Survival time after diagnosis of DM may be several months to years. Long-term follow-up is necessary to determine prognostic factors for survival in PTC with DM. The purpose of this study was to investigate the clinical features and therapeutic outcomes of PTC with DM after 10 years of follow-up. The study population consisted of 70 patients who underwent initial thyroidectomy before 2004 and had DM beyond the locoregional neck area. Of these 70 patients, 40 patients were diagnosed with DM before or within 9 months after initial thyroidectomy in first radioactive iodide (131I) whole-body scintigraphy (group A), and 30 patients were diagnosed with DM during the follow-up period (group B). Patients with DM underwent 3.7 to 7.4 GBq 131I therapy every 6 to 12 months. After a mean follow-up period of 10.1??0.9 years, the disease-specific mortality and remission rates were 70.0% (49/70) and 10% (7/70), respectively. The survival rates for patients in groups A and B were 72.5% and 96.7% at 1 year, 47.5% and 90.0% at 5 years, 40.0% and 70.0% at 10 years, 36.4% and 41.1% at 15 years, and 35.0% and 8.0% at 20 years, respectively. The percentage of male and older patients and patients with larger tumor size was higher in the mortality group than in the survival group, whereas the percentage of patients with 131I avid metastatic lesions (first DM) was lower in the mortality group. The percentage of patients with secondary primary cancers was higher in group B than in group A. In the multiple regression analysis, age and male gender were independently associated with disease-specific mortality. In conclusion, after a mean follow-up of 10.1 years, the disease-specific mortality rate for PTC with DM was 70.0%. Older patients and male PTC patients with DM need more aggressive treatment. The timing of DM diagnosis did not influence disease-specific mortality. PMID:26131826

  2. Long-term follow-up study of elderly patients with covered stent implantation after coronary perforation

    PubMed Central

    Wang, Geng; Han, Ya-Ling; Jing, Quan-Min; Wang, Xiao-Zeng; Ma, Ying-Yan; Wang, Bin

    2014-01-01

    Objective To evaluate the long-term efficacy of covered stent implantation in the treatment of elderly patients with coronary perforation while undergoing percutaneous coronary intervention (PCI). Methods From June 2004 to June 2012, our center has followed ten elderly patients (age ? 60 years) who sustained coronary perforation during PCI. The major adverse cardiac events (MACE) were observed as well. The patients were advised to take 75 mg/day Clopidogrel for two years, and indefinite use of 100 mg/day enteric-coated aspirin. Results Six out of the 10 patients aged from 60 to 76 years old (mean 68.6 5.2 years) were male, four were female. The average diameter of the implanted stents was 3.3 0.3 mm, and the average length was 22.1 3.7 mm. All the ruptures were successfully sealed without intra-procedural death. The follow-up duration ranged from 0.6 to 67 months (mean 31.7 24.5 months). One patient died of multiple organ failure due to lung infection in 19 days after PCI; one died of cardiac sudden death in 13 months after PCI; one had angina pectoris in 53 months after PCI; one underwent multi-slice CT examination in six months after PCI, and no in-stent restenosis was found. The other four patients received angiography follow-up, and the results showed that three patients had no intra-stent restenosis, while one had left anterior descending (LAD) restenosis in the covered stent in 67 months after PCI. The in-hospital mortality was 10% (1/10). The MACE rate in 12 months after PCI was 10% (1/10). During the entire followed-up period, the restenosis rate in target vessels was 20% (1/5), mortality was 20% (2/10), and the MACE rate was 40% (4/10). Conclusion Treatment of coronary perforation by using covered stents can achieve favorable long-term results; a two-year dual antiplatelet therapy (DAPT) after PCI can effectively prevent intra-stent thrombosis. PMID:25278970

  3. Cervical artificial disc replacement with ProDisc-C: clinical and radiographic outcomes with long-term follow-up.

    PubMed

    Malham, Gregory M; Parker, Rhiannon M; Ellis, Ngaire J; Chan, Philip G; Varma, Dinesh

    2014-06-01

    Cervical artificial disc replacement (ADR) is indicated for the treatment of severe radiculopathy permitting neural decompression and maintenance of motion. We evaluated the clinical and radiographic outcomes in cervical ADR patients using the ProDisc-C device (DePuy Synthes, West Chester, PA, USA) with a 5-9 year follow-up. Data were collected through a prospective registry, with retrospective analysis performed on 24 consecutive patients treated with cervical ADR by a single surgeon. All patients underwent single- or two-level ADR with the ProDisc-C device. Outcome measures included neck and arm pain (visual analogue scale), disability (neck disability index [NDI]), complications and secondary surgery rates. Flexion-extension cervical radiographs were performed to assess range of motion (ROM) of the device and adjacent segment disease (ASD). Average follow-up was 7.7 years. Neck and arm pain improved 60% and 79%, respectively, and NDI had an improvement of 58%. There were no episodes of device migration or subsidence. Mean ROM of the device was 6.4. Heterotopic ossification was present in seven patients (37%). Radiographic ASD below the device developed in four patients (21%) (one single-level and three two-level ADR). No patient required secondary surgery (repeat operations at the index level or adjacent levels). Fourteen out of 19 patients (74%) were able to return to employment, with a median return to work time of 1.3 months. The ProDisc-C device for cervical ADR is a safe option for patients providing excellent clinical outcomes, satisfactory return to work rates and maintenance of segmental motion despite radiographic evidence of heterotopic ossification and ASD on long-term follow-up. PMID:24417795

  4. Long-term follow-up of chronic autoimmune thrombocytopenic purpura refractory to splenectomy: a prospective analysis.

    PubMed

    Bourgeois, Emmanuelle; Caulier, Marie T; Delarozee, Catherine; Brouillard, Marc; Bauters, Francis; Fenaux, Pierre

    2003-03-01

    Splenectomy remains the most effective treatment of chronic autoimmune idiopathic thrombocytopenia (ITP) (i.e. of > 6 months duration). Treatment of patients refractory to splenectomy (with absence of response or relapse after initial response) is difficult, and their long-term outcome is not well known. Over a 10-year period, 183 patients with chronic ITP were splenectomized including 158 adults and 25 children (followed up for 5-15 years (median 7.5 years). Twelve of them, with moderate thrombocytopenia, remained untreated, and 35 were treated by a median of two regimens (range 1--6), to which 27 responded. Thirty-six (77%) of the refractory cases reached platelet counts durably > 100 x 10(9)/l, nine of them without treatment and 27 of them with low-dose steroids or azathioprine; six (13%) remained moderately thrombocytopenic (35 x 10(9)/l to 100 x 10(9)/l platelets); the last five patients, without response to any treatment (up to six regimens), remained severely thrombocytopenic (platelets < 20 x 10(9)/l), and three of them died from bleeding. Twenty-seven (57%) of the 47 refractory cases required at least one hospitalization, in the majority of cases for intravenous immunoglobulin (IVIg) infusions. Seven of the refractory cases occurred in children. Six of them subsequently reached platelet counts > 100 x 10(9)/l, but one died from bleeding. Our findings confirm the overall favourable long-term prognosis of chronic ITP refractory to splenectomy. PMID:12648082

  5. Morphological study of upper airways and long-term follow-up of obstructive sleep apnea syndrome in acromegalic patients.

    PubMed

    Castellani, Cinzia; Francia, Giuseppe; Dalle Carbonare, Luca; Ferrari, Marcello; Viva, Elena; Cerini, Roberto; Zaccarella, Alessandro; Trevisiol, Lorenzo; Davi', Maria Vittoria

    2016-02-01

    Pathogenesis and long-term outcome of obstructive sleep apnea syndrome (OSAS) in acromegalic patients are still under debate. The aim of the study was to assess the prevalence and long-term follow-up of a series of acromegalic patients with OSAS and to investigate site, degree, and possible causes of upper airway obstruction by morphological study. Cross-sectional and longitudinal study was conducted in 58 acromegalic patients (33 active, 25 controlled) with polysomnography in all subjects, repeated in 25 patients with OSAS, and echocardiography. Morphological study including fiberoptic nasopharyngoscopy with the Mller maneuver (FNMM), magnetic resonance imaging (MRI), with 3-dimensional (3D) elaboration was also performed. The prevalence of OSAS was 58.6% in the whole series: 63.6% in the active group and 52% in the controlled one. Left ventricular hypertrophy was more prevalent in patients with OSAS. OSAS improved in 62.5% of active patients after achieving hormonal control, whereas it persisted or got worse in 66.6% of the controlled ones. The uvula and tongue base were the main site of obstruction assessed by FNMM. Uvula diameters obtained by MRI study correlated with the severity of upper airway collapse assessed by FNMM and tongue measure with apnea-hypopnea index (p=0.044). A greater narrowing and a smaller total volume of upper airways were confirmed by 3D-MRI in patients with more severe OSAS. Uvula and tongue hypertrophy plays a relevant role in the pathogenesis and severity of OSAS. Intensive treatment of acromegaly needs to be promptly adopted in order to reverse it. PMID:26093846

  6. Combined laparoscopic pyelolithotomy and endoscopic pyelolithotripsy for staghorn calculi: long-term follow-up results from a case series

    PubMed Central

    Pastore, Antonio Luigi; Palleschi, Giovanni; Silvestri, Luigi; Leto, Antonino; Ripoli, Andrea; Fuschi, Andrea; Al Salhi, Yazan; Autieri, Domenico; Petrozza, Vincenzo; Carbone, Antonio

    2016-01-01

    Purpose: Staghorn renal stones are a challenging field in urology. Due to their high recurrence rates, particularly those associated with an infective process, a complete removal is the ultimate goal in their management. We report our experience with a combined approach of laparoscopic pyelolithotomy and endoscopic pyelolithotripsy, the stone clearance rate, and long-term, follow-up outcomes. Methods: From June 2012 to October 2014, nine adult patients with large staghorn renal calculi (mean size, 7.2 cm; range, 6.2–9.0 cm) underwent a combined laparoscopic and endoscopic approach. The technique comprised laparoscopic pyelolithotomy and holmium-YAG laser stone fragmentation with the use of a flexible cystoscope introduced through a 12 mm trocar. Results: The average operative time was 140 min (range, 90–190 min). The mean estimated hemoglobin loss was 0.6 mmol/l (range 0.5–0.7 mmol/l). None of the patients required an open- surgery conversion. The mean hospital stay was 4 days (range, 2–6 days). A computed tomography urogram control at 6 months of follow up did not show any stone recurrence. Conclusions: Laparoscopic pyelolithotomy combined with endoscopic pyelolithotripsy could be a therapeutic option in cases where mini-invasive procedures, that is, extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, and percutaneous nephrolithotomy (PCNL) have failed. This technique has a high stone-clearance rate (75–100%) comparable with open surgery and PCNL. However, it could be technically demanding and should be performed by skilled laparoscopy surgeons. PMID:26834835

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

    PubMed Central

    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

    2014-01-01

    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

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

    PubMed Central

    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

    2015-01-01

    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 www.ClinicalTrials.gov as #NCT01236391. PMID:26059948

  9. Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

    PubMed Central

    Dhejne, Cecilia; Lichtenstein, Paul; Boman, Marcus; Johansson, Anna L. V.; Lngstrm, Niklas; Landn, Mikael

    2011-01-01

    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, 19732003. 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 1.84.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.862.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.98.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.03.9). 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. PMID:21364939

  10. Long term follow-up of two sibs with an autosomal recessive form of chrondrodysplasia punctata and epilepsy.

    PubMed

    Stoll, C; Pauly, F; Steib, J P

    2004-01-01

    Long term follow-up of two sibs with an autosomal recessive form of chrondrodysplasia punctata and epilepsy: A variety of osteodysplasias are referred to with the term chondrodysplasia punctata (CDP). Here we report on two sibs, a boy and a girl, with probable autosomal recessive form of CDP and epilepsy followed-up for 30 and 19 years, respectively. Family history was unremarkable but for consanguinity. Pregnancies and deliveries were uneventful. At birth, length was 46 (-3SD) and 45 (-4SD) cm, respectively. Craniofacial dysmorphism was noted: severe nasal hypoplasia, flat face, hypertelorism, a low nasal bridge, short stature. Skeletal abnormalities included epiphyseal stippling in the thoracic spine, bilateral proximal and distal humeri, femur, tibia and bilateral carpal and tarsal bones. The boy had a hemivertebrae T12, with absence of a rib. After the age of 6 years facial dysmorphism had improved. Final height was 154 cm (-3SD) in the boy and 158 cm (-0,5SD) in the girl. The boy was operated on for scoliosis. Both sibs had club feet, the girl had also genu valgum. IQ was evaluated to be 55 in the girl and 83 in the boy. The first non febrile generalized seizure appeared in the boy when he was 11 months of age, and in the girl when she was 25 months of age. Both had many other seizures and were taking antiepileptics. EEG were abnormal. Karyotypes were normal. Extensive screening for metabolic disorders was normal. Acquired in utero CDP were excluded. We suggest the sibs described in this report have yet another provisionally unique possibly autosomal recessive syndrome, with CDP and epilepsy as phenotypic traits. PMID:15658616

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

    PubMed

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

    2012-03-01

    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. PMID:21327429

  12. Long term omeprazole therapy for reflux esophagitis: Follow-up in serum gastrin levels, EC cell hyperplasia and neoplasia

    PubMed Central

    Singh, Pankaj; Indaram, Anant; Greenberg, Ronald; Visvalingam, Vernu; Bank, Simmy

    2000-01-01

    AIM: To evaluate the long-term safety of omeprazole in patients of gastroesophageal reflux disease resistant to treatment with H2 receptor antagonist. METHODS: We prospectively followed 33 patients on omeprazole therapy for severe erosive esophagitis for 5-8 years, with periodic gastrin levels, H. pylori infection, gastric biopsies for incidence of ECL cell hyperplasia, carcinoids, gastric atrophy and neoplasia. A total 185 patient follow-up years and 137 gastric biopsies were done. RESULTS: Among the 33 patients, 36% reached their peak gastrin levels in an average of 8 mo to one year, then drifted Down slowly over 1-2 year period to just above their baseline level, 24% of the patients had a peak gastrin level above 400 ngL-1 and one patient had a peak level above 1000 ngL-1. One patient had a mild ECL cell hyperplasia which was self-limiting and did not show any dysplastic changes. Eighteen percent of patients were positive for H. pylori infection. The gastric biopsies did not show gastric atrophy, intestinal metaplasia or neoplastic changes. CONCLUSION: In a series of 33 patients followed for 5-8 years on omeprazole therapy for severe reflux esophagitis, we did not observe any evidence of significant ECL cell hyperplasia, gastric atrophy, intestinal metaplasia, dysplasia or neoplastic changes. PMID:11819697

  13. Long-term follow-up study of compensated low-dose /sup 131/I therapy for Graves' disease

    SciTech Connect

    Sridama, V.; McCormick, M.; Kaplan, E.L.; Fauchet, R.; DeGroot, L.J.

    1984-08-16

    We treated 187 patients who had Graves' disease with low-dose radioactive iodide (/sup 131/I), using a protocol that included a compensation for thyroid size. The incidence of early hypothyroidism (12 per cent) was acceptably low in the first year after /sup 131/I treatment, but we found a cumulative high incidence (up to 76 per cent) at the end of the 11th year. In contrast, the incidence of permanent hypothyroidism was relatively stable in 166 surgically treated patients, increasing from 19 to 27 per cent at the end of 11 years. Among 122 medically treated patients, only 40 per cent entered remission, and hypothyroidism developed in 2 per cent during the same period of follow-up. The long-term incidence of hypothyroidism in our patients treated with low-dose /sup 131/I therapy was much higher than that found in earlier studies using a comparable dose. Our study suggests that it will be difficult to modify therapy with /sup 131/I alone to produce both early control of thyrotoxicosis and a low incidence of hypothyroidism.

  14. Long-term follow-up of therapeutic ERCP in 78 patients aged 90 years or older.

    PubMed

    Hu, Lianghao; Sun, Xiaotian; Hao, Junfeng; Xie, Ting; Liu, Minghao; Xin, Lei; Sun, Tao; Liu, Muyun; Zou, Wenbin; Ye, Bo; Liu, Feng; Wang, Dong; Cao, Ning; Liao, Zhuan; Li, Zhaoshen

    2014-01-01

    This study aimed to determine the performance and long-term outcomes of therapeutic ERCP in very old patients. Patients aged or over 90 (Group A, n = 78) and consecutive sex-matched controls (Group B, n = 312) under 65 selected were compared. More patients in Group A had chronic concomitant diseases, but the success and complication rates were comparable. The follow-up of 61 patients (78.2%) in Group A were done, with a mean period of 27.5 (3-54) months. Seven patients survived; the main causes of death for the other patients were concomitant diseases (n = 43) and primary diseases (n = 11). In patients with choledocholithiasis, cases with complete extractions of stones in bile ducts survived longer than those without (30 vs. 24 months, P < 0.001). Therapeutic ERCP in patients aged 90 years or older is effective and safe. In patients with choledocholithiasis, complete clearance of stones is associated with longer survival time. PMID:24819780

  15. MHC class I antigens and tumour-infiltrating leucocytes in laryngeal cancer: long-term follow-up.

    PubMed Central

    Esteban, F.; Redondo, M.; Delgado, M.; Garrido, F.; Ruiz-Cabello, F.

    1996-01-01

    Alteration in MHC class I expression may be used by cancer cells to avoid immune destruction. Much experimental evidence supports this idea, although survival studies are very scarce. To investigate whether the presence or absence of HLA-A, -B and -C antigens in laryngeal carcinoma influences survival, a series of 60 primary laryngeal tumours treated surgically and normal tissues were evaluated in frozen sections for the expression of MHC class I antigens and tumour-infiltrating leucocytes (CD3, CD4, CD8, CD11b, CD1, CD20 and CD16), using monoclonal antibodies and the APAAP, technique. Long-term follow-up from the patients is available, ranging from 6 to 10 years. Thirteen tumours presented total HLA-ABC loss, five selective losses of HLA-A antigens and one absence of HLA-B antigens. Total losses were statistically associated with several clinical and pathological parameters, but there were no differences regarding tumour-infiltrating leucocytes. After conducting a prospective study, only T and N staging and scoring according to Glanz's malignancy classification were found to be independently related to patients' outcome. From our data, we conclude that neither complete loss of HLA class I antigens nor tumour-infiltrating leucocytes appear to influence survival in squamous cell carcinoma of the larynx. PMID:8956796

  16. The natural history of tardive dystonia. A long-term follow-up study of 107 cases.

    PubMed

    Kiriakakis, V; Bhatia, K P; Quinn, N P; Marsden, C D

    1998-11-01

    The clinical picture, risk factors and natural history of tardive dystonia resulting from dopamine-receptor antagonist (DRA) treatment in 107 patients (57 male and 50 female), seen between 1972 and 1995, are described. The mean age at onset (+/- SD) was 38.3 +/- 13.7 years (range 13-68 years), and the age at last follow-up was 46.3 +/- 15.7 years (range 15-80 years). These patients had received DRAs for schizophrenia (39%), for other psychiatric conditions (51.5%) and for non-psychiatric disorders (9.5%). All classes of neuroleptics used were implicated in producing tardive dystonia, which was found to develop at any time, ranging from 4 days to 23 years after their introduction (median 5, mean 6.2 +/- 5.1 years); there was no 'safe' period. Men were significantly younger than women at onset of dystonia, which developed after shorter exposure in men. At onset, the dystonia was focal in 83% of cases, but progressed over months or years and remained focal in only 17% at the time of maximum severity. The craniocervical region was involved in 87% of cases, and was the most commonly affected site both at onset and at maximum severity. There was a correlation between the site and age of onset; the site of onset ascended from the lower limbs to the face as the mean age of onset increased. Overall, the phenomenology of tardive dystonia was indistinguishable from that of primary (idiopathic) dystonia, although retrocollis and anterocollis, as well as torticollis to the right, were significantly more common in tardive dystonia. It is a very persistent disorder; only 14% of our patients had a remission over a mean follow-up period of 8.5 years. Remission occurred after a mean of 5.2 years from onset (range 1-12 years) and 2.6 years after discontinuation of neuroleptics (range 1 month to 9 years). Discontinuation of neuroleptics increased the chances of remission fourfold. Patients with < or = 10 years on neuroleptics had a five times greater chance of remission than those with > 10 years exposure, suggesting that the pathogenetic changes in tardive dystonia may become irreversible after long-term use of these drugs. None of the numerous treatments tried in these patients, including clozapine and botulinum toxin injections, seemed to relate to overall outcome, but there was a significant negative association between the occurrence of remission and the use of benzodiazepines. Although there were hints of a possible genetic predisposition, the question as to whether patients with tardive dystonia have an underlying vulnerability remains unanswered. PMID:9827766

  17. p53 protein in low-grade astrocytomas: a study with long-term follow-up.

    PubMed Central

    Iuzzolino, P.; Ghimenton, C.; Nicolato, A.; Giorgiutti, F.; Fina, P.; Doglioni, C.; Barbareschi, M.

    1994-01-01

    The immunohistochemical expression of p53 protein (p53) was examined in 52 patients out of a series of 66 patients with low-grade astrocytomas with long-term follow-up. All patients were also evaluated for several clinical and histological features, among which only preoperative Karnofsky score and the extent of surgery were statistically significant parameters to predict outcome on multivariate analysis. p53 accumulation was seen in 46.1% of patients, with a wide range of percentage of positive cells. Median survival for p53-positive and p53-negative patients was 41 and 37 months respectively. The survival curves of p53-positive and -negative patients were not statistically different. However, the curves showed a trend towards a more aggressive course in p53-positive patients beginning 3-4 years after surgery. Five years after diagnosis the survival estimate with the Kaplan-Meier method was 21.2% for patients with p53-positive tumours and 45.9% for patients with p53-negative tumours. This trend is not due to different distribution of major clinical prognostic factors (age, incomplete resection or Karnofsky status). The trend could be related to the time needed by the p53-positive clone to outgrow the rest of the p53-negative neoplastic cell population. This hypothesis is further supported by the fact that the five recurrences which were surgically removed (one anaplastic astrocytoma and four glioblastomas) derived from p53-positive tumours and were themselves intensely p53 positive. Images Figure 1 PMID:8123492

  18. Long-term follow-up study of rubella antibodies in naturally immune and vaccinated young adults.

    PubMed

    Christenson, B; Bttiger, M

    1994-01-01

    Selective rubella vaccination of 12-year-old schoolgirls was introduced in Sweden in 1973 and at the same time a long-term follow-up cohort study was initiated. In 1982, a two-dose programme with a combined vaccine against measles, mumps and rubella (MMR) was introduced and vaccinations were given at the ages of 18 months and 12 years to both boys and girls. The cohort initially comprised 486 girls. It was followed for between 8 and 16 years. All the girls enrolled were seronegative before vaccination and had seroconverted to a haemagglutination-inhibition (HAI) titre of at least 1:16. On the last test occasion 16 years later, 22% had titre values below 1:16, and 6% lacked detectable antibodies against rubella (< 1:8). A fourfold or greater rise in titre was seen in 36% of the girls during the first 8 years of observation, whereas during the following 8 years only 1% showed a significant increase of titre values. The geometric mean titre declined from 1:110 to 1:34 during the first 8 years and further to 1:18 during the following 8 years. From 1982 to 1990, the seroimmunity to rubella of 18-year-old girls and boys was studied yearly. The number studied was 3308 18-year-old schoolgirls and 6347 18-year-old recruits born between 1964 and 1972. The recruits were divided into two groups, 4610 unvaccinated and born in 1964-1969 and 1737 vaccinated and born in 1970-1972. Seropositive recruits in the first group were thus naturally immune only, while the second group had a mixture of natural and vaccine-induced immunity.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8303939

  19. Stigma and quality of life at long-term follow-up after surgery for epilepsy in Uganda.

    PubMed

    Fletcher, Anita; Sims-Williams, Helen; Wabulya, Angela; Boling, Warren

    2015-11-01

    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 8years 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. PMID:26414342

  20. [Who is long-term sick-listed in Norway? From the project Evaluation of the follow-up of long-term sick-listed].

    PubMed

    Tellnes, G; Mathisen, S; Skau, I; Thune, O; Ulsberg, S; Berg, J E

    1992-09-10

    The aim of the study was to analyse the characteristics of persons with long-term sickness certification at the end of 1990 in Norway. The study was based on data registered by the National Insurance Administration: Age, sex, place of residence, diagnoses, and prognosis as registered on Sickness certificate II. At the end of 1990 a total of 57,567 persons had been incapacitated for work for longer than eight weeks and up to 52 weeks. The prevalence was 27.9 per 1,000 employed persons, with a significantly higher prevalence among women than among men. 25% of the women certified as sick were 40-49 years old. The highest prevalence of long-term certification of sickness was found in the counties Finnmark and Troms in Northern Norway, and Hedmark in central Norway. In cases of long-term sickness certification, the most common diagnoses were musculoskeletal/connective tissue diseases and mental disorders, with a prevalence of 9.3 and 3.1 per 1,000 employed persons respectively. The study indicates the possibility of using data from existing administrative population registers to provide information on the epidemiology of long-term sickness certification in Norway. It is necessary to further improve the validity of the data. PMID:1412313

  1. Long-term follow-up and management guidelines in pediatric patients after allogenic hematopoietic stem cell transplantation.

    PubMed

    Frangoul, Haydar; Najjar, Jennifer; Simmons, Jill; Domm, Jennifer

    2012-01-01

    Over the past 50 years there has been considerable progress and success in the field of allogeneic hematopoietic stem cell transplant (HSCT) in children. In addition there has been significant improvement in transplant outcomes for both malignant and nonmalignant indications. These improved outcomes have resulted in many long-term survivors who are experiencing substantial long-term morbidities. There are limited data examining the long-term complications of transplant on the various organs. This issue is complicated by the fact that children receive their transplant at different stages of their growth and development (ie, infant, toddler, child, adolescent, and young adult). Each of these developmental stages has different sensitivities to treatment and can result in different sets of complications. We summarize the long-term side effects of allogeneic HSCT in children. PMID:22221789

  2. Persistent Recovery of Normal Left Ventricular Function and Dimension in Idiopathic Dilated Cardiomyopathy During Long?Term Follow?up: Does Real Healing Exist?

    PubMed Central

    Merlo, Marco; Stolfo, Davide; Anzini, Marco; Negri, Francesco; Pinamonti, Bruno; Barbati, Giulia; Ramani, Federica; Di Lenarda, Andrea; Sinagra, Gianfranco

    2015-01-01

    Background An important number of patients with idiopathic dilated cardiomyopathy have dramatically improved left ventricular function with optimal treatment; however, little is known about the evolution and long?term outcome of this subgroup, which shows apparent healing. This study assesses whether real healing actually exists in dilated cardiomyopathy . Methods and Results Persistent apparent healing was evaluated among 408 patients with dilated cardiomyopathy receiving tailored medical treatment and followed over the very long?term. Persistent apparent healing was defined as left ventricular ejection fraction ?50% and indexed left ventricular end?diastolic diameter ?33 mm/m2 at both mid?term (194 months) and long?term (1039 months) follow?up. At mid?term, 63 of 408 patients (15%) were apparently healed; 38 (60%; 9% of the whole population) showed persistent apparent healing at long?term evaluation. No predictors of persistent apparent healing were found. Patients with persistent apparent healing showed better heart transplantfree survival at very long?term follow?up (95% versus 71%; P=0.014) compared with nonpersistently normalized patients. Nevertheless, in the very long term, 37% of this subgroup experienced deterioration of left ventricular systolic function, and 5% died or had heart transplantation. Conclusions Persistent long?term apparent healing was evident in a remarkable proportion of dilated cardiomyopathy patients receiving optimal medical treatment and was associated with stable normalization of main clinical and laboratory features. This condition can be characterized by a decline of left ventricular function over the very long term, highlighting the relevance of serial and individualized follow?up in all patients with dilated cardiomyopathy, especially considering the absence of predictors for long?term apparent healing. PMID:25587018

  3. Web-based survey of resources for treatment and long-term follow-up for children with brain tumors in developing countries

    PubMed Central

    QADDOUMI, Ibrahim; UNAL, Ekrem; DIEZ, Blanca; KEBUDI, Rejin; QUINTANA, Yuri; BOUFFET, Eric; CHANTADA, Guillermo

    2012-01-01

    Introduction Information about pediatric survivors of brain tumors in developing countries is scant. Purpose In this study we aimed to investigate the availability of resources for treatment and long-term follow up of children with central nervous system tumors in developing countries Material methods A web-based questionnaire on available services and follow-up of brain tumor survivors was posted at www.cure4kids.org and registered users were invited to participate. Results A total of 140 evaluable responses from developing countries (n=103) and high-income countries (n=37) were obtained. There was a significant correlation between gross national income and the availability of services for treatment and follow-up and between patient load and the availability of some services. Conclusion The resources for treatment and long-term follow-up of children with brain tumors need to be improved in developing countries. PMID:21584746

  4. Do Nonsteroidal Anti-Inflammatory Drugs Cause Endoprosthetic Loosening? Mid- to Long-Term Follow-Up of 100 Total Hip Arthroplasties after Local NSAID Infiltration

    PubMed Central

    Nizam, Ikram; Kohan, Lawrence; Field, Clarice; Kerr, Dennis

    2015-01-01

    We evaluated the effect of local infiltration of NSAIDs on prosthetic fixation at mid- to long-term follow-up of total hip arthroplasties. Intra-articular local NSAID (ketorolac) was injected into hip joints and surrounding tissues intraoperatively and postoperatively as a part of multimodal pain management protocol. Clinical and radiographic evaluation was performed for any evidence of component loosening or failure and clinical outcomes in 100 total hip joint arthroplasties with a mean follow-up of 7.3 years (4.9 to 11 yrs). Radiographic analysis at the most recent follow-up showed no evidence of loosening, subsidence, or migration and no evidence of impending failure. Clinical outcomes showed improved Harris hip scores. Intra-articular NSAID used in the intraoperative/postoperative period in hip arthroplasty showed no evidence of prosthetic loosening at mid- to long-term follow-up. PMID:26090435

  5. Long-Term Follow-Up After Successful Transjugular Intrahepatic Portosystemic Shunt Placement in a Pediatric Patient with Budd-Chiari Syndrome

    SciTech Connect

    Carnevale, Francisco Cesar Szejnfeld, Denis Moreira, Airton Mota; Gibelli, Nelson; Gregorio, Miguel Angel De; Tannuri, Uenis; Cerri, Giovanni Guido

    2008-11-15

    Orthotopic liver transplantation is the standard of care in patients with Budd-Chiari syndrome (BCS), and transjugular intrahepatic portosystemic shunt (TIPS) has become an important adjunct procedure while the patient is waiting for a liver. No long-term follow up of TIPS in BCS patients has been published in children. We report successful 10-year follow-up of a child with BCS and iatrogenic TIPS dysfunction caused by oral contraceptive use.

  6. Long-Term Follow-Up to a Randomized Clinical Trial of Multisystemic Therapy with Serious and Violent Juvenile Offenders

    ERIC Educational Resources Information Center

    Schaeffer, Cindy M.; Borduin, Charles M.

    2005-01-01

    In this study, the authors examined the long-term criminal activity of 176 youths who had participated in either multisystemic therapy (MST) or individual therapy (IT) in a randomized clinical trial (C. M. Borduin et al., 1995). Arrest and incarceration data were obtained on average 13.7 (range = 10.2-15.9) years later when participants were on

  7. The Chronicity of Self-Injurious Behaviour: A Long-Term Follow-Up of a Total Population Study

    ERIC Educational Resources Information Center

    Taylor, Lorne; Oliver, Chris; Murphy, Glynis

    2011-01-01

    Background: Self-injurious behaviour (SIB) is a relatively common problem for people with intellectual disabilities and it is known to be associated with various risk markers, such as degree of disability, sensory impairments, and autism (McClintock "et al." 2003). Less is known about its long-term course however. Method: The present study was

  8. Long-term follow-up care recommendations after total hip and knee arthroplasty: results of the American Association of Hip and Knee Surgeons' member survey.

    PubMed

    Teeny, Steven M; York, Sally C; Mesko, J Wesley; Rea, Ruth E

    2003-12-01

    Long-term follow-up care is needed to evaluate and manage hip and knee arthroplasty outcomes, because impending failure may be asymptomatic. All active American Association of Hip and Knee Surgeons' members (N = 682) were surveyed for recommendations for follow-up care type and frequency, radiograph interpretation, and clinical indicators related to follow-up frequency intervals; and to describe reimbursement experiences and practice demographics. The response rate (65.5%, n = 447) established a 95% (+/-3%) confidence interval for the survey results. We found that 80% of respondents recommended annual or biennial orthopaedic clinical and radiographic examinations, with more frequent follow-up times for clinical or radiologic signs of failure, previous revision arthroplasty, previous joint sepsis, and subnormal periprosthetic bone quality. Further research is needed to correlate follow-up care type and frequency with outcomes, complications, and costs. PMID:14658097

  9. Long-term follow up of the FL2000 study comparing CHVP-interferon to CHVP-interferon plus rituximab in follicular lymphoma

    PubMed Central

    Bachy, Emmanuel; Houot, Roch; Morschhauser, Franck; Sonet, Anne; Brice, Pauline; Belhadj, Karim; Cartron, Guillaume; Audhuy, Bruno; Ferm, Christophe; Feugier, Pierre; Sebban, Catherine; Delwail, Vincent; Maisonneuve, Herv; Le Gouill, Steven; Lefort, Sophie; Brousse, Nicole; Foussard, Charles; Salles, Gilles

    2013-01-01

    Anti-CD20-containing chemotherapy regimens have become the standard of care for patients with follicular lymphoma needing cytotoxic therapy. Four randomized trials demonstrated a clinical benefit for patients treated with rituximab. However, no long-term follow up (i.e. > 5 years) of these trials is yet available. Between May 2000 and May 2002, 358 newly diagnosed patients with high tumor burden follicular lymphoma were randomized to receive cyclophosphamide, adriamycin, etoposide and prednisolone plus interferon-?2a or a similar chemotherapy-based regimen plus rituximab, and outcome was up-dated. With a median follow up of 8.3 years, addition of rituximab remained significantly associated with prolonged event-free survival (primary end point) (P=0.0004) with a trend towards a benefit for overall survival (P=0.076). The Follicular Lymphoma International Prognostic Index score was strongly associated with outcome for both event-free and overall survival in univariate analysis and its prognostic value remained highly significant after adjusting for other significant covariates in multivariate models (P<0.0001 and P=0.001, respectively). Considering long-term toxicity, the addition of rituximab in the first-line setting was confirmed as safe with regards to development of secondary malignancies. Long-term follow up of patients with follicular lymphoma treated in the FL2000 study confirms the sustained clinical benefit of rituximab without long-term toxicity. This study was registered at ClinicalTrials.gov (Identifier:00136552). PMID:23645690

  10. Long-term follow-up after ileocaecal continent cutaneous urinary diversion (Mainz I pouch): A retrospective study of a monocentric experience

    PubMed Central

    Khalil, Fahd; Fellahi, Saad; Ouslim, Hicham; Mhanna, Tarik; El Houmaidi, Amine; Aynaou, Mohammed; Boteng, Paapa Dua; Barki, Ali; Nouini, Yassine

    2015-01-01

    Objective To assess the long-term follow-up after ileocaecal continent cutaneous reservoir (ICCR) and to review the late complications. Patients and methods In all, 756 patients underwent an ICCR in our department, with long-term follow-up data available in 50 patients. The inclusion criterion was ICCR regardless of the indication and the exclusion criteria were orthotopic neobladder or other continent urinary diversions not performed with the ileocaecum. Patients were followed to record primary outcomes and late complications. Complications were stratified according to the Clavien–Dindo classification. Results The mean patient age was 44 years and pelvic malignancies were the first indication for urinary diversion. The mean (range) follow-up was 19 (9–36) years. A stoma stenosis was the most frequent outlet-related complication requiring re-intervention, followed by ischaemic outlet degeneration, and stoma incontinence. Six renal units (RUs) developed obstruction at the anastomotic site and were managed by open surgery. Three RUs had to be removed due to deterioration. A dederivation was necessary in three patients (6%). Conclusion The ICCR is a safe and established technique when an orthotopic pouch is impossible. The long-term follow-up shows acceptable complication rates and satisfactory continence conditions. However, large population studies are necessary to confirm this observation. PMID:26609442

  11. Long-term follow-up of the MAINTAIN Nephritis Trial, comparing azathioprine and mycophenolate mofetil as maintenance therapy of lupus nephritis

    PubMed Central

    Tamirou, Farah; D'Cruz, David; Sangle, Shirish; Remy, Philippe; Vasconcelos, Carlos; Fiehn, Christoph; Ayala Guttierez, Maria del Mar; Gilboe, Inge-Magrethe; Tektonidou, Maria; Blockmans, Daniel; Ravelingien, Isabelle; le Guern, Véronique; Depresseux, Geneviève; Guillevin, Loïc; Cervera, Ricard; Houssiau, Frédéric A

    2016-01-01

    Objective To report the 10-year follow-up of the MAINTAIN Nephritis Trial comparing azathioprine (AZA) and mycophenolate mofetil (MMF) as maintenance therapy of proliferative lupus nephritis, and to test different definitions of early response as predictors of long-term renal outcome. Methods In 2014, data on survival, kidney function, 24 h proteinuria, renal flares and other outcomes were collected for the 105 patients randomised between 2002 and 2006, except in 13 lost to follow-up. Results Death (2 and 3 in the AZA and MMF groups, respectively) and end-stage renal disease (1 and 3, respectively) were rare events. Time to renal flare (22 and 19 flares in AZA and MMF groups, respectively) did not differ between AZA and MMF patients. Patients with good long-term renal outcome had a much more stringent early decrease of 24 h proteinuria compared with patients with poor outcome. The positive predictive value of a 24 h proteinuria <0.5 g/day at 3 months, 6 months and 12 months for a good long-term renal outcome was excellent (between 89% and 92%). Inclusion of renal function and urinalysis in the early response criteria did not impact the value of early proteinuria decrease as long-term prognostic marker. Conclusions The long-term follow-up data of the MAINTAIN Nephritis Trial do not indicate that MMF is superior to AZA as maintenance therapy in a Caucasian population suffering from proliferative lupus nephritis. Moreover, we confirm the excellent positive predictive value of an early proteinuria decrease for long-term renal outcome. Trial registration number NCT00204022. PMID:25757867

  12. Long term follow up of idiopathic gingival enlargement associated with chronic periodontitis: A case report and review

    PubMed Central

    Nagarale, Girish P.; Ravindra, S.; Thakur, Srinath; Setty, Swati

    2013-01-01

    Background: Idiopathic gingival enlargement is a rare condition characterized by massive enlargement of the gingiva. It may be associated with other diseases/conditions characterizing a syndrome, but rarely associated with periodontitis. Case Description: This case report describes an unusual clinical form of gingival enlargement associated with chronic periodontitis. Clinical examination revealed diffuse gingival enlargement. The lesion was asymptomatic, firm, and pinkish red. Generalized periodontal pockets were observed. Radiographic evaluation revealed generalized severe alveolar bone loss. Histopathological investigations revealed atrophic epithelium with dense fibrocollagenous tissue. Lesions healed successfully following extraction and surgical excision, and no recurrence was observed after 1 year follow-up but recurrence was observed at 3 and 5-years follow-up. Clinical Implications: Successful treatment of idiopathic gingival enlargement depends on proper identification of etiologic factors and improving esthetics and function through surgical excision of the over growth. However, there may be recurrence. PMID:23869135

  13. Long-term follow up of paediatric liver transplant recipients: outcomes following transfer to adult healthcare in New Zealand.

    PubMed

    Harry, R; Fraser-Irwin, C; Mouat, S; Gane, E; Munn, S; Evans, H M

    2015-05-01

    Poor outcomes are reported in young people with chronic health conditions. We performed a retrospective notes review of New Zealand paediatric liver transplant recipients transferred to adult services. Two patients were lost to follow up. Out of 20, 12 were non-adherent, and out of 12, 7 developed rejection. Other risk behaviours were common in the non-adherent group. We conclude that dedicated services for these young people may be needed to optimise outcomes. PMID:25955464

  14. Negative capsule endoscopy in patients with obscure gastrointestinal bleeding reliable: Recurrence of bleeding on long-term follow-up

    PubMed Central

    Riccioni, Maria Elena; Urgesi, Riccardo; Cianci, Rossella; Rizzo, Gianluca; DAngelo, Luca; Marmo, Riccardo; Costamagna, Guido

    2013-01-01

    AIM: To assess the rate of recurrent bleeding of the small bowel in patients with obscure bleeding already undergone capsule endoscopy (CE) with negative results. METHODS: We reviewed the medical records related to 696 consecutive CE performed from December 2002 to January 2011, focusing our attention on patients with recurrence of obscure bleeding and negative CE. Evaluating the patient follow-up, we analyzed the recurrence rate of obscure bleeding in patient with a negative CE. Actuarial rates of rebleeding during follow-up were calculated, and factors associated with rebleeding were assessed through an univariate and multivariate analysis. A P value of less than 0.05 was regarded as statistically significant. The sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of negative CE were calculated. RESULTS: Two hundred and seven out of 696 (29.7%) CE studies resulted negative in patient with obscure/overt gastrointestinal bleeding. Overall, 489 CE (70.2%) were positive studies. The median follow-up was 24 mo (range 12-36 mo). During follow-up, recurrence of obscure bleeding was observed only in 34 out of 207 negative CE patients (16.4%); 26 out of 34 with obscure overt bleeding and 8 out of 34 with obscure occult bleeding. The younger age (< 65 years) and the onset of bleeding such as melena are independent risk factors of rebleeding after a negative CE (OR = 2.6703, 95%CI: 1.1651-6.1202, P = 0.0203; OR 4.7718, 95%CI: 1.9739-11.5350, P = 0.0005). The rebleeding rate (CE+ vs CE-) was 16.4% vs 45.1% (?2 test, P = 0.00001). The sensitivity, specificity, and PPV and NPV were 93.8%, 100%, 100%, 80.1%, respectively. CONCLUSION: Patients with obscure gastrointestinal bleeding and negative CE had a significantly lower rebleeding rate, and further invasive investigations can be deferred. PMID:23901227

  15. Chemoimmunotherapy With Fludarabine and Rituximab Produces Extended Overall Survival and Progression-Free Survival in Chronic Lymphocytic Leukemia: Long-Term Follow-Up of CALGB Study 9712

    PubMed Central

    Woyach, Jennifer A.; Ruppert, Amy S.; Heerema, Nyla A.; Peterson, Bercedis L.; Gribben, John G.; Morrison, Vicki A.; Rai, Kanti R.; Larson, Richard A.; Byrd, John C.

    2011-01-01

    Purpose The addition of rituximab to fludarabine-based regimens in chronic lymphocytic leukemia (CLL) has been shown to produce high response rates with extended remissions. The long-term follow-up of these regimens with respect to progression, survival, risk of secondary leukemia, and impact of genomic risk factors has been limited. Methods We report the long-term follow-up of the chemoimmunotherapy trial CALGB 9712 from the Cancer and Leukemia Group B, for which treatment regimen was previously reported, to examine end points of progression-free survival (PFS), overall survival (OS), impact of genomic features, and risk of therapy-related myeloid neoplasm (t-MN). Results A total of 104 patients were enrolled on this study and now have a median follow-up of 117 months (range, 66 to 131 months). The median OS was 85 months, and 71% of patients were alive at 5 years. The median PFS was 42 months, and 27% were progression free at 5 years. An estimated 13% remained free of progression at almost 10 years of follow-up. Multivariable models of PFS and OS showed that immunoglobulin heavy chain variable region mutational status was significant for both, whereas cytogenetic abnormalities were significant only for OS. No patient developed t-MN before relapse. Conclusion Long-term follow-up of CALGB 9712 demonstrates extended OS and PFS with fludarabine plus rituximab. Patients treated with fludarabine plus rituximab administered concurrently or sequentially have a low risk of t-MN. These long-term data support fludarabine plus rituximab as one acceptable first-line treatment for symptomatic patients with CLL. PMID:21321292

  16. Pediatric-onset Mastocytosis: A Long term Clinical follow-up and correlation with Bone Marrow Histopathology

    PubMed Central

    Uzzaman, Ashraf; Maric, Irina; Noel, Pierre; Kettelhut, Brett V.; Metcalfe, Dean D.; Carter, Melody C.

    2009-01-01

    Background Pediatric onset mastocytosis usually presents as urticaria pigmentosa; and less often as diffuse cutaneous mastocytosis. While the literature indicates that disease often resolves, there has been a move to more aggressive therapy for mastocytosis early in life. We addressed the long term prognosis of pediatric-onset disease by examining 17 children with mastocytosis which we had reported on in 1989.[1] Procedure We successfully contacted 15 of these patients and data was collected regarding their clinical status. Original bone marrow specimens were re-stained, re-examined, and correlated with disease outcome using consensus criteria. Three of five patients with persistent disease underwent repeat bone marrow biopsies. Results There was complete regression of disease as defined by cutaneous findings and symptoms (clinical disease severity) in 10 of 15 patients (67%). Three patients had major (20%) and two had partial regression of disease (13%). Repeat marrow examinations on three patients with persistent disease documented systemic mastocytosis based on marrow findings in one patient who had partial regression of disease and was the only patient with initial morphologic evidence of systemic disease. Of the remaining two patients, one demonstrated partial regression and the other major regression of disease; and neither had evidence of systemic mastocytosis. Conclusion This study demonstrates that initial bone marrow biopsies were prognostic in that those without evidence of systemic disease experienced disease regression; and that the long term prognosis for children managed symptomatically with mastocytosis is highly encouraging. PMID:19526526

  17. Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis.

    PubMed

    de Jong, Zuzana; Munneke, Marten; Kroon, Herman M; van Schaardenburg, Dirkjan; Dijkmans, Ben A C; Hazes, Johanna M W; Vliet Vlieland, Theodora P M

    2009-06-01

    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 of the participants who completed the 2-year high-intensity intervention in a randomized controlled trial (Rheumatoid Arthritis Patient In Training study). Eighteen months thereafter, measurements of compliance, aerobic capacity, muscle strength, functional ability, disease activity, and radiological damage of the large joints were performed. Seventy-one patients were available for follow-up at 18 months, of whom 60 (84%) were still exercising (exercise group: EG), with average similar intensity but at a lower frequency as the initial intervention. Eleven patients (16%) reported low intensity or no exercises (no-exercise group: no-EG). Patients in the EG had better aerobic fitness and functional ability, lower disease activity, and higher attendance rate after the initial 2-year intervention. At follow-up, both groups showed a deterioration of aerobic fitness and only patients in the EG were able to behold their muscle strength gains. Functional ability, gained during the previous participation in high-intensity exercises, remained stable in both groups. Importantly, no detrimental effects on disease activity or radiological damage of the large joints were found in either group. In conclusion, the majority of the patients who participated in the 24-month high-intensity exercise program continued exercising in the ensuing 18 months. In contrast to those who did not continue exercising, they were able to preserve their gains in muscle strength without increased disease activity or progression of radiological damage. PMID:19247575

  18. Complex craniofacial reconstruction using an implant-supported prosthesis: case report with long-term follow-up.

    PubMed

    Tolman, D E; Desjardins, R P; Jackson, I T; Brnemark, P I

    1997-01-01

    In complex craniofacial reconstruction involving an implant-supported prosthesis, problems such as tumor recurrence may require additional surgical resection. The solution to such recurrence may be autogenous bone grafting or additional implant placement or both (after resection of the tumor) and revision of the prosthesis. Tumor recurrence was seen during an 11-year, 8-month follow-up of a 58-year-old woman who had had an extensive mid-face defect. The various treatments, including extraoral and intraoral prostheses, provided the patient with an acceptable quality of life without interruption in use of the prostheses. PMID:9109276

  19. [Total colonic form of Hirschsprung disease. Treatment and long-term follow-up in 16 cases].

    PubMed

    Azzis, O; Fremond, B; Dabadie, A; Jouan, J; Bracq, H; Babut, J M

    1996-01-01

    From 1971 to 1994, 16 cases of total colon Hirschsprung's disease were treated at the University Hospital in Rennes. Diagnosis have been at 2 days to 3 months. Two children had a family history of Hirschsprung disease among which one associated megacolon and multiple endocrine neoplasia. This family had a mutation of the RET proto oncogene. Six children died before complete surgical cure, among whom 4 before total parenteral nutrition. Six were treated according to Lester Martin, 3 according to Duhamel, and 1 to Swenson. Diarrhea and occlusions happened during the first postoperative years. None had any enterocolitis. Eight of 9 followed children are continent. Technique had no influence on long term outcome. Early neonatal occlusion management seems to decrease enterocolitis's incidence. We abandoned Lester's technique and kept Duhamel's technique. The problems encountered during ileostomy period do not encourage us to forward the age of definitive surgery procedure. PMID:8945832

  20. Diagnosis and treatment of teeth with primary endodontic lesions mimicking periodontal disease: three cases with long-term follow ups

    PubMed Central

    Lim, Jae-Hyung; Lee, Ji-Hyun

    2014-01-01

    A tooth with primary endodontic disease that demonstrates a periodontal defect might be extracted because of misdiagnosis as severe periodontal disease or a vertical root fracture. The aim of this case report was to demonstrate the long-term survival of endodontically treated teeth, which had been initially considered unsavable. With meticulous evaluation including the patient's dental history, clinical and radiographic examinations, teeth with primary endodontic lesions could be differentiated and saved after proper root canal treatment. Pain history, vitality test, and radiographic examinations, as well as a general periodontal condition check with periodontal probing on an affected tooth, might be the key methods to differentiate endodontic pathosis from that of periodontal disease. PMID:24516831

  1. Thoracic endometriosis with catamenial haemoptysis and pneumothorax: computed tomography findings and long-term follow-up after danazol treatment

    PubMed Central

    Suwatanapongched, Thitiporn; Boonsarngsuk, Viboon; Amornputtisathaporn, Naparat; Leelachaikul, Paisan

    2015-01-01

    Thoracic endometriosis (TE) is an uncommon disorder affecting women of childbearing age. We herein report clinical and thin-section computed tomography (CT) findings of two cases, in which one woman presented with catamenial haemoptysis (CH) alone and another woman presented with bilateral catamenial pneumothoraces (CP) coinciding with CH, a rare manifestation of TE. The dynamic changes demonstrated on thin-section chest CT performed during and after menses led to accurate localisation and presumptive diagnosis of TE in both patients. Following danazol treatment, the patient with CH alone had a complete cure, while the patient with CP and CH had an incomplete cure and required long-term danazol treatment. We discuss the role of imaging studies in TE, with an emphasis on the appropriate timing and scanning technique of chest CT in women presenting with CH, potential mechanisms, treatment and patient outcomes. PMID:26243981

  2. Long-Term Follow-Up of the Percutaneous Treatment of Hydatid Cyst in the Adrenal Gland: A Case Report and Review of the Literature

    SciTech Connect

    Akhan, Okan; Canyigit, Murat; Kaya, Diana; Koksal, Ali; Akgoz, Ayca; Yucesoy, Cuneyt; Akinci, Devrim

    2011-02-15

    Although the most involved organs are liver and lung, hydatid cysts occur in adrenal glands, rarely, and constitute only 0.5% of hydatid cysts. Herein, we demonstrate and discuss, for the first time in the literature to the best of our knowledge, the radiological features of adrenal hydatid disease and evaluate the long-term results (57 months of follow-up) of the percutaneous treatment of hydatid cyst in the adrenal gland in a patient.

  3. Valvular Abnormalities Detected by Echocardiography in 5-Year Survivors of Childhood Cancer: A Long-Term Follow-Up Study

    SciTech Connect

    Pal, Helena J. van der; Caron, Huib N.; Kremer, Leontien C.; Dalen, Elvira C. van

    2015-01-01

    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 in CCS.

  4. Ginkgo Biloba Extract and Long-Term Cognitive Decline: A 20-Year Follow-Up Population-Based Study

    PubMed Central

    Amieva, Hélène; Meillon, Céline; Helmer, Catherine; Barberger-Gateau, Pascale; Dartigues, Jean François

    2013-01-01

    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 not. This effect may be a specific medication effect of EGb761®, since it was not observed for another nootropic medication, piracetam. PMID:23326356

  5. Long-Term Follow-Up of Bimaxillary Osteomyelitis Associated with Autosomal Dominant Osteopetrosis: A Case Report.

    PubMed

    Kulyapina, A; Verdaguer Martin, J; Navarro Cuellar, C; Navarro Vila, C

    2016-03-01

    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 10years. 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 2years. 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. PMID:26929564

  6. Improved survival with ursodeoxycholic acid prophylaxis in allogeneic stem cell transplantation: long-term follow-up of a randomized study.

    PubMed

    Ruutu, Tapani; Juvonen, Eeva; Remberger, Mats; Remes, Kari; Volin, Liisa; Mattsson, Jonas; Nihtinen, Anne; Hgglund, Hans; Ringdn, Olle

    2014-01-01

    We report the long-term results of a prospective randomized study on the use of ursodeoxycholic acid (UDCA) for prevention of hepatic complications after allogeneic stem cell transplantation. Two hundred forty-two patients, 232 with malignant disease, were randomized to receive (n = 123) or not to receive (n = 119) UDCA from the beginning of the conditioning until 90 days post-transplantation. The results were reported after 1-year follow-up. UDCA administration reduced significantly the proportion of patients developing high serum bilirubin levels as well as the incidence of severe acute graft-versus-host disease (GVHD), liver GVHD, and intestinal GVHD. In the UDCA prophylaxis group, nonrelapse mortality (NRM) was lower and overall survival better than in the control group. After a 10-year follow-up, the difference in the survival and NRM in favor of the UDCA-treated group, seen at 1 year, was maintained (survival 48% versus 38%, P = .037; NRM 28% versus 41%, P = .01). A landmark analysis in patients surviving at 1 year post-transplantation showed no significant differences between the study groups in the long-term follow-up in chronic GVHD, relapse rate, NRM, disease-free survival, or overall survival. These long-term results continue to support the useful role of UDCA in the prevention of transplant-related complications in allogeneic transplantation. PMID:24141008

  7. Long-term follow-up of stone formers treated with a low dose of sodium potassium citrate.

    PubMed

    Jendle-Bengten, C; Tiselius, H G

    2000-02-01

    We evaluated the clinical efficacy of long-term preventive treatment with a single evening dose of alkaline citrate. Information was collected from the files of 52 recurrent stone formers prescribed a daily intake of 3.75-5 g of sodium potassium citrate (SPC; 14-18 mmol of citrate). The annual and cumulative rates of stone formation and the rate of recurrence were compared before and during the treatment. A comparison was also made between the patients with (Group R) and without (Group NR) recurrent stone formation during treatment in terms of urine composition and previous history of the disease. For all patients who started the treatment, the number of stones was smaller during treatment (period tT) than during a period of the same length immediately before treatment (period tB), but greater than the number formed during a corresponding period immediately after the diagnosis (period tA). Via questionnaire we found low treatment compliance, with only 62% of the patients reporting consistent taking of their medication (Group T). The patients in Group T had a smaller cumulated number of stones during period tT than that during periods tA and tB, but the Kaplan-Meier curve of the fraction of patients remaining stone-free during treatment was almost identical to that recorded in 446 recurrent stone formers without medical treatment. No significant differences were recorded in terms of relevant pretreatment urinary risk factors between Groups T(R) and T(NR), but numerically higher values of calcium oxalate (CaOx) supersaturation and calcium/citrate quotients were observed in Group T(R). When 9 patients with a daily intake of SPC and a citrate excretion below 2.5 mmol/day were compared with 16 hypocitraturic patients only given drinking advice, the cumulated percentages of patients without recurrent stone formation in the 2 groups after 3 years were 44% and 48%, respectively. Although the number of patients in this study was small, our results indicate poor long-term protection from recurrent calcium stone formation when a single evening dose of only 3.75-5 g of SPC was taken. The rate of stone formation was apparently slightly reduced, but the fraction of patients free of recurrence was no different from that in patients without medical treatment. PMID:10757268

  8. [Oral flecainide in the treatment of refractory arrhythmias. Long-term follow-up of 98 patients].

    PubMed

    Haissaguerre, M; Warin, J F; Benchimol, D; Le Mtayer, P; Regaudie, J J; Blanchot, P

    1987-03-01

    Oral flecainide was administered to 98 patients with arrhythmias regarded as resistant to other antiarrhythmic agents: quinidines (82), propafenone (40), beta-blockers (30), amiodarone alone (38) or combined with a class I compound (19). Therapeutic effectiveness was assessed on clinical date, repeated Holter recordings (64 patients), exercise tests (8) and electrophysiological exploration (15). Mean follow-up was 11.7 +/- 11 months; the patients treated have now been followed up for 18.2 +/- 12 months (range: 7-58 months). Fifty-three patients had atrial arrhythmia (fibrillation or flutter in 45, atrial tachycardia in 8). Flecainide was effective in 26 patients (49%) and ineffective in 27 (51%). There was no significant difference in dosage between these 2 groups: 231 +/- 62 mg/day and 265 +/- 61 mg/day respectively. Paroxysms of re-entrant junctional tachycardia were controlled in 6 of the 8 cases observed. Eleven patients presented with Wolff-Parkinson-White syndrome: treatment was successful in the 3 patients with atrial fibrillation and in 8 of the 10 patients with orthodromic reciprocating rhythms. Among 30 patients with episodes of ventricular tachycardia, 9 (30%) responded to flecainide and 21 (70%) failed to respond. Flecainide reduced the repetitive forms by more than 90% in 7/15 patients and suppressed exercise-induced ventricular tachycardia in 2/8 patients. Fifteen out of 18 patients had ventricular tachycardia reproducible by programmed stimulation; under flecainide, the ventricular tachycardia spontaneously recurred in 4 cases, was provoked by stimulation in 5 other cases, was more easily inducible in 3 cases and was not inducible in a sustained manner in the last 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3113358

  9. CANCER AND NEUROLOGIC DEGENERATION IN XERODERMA PIGMENTOSUM: LONG TERM FOLLOW-UP CHARACTERIZES THE ROLE OF DNA REPAIR

    PubMed Central

    Bradford, Porcia T.; Goldstein, Alisa M.; Tamura, Deborah; Khan, Sikandar G.; Ueda, Takahiro; Boyle, Jennifer; Oh, Kyu-Seon; Imoto, Kyoko; Inui, Hiroki; Moriwaki, Shin-Ichi; Emmert, Steffen; Pike, Kristen M.; Raziuddin, Arati; Plona, Teri M.; DiGiovanna, John J.; Tucker, Margaret A.; Kraemer, Kenneth H.

    2011-01-01

    Background We determined the frequency of cancer, neurologic degeneration and mortality in xeroderma pigmentosum (XP) patients with defective DNA repair in a four decade natural history study. Methods All 106 XP patients admitted to the NIH from 1971 to 2009 were evaluated from clinical records and follow-up. Results In the 65 percent (n=69) of patients with skin cancer, non-melanoma skin cancer (NMSC) was increased 10,000fold and melanoma was increased 2,000-fold in patients under age 20. The 9 year median age at diagnosis of first non-melanoma skin cancer (NMSC) (n=64) was significantly younger than the 22 year median age at diagnosis of first melanoma (n= 38), a relative age reversal from the general population suggesting different mechanisms of carcinogenesis between NMSC and melanoma. XP patients with marked burning on minimal sun exposure (n=65) were less likely to develop skin cancer than those who did not. This may be related to the extreme sun protection they receive from an earlier age, decreasing their total UV exposure. Progressive neurologic degeneration was present in 24% (n=25) with 16/25 in complementation group XP-D. The most common causes of death were skin cancer (34%, n=10), neurologic degeneration (31%, n=9), and internal cancer (17%, n=5). The median age at death (29 years) in XP patients with neurodegeneration was significantly younger than those XP patients without neurodegeneration (37 years) (p=0.02). Conclusion This 39 year follow-up study of XP patients indicates a major role of DNA repair genes in the etiology of skin cancer and neurologic degeneration. PMID:21097776

  10. Clinical features, long-term follow-up and outcome of a large cohort of patients with Chronic Granulomatous Disease: an Italian multicenter study.

    PubMed

    Martire, Baldassarre; Rondelli, Roberto; Soresina, Annarosa; Pignata, Claudio; Broccoletti, Teresa; Finocchi, Andrea; Rossi, Paolo; Gattorno, Marco; Rabusin, Marco; Azzari, Chiara; Dellepiane, Rosa M; Pietrogrande, Maria C; Trizzino, Antonino; Di Bartolomeo, Paolo; Martino, Silvana; Carpino, Luigi; Cossu, Fausto; Locatelli, Franco; Maccario, Rita; Pierani, Paolo; Putti, Maria C; Stabile, Achille; Notarangelo, Luigi D; Ugazio, Alberto G; Plebani, Alessandro; De Mattia, Domenico

    2008-02-01

    A retrospective clinical and immunological survey was conducted in 60 patients with Chronic Granulomatous Disease. A prospective controlled non-randomized study of the efficacy of long-term IFNgamma treatment was carried out. The mean age at the time of diagnosis was 4.4 years; mean duration of follow-up was 10.4 years. Lung and skin infections were the most frequent manifestations both prior to diagnosis and during follow-up. Aspergillus species was the first cause of infection and of death in our cohort. The mortality rate was 13%. Long term prophylaxis with IFNgamma did not significantly change the rate of total infection per patient-year compared to controls (p=0.07). Our data provide clear evidence that protocols of continuing intensive surveillance and monitoring of compliance with anti-infective regimens may significantly improve the quality of life and long-term survival in patients with CGD. No evidence justifying long-term prophylaxis with IFNgamma was obtained. PMID:18037347

  11. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised trial

    PubMed Central

    Svege, Ida; Nordsletten, Lars; Fernandes, Linda; Risberg, May Arna

    2015-01-01

    Background Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown. Methods We conducted a long-term follow-up of a randomised trial investigating the efficacy of exercise therapy and patient education versus patient education only on the 6-year cumulative survival of the native hip to THR in 109 patients with symptomatic and radiographic hip OA. Results regarding the primary outcome measure of the trial, self-reported pain at 16?months follow-up, have been reported previously. Results There were no group differences at baseline. The response rate at follow-up was 94%. 22 patients in the group receiving both exercise therapy and patient education and 31 patients in the group receiving patient education only underwent THR during the follow-up period, giving a 6-year cumulative survival of the native hip of 41% and 25%, respectively (p=0.034). The HR for survival of the native hip was 0.56 (CI 0.32 to 0.96) for the exercise therapy group compared with the control group. Median time to THR was 5.4 and 3.5?years, respectively. The exercise therapy group had better self-reported hip function prior to THR or end of study, but no significant differences were found for pain and stiffness. Conclusions Our findings in this explanatory study suggest that exercise therapy in addition to patient education can reduce the need for THR by 44% in patients with hip OA. ClinicalTrials.gov number NCT00319423 (original project protocol) and NCT01338532 (additional protocol for long-term follow-up). PMID:24255546

  12. Maple syrup urine disease (MSUD): a case with long-term follow-up after liver transplantation.

    PubMed

    McLaughlin, Paula M; Hinshaw, Jessica; Stringer, Anthony Y

    2013-01-01

    Maple syrup urine disease (MSUD) is a rare hereditary metabolic condition where the body is unable to breakdown amino acids causing toxic buildup. Acute and long-term management of MSUD involves a restricted diet and regular monitoring of amino acid levels; however, more recently liver transplants have been shown to be successful in treating this condition. Even with successful management of MSUD there is evidence from pediatric cases that shows a distinct pattern of neurocognitive deficits associated with this condition, including impaired nonverbal skills and psychomotor functioning with relatively intact verbal abilities. In the present paper, we report an adult case of MSUD with associated neurocognitive deficits and functional limitations following liver transplantation. Neuroimaging revealed no structural abnormalities, while the results from the neuropsychological evaluation showed impairment in visual-spatial processing, attention, executive functioning, and psychomotor abilities, with relative strengths in verbal skills. The patient also showed reduced adaptive functioning and mild anxiety. This case demonstrates neurocognitive deficiencies within the context of normal magnetic resonance imaging. The possible underlying mechanism of this neuropsychological profile is discussed in relation to other neurodevelopmental models. PMID:23829516

  13. Self-help cessation programs for smokeless tobacco users: long-term follow-up of a randomized trial.

    PubMed

    Severson, Hebert H; Andrews, Judy A; Lichtenstein, Edward; Danaher, Brian G; Akers, Laura

    2007-02-01

    This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco (SLT) cessation reported to date. SLT users in five northwestern states were recruited to call a toll-free number, and 1,069 users were randomized to one of two self-help conditions: either a manual-only condition or an assisted self-help condition, which included the manual, a targeted video, and two support phone calls. Significant between-group differences were not found for either the 12- or 18-month point-prevalence measure of abstinence from either SLT only or all tobacco products using outcomes based on either the responder or intention-to-treat outcomes. However, using a repeated point-prevalence measure across all three assessment points, we found that significantly more assisted self-help participants reported abstinence, compared with manual-only participants. Compared with manual-only participants, those in the assisted self-help condition were significantly more likely to use recommended cessation techniques. Results demonstrate that low-cost, minimal interventions delivered by mail and phone can help a sizable proportion of individuals quit using SLT. PMID:17365759

  14. Ventricular pacing with epigastric transdiaphragmatic electrodes. Long-term follow-up and comparison with other implantation methods.

    PubMed

    Buffle, P J

    1976-08-01

    One hundred eighty-seven electrode systems were implanted in 158 consecutive patients--30 systems implanted by thoracotomy, 98 transvenous, and 52 epigastric transdiaphragmatic systems--and the long-term results were compared. With electrodes placed by thoracotomy there was a high rate of complication (76 per cent), prolonging the initial hospitalization (33 per cent) and necessitating frequent rehospitalizations (56 per cent). With transvenous electrodes the complication rate was 39 per cent (16 per cent during the first hospitalization, 28 per cent necessitating rehospitalization). With epigastric transdiaphragmatic electrodes these figures were, respectively, 15, 12, and 6 per cent. The most frequent complications with transvenous electrodes were displacement (15 per cent), ulcerations, and local infection; all were abolished when the epigastric approach was used. Threshold elevation was not more frequent with epigastric electrodes (sutured to the right ventricle) than with the other techniques. Four per cent of the epigastric electrodes caused complications severe enough to require another mode of pacing, contrasting with 18 and 26 per cent, respectively, for the transvenous and transthoracic electrodes. PMID:957738

  15. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis.

    PubMed

    Soykan, I; Sivri, B; Sarosiek, I; Kiernan, B; McCallum, R W

    1998-11-01

    Patients with gastroparesis frequently present challenging clinical, diagnostic, and therapeutic problems. Data from 146 gastroparesis patients seen over six years were analyzed. Patients were evaluated at the time of initial diagnosis and at the most recent follow-up in terms of gastric emptying and gastrointestinal symptomatology. The psychological status and physical and sexual abuse history in female idiopathic gastroparesis patients were ascertained and an association between those factors and gastrointestinal symptomatology was sought. Eighty-two percent of patients were females (mean age: 45 years old). The mean age for onset of gastroparesis was 33.7 years. The etiologies in 146 patients are: 36% idiopathic, 29% diabetic, 13% postgastric surgery, 7.5% Parkinson's disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudoobstruction, and 6% miscellaneous causes. Subgroups were identified within the idiopathic group: 12 patients (23%) had a presentation consistent with a viral etiology, 48% had very prominent abdominal pain. Other subgroups were gastroesophageal reflux disease and nonulcer dyspepsia (19%), depression (23%), and onset of symptoms immediately after cholecystectomy (8%). Sixty-two percent of women with idiopathic gastroparesis reported a history of physical or sexual abuse, and physical abuse was significantly associated with abdominal pain, somatization, depression, and lifetime surgeries. At the end of the follow-up period, 74% required continuous prokinetic therapy, 22% were able to stop prokinetics, 5% had undergone gastrectomy, 6.2% went onto gastric electrical stimulation (pacing), and 7% had died. At some point 21% had required nutrition support with a feeding jejunostomy tube or periods of parenteral nutrition. A good response to pharmacological agents can be expected in the viral and dyspeptic subgroups of idiopathics, Parkinson's disease, and the majority of diabetics, whereas a poorer outcome to prokinetics can be expected in postgastrectomy patients, those with connective tissue disease, a subgroup of diabetics, and the subset of idiopathic gastroparesis dominated by abdominal pain and history of physical and sexual abuse. Appreciation of the different etiologies and psychological status of the patients may help predict response to prokinetic therapy. PMID:9824125

  16. Long-term follow-up results of the treatment of high and intermediate anorectal malformations using a modified technique of posterior sagittal anorectoplasty.

    PubMed

    Liem, N T; Hau, B D

    2001-08-01

    The aim of this study was to evaluate the long-term follow-up result of a modified technique in the operation for high and intermediate anorectal malformations. The operation was performed by a posterior sagittal approach with three modifications: The external sphincter complex was not opened on the posterior side, the rectal pouch was not tapered, the dissection was performed outside the rectal pouch. From January 1984 to December 1992, 70 cases were operated on including 55 boys and 15 girls. There was one postoperative death during the first 48 hours due to malignant hyperthermia and one late death due to an unrelated disease. A follow-up result was obtained in 48 of 68 survivors (71 %) with follow-up ranging from 13 months to 10 years 11 months (mean: 72 months). According to the modified Wingspread criteria, 2 patients (4 %) had very good anorectal function, 26 children (54 %) had good anorectal function, 18 children (38 %) had fair anorectal function, and only two children (4 %) had poor anorectal function. All children had urinary continence and all boys had a normal erection. The long-term follow-up result was satisfactory. Two important factors affecting the anorectal function were the type of malformations and the thickness of the external sphincter complex. PMID:11558014

  17. What is the price of survival in Hodgkin's lymphoma? Long-term follow-up of cured patients.

    PubMed

    Zsfia, Miltnyi; Katalin, Keresztes; Judit, Vgh; Gyrgy, Szkely; Arpd, Ills

    2007-12-01

    The paper investigates the late complications of cured Hodgkin's lymphoma (HL) patients. Ninety cured HL patients between 1975 and 1994 were examined. The mean ages of patients at the time of diagnosing HL, and the median period of survival after diagnosis were 32 (11-70) years and 18 (10-30) years, respectively. Among the 90 patients, 73 are still alive, there is no information about 9 and 8 patients died, second malignant disease being the cause of death in 4 of them. Relapse was observed in 24 patients, of which 19 recovered after relapse and were included in the study then. Five patients had late relapse. In 38% of patients, cardiovascular changes, while in 32% pulmonary and pleural damages were observed. Disorders of the thyroid gland, overwhelmingly hypothyroidism, were found in 24%. Less frequently, a second malignant tumour (9%), damage to the skin, musculature, bones and genitourinary system (6%) as well as the gastrointestinal system could be detected. Treatment based on modern therapeutic approaches is expected to decrease the incidence of complications. Still the aim is early detection through close patient follow-up, which may improve the quality of life and decrease mortality as a result. PMID:17607807

  18. Management of chronic anterior uveitis relapses: efficacy of oral phospholipidic curcumin treatment. Long-term follow-up.

    PubMed

    Allegri, Pia; Mastromarino, Antonio; Neri, Piergiorgio

    2010-01-01

    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 relapse frequency in all treated patients, before and after Norflo treatment, followed by the number of relapses 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. PMID:21060672

  19. Feasibility study for a long-term follow-up in a historical cohort of Brazilian coal miners.

    PubMed

    Veiga, L H S; Melo, V P; Amaral, E C S; Koifman, S

    2007-09-01

    The first Brazilian historical mortality cohort study on miners was conducted. The cohort consisted of 3224 workers in the underground coal mining industry in southern Brazil. This industry has been operating since 1942 without compliance with any regulatory standards, since there were no relevant national regulations. Over almost 60 years, about 5000 workers were exposed to high levels of radiation. However, later radiation exposure was significantly reduced, particularly that due to radon exposure. Recent radon concentration measurements indicated an average annual exposure to radon progeny of 2.1 WLM, ranging from 0.2 to 7.2 WLM. As radon exposure in the past was unknown, it can be suggested that mine workers have not been working safely as regards the health hazard related to radon and radon progeny exposure. The cohort inclusion criteria are as follows: (a) all male employees who had worked for at least one year at the coal mine; (b) workers with complete workplace information (underground and surface); (c) employment hiring between 1945 and 1997 and (d) the worker must have been alive on 1 January 1979. Through multiple strategies of search it was possible to follow up the members of the cohort with a success rate of 92%. This paper presents the characteristics of the study population and provides information about the feasibility of conducting a retrospective mortality study in Brazil, taking into account the methodological and logistical difficulties of conducting such a study in a developing country. PMID:17768333

  20. Multiple major morbidities and increased mortality during long-term follow-up after recovery from thrombotic thrombocytopenic purpura

    PubMed Central

    Deford, Cassandra C.; Reese, Jessica A.; Schwartz, Lauren H.; Perdue, Jedidiah J.; Kremer Hovinga, Johanna A.; Lämmle, Bernhard; Terrell, Deirdra R.; Vesely, Sara K.

    2013-01-01

    Recovery from acute episodes of thrombotic thrombocytopenic purpura (TTP) appears complete except for minor cognitive abnormalities and risk for relapse. The Oklahoma TTP-HUS (hemolytic uremic syndrome) Registry enrolled 70 consecutive patients from 1995 to 2011 with ADAMTS13 activity <10% at their initial episode; 57 survived, with follow-up through 2012. The prevalence of body mass index (BMI), glomerular filtration rate (GFR), urine albumin/creatinine ratio (ACR), hypertension, major depression, systemic lupus erythematosus (SLE), and risk of death were compared with expected values based on the US reference population. At initial diagnosis, 57 survivors had a median age of 39 years; 45 (79%) were women; 21 (37%) were black; BMI and prevalence of SLE (7%) were greater (P < .001) than expected; prevalence of hypertension (19%; P = .463) was not different. GFR (P = .397) and ACR (P = .793) were not different from expected values. In 2011-2012, prevalence of hypertension (40% vs 23%; P = .013) and major depression (19% vs 6%; P = .005) was greater than expected values. Eleven patients (19%) have died, a proportion greater than expected compared with US and Oklahoma reference populations (P < .05). TTP survivors may have greater risk for poor health and premature death. PMID:23838348

  1. The posterior operation in treatment of cervical spondylosis with myelopathy: a long-term follow-up study

    PubMed Central

    Bishara, S. N.

    1971-01-01

    An analytical study of 59 patients who underwent the posterior operation for cervical spondylosis with myelopathy at the London Hospital between 1945 and 1960 has been made. The postoperative period of observation ranged from five to 20 years with an average of 10 years. Initially 36 patients were improved by the operation, 24 considerably so, and in 15 patients further deterioration was prevented. Five years after operation 33 patients were still improved and in five patients co-existent disease had become apparent. Ten years after operation 30 patients had maintained their initial improvement; progression of the disease accounted for a drop of 10% in the success rate initially achieved. No patient in this series developed postoperative instability of the cervical spine. Patients with less than two years' duration of symptoms and with less neurological disability fared better. The importance of a long follow-up period for the proper assessment of results is thus emphasized. It is suggested that the posterior operation has stood the test of time and will continue to maintain a useful place in the treatment of this condition. Some points are outlined for the successful practice of this operation. PMID:5096553

  2. Pyrocarbon proximal interphalangeal joint arthroplasty: a medium to long term follow-up of a single surgeon series.

    PubMed

    Storey, P A; Goddard, M; Clegg, C; Birks, M E; Bostock, S H

    2015-11-01

    We retrospectively reviewed a consecutive single surgeon series of 57 Ascension pyrocarbon proximal interphalangeal joint arthroplasties, with a mean follow-up of 7.1?years (range 2?years to 11?years 6?months). We assessed the ranges of motion, deformity, stability and pain of the operated joints, grip strength of the hand and patient satisfaction. Of the cases, 44 were for osteoarthritis, five for rheumatoid arthritis and eight for post-traumatic arthritis. The median post-operative active arc of motion was from 0 to 60. The median post-operative visual analogue pain score was 0.3 out of ten. Thirty six of the joints had no complications; 14 had minor complications (squeak, slight swan neck); three required early reoperation (joint release, flexor tenodesis); and five required implant removal. A total of 69% of our patients would have the same operation if they had to make the decision again. The Kaplan-Meier survival method estimates the mean implant survival to be 10.7?years (95% confidence intervals 9.96-11.37?years). All five failures occurred during the first 2?years.Level of evidence 4 (Case-series). PMID:25735308

  3. [Working in basic groups. From the Project Evaluation of Follow-up of Long-term Sick-listed Persons].

    PubMed

    Brdholt, A; Tellnes, G; Berg, J E; Johnsen, B

    1992-01-20

    By 1988, all Norwegian municipalities were to have established "basic groups", i.e. interprofessional groups to guide patients in their vocational rehabilitation process. The work of these "basic groups" has been evaluated, both in terms of patients admitted for group discussions, type of actions taken and the work status of the patients one year later. The material consists of all patients admitted for basic group discussions in eight municipalities over a three months' period in the autumn 1988 (n = 261). In general the educational level of the patients was found to be low and their most common complaint was musculoskeletal/connective tissue diseases. The most frequent action suggested by the basic groups was continued medical attention. Only 11% of the patients actually attended the meeting where their situation was discussed. After a follow-up period of one year one fifth of the patients were back at their normal job, and one fourth were receiving a disability pension. Good motivation was regarded as the most important factor influencing whether the patients returned to work. PMID:1566258

  4. Multiple major morbidities and increased mortality during long-term follow-up after recovery from thrombotic thrombocytopenic purpura.

    PubMed

    Deford, Cassandra C; Reese, Jessica A; Schwartz, Lauren H; Perdue, Jedidiah J; Kremer Hovinga, Johanna A; Lämmle, Bernhard; Terrell, Deirdra R; Vesely, Sara K; George, James N

    2013-09-19

    Recovery from acute episodes of thrombotic thrombocytopenic purpura (TTP) appears complete except for minor cognitive abnormalities and risk for relapse. The Oklahoma TTP-HUS (hemolytic uremic syndrome) Registry enrolled 70 consecutive patients from 1995 to 2011 with ADAMTS13 activity <10% at their initial episode; 57 survived, with follow-up through 2012. The prevalence of body mass index (BMI), glomerular filtration rate (GFR), urine albumin/creatinine ratio (ACR), hypertension, major depression, systemic lupus erythematosus (SLE), and risk of death were compared with expected values based on the US reference population. At initial diagnosis, 57 survivors had a median age of 39 years; 45 (79%) were women; 21 (37%) were black; BMI and prevalence of SLE (7%) were greater (P < .001) than expected; prevalence of hypertension (19%; P = .463) was not different. GFR (P = .397) and ACR (P = .793) were not different from expected values. In 2011-2012, prevalence of hypertension (40% vs 23%; P = .013) and major depression (19% vs 6%; P = .005) was greater than expected values. Eleven patients (19%) have died, a proportion greater than expected compared with US and Oklahoma reference populations (P < .05). TTP survivors may have greater risk for poor health and premature death. PMID:23838348

  5. Primary Whipple disease of the brain: case report with long-term clinical and MRI follow-up

    PubMed Central

    Peregrin, Jan; Malikova, Hana

    2015-01-01

    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. PMID:26445540

  6. Urinary Symptom Flare in 712 {sup 125}I Prostate Brachytherapy Patients: Long-Term Follow-Up

    SciTech Connect

    Keyes, Mira; Miller, Stacy; Moravan, Veronika; Pickles, Tom; Liu, Mitchell; Spadinger, Ingrid; Lapointe, Vincent; Morris, W. James

    2009-11-01

    Purpose: To describe the late transient worsening of urinary symptoms ('urinary symptom flare') in 712 consecutive prostate brachytherapy patients, associated predictive factors, association with rectal and urinary toxicity, and the development of erectile dysfunction. Methods and Materials: Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). International Prostate Symptom Score (IPSS), Radiation Therapy Oncology Group (RTOG) toxicity, and erectile function data were prospectively collected. Flare was defined as an increase in IPSS of >=5 and of >=8 points greater than the post-treatment nadir. The relationships between the occurrence of flare and the patient, tumor, and treatment characteristics were examined. The Cox proportional hazards method was used to test individual variables and the multivariate models. Results: The incidence of flare was 52% and 30% using the flare definition of an IPSS of >=5 and >=8 points greater than the postimplant nadir, respectively. Of the patients with symptoms, 65% had resolution of their symptoms within 6 months and 91% within 1 year. Flares most commonly occurred 16-24 months after implantation. On multivariate analysis, a greater baseline IPSS and greater maximal postimplant IPSS were the predictors of flare, regardless of the flare definition used. Androgen suppression was a predictor for fewer flares (IPSS >=5). Diabetes and prostate edema predicted for more frequent flares (IPSS >=8). Patients with flare had a greater incidence of RTOG Grade 3 urinary toxicity and RTOG Grade 2 or greater rectal toxicity. No association was found between erectile dysfunction and the occurrence of flare. Conclusion: Urinary symptom flare is a common, transient phenomenon after prostate brachytherapy. A greater baseline IPSS and maximal postimplant IPSS were the strongest predictive factors. Flare was associated with a greater incidence of late RTOG Grade 3 urinary toxicity and greater rate of late RTOG Grade 2 or greater rectal toxicity.

  7. Effect of External Boost Volume in Breast-Conserving Therapy on Local Control With Long-Term Follow-Up

    SciTech Connect

    Jobsen, Jan J. Palen, Job van der; Ong, Francisca

    2008-05-01

    Purpose: To determine the effects of boost volume (BV) in relation to margin status and tumor size on the development of local recurrence with breast-conserving therapy. Methods and Materials: Between 1983 and 1995, 1,073 patients with invasive breast cancer underwent 1,101 breast-conserving therapies. Of these 1,101 BCTs, 967 were eligible for analysis. The BV was categorized into tertiles: <66 cm{sup 3} (n = 330), 66-98 cm{sup 3} (n = 326), and >98 cm{sup 3} (n = 311). The median follow-up was 141 months. Separate analyses were done for women {<=}40 years and >40 years. Results: No significant difference in local recurrence was shown between the tertiles and the recurrence site. The 15-year local recurrence-free survival rate was 87.9% for the first tertile, 88.7% for the second, and 89% for the third. For women {<=}40 years old, the corresponding 15-year local recurrence-free survival rate was 80%, 74.5%, and 69.2%. For women >40 years old, the corresponding rate was 88.7%, 89.5%, and 90.9%. At 5 years, women >40 years old had significantly more local failures in the first tertile; this difference disappeared with time. A test for trend showed significance at 5 years (p = 0.0105) for positive margins for ductal carcinoma in situ in women >40 years of age. Conclusion: The results of this study have shown that the size of the external BV has no major impact on local control. For women >40 years old, positive margins for ductal carcinoma in situ showed a trend with respect to BV at 5 years. The BV had no influence on local control in the case of positive margins for invasive carcinoma.

  8. Adrenocortical carcinoma in children: first population-based clinicopathological study with long-term follow-up.

    PubMed

    Kerkhofs, T M A; Ettaieb, M H T; Verhoeven, R H A; Kaspers, G J L; Tissing, W J E; Loeffen, J; Van den Heuvel-Eibrink, M M; De Krijger, R R; Haak, H R

    2014-12-01

    Adrenocortical carcinoma (ACC) is rare in both adult and pediatric populations. Literature suggests significant differences between children and adults in presentation, histological properties and outcome. The aim of this first nationwide study on pediatric ACC was to describe the incidence, presentation, pathological characteristics, treatment and survival in The Netherlands. All ACC patients aged <20 years at diagnosis and registered in the population-based Netherlands Cancer Registry between 1993 and 2010 were included. Clinical data were extracted from medical records. Archival histological slides were collected via the Dutch Pathology Registry (PALGA). We compared our findings to all clinical studies on pediatric ACC that were found on PubMed. Based on the results, 12 patients were identified: 8 females and 4 males. The median age was 4.1 years (range 1.1-18.6). The population-based age-standardized incidence rate for patients <20 years was 0.18 per million person-years. Autonomous hormonal secretion was present in 10 patients. Seven patients were aged ≤4 years at diagnosis, 5 presented with localized disease and 2 with locally advanced disease. Five patients were aged ≥5 years, 3 presented with distant metastases and 1 with locally advanced disease. For all patients, histological examination displayed malignant characteristics. All patients aged ≤4 years at diagnosis survived; the median follow-up was 97 months (57-179 months). All patients aged ≥5 years died; the median survival was 6 months (0-38 months). Pediatric ACC is extremely rare in the Western world. The clinical outcome was remarkably better in patients aged ≤4 years. This is in accordance with less advanced stage of disease at presentation, yet contrasts with the presence of adverse histological characteristics. Clinical management in advanced disease is adapted from adult practice in the absence of evidence regarding pediatric ACC. PMID:25241764

  9. Long-term follow-up of testicular function following radiation therapy for early-stage Hodgkin's disease

    SciTech Connect

    Kinsella, T.J.; Trivette, G.; Rowland, J.; Sorace, R.; Miller, R.; Fraass, B.; Steinberg, S.M.; Glatstein, E.; Sherins, R.J.

    1989-06-01

    Seventeen male patients with pathological staged I-IIIA1 Hodgkin's disease were followed prospectively for radiation damage to the testes from low-dose scattered irradiation. During conventionally fractionated radiation therapy, the testicular dose ranged from 6 to 70 cGy. Testicular function was measured in a prospective fashion by repeated analyses (every 6 to 12 months) of serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. Patients were also followed by serial semen analyses and by a questionnaire on fertility. The follow-up period ranged from 3 to 7 years after completion of radiation therapy. In patients receiving greater than or equal to 20 cGy, there was a dose-dependent increase in serum FSH values following irradiation, with the maximum difference at 6 months compared with pretreatment levels. All patients showed a return to normal FSH values within 12 to 24 months following irradiation. No significant changes in LH and testosterone were observed in this patient group. Eight patients with a normal pretreatment semen analysis provided serial semen samples and two patients showed transient oligospermia with complete recovery by 18 months following treatment. Four patients have fathered normal offspring following radiation therapy. We conclude that low doses (greater than 20 cGy) of scatter irradiation during treatment for Hodgkin's disease can result in transient injury to the seminiferous tubule as manifested by elevations of FSH for 6 to 24 months following treatment. Below 20 cGy, FSH values remained in the normal range. No evidence of Leydig cell injury (using LH and testosterone) was seen in this dose range (up to 70 cGy). Thus, patients with early-stage Hodgkin's disease can be treated with radiation therapy with little to no risk of irreversible testicular injury. Radiation treatment techniques to shield the testes are discussed.

  10. The cost-effectiveness of short-term and long-term psychotherapy in the treatment of depressive and anxiety disorders during a 5-year follow-up.

    PubMed

    Maljanen, Timo; Knekt, Paul; Lindfors, Olavi; Virtala, Esa; Tillman, Päivi; Härkänen, Tommi

    2016-01-15

    Both short-term and long-term psychotherapies are used extensively in treating different mental disorders, but there have been practically no attempts to compare their cost-effectiveness. The aim of this study, which is part of the Helsinki Psychotherapy Study, is to assess the cost-effectiveness of two short-term therapies compared to that of a long-term therapy. In this study 326 outpatients suffering from mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP) or to long-term psychodynamic psychotherapy (LPP). Psychiatric symptoms and working ability were assessed at baseline and then 4-9 times during a 5-year follow-up using eight widely used measures including e.g. Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS), Symptom Check List, Global Severity Index (SCL-90-GSI), and the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR). Both direct and indirect costs were measured. During the 5-year follow-up period statistically significant improvements were observed in all health indicators in all therapy groups. At first the recovery was faster in the short-term therapy groups than in the LPP group, but taking the whole follow-up period into account, the effectiveness of the LPP was somewhat greater than that of the short-term therapies. Especially the direct costs were, however, much higher in the LPP group than in the short-term therapy groups. Thus the long-term therapy can hardly be regarded as cost-effective compared to short-term therapies when patients are randomized to the therapy groups. PMID:26540079

  11. Is hypercapnia associated with poor prognosis in chronic obstructive pulmonary disease? A long-term follow-up cohort study

    PubMed Central

    Yang, Hui; Xiang, Pingchao; Zhang, Erming; Guo, Weian; Shi, Yanwei; Zhang, Shuo; Tong, Zhaohui

    2015-01-01

    Objectives To assess whether hypercapnia may predict the prognosis in chronic obstructive pulmonary disease (COPD). Design Prospective cohort study comparing the survival of patients with COPD and normocapnia to those with chronic hypercapnia. Setting Patients with consecutive COPD were enrolled between 1 May 1993 and 31 October 2006 at two medical centres. Follow-up was censored on 31 October 2011. Participants A total of 275 patients with stable COPD and aged 40–85 years were enrolled. Diagnosis of hypercapnia was confirmed by blood gas analysis. Patients with near-terminal illness or comorbidities that affect PaCO2 (obstructive sleep apnoea, obesity-related hypoventilation, or neuromuscular disease) were excluded. The outcome of 98 patients with normocapnia and 177 with chronic hypercapnia was analysed. Outcome measures Overall survival. Results Median survival was longer in patients with normocapnia than in those with hypercapnia (6.5 vs 5.0 years, p=0.016). Multivariate COX regression analysis indicated that age (HR=1.043, 95% CI 1.012 to 1.076), Charlson Index, which is a measure of comorbidity (HR=1.172, 95% CI 1.067 to 1.288), use of medication (HR=0.565, 95% CI 0.379 to 0.842), body mass index (BMI) (HR=0.922, 95% CI 0.883 to 0.963), PaCO2 (HR=1.026, 95% CI 1.011 to 1.042), Cor pulmonale (HR=2.164, 95% CI 1.557 to 3.006), non-invasive positive-pressure ventilation (NPPV) (HR=0.615, 95% CI 0.429 to 0.881) and per cent of forced expiratory volume in 1 s (FEV1%) (HR=0.979, 95% CI 0.967 to 0.991), were independent risk factors for mortality. Conclusions Increased age, Charlson Index, chronic hypercapnia and Cor pulmonale, and decreased FEV1%, use of medication, BMI and NPPV, were associated with a poor prognosis in patients with COPD. PMID:26671953

  12. TREATMENT TRIAL AND LONG-TERM FOLLOW-UP EVALUATION AMONG COMORBID YOUTH WITH MAJOR DEPRESSION AND A CANNABIS USE DISORDER

    PubMed Central

    Cornelius, Jack R.; Salloum, Ihsan M.; Ferrell, Robert; Douaihy, Antoine B.; Hayes, Jeanie; Kirisci, Levent; Horner, Michelle; Daley, Dennis C.

    2013-01-01

    Objective 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. Methods 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. Results 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. Conclusions Fluoxetine did not demonstrate greater efficacy than placebo for treating either the depressive symptoms or the cannabis-related symptoms of our study sample during the acute phase study or at the 1-year follow-up assessment. The lack of a significant treatment effect for fluoxetine may at least in part reflect efficacy of the CBT/MET psychotherapy. A persistence of the efficacy of the acute phase treatment was noted at the 1-year follow-up evaluation, suggesting long-term effectiveness for the CBT/MET psychotherapy. PMID:25328373

  13. Follow-Up Care Experiences and Perceived Quality of Care Among Long-Term Survivors of Breast, Prostate, Colorectal, and Gynecologic Cancers

    PubMed Central

    Weaver, Kathryn E.; Aziz, Noreen M.; Arora, Neeraj K.; Forsythe, Laura P.; Hamilton, Ann S.; Oakley-Girvan, Ingrid; Keel, Gretchen; Bellizzi, Keith M.; Rowland, Julia H.

    2014-01-01

    Introduction: Post-treatment follow-up represents a crucial aspect of quality cancer care; however, data are lacking regarding follow-up care experiences, perception of provider involvement in care, and perceived quality of care from diverse samples of long-term survivors diagnosed as adults. Methods: Questionnaires were mailed in 2005 to 2006 to breast, prostate, colorectal, endometrial, and ovarian cancer survivors (4 to 14 years after diagnosis), sampled from California SEER cancer registries. Results: Most survivors (n = 1,490) reported recent follow-up care (68.7%), generally from oncology specialists only (47.4%) or shared between oncology and primary care providers (PCPs; 27.6%). Most survivors reported follow-up care advice (79.9%); fewer reported late-effects advice or receipt of a treatment summary (41.7% and 19.9%, respectively). Survivors who identified a PCP as their main follow-up care physician were as likely as those identifying an oncology specialist to rate their care as high quality (odds ratio [OR], 2.56; 95% CI, 0.98 to 6.74); however, survivors who could not identify a main follow-up care provider were less likely to report high-quality care (OR, 0.20; 95% CI, 0.08 to 0.50). Compared with follow-up care by an oncology specialist only, care by a PCP only was associated with a lower quality-of-care rating (OR, 0.34; 95% CI, 0.13 to 0.91), but there was no significant difference in quality rating by survivors when care was shared by an oncology specialist and PCP compared with an oncology specialist only. Conclusion: Long-term survivors commonly report follow-up care years after their diagnosis; however, many patients' follow-up lacks important components. Care is more likely to be rated as high quality when one main provider is identified and an oncology specialist is involved. PMID:24695901

  14. Recurrence rate of superficial basal cell carcinoma following treatment with imiquimod 5% cream: conclusion of a 5-year long-term follow-up study in Europe.

    PubMed

    Gollnick, Harald; Barona, Carlos Guilln; Frank, Ronald Gj; Ruzicka, Thomas; Megahed, Mosaad; Maus, Joachim; Munzel, Ullrich

    2008-01-01

    Imiquimod 5% cream is an immune response modifier approved for the treatment of superficial basal cell carcinoma (sBCC) once daily, 5 x per week for 6 weeks. This report reveals the final results of a 5-year follow-up study to evaluate the recurrence rate of sBCCs treated with imiquimod. As previously reported, 182 patients were enrolled in the study and 163 (89.6%) had no clinical evidence of their target sBCC at the 12-week post-treatment assessment; these 163 were followed for up to 5 years. During the follow-up period, 18 clinical recurrences occurred at the target tumour site, 8 and 10 of which occurred during the first 6 and 12 months of follow-up, respectively. The 5-year Kaplan-Meier and life-table estimates for sustained clinical clearance of those patients initially cleared were 84.5% and 86.9%, respectively, and 90.3% considering histology. The estimate of overall treatment success for all treated patients at the end of follow-up was 77.9% (80.9% considering histology). The data support clinical assessment of initial response as predictive of long-term outcome. Most of the recurrences occurred early, indicating that careful follow-up is important during the first year after treatment. PMID:18955210

  15. Mid- and long-term effects of family constellation seminars in a general population sample: 8- and 12-month follow-up.

    PubMed

    Hunger, Christina; Weinhold, Jan; Bornhäuser, Annette; Link, Leoni; Schweitzer, Jochen

    2015-06-01

    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. PMID:25264190

  16. High prevalence of minor neurologic deficits in a long-term neurodevelopmental follow-up of children with severe persistent pulmonary hypertension of the newborn: a cohort study

    PubMed Central

    2010-01-01

    Background Persistent pulmonary hypertension of the newborn (PPHN) is a severe condition that determines a profound brain hypoxia. Inhaled nitric oxide was approved for the treatment of PPHN since the end of the 1990s. The debate upon the long term outcome of these children is still open. Our aim was to investigate the incidence of minor long-term neurodevelopmental problems in a cohort of children affected by severe PPHN. Methods All neonates with severe PPHN treated with inhaled nitric oxide in our facility between 01.01.02 and 31.12.07 were seen in a follow up visit and evaluated with a neurodevelopmental scale, according to their age at the time of observation. Results in the study period 31 children were diagnosed with severe PPHN. 29 survived. 27 accepted to come for follow-up. Mean age: 41 months (range 12 - 70 months). 26% of the evaluated children had some behavioural problems, while 22% had some language disturbances. Conclusions This is the first neurodevelopmental follow-up of neonates with PPHN in which children older than 36 months have been evaluated. There is an unexpected high incidence of minor neurological deficits, mainly regarding the fields of language and behaviour. These deficits seem to be related to the severity of illness rather than to the treatment. Language and behaviour are considered "higher functions" in humans and their integrity can be better defined in older children. PMID:20540801

  17. Different techniques for aortic valve repair and the associated root reconstruction – prospective long-term follow-up of the first 100 patients

    PubMed Central

    Gocol, Radosław; Malinowski, Marcin; Hudziak, Damian; Duraj, Piotr; Frackiewicz, Joanna; Kargul, Tomasz; Deja, Marek A.; Woś, Stanisław

    2014-01-01

    Introduction The advantages of aortic valve and aortic root reconstructive surgery include the provision of natural postoperative valve hemodynamics and the avoidance of prosthetic valve-related complications. A systematic approach based on functional classification of aortic regurgitation allows standardization and reproducibility. Its potential applicability, however, is limited by the relative lack of long-term follow-up data. Aim To achieve the long term results of aortic valve and root repair in prospectively recruited group of 100 patients operated on during first seven years. Material and methods Between the years 2003 and 2013, 225 consecutive patients (175 male, 50 female, mean age 51.3 years) with severe aortic regurgitation and aortic root enlargement underwent aortic valve repair or sparing surgery. The first 100 patients operated between 2003 and 2009 were prospectively enrolled in the study in order to achieve a 105-month follow-up. They underwent aortic valve repair and associated aortic root reconstruction. This prospective study is aimed at assessing the major endpoints of overall survival and freedom from reoperation. Additionally, log-rank testing for the risk factors associated with overall mortality, reoperation, and aortic valve repair failure was performed. Results Among 225 patients, early mortality occurred in the case of 5 patients (2.2%), while 6 (2.5%) patients experienced early valve failure. In a prospective analysis performed on the first 100 patients, long-term results achieved with Kaplan-Meier analysis showed a survival rate of 93% and freedom from reoperation at the level of 91.3%. The risk factors for overall mortality included NYHA class, creatinine level, and perioperative root replacement as reimplantation. Redo operation was associated with bicuspid aortic valve and perioperative leaflet resection with pericardial patch repair. Conclusions One hundred and five month follow-up data from this prospectively analyzed cohort of patients prove that aortic valve repair associated with aortic root reconstruction can be performed with satisfactory results. PMID:26336452

  18. Long-term follow-up of a randomized trial on 118 patients with polyarteritis nodosa or microscopic polyangiitis without poor-prognosis factors.

    PubMed

    Samson, Maxime; Puéchal, Xavier; Devilliers, Hervé; Ribi, Camillo; Cohen, Pascal; Bienvenu, Boris; Ruivard, Marc; Terrier, Benjamin; Pagnoux, Christian; Mouthon, Luc; Guillevin, Loïc

    2014-02-01

    The purpose of this study was to assess the long-term outcomes of patients with polyarteritis nodosa (PAN) or microscopic polyangiitis (MPA) without Five-Factor Score (FFS)-defined poor-prognosis factors (FFS=0) and enrolled in a prospective clinical trial. Patients were followed (2005-2012) under routine clinical care in an extended study and data were recorded prospectively. Long-term survival, disease-free survival (DFS), relapses, therapeutic responses and sequelae were analyzed. Mean±SD follow-up was 98.2±41.9months. After having initially received glucocorticoids (GC) alone, according to the study protocol, 82% (97/118) patients achieved remission but 18% (21/118) required ≥1 immunosuppressant(s) (IS) before 19/21 achieved remission. Two patients died before entering remission. After remission, 53% (61/116) patients relapsed 25.6±27.9months after starting treatment. The 5- and 8-year overall survival rates were 93% and 86%, respectively, with no difference between PAN and MPA, and between relapsers and nonrelapsers. DFS was shorter for MPA than PAN patients (P=0.02). Throughout follow-up, 47% of patients required ≥1 IS. At the last follow-up visit, 44% were still taking GC and 15% IS. The mean vasculitis damage index score was 1.9±1.9; the most frequent sequelae were peripheral neuropathy, hypertension and osteoporosis. For PAN or MPA patients without poor-prognosis factors at diagnosis and treated initially with GC alone, long-term survival was excellent. However, relapses remained frequent, requiring IS introduction for nearly half of the patients. To lower the frequencies of relapses and sequelae remains a challenge for FFS=0 PAN and MPA patients. PMID:24161361

  19. Weight Changes in Patients with Differentiated Thyroid Carcinoma during Postoperative Long-Term Follow-up under Thyroid Stimulating Hormone Suppression

    PubMed Central

    Sohn, Seo Young; Joung, Ji Young; Cho, Yoon Young; Park, Sun Mi; Jin, Sang Man; Chung, Jae Hoon

    2015-01-01

    Background There 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). Methods We 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. Results Significant 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. Conclusion Female 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. PMID:26248858

  20. Lessons Learned Through the Follow-up of the Long-Term Effects of Over-Exposure to an Ir192 Industrial Radiography Source in Bangladesh

    SciTech Connect

    Jalil, A.; Rabbani, G.; Hossain, M. K.; Alam, M. K.; Koddus, A.

    2003-02-24

    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.

  1. Heart rate reduction for 36 months with ivabradine reduces left ventricular mass in cardiac allograft recipients: a long-term follow-up study

    PubMed Central

    Doesch, Andreas O; Mueller, Susanne; Erbel, Christian; Gleissner, Christian A; Frankenstein, Lutz; Hardt, Stefan; Ruhparwar, Arjang; Ehlermann, Philipp; Dengler, Thomas; Katus, Hugo A

    2013-01-01

    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 53.311.3 years and mean time after heart transplantation was 5.04.8 years. After 36 months, the mean ivabradine dose was 12.03.4 mg/day. Resting heart rate was reduced from 91.010.7 beats per minute before initiation of ivabradine therapy (ie, baseline) to 81.29.8 beats per minute at follow-up (P=0.0006). After 36 months of ivabradine therapy, a statistically significant reduction of LVMI was observed (104.322.7 g at baseline versus 93.418.4 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 ivabradine intake despite active inquiry. Conclusion In line with previously published 12-month data, heart rate reduction with ivabradine remained effective and safe in chronic stable patients after heart transplantation, and also during 36-month long-term follow-up. Further, a significant reduction of LVMI was observed only during ivabradine therapy. Therefore, ivabradine may have a sustained long-term beneficial effect with regard to left ventricular remodeling in heart transplant patients. PMID:24235815

  2. Facilitating care for childhood cancer survivors: integrating children's oncology group long-term follow-up guidelines and health links in clinical practice.

    PubMed

    Eshelman, Debra; Landier, Wendy; Sweeney, Teresa; Hester, Allison L; Forte, Kathy; Darling, Joan; Hudson, Melissa M

    2004-01-01

    Childhood cancer survivors are a growing, vulnerable group with health care needs unique to their cancer treatments. They may experience many late physical and psychological complications (late effects) of treatment including organ dysfunction, infertility, second neoplasms, chronic hepatitis, musculoskeletal problems, alterations in cognitive function, and myriad psychosocial problems. Health care providers may be unaware of actual or potential survivor problems. Until recently, there were no clearly defined, easily accessible risk-based guidelines for cancer survivor follow-up care. This article will use a case-study approach to demonstrate how the newly developed Children's Oncology Group Long-term Follow-up Guidelines and Health Links can be used in clinical practice to improve awareness about late effects and the importance of follow-up care for childhood cancer survivors. The Children's Oncology Group Guidelines and Health Links were created by a multidisciplinary team of health care experts and patient advocates to provide a systematic plan for pediatric cancer survivor follow-up care and health education across the cancer continuum. PMID:15381795

  3. Long-term follow-up of patients with invasive fungal disease who received adjunctive therapy with recombinant human macrophage colony-stimulating factor.

    PubMed

    Nemunaitis, J; Shannon-Dorcy, K; Appelbaum, F R; Meyers, J; Owens, A; Day, R; Ando, D; O'Neill, C; Buckner, D; Singer, J

    1993-09-01

    Mortality of bone marrow transplant (BMT) patients who develop invasive fungal infection is greater than 80%. Long-term follow-up of 46 consecutive BMT patients who received recombinant human macrophage colony-stimulating factor (rhM-CSF) as adjunctive therapy with standard antifungal treatment who were entered into phase I/II trials at The Fred Hutchinson Cancer Research Center is reported. rhM-CSF (100 micrograms/m2 to 2,000 micrograms/m2; Chiron/Cetus Corporation, Emeryville, CA) was administered from day 0 to 28 after determination of progressive fungal disease. Results of long-term follow-up of fungal infection, relapse, and survival were compared with 58 similar historical controls. Multivariable analysis of the patients who received rhM-CSF showed two factors that significantly correlated with poor survival: Karnofsky score < or = 20% and Aspergillus infection. Overall, survival of patients who received rhM-CSF was greater than that of historical patients (27% v 5%) and was entirely because of a 50% survival rate in patients with Candida infection and Karnofsky scores greater than 20%. Prospective, randomized, controlled trials to determine efficiency of rhM-CSF are indicated and should be directed at patients with invasive candidiasis. PMID:8364195

  4. Combined oral pulse and topical corticosteroid therapy for severe alopecia areata in children: a long-term follow-up study.

    PubMed

    Lalosevic, Jovan; Gajic-Veljic, Mirjana; Bonaci-Nikolic, Branka; Nikolic, Milos

    2015-01-01

    There are no widely accepted therapy protocols for severe alopecia areata (AA). We treated 65 children/adolescents with AA affecting >30% of scalp. Fourty-three percent of patients had AA plurifocalis (AAP). Fifty-seven percent had AA subtotalis (AAS), AAP+ophiasis (AAP+OPH), and alopecia totalis/universalis (AT/AU). Long-term follow-up (median 96 months) data were available for 69% of patients. Oral dexamethasone (prednisolone 5 mg/kg equivalent) was given once in 4 weeks. Patients received 6, 9, or 12 pulses. Clobetasol propionate 0.05% ointment under plastic wrap occlusion was applied 6 days a week. Hair growth was assessed on a scale ranging 0-100% of regrowth in individual AA lesions. Regrowth >50% was considered good response. Six to twelve months months after the therapy, 56.9% of patients had >75% of hair regrowth. In AAP, 65.5% had complete regrowth. 61.5% of all patients were considered good responders. Significantly, higher percentage of good responders was found in AA lasting ?12 months. No patients had serious side effects. There was no change in stability of the hair status at the long-term follow-up. Most AA patients had beneficial effects with this protocol. Best results were in AAP and AAP+OPH. Combined topical and oral pulse corticosteroid therapy of AA in children shows long-lasting results, without serious side effects. PMID:26179196

  5. Family-focused cognitive behaviour therapy versus psycho-education for adolescents with chronic fatigue syndrome: long-term follow-up of an RCT.

    PubMed

    Lloyd, Samantha; Chalder, Trudie; Rimes, Katharine A

    2012-11-01

    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 deterioration in these outcomes between six and 24-month follow-up. PMID:22985998

  6. Long-term Evolution of Slipped Capital Femoral Epiphysis Treated by in Situ Fixation: A 26 Years Follow-up of 11 Hips

    PubMed Central

    Murgier, Jérôme; de Gauzy, Jérôme Sales; Jabbour, Fouad C.; Iniguez, Xavier Bayle; Cavaignac, Etienne; Pailhé, Régis; Accadbled, Franck

    2014-01-01

    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. PMID:25002939

  7. Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction.

    PubMed

    Chadwick, C; Whitehouse, S L; Saxby, T S

    2015-03-01

    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 < 0.001). The mean American Orthopedic 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. PMID:25737518

  8. Cochlea sparing effects of intensity modulated radiation therapy in head and neck cancers patients: a long-term follow-up study

    PubMed Central

    2014-01-01

    Background Radiation to the inner ear may lead to (irreversible) sensorineural hearing loss. The purpose of this study was to evaluate the long-term effect of radiotherapy on hearing in patients treated with Intensity Modulated Radiation Therapy (IMRT), sparing the inner ear from high radiation dose as much as possible. Methods Between 2003 and 2006, 101 patients with head and neck cancer were treated with IMRT. Audiometry was performed before, short-term, and long-term after treatment. Data were compared to normal hearing levels according to the International Organisation for Standardization (ISO). Statistical analysis was done using repeated measurements. None of the patients received chemotherapy. Results In 36 patients an audiogram at long-term follow-up (median 7.6years) was available. The mean dose to the cochlea was 17.8Gy (1.0-66.6Gy). A hearing deterioration of 1.8dB at Pure Tone Average (PTA) 0.5-1-2kHz (p?=?0.11), 2.3dB at PTA 1-2-4kHz (p?=?0.02), and 4.4dB at PTA 8-10-12.5kHz (p?=?0.01) was found. According to the ISO, the expected age-related hearing loss was 2.7, 4.8, and 8.8dB at PTA 0.5-1-2kHz, 1-2-4kHz, and 8-10-12.5kHz, respectively. Conclusions After IMRT with radiation dose constraint to the cochlea, potential long-term adverse effects of IMRT remained subclinical. The progressive hearing loss over time was mild and could be attributed to the natural effects of ageing. Therefore, we recommend that a dose constraint to the cochlea should be incorporated in the head and neck radiotherapy protocols. PMID:25095702

  9. [Long-term follow-up of patients with extensive ulcerous colitis with emphasis on the occurrence of dysplastic changes and colorectal carcinoma].

    PubMed

    Konecn, M; Ehrmann, J; Prochzka, V; Kucerov, V; Vyslouzil, K

    2001-10-01

    The chronic course of idiopathic intestinal inflammations is characterized also by a relatively high incidence of complications, local ones affecting the entire large intestine, as well as extraintestinal ones in remote organs. In the submitted paper the authors present the results of a six-year follow-up focused on the incidence of dysplastic changes of the intestinal mucosa and colorectal carcinoma in 46 patients from a group of 220 patients followed up on a long-term basis at the Second Medical Clinic of the Faculty Hospital and Medical Faculty Olomouc because of the extensive type of ulcerative colitis. The incidence of these complications is not high in our group and is only slightly higher than in the general population. As it is however a very serious disease and so far an optimal algorithm for its follow up has not been elaborated, we feel it is useful to investigate this high risk group of patients after 6-24-month intervals according to the confirmed grade of dysplasia of the intestinal mucosa. PMID:11789007

  10. Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long-term follow-up: value of renal scan.

    TOXLINE Toxicology Bibliographic Information

    Yetgin S; Olgar S; Aras T; Cetin M; Düzova A; Beylergil V; Akhan O; Oĝuz O; Saraçbaşi O

    2004-10-01

    In order to evaluate potential long-term kidney damage of childhood leukemia and risk factors affecting renal damage, we studied 116 children treated for acute lymphoblastic leukemia (ALL) using the St. Jude Total XI and XIII protocols in 1991-1998. The median follow-up period after the completion of treatment was 35 months. The following parameters were examined: urinalysis, urinary creatinine (Cr), calcium (Ca), phosphorus, beta2-microglobulin, glomerular filtration rate (GFR), tubular phosphorus reabsorption (TPR), and renal function tests. Radiological evaluation included renal ultrasonography (US), and renal scans with DMSA or MAG-3 were performed. Blood chemistry and renal US patients were normal in all patients except two. GFR, TPR, urinary Ca/Cr, beta2-microglobulin, and renal scan were abnormal in 19.0%, 16.4%, 13.8%, 6.0%, and 40.5% of patients, respectively. The abnormality rate in GFR was significantly higher in patients <2 years of age. TPR abnormality was found to be significantly higher in patients who did not have G-CSF. An abnormal renal scan was associated with Hb < 10 g/dL, kidney infiltration, or hypertension at presentation and also occurred patients who underwent methotrexate treatment with frequent intervals during the follow-up period. Patients should be followed-up after cessation of therapy with the conventional tests mentioned above. In case of any abnormality, further detailed tests should be performed; renal scan seems to be more predictive for renal damage.

  11. Evaluation of kidney damage in patients with acute lymphoblastic leukemia in long-term follow-up: value of renal scan.

    PubMed

    Yetgin, Sevgi; Olgar, Seref; Aras, Tülin; Cetin, Mualla; Düzova, Ali; Beylergil, Volkan; Akhan, Okan; Oĝuz, Oĝuzhan; Saraçbaşi, Osman

    2004-10-01

    In order to evaluate potential long-term kidney damage of childhood leukemia and risk factors affecting renal damage, we studied 116 children treated for acute lymphoblastic leukemia (ALL) using the St. Jude Total XI and XIII protocols in 1991-1998. The median follow-up period after the completion of treatment was 35 months. The following parameters were examined: urinalysis, urinary creatinine (Cr), calcium (Ca), phosphorus, beta2-microglobulin, glomerular filtration rate (GFR), tubular phosphorus reabsorption (TPR), and renal function tests. Radiological evaluation included renal ultrasonography (US), and renal scans with DMSA or MAG-3 were performed. Blood chemistry and renal US patients were normal in all patients except two. GFR, TPR, urinary Ca/Cr, beta2-microglobulin, and renal scan were abnormal in 19.0%, 16.4%, 13.8%, 6.0%, and 40.5% of patients, respectively. The abnormality rate in GFR was significantly higher in patients <2 years of age. TPR abnormality was found to be significantly higher in patients who did not have G-CSF. An abnormal renal scan was associated with Hb < 10 g/dL, kidney infiltration, or hypertension at presentation and also occurred patients who underwent methotrexate treatment with frequent intervals during the follow-up period. Patients should be followed-up after cessation of therapy with the conventional tests mentioned above. In case of any abnormality, further detailed tests should be performed; renal scan seems to be more predictive for renal damage. PMID:15389822

  12. Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial

    PubMed Central

    Gallagher, Martin; Cass, Alan; Bellomo, Rinaldo; Finfer, Simon; Gattas, David; Lee, Joanne; Lo, Serigne; McGuinness, Shay; Myburgh, John; Parke, Rachael; Rajbhandari, Dorrilyn

    2014-01-01

    Background The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI. Methods and Findings We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.048.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.961.12, p?=?0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.632.00, p?=?0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p?=?0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration. Conclusions Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis. Trial registration www.ClinicalTrials.gov NCT00221013 Please see later in the article for the Editors' Summary PMID:24523666

  13. Long-term follow-up and suboptimal treatment rates of treatment-eligible chronic hepatitis B patients in diverse practice settings: a gap in linkage to care

    PubMed Central

    Vu, Vinh D; Do, Ailinh; Nguyen, Nghia H; Kim, Lily H; Trinh, Huy N; Nguyen, Huy A; Nguyen, Khanh K; Nguyen, My; Huynh, Andrew; Nguyen, Mindie H

    2015-01-01

    Background and aims Despite available effective therapies, only a minority of patients with chronic hepatitis B (CHB) receive treatment. Our goal is to study treatment rates and time to treatment initiation in patients who meet treatment criteria on long-term follow-up. Methods We performed a retrospective cohort study of 608 consecutive treatment-eligible patients with CHB (by 2008 US Panel or 2009 American Association for the Study of Liver Disease (AASLD) criteria) at a US community gastroenterology clinic and a university liver clinic between 2007 and 2011. Patients were observed until they started treatment or last follow-up if untreated. Results Mean age was 44 and most were Asian (96%) with community patients being younger and having lower alanine aminotransferase (ALT) levels. A total of 62% started treatment, and 38% remained untreated after median follow-up of 17?months (IQR=140?months). Overall, treatment rate was significantly higher at university liver clinic than in the community (66.7% vs 59.9%, p=0.01). In multivariate analysis, older age (HR 1.02, p=0.002), male gender (HR 1.37, p=0.02), and baseline ALT >45?U/L for males and >29?U/L for females (HR 2.24, p<0.0001) were significant predictors of treatment initiation, but not practice setting. Conclusions Approximately 40% of treatment-eligible patients still have not started treatment on longer follow-up. Treatment rates were higher at university clinics, but practice setting was not a predictor for treatment, but older age, male gender, and higher ALT levels were. Further studies are needed to determine the barriers for treatment initiation and to improve treatment rates in treatment-eligible patients. PMID:26543565

  14. Long-Term Treatment Outcome in Adult Male Prisoners With Attention-Deficit/Hyperactivity Disorder: Three-Year Naturalistic Follow-Up of a 52-Week Methylphenidate Trial.

    PubMed

    Ginsberg, Ylva; Lngstrm, Niklas; Larsson, Henrik; Lindefors, Nils

    2015-10-01

    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 (ClinicalTrials.gov: 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. PMID:26284932

  15. Long-term Efficacy of an Internet-based Intervention for Infant and Toddler Sleep Disturbances: One Year Follow-Up

    PubMed Central

    Mindell, Jodi A.; Du Mond, Courtney E.; Sadeh, Avi; Telofski, Lorena S.; Kulkarni, Neema; Gunn, Euen

    2011-01-01

    Objective: To examine at one-year follow-up the efficacy of an internet-based intervention for infant and toddler sleep disturbances, as well as to assess any indirect benefits to maternal sleep and confidence. Methods: Participants included 171 (64.8%) of 264 mothers of an infant or toddler (ages 18-48 months) who had previously participated in a 3-week study. Families had been randomly assigned to one of 2 intervention groups (algorithmic internet-based intervention alone or in combination with a prescribed bedtime routine) or a control group. After a one-week baseline, the intervention groups followed personalized sleep recommendations. The initial internet-intervention was found to be efficacious at 2 weeks post-intervention. The current study investigates a one-year follow-up, with mothers completing a short survey that included 8 questions from the Brief Infant Sleep Questionnaire and 1 question from the Pittsburgh Sleep Quality Index. Results: Improvements in difficulty falling asleep, number/duration of night wakings, and longest continuous sleep period were maintained at one year follow-up in the 2 intervention groups compared to baseline and end of the initial study, p < 0.001. Children in the control group, in which limited changes were seen in the initial study, showed improvements in the duration of night wakings and longest continuous sleep period compared to the end of the initial study. Mothers in all groups were less likely to describe their child's sleep as a problem. Conclusions: These results suggest that a brief internet-intervention for early childhood sleep problems is effective in improving child and maternal sleep, with improvements maintained one year later. Citation: Mindell JA; Du Mond CE; Sadeh A; Telofski LS; Kulkarni N; Gunn E. Long-term efficacy of an internet-based intervention for infant and toddler sleep disturbances: one year follow-up. J Clin Sleep Med 2011;7(5):507-511. PMID:22003347

  16. Primary Infrarenal Aortic Stenting With or Without Iliac Stenting for Isolated and Aortoiliac Stenoses: Single-Centre Experience With Long-Term Follow-Up

    SciTech Connect

    Tapping, C. R.; Ahmed, M.; Scott, P. M.; Lakshminarayan, R.; Robinson, G. J.; Ettles, D. F.; Shrivastava, V.

    2013-02-15

    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 disease.

  17. NCI, NHLBI/PBMTC First International Consensus Conference on Late Effects after Pediatric Hematopoietic Cell Transplantation: The Need for Pediatric Specific Long Term Follow-up Guidelines

    PubMed Central

    Pulsipher, Michael A.; Skinner, Roderick; McDonald, George B.; Hingorani, Sangeeta; Armenian, Saro H.; Cooke, Kenneth R.; Gracia, Clarisa; Petryk, Anna; Bhatia, Smita; Bunin, Nancy; Nieder, Michael L.; Dvorak, Christopher C.; Sung, Lillian; Sanders, Jean E.; Kurtzberg, Joanne; Baker, K. Scott

    2012-01-01

    Existing standards for screening and management of late effects occurring in children who have undergone hematopoietic cell transplantation (HCT) include recommendations from pediatric cancer networks and consensus guidelines from adult-oriented transplantation societies applicable to all recipients of HCT. While these approaches have significant merit, they are not pediatric-HCT focused and they do not address post-HCT challenges faced by children with complex non-malignant disorders. In this article we discuss the strengths and weaknesses of current published recommendations and conclude that pediatric-specific guidelines for post-HCT screening and management would be beneficial to the long-term health of these patients and would promote late-effects research in this field. Our panel of late effects experts also provides recommendations for follow up and therapy of selected post-HCT organ and endocrine complications in pediatric patients. PMID:22248713

  18. Single forearm radius and ulna asymmetric lengthening in multiple cartilaginous exostoses: a case report and a long-term follow-up.

    PubMed

    Massobrio, Marco; Antonietti, Giorgio; Pellican, Giovanni; Necci, Fabiana

    2015-11-01

    We describe one case of forearm deformity in a patient affected by multiple cartilaginous exostoses - also known as the forearm 'candy stick deformity'. Surgical treatment usually focuses on the correction of the wrist deformity without correcting the forearm shortening, the latter not being given the same consideration as lower limb shortening. In the presented case, radius and ulna corticotomies were performed and distal forearm deformity and shortening were corrected by two independent monoaxial external fixators, with full pronosupination. It is our belief that simultaneous treatment of forearm shortening and deformity not only results in an improved clinical and functional result but also provides significant psychological benefit. We recommend a long-term follow-up. PMID:26196368

  19. Long-term follow-up of hepatic ultrasound findings in subjects with magnetic resonance imaging defined hepatic steatosis following clinical islet transplantation: a case-control study.

    PubMed

    Jackson, Stephanie; Mager, Diana R; Bhargava, Ravi; Ackerman, Thomas; Imes, Sharleen; Hubert, Grace; Koh, Angela; Shapiro, A M James; Senior, Peter A

    2013-01-01

    Hepatic steatosis is one complication patients may experience following clinical islet transplantation (CIT), yet the cause and consequences of this are poorly understood. The purpose of this case-control study was to examine the relationship between hepatic steatosis, metabolic parameters and graft function in an Albertan cohort of CIT recipients. Hepatic steatosis was detected by magnetic resonance imaging (MRI) in n = 10 cases age-matched with n=10 MRI-negative controls. Progression/regression of steatosis was determined by ultrasound (US) in cases. Hepatic steatosis first appeared 2.8 2.2 (mean SD) years post-CIT, and lasted approximately 4.6 2.0 years. In five cases steatosis resolved, with recurrence in two cases during the follow-up period (8.5 3.2 years). No evidence of CIT causing deleterious effects on long-term liver function or graft outcome was observed. PMID:23514958

  20. Long-term follow-up study of porcine anti-human thymocyte immunoglobulin therapy combined with cyclosporine for severe aplastic anemia.

    PubMed

    Chen, Miao; Liu, Chao; Zhuang, Junling; Zou, Nong; Xu, Ying; Zhang, Wei; Li, Jian; Duan, Minghui; Zhu, Tienan; Cai, Huacong; Cao, Xinxin; Wang, Shujie; Zhou, Daobin; Han, Bing

    2016-03-01

    Immunosuppressive therapy with antithymocyte immunoglobulin (ATG) and cyclosporine A is the first treatment option for severe aplastic anemia (SAA) patients without transplantation. Horse ATG is not marketed in China. Because the price of porcine ATG (pATG) is only about one-third of the price of rabbit ATG (rATG), long-term follow-up studies of pATG's efficacy will help provide valuable insights into the treatment of SAA. Retrospective studies were performed to analyze the clinical information of 102 SAA patients treated with pATG and cyclosporine A from 1999 to 2014 in Peking Union Medical College Hospital. The median age was 29 years old (range 12-72). Median follow-up time was 59.6 months (0.2-176.8). The overall response rate was 74.5% (CR 42.1%, PR 32.4%). The recurrence rate was 9.9%. The mortality rate was 16.7%. The median survival time has not been reached, and the 5-year survival rate was 81.8%. Other hematologic abnormalities were observed in 7.8% of patients, including symptomatic PNH, MDS, and AML. Multivariate analysis revealed there was no significant effect on survival by factors such as gender, age, severity of disease, treatment time, and PNH clone (P > 0.05). These data have indicated pATG therapy combined with cyclosporine A has significant long-term efficacy and high overall survival in SAA. PMID:25996247

  1. A long-term follow-up study of open reduction using Ludloffs approach for congenital or developmental dislocation of the hip

    PubMed Central

    Yamada, K.; Mihara, H.; Fujii, H.; Hachiya, M.

    2014-01-01

    Objectives There are several reports clarifying successful results following open reduction using Ludloffs medial approach for congenital (CDH) or developmental dislocation of the hip (DDH). This study aimed to reveal the long-term post-operative course until the period of hip-joint maturity after the conventional surgical treatments. Methods A long-term follow-up beyond the age of hip-joint maturity was performed for 115 hips in 103 patients who underwent open reduction using Ludloffs medial approach in our hospital. The mean age at surgery was 8.5 months (2 to 26) and the mean follow-up was 20.3 years (15 to 28). The radiological condition at full growth of the hip joint was evaluated by Severins classification. Results All 115 hips successfully attained reduction after surgery; however, 74 hips (64.3%) required corrective surgery at a mean age of 2.6 years (one to six). According to Severins classification, 69 hips (60.0%) were classified as group I or II, which were considered to represent acceptable results. A total of 39 hips (33.9%) were group III and the remaining seven hips (6.1%) group IV. As to re-operation, 20 of 21 patients who underwent surgical reduction after 12 months of age required additional corrective surgeries during the growth period as the hip joint tended to subluxate gradually. Conclusion Open reduction using Ludloffs medial approach accomplished successful joint reduction for persistent CDH or DDH, but this surgical treatment was only appropriate before the ambulating stage. Cite this article: Bone Joint Res 2014;3:16. PMID:24398153

  2. Long-term clinical outcomes after deployment of femoral vascular closure devices in coronary angiography and percutaneous coronary intervention: an observational single-centre registry follow-up

    PubMed Central

    Lee, Stephen Wai-Luen; Tam, Chor-Cheung; Wong, Ka-Lam; Kong, Shun-Ling; Yung, See-Yue; Wong, Yiu-Tung; Chiu, Suk-Yee; Lam, Cheung-Chi; Chan, Ki-Wan; Chan, Hon-Wah

    2014-01-01

    Objectives There are few data evaluating the long-term effect of femoral vascular closure devices (FCDs) on patients’ clinical outcome. We aim to evaluate the incidence of peripheral vascular disease (PVD) in patients who received FCD following its deployment in coronary angiography and percutaneous coronary intervention (PCI) procedures. Design and setting Observational study of a single-centre registry. Participants From June 2000 to September 2004, 265 patients who received FCD after coronary angiography and PCIs were enrolled on the study. Outcome measures Clinical follow-up (using Rutherford's categories of claudication), ankle brachial index (ABI) and duplex ultrasound of femoral arteries (using the non-accessed side as control) were performed to evaluate the presence of PVD. Results The mean follow-up interval was 3320±628 days. 1 patient (0.4%) suffered from grade 2 claudication and another (0.4%) suffered from grade 1 claudication. The mean ABIs of the accessed side and non-accessed side were 1.06±0.13 and 1.08±0.11, respectively (p=0.17). For duplex ultrasound, the mean common femoral artery peak systolic velocities of the accessed side and non-accessed side were 87.4±22.3 and 87.7±22.1 cm/s, respectively (p=0.73); the mean superficial femoral artery peak systolic velocities of the accessed side and non-accessed side were 81.4±20.1 and 81.31±17.8 cm/s, respectively (p=0.19). Conclusions The use of FCD after a coronary angiogram and PCI is safe and does not increase the long-term risk of PVD. PMID:24928591

  3. Endovascular Treatment of 429 Anterior Communicating Artery Aneurysms Using Bare-Platinum Coils : Clinical and Radiologic Outcomes at the Long-term Follow-up

    PubMed Central

    Lee, Jong Young; Seo, Jeong Hwa; Cho, Young Dae; Kang, Hyun-Seung

    2015-01-01

    Objective We reviewed the feasibility, safety and efficacy as well as the clinical outcome and long-term angiographic results of endovascular treatment (EVT) of the anterior communicating artery (ACoA) aneurysms. Methods A total of 429 ACoA aneurysms in 426 patients were treated using coil embolization between March 1996 and October 2010 in a single institution. Pretreatment aneurysmal features were checked using angiogram. We had usually used tailored steam shaped microcatheter according to individual angiographic architectures. Immediate postembolization outcomes were evaluated using an angiographic outcome scale and clinical evaluation was performed using the Glasgow Outcome Scale (GOS). Results Postembolization angiograms demonstrated total occlusion of aneurysm in 290 of 429 (67.6%) aneurysms, neck remnant in 80 (18.6%) and body filling in 59 (13.8%). Dome direction and aneurysm angle was not associated with initial angiographic outcomes. The procedure-related morbidity rate was 0.9% (4 of 429). Clinical and imaging follow-up more than 6 months were available in 382 (89.0%) patients with a mean of 26.2 months. Overall rate of major recanalization was 7.9% (30 of 382) and all of them were retreated without complications. At the last follow-up, 233 (99.2%) of 235 patients had GOS of 5 in unruptured group, and 152 (79.5%) of 191 patients showed good clinical outcomes (GOS of 4 or 5) in ruptured group. Conclusion Tailored steam shaping of the microcatheter is vital to achieve good angiographic outcomes regardless of aneurysmal direction. EVT is feasible and safe for most ACoA aneurysms with acceptable immediate and long-term outcomes. PMID:25810854

  4. 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.

    PubMed

    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, Aime R

    2015-04-27

    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. PMID:25796338

  5. [How is it going with the Sick-listing II patients? From the project Evaluation of Follow-up of Long-term Sick-listed Persons].

    PubMed

    Berg, J E; Tellnes, G; Bjerkedal, T

    1992-01-20

    The aim of the study was to follow up 712 persons with respect to social insurance and labour market status one year after the start of a period of long-term sickness certificate. The study is based on information from the local National Insurance Offices in five municipalities in Norway. Mean duration of the long-term sickness certificate was 185 calendar days, slightly longer for males than females. 44.9% returned to work during the first year, another 2.9% attended vocational rehabilitation programmes, 11.7% were still receiving medical treatment, 12.2% had qualified for a disability pension, 5.6% were in receipt of an old age pension and 5.6% were unemployed. The remaining 17.1% had either died or had moved from the municipality. The few patients attending vocational rehabilitation programmes, compared with the increasing number of persons granted a disability pension in Norway since 1985 indicate insufficient effort to provide vocational rehabilitation. PMID:1566256

  6. Minimally invasive mitral valve repair through right minithoracotomy in the setting of degenerative mitral regurgitation: early outcomes and long-term follow-up

    PubMed Central

    Murzi, Michele; Canarutto, Daniele; Gilmanov, Danyiar; Ferrarini, Matteo; Farneti, Pier A.; Solinas, Marco; Glauber, Mattia

    2015-01-01

    Background Mitral valve (MV) repair is the gold standard for the treatment of degenerative MV regurgitation. Recently, minimally invasive mitral valve surgery (MIMVS) has shown excellent postoperative outcomes compared with conventional surgery. The aim of our study is to report early and long-term outcomes of patients undergoing MIMVS through right mini-thoracotomy (RT) over an eight year period. Methods From September 2003 to December 2011, a total of 1,604 consecutive patients underwent MIMVS through RT. Results The mean age was 6213 years, 295 (42%) patients were female and 16 (2.3%) had previous cardiac operations. MV repair was successfully performed in 670 patients, with a rate of success of 95.3%. Repair techniques included annuloplasty (89%), leaflet resection (n=54.2%), neochordae implantation (12.1%), and sliding plasty (10.5%). Overall in-hospital mortality was 0.1%. Incidence of stroke was 1.3%. At eight-year follow-up, overall survival was 90.1%, freedom from reoperation 93%, and freedom from recurrent mitral regurgitation was 90%. Conclusions MIMV repair through right minithoracotomy is a safe and reproducible procedure associated with high rate of MV repair, and excellent early postoperative and long-term results. PMID:26539346

  7. Long-term follow-up after percutaneous closure of patent foramen ovale with Amplatzer PFO Occluder: a single center experience

    PubMed Central

    Grygier, Marek; Iwańczyk, Sylwia; Trojnarska, Olga; Lesiak, Maciej; Grajek, Stefan

    2016-01-01

    Introduction Patent foramen ovale (PFO) is associated with the occurrence of cryptogenic strokes, transient neurological ischemic attacks (TIA) and migraine. Therefore despite the recent ambiguous results of prospective controlled trials, percutaneous closure of PFO is still performed in many centers. Aim To evaluate the safety and effectiveness of percutaneous PFO closure in the prevention of recurrence of neurologic events and migraine symptoms in long-term observation. Material and methods In 70 patients (31 male, age: 38 ±18 years) percutaneous PFO closure was successfully performed with the Amplatzer PFO Occluder. An interview in conjunction with neurological follow-up was performed in all patients to reveal recurrence of embolism such as TIA or stroke and the presence of migraine symptoms before and after the procedure. Results The mean follow-up period was 857 ±363 days (median: 571 days). No serious complications of the procedure and no death were observed. Neurological events recurred in 5 (7.1%) patients – stroke in 1 patient, TIA in 3 patients, ocular embolism in 1 patient. All of these patients were over 40 years old or had other cardiovascular risk factors. Migraine was observed in 21 (30%) patients before the procedure and in 11 (15.7%) after the procedure (p = 0.04). Conclusions The complication rate and recurrence of neurological events in young patients after PFO closure are low. However, careful qualification and postprocedural monitoring of the patients are necessary. Patent foramen ovale closure seems to result in attenuation of migraine symptoms. PMID:26966449

  8. Long-term follow-up (11 years plus) results of JRI (Furlong) total hip arthroplasty in young patients: cause for concern regarding acetabular cup?

    PubMed

    Sharma, D K; Brooks, Stuart

    2006-10-01

    We describe the clinical and radiological long-term outcomes of 77 primary total hip replacements in 69 patients using the fully hydroxyapatite-coated JRI (Furlong) total hip replacement. The total cases followed up were 77 hips, performed at a mean duration of 11 years and 2 months. Twelve hips could not be followed up for various reasons, which are discussed in the results section. The mean Harris hip score was 89. Seventeen acetabular cups were revised for aseptic loosening. Only one femoral stem was revised, for fracture. By Engh's criteria there were a further two unstable cups with no symptoms, and all femoral stems were stable. Kaplan-Meier survivorship analysis revealed a survival of 98.8% for the femoral stem, 78.7% for the acetabular cup, and a combined survival of 77.8% for both components. Our findings suggest that the JRI (Furlong) hip gives a durable femoral stem implant fixation, whereas the prosthesis-bone interface achieved with the acetabular component is questionable. PMID:16761147

  9. High-power (80-w) KTP laser vaporization of the prostate in the management of urinary retention: long-term follow up

    NASA Astrophysics Data System (ADS)

    Kleeman, M.; Nseyo, Unyime O.

    2004-07-01

    Introduction and Objectives: We have previously reported the use of high-powered photoselective vaporization of the prostate (PVP) for patients in urinary retention due to benign prostatic hyperplasia (BPH). PVP is a relatively new treatment for bladder outlet obstruction due to BPH, using laser energy to vaporize obstructing prostatic tissue. This study investigates the long-term follow up of patients treated with PVP for urinary retention. Materials and Methods: All participants signed informed consent, and were treated with high power 80 W quasi-continuous wave potassium-titanyl-phosphate (KTP) laser. Ten patients underwent the procedure from December 2001 until the present. One patient was excluded from the study for failure to return for follow-up. Mean patient follow-up was nine months, maximum of twelve months. Results: The mean pre-operative gland size by trans-rectal ultrasound was 48 grams. Mean urethral length was 3.2 cm. Mean laser time was 48.2 minutes and the mean energy usage was 82.2 kJoules. There were no peri-operative complications such as sepsis or measurable postoperative bleeding. The preoperative AUA Symptom Score (AUASS) decreased from a mean of 22.6 preoperatively to 17 at nine months postoperatively (p = 0.032). The Quality of Life Score (QOL) decreased from 4.6 preoperatively to 3.25 at 12 months postoperatively (p = 0.26). The maximum urine flow rate increased from a mean of 7.7 cc/sec preoperatively to 14.5 cc/sec at six months follow-up (p = 0.03). Conclusions: This follow-up study suggests that HP-KTP has a durable response in patients treated specifically for retention. It significantly improved urine flow rate and symptom score, and had a trend towards improvement in subjective quality of life. HP-KTP prostatectomy should be considered in treating patients in retention, especially those with significant co-morbidities or taking anticoagulation.

  10. Sequential therapy with cyclophosphamide and mycophenolic acid in patients with progressive immunoglobulin A nephropathy: a long-term follow-up.

    PubMed

    Rasche, F M; Keller, F; Rasche, W G; Schiekofer, S; Kahn, T; Fahnert, J

    2016-02-01

    In progressive immunoglobulin (Ig)A nephropathy (IgAN), cyclophosphamide pulse therapy (CyP), high-dose intravenous immunoglobulins (IVIg) and mycophenolic acid (MPA) have been used to stop progressive loss of renal function, but disease progression may occur after the end of the initial treatment. Here, we report the long-term follow-up of patients with progressive IgAN with MPA as maintenance therapy after CyP (CyP-MPA). In a median observation time of 62 years, we analysed the slopes of the loss of renal function of 47 patients with biopsy-proven IgAN and treated with CyP. Thirty-one patients with further progression were treated with MPA maintenance for a median time of 52 years. Follow-up was compared with symptomatic therapy and IVIg as historically matched control groups. Median loss of renal function was reduced significantly from 09 ml/min to 01 ml/min per month with CyP (P?long-term follow-up observation indicates that sequential CyP-MPA therapy maintains renal survival significantly. PMID:26439797

  11. Long-term sonographic and serological follow-up of inactive echinococcal cysts of the liver: hints for a "watch-and-wait" approach.

    PubMed

    Piccoli, Luca; Tamarozzi, Francesca; Cattaneo, Federico; Mariconti, Mara; Filice, Carlo; Bruno, Antonella; Brunetti, Enrico

    2014-08-01

    Human cystic echinococcosis is a chronic, complex and neglected infection. Its clinical management has evolved over decades without adequate evaluation of efficacy. Recent expert opinion recommends that uncomplicated inactive cysts of the liver should be left untreated and solely monitored over time ("watch-and-wait" approach). However, clinical data supporting this approach are still scant and published mostly as conference proceedings. In this study, we report our experience with long-term sonographic and serological follow-up of inactive cysts of the liver. From March 1994 to October 2013, 38 patients with 47 liver cysts, diagnosed as inactive without any previous treatment history, were followed with ultrasound and serology at 6-12 months intervals for a period of at least 24 months (median follow-up 51.95 months) in our outpatient clinic. In 97.4% of patients, the cysts remained inactive over time and in only one case was reactivation of the cyst detected. No complications occurred during the time of monitoring. During follow-up, serology tests for CE were negative at diagnosis or became negative in 74.1% and were positive or became positive in 25.9% of cases. Patients with inactive cysts on ultrasound but positive serological tests were also investigated by CT scan (chest and abdomen) to rule out extra-hepatic cyst localization. This study confirms the importance of a stage-specific approach to the management of cystic echinococcosis and supports the use of a monitoring-only approach to inactive, uncomplicated cysts of the liver. It also confirms that serology plays only an ancillary role in the clinical management of these patients, compared to ultrasound and other imaging techniques. The implications of these findings for clinical management and natural history of cystic echinococcosis are discussed. PMID:25122222

  12. Characteristics and long-term follow-up of patients hospitalized for mood disorders in the Phipps Clinic, 1913-1940.

    PubMed

    Stephens, J H; McHugh, P R

    1991-02-01

    From a sample of 2809 mood disorder patients hospitalized between 1913 and 1940, we selected for detailed study 914 patients with at least a 5 year follow-up and 103 patients who committed suicide within 5 years of discharge. Patients with clearly mood incongruent delusions or an onset associated with a physical illness were excluded. Based on the presence or absence of manic symptoms, this cohort of 1017 cases was divided into 297 bipolar and 945 unipolar patients. Bipolar patients had an earlier age of onset and admission and were more likely to be delusional and hallucinated. They also had more sudden onsets, more previous admissions, worse premorbid characteristics, and more problems with alcohol, but more patients were discharged as recovered. Unipolar patients were more often female and married, more likely to have made previous suicidal attempts, and more likely to have experienced a precipitating event. On a mean follow-up of 13.5 years, only 11% of the bipolar and 22% of the unipolar patients experienced no further episodes of mania or depression. Of the bipolar group, 77% had to be rehospitalized, as did 56% of the unipolars. Only 2% of the sample had manic episodes with no lifetime depressions; this small group had the best outcome. One third of all the patients were rated unimproved on follow-up. Thirteen percent committed suicide, usually within 1 year of discharge. Bipolar patients had the worst outcome, with 43% rated unimproved. The sample was split by odd or even case number and one half was used to construct a prognostic scale significantly correlated with long-term outcome. It was cross-validated on the other half of the sample with little shrinkage. Patients with non-drug-treated affective disorders hospitalized half a century ago were found to have polyepisodic illnesses with a frequently chronic course. PMID:1990073

  13. Levetiracetam extended release for the treatment of patients with partial-onset seizures: A long-term, open-label follow-up study.

    PubMed

    Chung, Steve; Ceja, Hugo; Gaw?owicz, Jacek; McShea, Cindy; Schiemann, Jimmy; Lu, Sarah

    2016-02-01

    This was an open-label study (N01281 [NCT00419393]) assessing the long-term safety of extended-release levetiracetam (LEV XR) in patients with partial-onset seizures (POS); the study was a follow-up to a double-blind, randomized, historical controlled, multicenter, conversion to monotherapy study (N01280 [NCT00419094]). Eligible patients initially received LEV XR 2000mg/day; dose adjustments and the addition of other antiepileptic drugs (AEDs) were permitted. Overall, 190 patients were enrolled, 189 (99.5%) received LEV XR (safety and efficacy populations) and 166 patients (87.4%) completed the study. The study duration in completed patients was 5.5-24.6 months. Mean daily dose of LEV XR was 2131mg/day. Treatment-emergent adverse events (TEAEs) occurred in 126 patients (66.7%); most were of mild or moderate severity. Five patients (2.6%) had a TEAE that led to treatment discontinuation. Treatment-emergent serious adverse events occurred in 22 patients (11.6%). Twenty-six patients (13.8%) experienced a psychiatric TEAE. The median 7-day normalized POS frequency was: 1.38 at N01280 study baseline; 0.50 at the first visit of N01281 (last visit of N01280); and 0.00-0.36 between all subsequent visits. Overall, 171 patients (90.5%) entered the N01281 study on LEV XR monotherapy; 65.3% (32/49) of patients remained on monotherapy for 12 months and 47.1% (8/17) for 18 months. While remaining on LEV XR monotherapy, 27/139 patients (19.4%) were seizure-free at 6 months and 8/49 (16.3%) at 12 months. In conclusion, LEV XR was well tolerated when administered as long-term monotherapy or in combination with other AEDs in patients with inadequately controlled POS. PMID:26716580

  14. Differences in the association between sickness absence and long-term sub-optimal health by occupational position: a 14-year follow-up in the GAZEL cohort

    PubMed Central

    Ferrie, Jane E.; Kivimki, Mika; Westerlund, Hugo; Head, Jenny; Melchior, Maria; Singh-Manoux, Archana; Zins, Marie; Goldberg, Marcel; Alexanderson, Kristina; Vahtera, Jussi

    2011-01-01

    Objectives Although sickness absence is a strong predictor of health, little work has examined whether this association varies by occupational position. The aim of this study was to investigate overall and diagnosis-specific sickness absence as a predictor of future long-term sub-optimal health by occupational position. Methods Prospective occupational cohort study; 15,320 employees (73% men) aged 3751. Sickness absences (19901992), including 13 diagnostic categories, were examined by occupational position, in relation to self-rated health measured annually 19932006. Results 60% of employees in higher occupational position and 22% in lower position had no sickness absence. Conversely, 9.5% of employees in higher position and 40% in lower occupational position had over 30 sick-leave days. Repeated-measures logistic regression analyses adjusted for age, sex, and chronic disease showed employees with over 30 days absence, compared to those with no absence, had approximately double the risk of suboptimal health over the 14-year follow-up in all occupational positions. However, 130 days sick-leave was associated with greater odds of suboptimal health in the high; odds ratio 1.48, 95% confidence intervals (1.271.72) and intermediate 1.29 (1.151.45), but not lower occupational positions 1.06 (0.821.38). Differences by occupational position in the association between sickness absence in 13 specific diagnostic categories and sub-optimal health over the ensuing 14 years were limited to stronger associations observed with cancer and mental disorders in the higher occupational positions. Conclusions The association between sickness absence of over 30 days a year and future long-term self-rated health appears to differ little by occupational position. PMID:21242277

  15. Long-term Bone Remodeling in HA-coated Stems: A Radiographic Review of 208 Total Hip Arthroplasties (THAs) with 15 to 20 Years Follow-up.

    PubMed

    Boldt, Jens G; Cartillier, Jean-Claude; Machenaud, Alain; Vidalain, Jean-Pierre

    2015-11-01

    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. PMID:26680411

  16. Long-term follow up Helicobacter Pylori reinfection rate after second-line treatment: bismuth-containing quadruple therapy versus moxifloxacin-based triple therapy

    PubMed Central

    2013-01-01

    Background The increasing trend of antibiotic resistance requires effective second-line Helicobacter pylori (H. pylori) treatment in high prevalence area of H. pylori. The aim of our study was to evaluate the reinfection rate of H. pylori after second-line treatment that would determine the long-term follow up effect of the rescue therapy. Methods A total of 648 patients who had failed previous H. pylori eradication on standard triple therapy were randomized into two regimens: 1, esomeprazole (20mg b.i.d), tripotassium dicitrate bismuthate (300mg q.i.d), metronidazole (500mgt.i.d), and tetracycline (500mg q.i.d) (EBMT) or 2, moxifloxacin (400mg q.d.), esomeprazole (20mg b.i.d), and amoxicillin (1000mg b.i.d.) (MEA). At four weeks after completion of eradication therapy, H. pylori tests were performed with 13C urea breath test or invasive tests. In patients who maintained continuous H. pylori negativity for the first year after eradication therapy, H. pylori status was assessed every year. For the evaluation of risk factors of reinfection, gender, age, clinical diagnosis, histological atrophic gastritis or intestinal metaplasia were analyzed. Results The recrudescence rate of the EBMT was 1.7% and of the MEA group 3.3% (p?=?0.67). The annual reinfection rate of H. pylori of EBMT was found to be 4.45% and the MEA group 6.46%. Univariate analysis (Log-rank test) showed no association with any clinical risk factor for reinfection. Conclusions The long-term reinfection rate of H. pylori stayed low in both of bismuth-containing quadruple therapy and moxifloxacin-based triple therapy; thus reinfection cannot affect the choice of second-line treatment. Trial registration Clinical Trial Registration Number NCT01792700 PMID:24050512

  17. Early detection of CIN3 and cervical cancer during long-term follow-up using HPV/Pap smear co-testing and risk-adapted follow-up in a locally organised screening programme.

    PubMed

    Luyten, Alexander; Buttmann-Schweiger, Nina; Luyten, Katrin; Mauritz, Claudia; Reinecke-Lthge, Axel; Pietralla, Martina; Meijer, Chris J L M; Petry, Karl Ulrich

    2014-09-15

    We evaluated compliance with human papillomavirus (HPV) testing and risk-adapted patient pathways and monitored changes in high-grade cervical disease during long-term follow-up. Women aged >30 years attending routine screening for cervical cancer were managed according to results from first-round screening tests (cytology and high-risk HPV; Hybrid Capture 2). Between February 2006 and January 2011, 19,795 of 19,947 women agreed to participate, of whom 4,067 proceeded to a second screening round 5 years after recruitment. Predefined endpoints were compliance, grade 3 cervical intraepithelial neoplasia or cancer (CIN3+), new HPV infection, HPV persistence and abnormal smears in round 2. A total of 765 of 19,795 women (3.9%) in round 1 and 41 of 4,067 (1.0%) in round 2 were referred for colposcopy. Compliance rates with colposcopy were 93.1 and 92.7%, respectively, while histological assessment was performed in 680 of 712 (95.5%) and 36 of 38 (94.7%), respectively. CIN3+ rates were 172 of 19,795 (0.87%; 95% confidence intervals: 0.7-1.0) in round 1 and 2 of 4,064 (0.05%; 95% confidence intervals: 0.006-0.2) in round 2; the difference was statistically significant (Fisher's exact test, p<0.001). After 5 years, the incidence of new HPV infection was 124 of 3,906 (3.2%) and HPV persistence was observed in 22 of 161 (13.7%). Locally organised HPV/cytology co-testing is feasible and acceptable to women. Risk-adapted management rapidly detected a high rate of prevalent CIN3+, while the subsequent long-term risk of new high-grade cervical disease was surprisingly low. It remains unclear if this phenomenon is explained by CIN3 mostly occurring early in life or by modifying the natural course of HPV infection with colposcopy and histological assessment. PMID:24519782

  18. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial

    PubMed Central

    Cuzick, Jack; Sestak, Ivana; Cawthorn, Simon; Hamed, Hisham; Holli, Kaija; Howell, Anthony; Forbes, John F

    2015-01-01

    Summary Background Four previously published randomised clinical trials have shown that tamoxifen can reduce the risk of breast cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation. Methods In the IBIS-I randomised controlled trial, premenopausal and postmenopausal women 35–70 years of age deemed to be at an increased risk of developing breast cancer were randomly assigned (1:1) to receive oral tamoxifen 20 mg daily or matching placebo for 5 years. Patients were randomly assigned to the two treatment groups by telephone or fax according to a block randomisation schedule (permuted block sizes of six or ten). Patients and investigators were masked to treatment assignment by use of central randomisation and coded drug supply. The primary endpoint was the occurrence of breast cancer (invasive breast cancer and ductal carcinoma in situ), analysed by intention to treat. Cox proportional hazard models were used to assess breast cancer occurrence and mortality. The trial is closed to recruitment and active treatment is completed, but long-term follow-up is ongoing. This trial is registered with controlledtrials.com, number ISRCTN91879928. Findings Between April 14, 1992, and March 30, 2001, 7154 eligible women recruited from genetics clinics and breast care clinics in eight countries were enrolled into the IBIS-I trial and were randomly allocated to the two treatment groups: 3579 to tamoxifen and 3575 to placebo. After a median follow up of 16·0 years (IQR 14·1–17·6), 601 breast cancers have been reported (251 [7·0%] in 3579 patients in the tamoxifen group vs 350 [9·8%] in 3575 women in the placebo group; hazard ratio [HR] 0·71 [95% CI 0·60–0·83], p<0·0001). The risk of developing breast cancer was similar between years 0–10 (226 [6·3%] in 3575 women in the placebo group vs 163 [4·6%] in 3579 women in the tamoxifen group; hazard ratio [HR] 0·72 [95% CI 0·59–0·88], p=0·001) and after 10 years (124 [3·8%] in 3295 women vs 88 [2·6%] in 3343, respectively; HR 0·69 [0·53–0·91], p=0·009). The greatest reduction in risk was seen in invasive oestrogen receptor-positive breast cancer (HR 0·66 [95% CI 0·54–0·81], p<0·0001) and ductal carcinoma in situ (0·65 [0·43–1·00], p=0·05), but no effect was noted for invasive oestrogen receptor-negative breast cancer (HR 1·05 [95% CI 0·71–1·57], p=0·8). Interpretation These results show that tamoxifen offers a very long period of protection after treatment cessation, and thus substantially improves the benefit-to-harm ratio of the drug for breast cancer prevention. Funding Cancer Research UK (UK) and the National Health and Medical Research Council (Australia). PMID:25497694

  19. Risk Factors for Long-Term Mortality after Hospitalization for Community-Acquired Pneumonia: A 5-Year Prospective Follow-Up Study

    PubMed Central

    Holter, Jan C.; Ueland, Thor; Jenum, Pål A.; Müller, Fredrik; Brunborg, Cathrine; Frøland, Stig S.; Aukrust, Pål; Husebye, Einar; Heggelund, Lars

    2016-01-01

    Background Contributors to long-term mortality in patients with community-acquired pneumonia (CAP) remain unclear, with little attention paid to pneumonia etiology. We examined long-term survival, causes of death, and risk factors for long-term mortality in adult patients who had been hospitalized for CAP, with emphasis on demographic, clinical, laboratory, and microbiological characteristics. Methods Two hundred and sixty-seven consecutive patients admitted in 2008–2011 to a general hospital with CAP were prospectively recruited and followed up. Patients who died during hospital stay were excluded. Demographic, clinical, and laboratory data were collected within 48 hours of admission. Extensive microbiological work-up was performed to establish the etiology of CAP in 63% of patients. Mortality data were obtained from the Norwegian Cause of Death Registry. Cox regression models were used to identify independent risk factors for all-cause mortality. Results Of 259 hospital survivors of CAP (median age 66 years), 79 (30.5%) died over a median of 1,804 days (range 1–2,520 days). Cumulative 5-year survival rate was 72.9% (95% CI 67.4–78.4%). Standardized mortality ratio was 2.90 for men and 2.05 for women. The main causes of death were chronic obstructive pulmonary disease (COPD), vascular diseases, and malignancy. Independent risk factors for death were the following (hazard ratio, 95% CI): age (1.83 per decade, 1.47–2.28), cardiovascular disease (2.63, 1.61–4.32), COPD (2.09, 1.27–3.45), immunocompromization (1.98, 1.17–3.37), and low serum albumin level at admission (0.75 per 5g/L higher, 0.58–0.96), whereas active smoking was protective (0.32, 0.14–0.74); active smokers were younger than non-smokers (P < 0.001). Microbial etiology did not predict mortality. Conclusions Results largely confirm substantial comorbidity-related 5-year mortality after hospitalization for CAP and the impact of several well-known risk factors for death, and extend previous findings on the prognostic value of serum albumin level at hospital admission. Pneumonia etiology had no prognostic value, but this remains to be substantiated by further studies using extensive diagnostic microbiological methods in the identification of causative agents of CAP. PMID:26849359

  20. EUCROMIC (European Collaborative Research on Mosaicism in Chorionic Villus Sampling): New initiatives concerning uniparental disomy research and long-term clinical follow-up

    SciTech Connect

    DeLozier-Blanchet, C.D.; Hahnemann, J.M.; Vejersley, L.O.

    1994-09-01

    Since 1986 the European collaborative study on mosaicism in chorionic villus sampling (CVS), based in Glostrup, Denmark. has been collecting cytogenetic and clinical data on pregnancies in which testing revealed mosaicism or fetal/extrafetal chromosomal discrepancies. From 1986-1992, data on 60,823 samples, including 751 mosaics and 241 nonmosaic discrepancies, was collected. This information has proven helpful in prenatal counseling, by indicating which chromosomes are most often involved in mosaicism, whether the latter is likely to be confirmed in the fetus and/or placenta, and the relationship of cytogenetic results obtained by different culture techniques to pregnancy outcome. Since December 1, 1993 the European collaborative study has been funded by the European Community and by the Swiss government as a concertation project, {open_quotes}EUCROMIC{close_quotes}, a step which has allowed enlargement of the database and broadening of the project goals. Forty-five genetics centers are currently involved in this effort to monitor not only CVS, but changing trends in prenatal diagnosis in Europe. Two ancillary projects, based in Geneva, were initiated in early 1993: long-term clinical follow-up of children born after CVS mosaicism, and a search for uniparental disomy (UPD) in these same children (as well as in abortuses). Clinical data is collected from the initial reporting centers via questionnaires; at the time of writing, clinical follow-up has been obtained for over 250 children liveborn after CVS mosaicism. UPD testing results are received from the individual centers; for those not having the possibility to do the parental origin analyses themselves, testing is offered in one of several EUCROMIC-UPD laboratories.

  1. Long-term follow-up after botulinum toxin A (BTX-A) injection into the detrusor for treatment of neurogenic detrusor hyperactivity in children

    PubMed Central

    Becker, Tanja; Koen, Mark; Berger, Christoph; Riccabona, Marcus

    2012-01-01

    Purpose To prove the long-term efficacy of BTX-A injection in the management of children with neurogenic detrusor hyperactivity. Materials and methods 28 out of 145 children with neurogenic bladder (15 male and 13 female, mean age 10.7 years) who were treated between 2002 and 2010 and became non-responders to conservative treatment were included into the retrospective study. We injected 10-12 U/kg of BTX-A (Botox) into the detrusor at 20-30 sites, sparing the trigone. The mean follow-up was 48 months (range 6-84 months). Results Group 1. 14 patients had a single injection of BTX-A. Five of them were successful. Mean bladder reflex volume increased (from 62.9 to 117.5 ml), maximum detrusor pressure decreased (from 59 to 37.5 cm H2O), detrusor compliance increased (from 4.8 to 9.5 ml/cm H2O), and leak-point-pressure decreased (from 46.5 to 24.2 cm H2O). Four patients did not respond and were treated by ileocystoplasty. Another five were lost to follow-up. Group 2. 14 patients had repeated (mean 2.5) injections of BTX-A with a mean interval of 13.7 months. In thirteen patients, urodynamic parameters of the first and last injection were similar to those obtained in Group 1, showing a good response. One patient received an ileocystoplasty. Conclusion BTX-A is a safe alternative in the treatment of detrusor hyperactivity in children with myelomeningocele (MMC). The efficacy lasted a mean of 12 months and urodynamic response was unchanged even after several injections. In our series, 21.7% of children with severe low-compliance bladders were non-responders. PMID:24578954

  2. Efficacy of treatment and long-term follow-up of Batrachochytrium dendrobatidis PCR-positive anurans following itraconazole bath treatment.

    PubMed

    Georoff, Timothy A; Moore, Robert P; Rodriguez, Carlos; Pessier, Allan P; Newton, Alisa L; McAloose, Denise; Calle, Paul P

    2013-06-01

    All anuran specimens in the Wildlife Conservation Society's collections testing positive for Batrachochytrium dendrobatidis (Bd) were treated with itraconazole and then studied after treatment to assess the long-term effects of itraconazole and the drug's effectiveness in eliminating Bd carriers. Twenty-four individuals and eight colonies of 11 different species (75 total specimens) tested positive for Bd via polymerase chain reaction (PCR) on multicollection survey. All positive individuals and colonies were treated with a 0.01% itraconazole bath solution and retested for Bd via one of two PCR methodologies within 14 days of treatment completion, and all were negative for Bd. A total of 64 animals received secondary follow-up PCR testing at the time of death, 6-8 mo, or 12-15 mo post-treatment. Fourteen animals (14/64, 21.9%) were PCR positive for Bd on second follow-up. The highest percentage positive at second recheck were green-and-black poison dart frogs (Dendrobates auratus; 5/5 specimens, 100%), followed by red-eyed tree frogs (Agalychnis callidryas; 4/11, 36.4%), grey tree frogs (Hyla versicolor; 1/3, 33.3%), and green tree frogs (Hyla cinera; 3/11, 27.3%). Re-testing by PCR performed on 26/28 individuals that died during the study indicated 11/26 (42.3%) were positive (all via DNA extracted from formalin-fixed paraffin-embedded skin sections). However, there was no histologic evidence of chytridiomycosis in any of 27/28 individuals. The small number of deceased animals and effects of postmortem autolysis limited the ability to determine statistical trends in the pathology data, but none of the necropsied specimens showed evidence of itraconazole toxicity. Problems with itraconazole may be species dependent, and this report expands the list of species that can tolerate treatment. Although itraconazole is effective for clearance of most individuals infected with Bd, results of the study suggest that repeat itraconazole treatment and follow-up diagnostics may be required to ensure that subclinical infections are eliminated in amphibian collections. PMID:23805558

  3. Long-term follow-up of patients with diffuse large B-cell non-Hodgkins lymphoma receiving purged autografts after induction failure

    PubMed Central

    Benjamin, JE; Chen, GL; Cao, TM; Cao, PD; Wong, RM; Sheehan, K; Shizuru, JA; Johnston, LJ; Negrin, RS; Lowsky, R; Laport, GG

    2010-01-01

    Patients with diffuse large B-cell lymphoma (DLBCL) who do not achieve a complete response to front-line combination chemotherapy are often offered high-dose therapy and autologous hematopoietic cell transplantation (AHCT). However, the efficacy of this therapy in this patient population has been addressed in only a few published reports. We retrospectively analyzed the outcomes of patients with a diagnosis of de novo DLBCL who underwent AHCT at our center between 1988 and 2002, and identified 43 consecutive patients who had not achieved a CR before AHCT, although most showed at least a partial response (PR) to either induction or subsequent salvage chemotherapy. A total of 15 patients received a conditioning regimen that included high-dose chemotherapy with fractionated TBI (FTBI), whereas 28 patients received high-dose chemotherapy only. All autografts were treated ex vivo with MoAbs and complement in an effort to remove any residual malignant B cells. A total of 33 (77%) patients achieved a CR after AHCT. With a median follow-up of 7.3 years, the 5-year OS was 69% and EFS was 59%. Four patients died from non-relapse mortality. By univariate analyses, the following characteristics did not significantly impact OS: disease stage at diagnosis, age-adjusted IPI (International Prognostic Index) score, age ?40 years, earlier radiotherapy and the use of FTBI in the conditioning regimen. These results confirm the long-term efficacy of AHCT for patients with DLBCL after induction failure. PMID:19597427

  4. Evalution of Renal Involvement in Patients with Behçet Disease: Need to be Aware About Potential Hypertension in Long Term Follow Up?

    PubMed Central

    Ozel, Deniz; Ozel, Betul Duran; Ozkan, Fuat; Kutlu, Ramazan

    2016-01-01

    Summary Backround The aim of this study was to evaluate frequency and severity of kidney involvement with some clinical, ultrasonography and color Doppler measurements in patients with Behçet disease. Material/Methods This study was including 32 patients with Behçet disease and 32 healthy sex and age-matched control subjects. Patients were divided into two groups as period of disease 0–6 years and 7 years and above to evaluate effect of duration of disease. We evaluated some biochemical tests in both blood and urine related to renal functions, blood pressure values. Gray scale and color Doppler findings were noted. Results Renal artery volume flow in patients with a duration of 7 years or above was significantly decreased compared to control group (p<0.05). However, gray scale ultrasound and color Doppler measurements reveal there was not statistically significant change compared to control group. There was no biochemical abnormalities in any patient. Four patients had elevated blood pressure but mean blood pressure values were not statistically different compared to volunteers. Conclusions Renal involvement ratios varies in different studies but not common. End stage renal failure can be seen very rare. Furthermore, vasculitic changes can lead renal artery narrowness and can result to decrease in renal blood flow. It has a potential to activate renin angiotensin aldosterone cascade to elevate blood pressure. We must be aware about blood pressure of patients with Behçet disease, especially with long term follow up. PMID:26937259

  5. Long-term follow-up of idiotype vaccination in human myeloma as a maintenance therapy after high-dose chemotherapy.

    PubMed

    Coscia, M; Mariani, S; Battaglio, S; Di Bello, C; Fiore, F; Foglietta, M; Pileri, A; Boccadoro, M; Massaia, M

    2004-01-01

    The aim of this work was to evaluate the long-term immunological and clinical impact of idiotype (Id) vaccination in multiple myeloma (MM) patients in first remission after high-dose chemotherapy. A total of 15 patients received a series of subcutaneous (s.c.) injections of autologous Id, conjugated to keyhole limpet hemocyanin (KLH) and in association with low doses of GM-CSF. The median duration of follow-up was 110 months from diagnosis. The vaccine induced immune responses that lasted almost 2 years after the end of treatment. Antibody responses included anti-KLH IgM and IgG (90% of patients), anti-KLH IgE (30%), anti-GM-CSF IgG (20%), anti-Id IgG (20%), and anti-Id IgE (30%). Id-specific delayed type hypersensitivity skin tests were positive in 85% of tested patients. Following vaccination, a progressive recovery of T-cell receptor (TCR) diversity was observed and the loss of oligoclonality was significantly correlated with the remission duration. Although Id/KLH conjugates did not eliminate the residual tumor burden, the median progression-free survival, and overall survival were 40 and 82 months, respectively. A retrospective case-matched analysis showed similar results in patients treated with IFN-alpha alone or in association with steroids. This vaccine formulation can overcome Id-specific immune tolerance by inducing clinical responses that are worthy of further investigation. PMID:14574332

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

    SciTech Connect

    Shaitelman, Simona F.; Wilkinson, J. Ben; Kestin, Larry L.; Ye Hong; Goldstein, Neal S.; Martinez, Alvaro A.; Vicini, Frank A.

    2012-07-01

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

  7. Long-term follow-up of reduced-intensity allogeneic stem cell transplantation for chronic lymphocytic leukemia: prognostic model to predict outcome.

    PubMed

    Brown, J R; Kim, H T; Armand, P; Cutler, C; Fisher, D C; Ho, V; Koreth, J; Ritz, J; Wu, C; Antin, J H; Soiffer, R J; Gribben, J G; Alyea, E P

    2013-02-01

    Chronic lymphocytic leukemia (CLL) remains incurable with chemoimmunotherapy, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the potential for cure. We assessed the outcomes of 108 CLL patients undergoing first allogeneic HSCTs, 76 with reduced-intensity (RIC) and 32 with myeloablative conditioning (MAC) between 1998 and 2009 at Dana-Farber Cancer Institute. With median follow-up of 5.9 years in surviving patients, the 5-year overall survival (OS) for the entire cohort is 63% for RIC regimens and 49% for MAC regimens (P=0.18). The risk of death declined significantly starting in 2004, and we found that 5-year OS for HSCT between 2004 and 2009 was 83% for RIC regimens compared with 47% for MAC regimens (P=0.003). For RIC transplantation, we developed a prognostic model based on predictors of progression-free survival (PFS), specifically remission status, lactate dehydrogenase, comorbidity score and lymphocyte count, and found 5-year PFS to be 83% for Score 0, 63% for Score 1, 24% for Score 2 and 6% for Score ?3 (P<0.0001). We conclude that RIC HSCT for CLL in the current era is associated with excellent long-term PFS and OS, and, as potentially curative therapy, should be considered early in the disease course of relapsed high-risk CLL patients. PMID:22955330

  8. Smith-Magenis syndrome with West syndrome in a 5-year-old girl: a long-term follow-up study.

    PubMed

    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

    2009-07-01

    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. PMID:19264735

  9. Mortality and loss to follow-up among HIV-infected persons on long-term antiretroviral therapy in Latin America and the Caribbean

    PubMed Central

    Carriquiry, Gabriela; Fink, Valeria; Koethe, John Robert; Giganti, Mark Joseph; Jayathilake, Karu; Blevins, Meridith; Cahn, Pedro; Grinsztejn, Beatriz; Wolff, Marcelo; Pape, Jean William; Padgett, Denis; Madero, Juan Sierra; Gotuzzo, Eduardo; McGowan, Catherine Carey; Shepherd, Bryan Earl

    2015-01-01

    Introduction Long-term survival of HIV patients after initiating highly active antiretroviral therapy (ART) has not been sufficiently described in Latin America and the Caribbean, as compared to other regions. The aim of this study was to describe the incidence of mortality, loss to follow-up (LTFU) and associated risk factors for patients enrolled in the Caribbean, Central and South America Network (CCASAnet). Methods We assessed time from ART initiation (baseline) to death or LTFU between 2000 and 2014 among ART-nave adults (?18 years) from sites in seven countries included in CCASAnet: Argentina, Brazil, Chile, Haiti, Honduras, Mexico and Peru. Kaplan-Meier techniques were used to estimate the probability of mortality over time. Risk factors for death were assessed using Cox regression models stratified by site and adjusted for sex, baseline age, nadir pre-ART CD4 count, calendar year of ART initiation, clinical AIDS at baseline and type of ART regimen. Results A total of 16,996 ART initiators were followed for a median of 3.5 years (interquartile range (IQR): 1.66.2). The median age at ART initiation was 36 years (IQR: 3044), subjects were predominantly male (63%), median CD4 count was 156 cells/L (IQR: 60251) and 26% of subjects had clinical AIDS prior to starting ART. Initial ART regimens were predominantly non-nucleoside reverse transcriptase inhibitor based (86%). The cumulative incidence of LTFU five years after ART initiation was 18.2% (95% confidence interval (CI) 17.518.8%). A total of 1582 (9.3%) subjects died; the estimated probability of death one, three and five years after ART initiation was 5.4, 8.3 and 10.3%, respectively. The estimated five-year mortality probability varied substantially across sites, from 3.5 to 14.0%. Risk factors for death were clinical AIDS at baseline (adjusted hazard ratio (HR)=1.65 (95% CI 1.471.87); p<0.001), lower baseline CD4 (HR=1.95 (95% CI 1.632.32) for 50 vs. 350 cells/L; p<0.001) and older age (HR=1.47 (95% CI 1.291.69) for 50 vs. 30 years at ART initiation; p<0.001). Conclusions In this large, long-term study of mortality among HIV-positive adults initiating ART in Latin America and the Caribbean, overall estimates of mortality were heterogeneous, generally falling between those reported in high-income countries and sub-Saharan Africa. PMID:26165322

  10. Diisocyanate-induced asthma in Switzerland: long-term course and patients’ self-assessment after a 12-year follow-up

    PubMed Central

    2014-01-01

    Background Isocyanates are among the most common causes of occupational asthma (OA) in Switzerland. Patients with OA have been shown to have unfavourable medical, socioeconomic and psychological outcomes. We investigated long-term asthma and the socio-economic outcomes of diisocyanate-induced asthma (DIA) in Switzerland. Patients and methods We conducted an observational study on 49 patients with DIA and followed 35 of these patients over a mean exposure-free interval of 12 ± 0.5 (range 11.0-13.0) years. At the initial and follow-up examinations, we recorded data on respiratory symptoms and asthma medication; measured the lung function; and tested for bronchial hyperreactivity. We allowed the patients to assess their state of health and overall satisfaction using a visual analogue scale (VAS) at these visits. Results The 35 patients whom we could follow had a median symptomatic exposure time of 12 months, interquartile range (IQR) 26 months and a median overall exposure time of 51 (IQR 104) months. Their subjective symptoms (p < 0.001) and the use of asthma medication (p = 0.002), particularly the use of inhaled corticosteroids (p < 0.001), decreased by nearly 50%. At the same time, the self-assessment of the patients’ state of health and overall satisfaction increased considerably according to both symptomatology and income. In contrast, slight reductions in terms of FVC% predicted from 102% to 96% (p = 0.04), of FEV1% predicted from 91% to 87% (p = 0.06) and of the FEV1/FVC ratio of 3%; (p = 0.01) were observed while NSBHR positivity did not change significantly. In univariate as well as multivariate logistic analyses we showed significant associations between age, duration of exposure and FEV1/FVC ratio with persistent asthma symptoms and NSBHR. Conclusions We found that the patients’ symptoms, the extent of their therapy and the decrease in their lung volumes during the follow-up period were similar to the findings in the literature. The same hold true for some prognostic factors, whereas the patients’ self-assessment of their state of health and overall satisfaction improved considerably. PMID:24949081

  11. Long-term immigrant adaptation: eight-year follow-up study among immigrants from Russia and Estonia living in Finland.

    PubMed

    Jasinskaja-Lahti, Inga

    2008-02-01

    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 tude longitudinale a examin trois diffrentes dimensions de l'adaptation long-terme de l'immigr (i.e., adaptation psychologique, socio-culturelle et socio-conomique) et de la relation entre elles dans un suivi de 8 ans avec des donnes de panel. Les 282 rpondants taient des immigrs en Finland provenant de l'ancienne Union Sovitique ns entre 1961 et 1976. Les rsultats suggrent que l'adaptation de ces immigrants s'est dveloppe favorablement. En huit ans, les rpondants avaient amlior leurs habilets en finlandais sur le march de travail. Aucune diffrence n'a t observe dans leurs niveaux de bien-tre psychologique entre les deux valuations. Parmi les trois dimensions de l'adaptation values, l'adaptation socio-culturelle telle que mesure par la capacit de comprendre, de parler, de lire et d'crire le finlandais s'est avre tre le prdicteur le plus significatif des deux autres rsultats long-terme de l'adaptation de l'immigr (i.e., socio-conomique et psychologique). Particulirement, meilleure avait t la connaissance initiale du finlandais, meilleurs taient leurs rsultats de l'adaptation socio-conomiques et psychologiques aprs 8 ans de rsidence. Ces rsultats dmontrent l'importance des valuations parallles et longitudinales de diffrents rsultats de l'adaptation de l'immigr pour mieux tudier quelles dimensions particulires de l'adaptation sont les plus critiques au dbut de l'acculturation en matire de la dtermination du dveloppement positif et de l'adaptation long-terme de l'immigr. El estudio consisti en una investigacin longitudinal sobre tres diferentes dimensiones de adaptacin de inmigrantes a largo plazo (i.e. adaptacin psicolgica, sociocultural, socioeconmica) y la relacin entre ellas en 8 aos de seguimiento con los datos de grupo. Los 282 encuestados fueron inmigrantes en Finlandia procedentes de los pases de la antigua Union Sovietica, nacidos entre 1961 y 1976. Los resultados sugieren que la adaptacin de estos inmigrantes se desarroll favorablemente. En ocho aos, los encuestados han mejorado sus conocimientos del idioma finlandes y su posicin en el mercado laboral. No se observ ningunas diferencias en su nivel del bienestar psicolgico entre las dos evaluaciones. Entre las tres dimesiones de adaptacin que fueron evaluadas, adaptacin sociocultural, medida como aptitud de comprensin, habla, lectura y escritura en finlandes fue el predictor ms significante de los resultados en otras dimensiones de adaptacin de los inmigrantes a largo plazo (i.e. socioeconmica y psicolgica). Particularmente, cuando mejor era el dominio inicial del idioma finlandes, mejores eran los resultados de adaptacin socioeconmica y psicolgica despus de 8 aos de residencia. Estos estudios demuestran la importancia de la evaluacin en paralelo y longitudinal de diferentes resultados de adaptacin de los inmigrantes para saber cules particulares dimensines de adaptacin son las ms crticas en el principio de aculturacin para determinar el desarrollo. PMID:22023496

  12. Are adults content or continent after repair for high anal atresia? A long-term follow-up study in patients 18 years of age and older.

    PubMed Central

    Hassink, E A; Rieu, P N; Severijnen, R S; vd Staak, F H; Festen, C

    1993-01-01

    OBJECTIVE: This study investigated the current state of fecal and urinary continence in an extensive group of adults after operative correction for high anorectal malformations and how they cope with their incontinence. SUMMARY BACKGROUND DATA: Normal fecal continence is hardly to be expected after correction for high anorectal malformation; despite this, it is commonly accepted that for most patients fecal continence improves with growing age and that most adult patients have no problems. Until now, however, few long-term follow-up studies in small groups of adults have been performed to assess continence after operative repair for high anorectal malformation. METHODS: Fifty-eight adult patients (median age, 26.0 years; range, 18.1 to 56.9 years) with an operatively corrected high anorectal malformation were evaluated by questionnaire with respect to their current state of fecal and urinary continence and mode of control of defecation. RESULTS: Seven patients have a permanent ileostoma or colostoma. Of the 51 patients with anal defecation, 61% control defecation by themselves, whereas 35% control defecation by using enemas or bowel irrigations, and 4% do not have any control at all. Besides medical therapy, 65% take dietary measures to influence defecation. According to existing scoring methods, 41% reached good and 49% fair control of defecation, whereas only 10% had poor control. Current control of defecation was reached from a median age of 15.0 years (range, 5 to 31 years). CONCLUSION: Conclusively, the authors can say that after correction for high anorectal malformation nobody reached normal fecal continence. Most patients with anal defecation reached good and fair control of defecation, however. Of all 58 patients, 84% are satisfied with their level of cleanliness. PMID:8343000

  13. The assessment of immune-regulatory effects of extracorporeal photopheresis in systemic sclerosis: a long-term follow-up study.

    PubMed

    Papp, Gabor; Horvath, Ildiko Fanny; Gyimesi, Edit; Barath, Sandor; Vegh, Judit; Szodoray, Peter; Zeher, Margit

    2016-04-01

    The therapeutic options in systemic sclerosis (SSc) are limited mainly to the management of complications, and decelerating fibrosis and preventing disease progression are still great challenges. Extracorporeal photopheresis (ECP) is one of the promising therapeutic strategies in SSc; nevertheless, there is no consensus on the ideal timing and frequency of treatment cycles. In the present study, we evaluated the long-term effects of consecutive ECP treatments, and the stability of clinical and laboratory improvements. We enrolled nine patients with diffuse cutaneous SSc and performed 12 ECP cycles (24 ECP treatments) per patient in total. ECP cycles were carried out once in every 6weeks, and each cycle consisted of two procedures. Sixteen healthy individuals served as controls for laboratory assessment. Following the sixth ECP cycle, we observed further improvement in skin score, which was confirmed by high-resolution ultrasonography as well. After the second ECP cycle, values of Tr1 and CD4+CD25(bright) Treg cells increased; however, Tr1 cells remained under control values until the 10th cycle. Suppressor activity of CD4+CD25+ Treg cells improved, while percentages of Th17 cells decreased. At the end of 12-month follow-up, we did not observe significant deterioration in skin involvement; however, improvement in laboratory parameters diminished after 12months. If the first six ECP cycles are effective, uninterrupted continuation of treatment should be considered, which may lead to the normalization of Tr1 cell values along with further clinical improvement. Our laboratory observations indicate that immunomodulatory effect of ECP treatments lasts for 1year only. PMID:26168768

  14. Does Mechanical Thrombectomy in Acute Embolic Stroke Have Long-term Side Effects on Intracranial Vessels? An Angiographic Follow-up Study

    SciTech Connect

    Kurre, Wiebke Perez, Marta Aguilar; Horvath, Diana; Schmid, Elisabeth; Baezner, Hansjoerg; Henkes, Hans

    2013-06-15

    Purpose. Mechanical thrombectomy (mTE) proved to be effective treating acute vessel occlusions with an acceptable rate of procedural complications. Potential long-term side effects of the vessel wall trauma caused by mechanical irritation of the endothelium are unknown up to now. Methods. From a retrospectively established database of 640 acute stroke treatments, we selected 261 patients with 265 embolic vessel occlusions treated successfully by mTE without permanent implantation of a stent. Analysis comprised the type of devices used and the number of passes performed. Digital subtraction angiography immediately after treatment was evaluated for vasospasm, dissection, and extravasation. Control angiographic images were evaluated for any morphological change compared to the immediate posttreatment angiographic run. Results. Recanalization was achieved with a median of one (range 1-10) mTE maneuvers. Vasospasm occurred in 69 territories (26.0 %) and was treated with glyceroltrinitrate in three. Dissection was observed in one vessel (0.4 %). Intraprocedural hemorrhage in two patients (0.8 %) was either wire or device induced. Follow-up digital subtraction angiography was available for 117 territories after a median of 107 days, revealing target vessel occlusion in one segment (0.9 %) and a de novo stenosis of four segments (3.4 %). All findings were clinically asymptomatic. Posttreatment vasospasm was more frequent in patients with de novo stenosis and occlusion (p = 0.038). Conclusion. De novo stenoses and occlusions occur in a small proportion of patients after mTE. Because all lesions were clinically asymptomatic, this finding does not affect the overall benefit of the treatment. Vasospasm may predict late vessel wall changes.

  15. Hyperbaric Oxygen Treatment of Chronic Refractory Radiation Proctitis: A Randomized and Controlled Double-Blind Crossover Trial With Long-Term Follow-Up

    SciTech Connect

    Clarke, Richard E. Tenorio, L. M. Catalina; Hussey, James R.; Toklu, Akin S.; Cone, D. Lindsie; Hinojosa, Jose G.; Desai, Samir P.; Dominguez Parra, Luis; Rodrigues, Sylvia D.; Long, Robert J.; Walker, Margaret B.

    2008-09-01

    Purpose: Cancer patients who undergo radiotherapy remain at life-long risk of radiation-induced injury to normal tissues. We conducted a randomized, controlled, double-blind crossover trial with long-term follow-up to evaluate the effectiveness of hyperbaric oxygen for refractory radiation proctitis. Methods and Materials: Patients with refractory radiation proctitis were randomized to hyperbaric oxygen at 2.0 atmospheres absolute (Group 1) or air at 1.1 atmospheres absolute (Group 2). The sham patients were subsequently crossed to Group 1. All patients were re-evaluated by an investigator who was unaware of the treatment allocation at 3 and 6 months and Years 1-5. The primary outcome measures were the late effects normal tissue-subjective, objective, management, analytic (SOMA-LENT) score and standardized clinical assessment. The secondary outcome was the change in quality of life. Results: Of 226 patients assessed, 150 were entered in the study and 120 were evaluable. After the initial allocation, the mean SOMA-LENT score improved in both groups. For Group 1, the mean was lower (p 0.0150) and the amount of improvement nearly twice as great (5.00 vs. 2.61, p = 0.0019). Similarly, Group 1 had a greater portion of responders per clinical assessment than did Group 2 (88.9% vs. 62.5%, respectively; p 0.0009). Significance improved when the data were analyzed from an intention to treat perspective (p = 0.0006). Group 1 had a better result in the quality of life bowel bother subscale. These differences were abolished after the crossover. Conclusion: Hyperbaric oxygen therapy significantly improved the healing responses in patients with refractory radiation proctitis, generating an absolute risk reduction of 32% (number needed to treat of 3) between the groups after the initial allocation. Other medical management requirements were discontinued, and advanced interventions were largely avoided. Enhanced bowel-specific quality of life resulted.

  16. Good Quality of Life in Former Buruli Ulcer Patients with Small Lesions: Long-Term Follow-up of the BURULICO Trial

    PubMed Central

    Klis, Sandor; Ranchor, Adelita; Phillips, Richard O.; Abass, Kabiru M.; Tuah, Wilson; Loth, Susanne; Velding, Kristien; van der Werf, Tjip S.; Stienstra, Ymkje

    2014-01-01

    Background Buruli Ulcer is a tropical skin disease caused by Mycobacterium ulcerans, which, due to scarring and contractures can lead to stigma and functional limitations. However, recent advances in treatment, combined with increased public health efforts have the potential to significantly improve disease outcome. Objectives To study the Quality of Life (QoL) of former Buruli Ulcer patients who, in the context of a randomized controlled trial, reported early with small lesions (cross-sectional diameter <10 cm), and received a full course of antibiotic treatment. Methods 127 Participants of the BURULICO drug trial in Ghana were revisited. All former patients aged 16 or older completed the Dermatology Life Quality Index (DLQI) and the abbreviated World Health Organization Quality of Life scale (WHOQOL-BREF). The WHOQOL-BREF was also administered to 82 matched healthy controls. Those younger than 16 completed the Childrens' Dermatology Life Quality Index (CDLQI) only. Results The median (Inter Quartile Range) score on the DLQI was 0 (04), indicating good QoL. 85% of former patients indicated no effect, or only a small effect of the disease on their current life. Former patients also indicated good QoL on the physical and psychological domains of the WHOQOL-BREF, and scored significantly higher than healthy controls on these domains. There was a weak correlation between the DLQI and scar size (??=?0.32; p<0.001). Conclusions BU patients who report early with small lesions and receive 8 weeks of antimicrobial therapy have a good QoL at long-term follow-up. These findings contrast with the debilitating sequelae often reported in BU, and highlight the importance of early case detection. PMID:25010061

  17. Long-term renal allograft function under maintenance immunosuppression with cyclosporin A or azathioprine. A single center, five-year follow-up study.

    PubMed

    Linder, R; Lindholm, A; Restifo, A; Duraj, F; Groth, C G

    1991-09-01

    In order to evaluate long-term renal graft function, 149 cyclosporin A and prednisolone (CyA/P)-treated renal transplant recipients were compared with 119 azathioprine and prednisolone (Aza/P)-treated patients. Only patients who had a functioning graft for at least 1 year and who were maintained on their initial immunosuppressive protocol were included. The minimum follow-up period was 4 years. Renal graft function was estimated by yearly determinations of serum creatinine and creatinine clearance. The CyA/P-treated patients had a significantly higher serum creatinine and a significantly lower creatinine clearance at every point in time post-transplantation than Aza/P-treated patients (P less than 0.001). The evolution of renal graft function, as reflected in the line of regression for serum creatinine and creatinine clearance versus time, was estimated for each individual patient. There was an almost stable renal function, as assessed by the median of the slopes of the regression line for serum creatinine versus time in both groups. The median increase in serum creatinine was only 1.4 mumol/l per year for Aza/P-treated patients and 2.4 mumol/l per year for CyA/P-treated patients (difference NS). The median decline in creatinine clearance was 2.18 ml/min per 1.73 m2/year in the Aza/P group and 1.07 ml/min per 1.73 m2/year in the CyA/P group (P = 0.05). In patients with a functioning graft for at least 5 years, creatinine clearance remained unchanged in both groups during the study period. In conclusion, renal graft function, as assessed by measurements of serum creatinine and creatinine clearance, remained essentially unchanged for at least 5 years after transplantation, regardless of the immunosuppressive protocol used.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1958282

  18. Evaluating Aspects of Online Medication Safety in Long-Term Follow-Up of 136 Internet Pharmacies: Illegal Rogue Online Pharmacies Flourish and Are Long-Lived

    PubMed Central

    2013-01-01

    Background A growing number of online pharmacies have been established worldwide. Among them are numerous illegal websites selling medicine without valid medical prescriptions or distributing substandard or counterfeit drugs. Only a limited number of studies have been published on Internet pharmacies with regard to patient safety, professionalism, long-term follow-up, and pharmaceutical legitimacy verification. Objective In this study, we selected, evaluated, and followed 136 Internet pharmacy websites aiming to identify indicators of professional online pharmacy service and online medication safety. Methods An Internet search was performed by simulating the needs of potential customers of online pharmacies. A total of 136 Internet pharmacy websites were assessed and followed for four years. According to the LegitScript database, relevant characteristics such as longevity, time of continuous operation, geographical location, displayed contact information, prescription requirement, medical information exchange, and pharmaceutical legitimacy verification were recorded and evaluated. Results The number of active Internet pharmacy websites decreased; 23 of 136 (16.9%) online pharmacies ceased operating within 12 months and only 67 monitored websites (49.3%) were accessible at the end of the four-year observation period. However, not all operated continuously, as about one-fifth (31/136) of all observed online pharmacy websites were inaccessible provisionally. Thus, only 56 (41.2%) Internet-based pharmacies were continuously operational. Thirty-one of the 136 online pharmacies (22.8%) had not provided any contact details, while only 59 (43.4%) displayed all necessary contact information on the website. We found that the declared physical location claims did not correspond to the area of domain registration (according to IP address) for most websites. Although the majority (120/136, 88.2%) of the examined Internet pharmacies distributed various prescription-only medicines, only 9 (6.6%) requested prior medical prescriptions before purchase. Medical information exchange was generally ineffective as 52 sites (38.2%) did not require any medical information from patients. The product information about the medicines was generally (126/136, 92.6%) not displayed adequately, and the contents of the patient information leaflet were incomplete in most cases (104/136, 76.5%). Numerous online operators (60/136, 44.1%) were defined as rogue Internet pharmacies, but no legitimate Internet-based pharmacies were among them. One site (0.7%) was yet unverified, 23 (16.9%) were unapproved, while the remaining (52/136, 38.2%) websites were not available in the LegitScript database. Contrary to our prior assumptions, prescription or medical information requirement, or the indication of contact information on the website, does not seem to correlate with “rogue pharmacy” status using the LegitScript online pharmacy verification standards. Instead, long-term continuous operation strongly correlated (P<.001) with explicit illegal activity. Conclusions Most Internet pharmacies in our study sample were illegal sites within the definition of “rogue” Internet pharmacy. These websites violate professional, legal, and ethical standards and endanger patient safety. This work shows evidence that online pharmacies that act illegally appear to have greater longevity than others, presumably because there is no compelling reason for frequent change in order to survive. We also found that one in five websites revived (closed down and reopened again within four years) and no-prescription sites with limited medicine and patient information are flourishing. PMID:24021777

  19. Wide versus narrow excision margins for high-risk, primary cutaneous melanomas: long-term follow-up of survival in a randomised trial

    PubMed Central

    Hayes, Andrew J; Maynard, Lauren; Coombes, Gillian; Newton-Bishop, Julia; Timmons, Michael; Cook, Martin; Theaker, Jeffrey; Bliss, Judith M; Thomas, J Meirion

    2016-01-01

    Summary Background The necessary margin of excision for cutaneous melanomas greater than 2 mm in thickness is controversial. At a median follow-up of 5 years, findings from our previously published randomised trial of narrow (1 cm) versus wide (3 cm) excision margins in patients with thick cutaneous melanomas showed that narrow margins were associated with an increased frequency of locoregional relapse, but no significant difference in overall survival was apparent. We now report a long-term survival analysis of that trial. Methods We did a randomised, open-label multicentre trial in 59 hospitals—57 in the UK, one in Poland, and one in South Africa. Patients with one primary localised cutaneous melanoma greater than 2 mm in Breslow thickness on the trunk or limbs (excluding palms or soles) were randomly assigned (1:1) centrally to receive surgery with either a 1 cm or 3 cm excision margin following an initial surgery. The randomisation lists were generated with random permuted blocks and stratified by centre and extent of initial surgery. The endpoints of this analysis were overall survival and melanoma-specific survival. Analyses were done in the intention-to-treat population. This trial was not registered because it predated mandatory trial registration. Findings Between Dec 16, 1992, and May 22, 2001, we randomly assigned 900 patients to surgery with either a 1 cm excision margin (n=453) or a 3 cm excision margin (n=447). At a median follow-up of 8·8 years (106 months [IQR 76–135], 494 patients had died, with 359 of these deaths attributed to melanoma. 194 deaths were attributed to melanoma in the 1 cm group compared with 165 in the 3 cm group (unadjusted hazard ratio [HR] 1·24 [95% CI 1·01–1·53]; p=0·041). Although a higher number of deaths overall occurred in the 1 cm group compared with the 3 cm group (253 vs 241), the difference was not significant (unadjusted HR 1·14 [95% CI 0·96–1·36]; p=0·14). Surgical complications were reported in 35 (8%) patients in the 1 cm excision margin group and 65 (15%) patients in the 3 cm group. Interpretation Our findings suggest that a 1 cm excision margin is inadequate for cutaneous melanoma with Breslow thickness greater than 2 mm on the trunk and limbs. Current guidelines advise a 2 cm margin for melanomas greater than 2 mm in thickness but only a 1 cm margin for thinner melanomas. The adequacy of a 1 cm margin for thinner melanomas with poor prognostic features should be addressed in future randomised studies. Funding Cancer Research UK, North Thames National Health Service Executive, Northern and Yorkshire National Health Service Executive, British United Provident Association Foundation, British Association of Plastic Surgeons, the Meirion Thomas Cancer Research Fund, and the National Institute for Health and Research Biomedical Research Centre at The Royal Marsden NHS Foundation Trust. PMID:26790922

  20. Lymphocytic infundibulo-neurohypophysitis: a clinical overview.

    PubMed

    Johnston, Philip C; Chew, Luen S; Hamrahian, Amir H; Kennedy, Laurence

    2015-12-01

    Lymphocytic infundibulo-neurohypophysitis is an uncommon inflammatory disorder postulated to be autoimmune in origin. Because of the location of inflammation, it selectively affects the posterior lobe of the pituitary (neurohypophysis) and pituitary stalk (infundibulum). The most common presentation is central diabetes insipidus. Although the definitive diagnosis is established histologically by a pituitary biopsy, radiological imaging can be valuable in diagnosing this condition. In this paper, we provide an overview of the pathophysiology, investigations, management, and outcomes of lymphocytic infundibulo-neurohypophysitis. PMID:26219407

  1. Adult height after long term treatment with recombinant growth hormone for idiopathic isolated growth hormone deficiency: observational follow up study of the French population based registry

    PubMed Central

    Carel, Jean-Claude; Ecosse, Emmanuel; Nicolino, Marc; Tauber, Mat; Leger, Juliane; Cabrol, Sylvie; Basti-Sigeac, Irne; Chaussain, Jean-Louis; Coste, Jol

    2002-01-01

    Objective To evaluate the efficacy of recombinant growth hormone for increasing adult height in children treated for idiopathic isolated growth hormone deficiency. Design Observational follow up study. Setting Population based registry. Participants All 2852 French children diagnosed as having isolated idiopathic growth hormone deficiency whose treatment started between 1987 and 1992 and ended before 1996. Main outcome measures Change in height between the start of treatment and adulthood; classification of patients according to whether treatment was completed as scheduled or stopped early. Results Adult height was obtained for 2165 (76%) patients. The mean dose of growth hormone at start of treatment was 0.42 IU/kg/week. Height gain was 1.1 (SD 0.9) standard deviation (SD) scores, resulting in an adult height of 1.6 (0.9) SD score (girls, 154 (5) cm; boys, 167 (6) cm). Patients who completed the treatment gained 1.0 (0.7) SD score of height in 3.6 (1.4) years. Patients with treatments stopped early gained 0.6 (0.6) SD score in 2.7 (1.4) years while receiving treatment and a further 0.4 (0.9) SD score after the end of treatment. Most of the variation in height gain was explained by regression towards the mean, patients' characteristics, and delay in starting puberty. Severe growth hormone deficiency was associated with better outcome. Each year of treatment was associated with a gain of 0.2 SD score(1.3 cm). Conclusion The effect of growth hormone is unclear in many patients treated for so called idiopathic isolated growth hormone deficiency. Most of the patients have pubertal delay and a spontaneous growth potential, which must be taken into account when measuring the effect and cost effectiveness of treatments. Growth hormone deficiency should be clearly distinguished from pubertal delay, and criteria should restrict the definition to patients with severely and permanently altered growth hormone secretion as our results support the use of growth hormone in such patients. Long term trials are required for most patients currently treated. What is already known on this topicLarge numbers of children are treated with recombinant growth hormone for so called idiopathic isolated growth hormone deficiencyThe effect on adult height is unclear because of a lack of controlled trials and analysis, and that subgroups, rather than entire populations, are analysed.What this study addsHalf the patients treated for idiopathic isolated growth hormone deficiency stop treatment before reaching adult height and achieve adult heights similar to those of patients who complete their treatmentMany patients diagnosed as having growth hormone deficiency actually have pubertal delayA small proportion of patients with severe growth hormone deficiency respond better to treatment than patients with less severe growth hormone deficiency PMID:12114235

  2. Effect of bivalent human papillomavirus vaccination on pregnancy outcomes: long term observational follow-up in the Costa Rica HPV Vaccine Trial

    PubMed Central

    Befano, Brian L; Gonzalez, Paula; Rodríguez, Ana Cecilia; Herrero, Rolando; Schiller, John T; Kreimer, Aimée R; Schiffman, Mark; Hildesheim, Allan; Wilcox, Allen J

    2015-01-01

    Objective To examine the effect of the bivalent human papillomavirus (HPV) vaccine on miscarriage. Design Observational long term follow-up of a randomized, double blinded trial combined with an independent unvaccinated population based cohort. Setting Single center study in Costa Rica. Participants 7466 women in the trial and 2836 women in the unvaccinated cohort enrolled at the end of the randomized trial and in parallel with the observational trial component. Intervention Women in the trial were assigned to receive three doses of bivalent HPV vaccine (n=3727) or the control hepatitis A vaccine (n=3739). Crossover bivalent HPV vaccination occurred in the hepatitis A vaccine arm at the end of the trial. Women in the unvaccinated cohort received (n=2836) no vaccination. Main outcome measure Risk of miscarriage, defined by the US Centers for Disease Control and Prevention as fetal loss within 20 weeks of gestation, in pregnancies exposed to bivalent HPV vaccination in less than 90 days and any time from vaccination compared with pregnancies exposed to hepatitis A vaccine and pregnancies in the unvaccinated cohort. Results Of 3394 pregnancies conceived at any time since bivalent HPV vaccination, 381 pregnancies were conceived less than 90 days from vaccination. Unexposed pregnancies comprised 2507 pregnancies conceived after hepatitis A vaccination and 720 conceived in the unvaccinated cohort. Miscarriages occurred in 451 (13.3%) of all exposed pregnancies, in 50 (13.1%) of the pregnancies conceived less than 90 days from bivalent HPV vaccination, and in 414 (12.8%) of the unexposed pregnancies, of which 316 (12.6%) were in the hepatitis A vaccine group and 98 (13.6%) in the unvaccinated cohort. The relative risk of miscarriage for pregnancies conceived less than 90 days from vaccination compared with all unexposed pregnancies was 1.02 (95% confidence interval 0.78 to 1.34, one sided P=0.436) in unadjusted analyses. Results were similar after adjusting for age at vaccination (relative risk 1.15, one sided P=0.17), age at conception (1.03, P=0.422), and calendar year (1.06, P=0.358), and in stratified analyses. Among pregnancies conceived at any time from bivalent HPV vaccination, exposure was not associated with an increased risk of miscarriage overall or in subgroups, except for miscarriages at weeks 13-20 of gestation (relative risk 1.35, 95% confidence interval 1.02 to 1.77, one sided P=0.017). Conclusions There is no evidence that bivalent HPV vaccination affects the risk of miscarriage for pregnancies conceived less than 90 days from vaccination. The increased risk estimate for miscarriages in a subgroup of pregnancies conceived any time after vaccination may be an artifact of a thorough set of sensitivity analyses, but since a genuine association cannot totally be ruled out, this signal should nevertheless be explored further in existing and future studies. Trial registration Clinicaltrials.gov NCT00128661 and NCT01086709. PMID:26346155

  3. Feasibility of conducting long-term follow-up of children and infants treated for CNS tumors on the same cooperative group clinical trial protocol.

    PubMed

    Hoag, Jennifer; Kupst, Mary Jo; Briere, Marie-Eve; Mabbott, Donald; Elkin, T David; Trask, Christine L; Isenberg, Jill; Holm, Suzanne; Ambler, Cheryl; Strother, Douglas R

    2014-06-01

    Given the barriers to conducting long-term assessment of neurocognitive and psychosocial functioning of those treated in infancy for central nervous system (CNS) tumors, a multi-site feasibility study was conducted. The primary objective was to demonstrate that it is feasible to identify, locate and assess the functioning of children treated on the same protocol 10-years post-treatment. Six sites obtained institutional approval, identified and recruited subjects, and obtained comprehensive neurocognitive and psychosocial data. All feasibility objectives were met. Barriers to participation included length of time for Institutional Review Board submission and review, clinical demands, limited eligible participants at individual institutions, difficulty locating long-term subjects and stipend/reimbursement concerns. Results indicate that long-term studies are feasible and essential given the need to address long-term issues of children treated at a young age for CNS tumors, especially as they relate to later academic and vocational planning, but require significant coordination and commitment of cooperative group and institutional resources. PMID:24668336

  4. Ponseti's manipulation in neglected clubfoot in children more than 7 years of age: a prospective evaluation of 25 feet with long-term follow-up.

    PubMed

    Khan, Shah Alam; Kumar, Ashok

    2010-09-01

    We wanted to evaluate the efficacy of Ponseti's technique in neglected clubfoot in children more than 7 years of age. The results of Ponseti's method were evaluated in 21 children (25 feet) with neglected club feet. Patients were evaluated using the Dimeglio scoring system. All patients underwent percutaneous tenotomy of the Achilles tendon. The mean age at the time of treatment was 8.9 years. The mean follow-up period was 4.7 years. The average Dimeglio score at the start of the treatment was 14.2 compared with an average score of 0.95 at the end of the treatment at 1-year follow-up. Eighteen feet (85.7%) had full correction. Recurrence was seen in six feet (24%). At 4-year follow-up, the average Dimeglio score for 19 feet was 0.18. We recommend that Ponseti's method should be the preferred initial treatment modality for neglected clubfeet. PMID:20581694

  5. Renin-angiotensin-aldosterone system: a long-term follow-up study in 17 alpha-hydroxylase deficiency syndrome (17OHDS).

    PubMed

    Scaroni, C; Opocher, G; Mantero, F

    1986-01-01

    We studied the mineralocorticoid pattern in 4 patients with 17OHD during long-term glucocorticoid treatment. We observed reduction of BP, normalization of K levels, a gradual increase in PRA and in urinary Aldosterone (ALDO); a normal response of plasma ALDO to ACTH and to angiotensin II was present only in one case. We observed a prompt decrease of mineralocorticoid hormones, normalized by long-term therapy only in one case. Discontinuation of treatment induced an increase of ALDO that became suppressed in late off-treatment. Thus, glucocorticoid treatment decreases abnormal steroid levels and activates zona glomerulosa (ZG) function, even if it may take years for ALDO to normalize. Brief discontinuation of therapy induces a surge in ALDO levels, revealing no biosynthetic defect in ZG, while in late off-treatment mineralocorticoids seem to come exclusively from zona fasciculata. PMID:3530552

  6. Long-term follow-up of patients who received recombinant human granulocyte-macrophage colony stimulating factor after autologous bone marrow transplantation for lymphoid malignancy.

    PubMed

    Nemunaitis, J; Singer, J W; Buckner, C D; Mori, T; Laponi, J; Hill, R; Storb, R; Sullivan, K M; Hansen, J A; Appelbaum, F R

    1991-01-01

    Twenty-seven patients with lymphoid neoplasia who underwent autologous bone marrow transplant (BMT) and who had received recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF) were followed in order to examine the potential long-term consequences of rhGM-CSF. rhGM-CSF (15-240 micrograms/m2/day) was given daily either for 14 or 21 days after marrow infusion. All surviving patients who remained in remission had stable marrow graft function. The actuarial survival rate was 45% and the relapse incidence was 50% at a median of 774 days after autologous BMT. These findings suggest that treatment with rhGM-CSF does not have profound adverse long-term consequences. PMID:2043878

  7. Long-term post-marketing surveillance of mizoribine for the treatment of lupus nephritis: Safety and efficacy during a 3-year follow-up

    PubMed Central

    Okada, Kenya; Sudo, Yohei; Itoh, Hiromichi; Yoshida, Hisao; Kuroda, Tatsuhiko

    2014-01-01

    Objective: To determine the safety and efficacy of long-term use of mizoribine by undertaking a 3-year post-marketing surveillance study. Methods: Subjects were all lupus nephritis patients newly treated with mizoribine between 1 October 2003 and 30 September 2005 at contracted study sites. Results: Mizoribine was administered to 881 lupus nephritis patients in the safety analysis set consisting of 946 patients recruited from 281 contracted study sites after satisfying the eligibility criteria. There were 301 events of adverse drug reactions that were observed in 196 (20.7%) of the 946 subjects. There were 34 events of serious adverse drug reactions in 31 patients (3.2%). No deterioration in hematological and biochemical test values was observed, but immunological testing showed significant improvements in C3, CH50, and anti-DNA antibody titers. The negative rate of proteinuria also increased over time. The median steroid dosage was 15 mg/day at the commencement of treatment, but was reduced to 10 mg/day at 12 months and 8 mg/day at 36 months. Conclusion: The findings of the 3-year long-term drug use surveillance study indicated that mizoribine can be used over the long term with relatively few adverse drug reactions, suggesting its suitability for use in maintenance drug therapy. PMID:26770729

  8. A Cognitive- Behavioral Therapeutic Program for Patients with Obesity and Binge Eating Disorder: Short- and Long- Term Follow-Up Data of a Prospective Study

    ERIC Educational Resources Information Center

    Vanderlinden, Johan; Adriaensen, An; Vancampfort, Davy; Pieters, Guido; Probst, Michel; Vansteelandt, Kristof

    2012-01-01

    The goal of this study is to investigate the efficacy of a manualized cognitive-behavioral therapeutic (CBT) approach for patients with obesity and binge eating disorder (BED) on the short and longer term. A prospective study without a control group consisting of three measurements (a baseline measurement and two follow-up assessments up to 5

  9. A Cognitive- Behavioral Therapeutic Program for Patients with Obesity and Binge Eating Disorder: Short- and Long- Term Follow-Up Data of a Prospective Study

    ERIC Educational Resources Information Center

    Vanderlinden, Johan; Adriaensen, An; Vancampfort, Davy; Pieters, Guido; Probst, Michel; Vansteelandt, Kristof

    2012-01-01

    The goal of this study is to investigate the efficacy of a manualized cognitive-behavioral therapeutic (CBT) approach for patients with obesity and binge eating disorder (BED) on the short and longer term. A prospective study without a control group consisting of three measurements (a baseline measurement and two follow-up assessments up to 5…

  10. Assessing the Long-Term Effects of EMDR: Results from an 18-Month Follow-Up Study with Adult Female Survivors of CSA

    ERIC Educational Resources Information Center

    Edmond, Tonya; Rubin, Allen

    2004-01-01

    This 18-month follow-up study builds on the findings of a randomized experimental evaluation that found qualified support for the short-term effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in reducing trauma symptoms among adult female survivors of childhood sexual abuse (CSA). The current study provides preliminary evidence

  11. Assessing the Long-Term Effects of EMDR: Results from an 18-Month Follow-Up Study with Adult Female Survivors of CSA

    ERIC Educational Resources Information Center

    Edmond, Tonya; Rubin, Allen

    2004-01-01

    This 18-month follow-up study builds on the findings of a randomized experimental evaluation that found qualified support for the short-term effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in reducing trauma symptoms among adult female survivors of childhood sexual abuse (CSA). The current study provides preliminary evidence…

  12. Long term follow-up in patients with initially diagnosed low grade Ta non-muscle invasive bladder tumors: tumor recurrence and worsening progression

    PubMed Central

    2014-01-01

    Background We evaluated the clinical outcome of low grade Ta bladder cancer followed-up for a long period using the 2004 WHO grading system. Methods We retrospectively reviewed 190 patients with primary, low grade Ta bladder cancer. We defined worsening progression (WP) as confirmed high grade Ta, all T1 or Tis/concomitant CIS of bladder recurrence, upper urinary tract recurrence (UTR), or progression to equal to or more than T2. The associations between clinicopathological factors and tumor recurrence as well as WP pattern were analyzed. We also evaluated the late recurrence of 76 patients who were tumor-free for more than 5 years. Results Tumor recurrence and WP occurred in 82 (43.2%) and 21 (11.1%) patients during follow-up (median follow-up: 101.5months), respectively. WP to high grade Ta, all T1 or Tis/concomitant CIS was seen in 17 patients, and UTR and progression to equal to or more than T2 were seen in 2 and 2 patients, respectively. Multivariate analyses demonstrated that multiple tumor (p?follow-up cystoscopy, however, only 2 patients recurred beyond 10 years and were found by gross hematuria. There were no significant risk factors of late recurrence. Conclusions Multiple tumor was a risk factor for both tumor recurrence and WP while IVI did not affect the occurrence of WP. Our results suggest that routine follow-up of patients with low grade Ta bladder cancer is needed up to 10 years from the initial diagnosis. PMID:24400640

  13. Endovascular Treatment of Pelvic Congestion Syndrome: Visual Analog Scale (VAS) Long-Term Follow-up Clinical Evaluation in 202 Patients

    SciTech Connect

    Laborda, Alicia Medrano, Joaquin; Blas, Ignacio de; Urtiaga, Ignacio; Carnevale, Francisco Cesar; Gregorio, Miguel A. de

    2013-08-01

    PurposeThis study was designed to evaluate the clinical outcome and patients' satisfaction after a 5 year follow-up period for pelvic congestion syndrome (PCS) coil embolization in patients who suffered from chronic pelvic pain that initially consulted for lower limb venous insufficiency.MethodsA total of 202 patients suffering from chronic pelvic pain were recruited prospectively in a single center (mean age 43.5 years; range 27-57) where they were being treated for lower limb varices. Inclusion criteria were: lower limb varices and chronic pelvic pain (>6 months), >6 mm pelvic venous caliber in ultrasonography, and venous reflux or presence of communicating veins. Both ovarian and hypogastric veins were targeted for embolization. Pain level was assessed before and after embolotherapy and during follow-up using a visual analog scale (VAS). Technical and clinical success and recurrence of leg varices were studied. Patients completed a quality questionnaire. Clinical follow-up was performed at 1, 3, and 6 months and every year for 5 years.ResultsTechnical success was 100 %. Clinical success was achieved in 168 patients (93.85 %), with complete disappearance of symptoms in 60 patients (33.52 %). Pain score (VAS) was 7.34 {+-} 0.7 preprocedural versus 0.78 {+-} 1.2 at the end of follow-up (P < 0.0001). Complications were: groin hematoma (n = 6), coil migration (n = 4), and reaction to contrast media (n = 1). Twenty-three cases presented abdominal pain after procedure. In 24 patients (12.5 %), there was recurrence of their leg varices within the follow-up. The mean degree of patients' satisfaction was 7.4/9.ConclusionsCoil embolization of PCS is an effective and safe procedure, with high clinical success rate and degree of satisfaction.

  14. Recombinant human bone morphogenetic protein type 2 in the reconstruction of atrophic maxilla: Case report with long-term follow-up

    PubMed Central

    Ztola, Andr Luiz; Verbicaro, Thalyta; Littieri, Sahara; Larson, Rafaela; Giovanini, Allan Fernando; Deliberador, Tatiana Miranda

    2014-01-01

    Autologous bone is reported by scientific literature as the gold standard for the replacement of the bone loss in maxillary atrophic area. Notwithstanding, this grafting type shows several disadvantages as: The procedure morbidity, limited size of the graft and longer recovering time. Recombinant human bone morphogenetic protein type 2 (rhBMP-2) has been used as bone substitute for the reconstruction of large bone defects. The aim of this case was to report a clinical case exhibiting the reconstruction of the atrophic maxilla through using rhBMP-2 as grafting material associated with absorbable collagen sponge (ACS). At 8 months of following-up, osseointegrated implants were placed. After 2 years and 5 months of following-up, it could be observed an appropriate aesthetical and functional rehabilitation. PMID:25624638

  15. Long-term risk factors for developing asthma and allergic rhinitis: a 23-year follow-up study of college students.

    PubMed

    Settipane, R J; Hagy, G W; Settipane, G A

    1994-01-01

    In the initial study of 23 years ago, 1836 college freshmen were prospectively evaluated by questionnaires, interviews, and physical examinations for medical conditions which included the presence of asthma, allergic rhinitis, and positive allergy skin tests to a battery of pollens, animal extracts, and mold. In a 23-year follow-up study, 1021 (64%) returned their completed questionnaires. Of these, 738 (72%) had been skin tested as freshmen. The results of this follow-up study revealed that the frequency of asthma and allergic rhinitis continue to increase as the individuals become older. Allergic rhinitis and positive allergy skin tests are significant risk factors for developing new asthma. Individuals with either of these diagnoses are about three times more likely to develop asthma than negative controls. Positive allergy skin tested students have more than twice (2.3x) the risk of developing new hay fever than do negative skin tested students over a 23-year period. PMID:8005452

  16. [Interprofessional cooperation in the municipalities: basic groups. From the project Evaluation of the follow-up of patients with long-term sickness certification].

    PubMed

    Tellnes, G; Edvardsen, O; Bjrnsen, T; Stensen, R V

    1989-04-20

    The Norwegian Government has decided that an interprofessional co-operation group should be established in all municipalities as from 1988. The purpose of the co-operation groups is to improve rehabilitation of patients with long-term sickness certification. The aim of the survey was to describe the establishment and function of the co-operation groups as per 1/7 1988. The local national insurance offices reported that 88% of the municipalities had started a co-operation group and 63% had held meetings. The co-operation groups were most effective in small municipalities. Activity was low in the larger towns. PMID:2499949

  17. The long-term effects of training interventions on transfusion practice: a follow-up audit of red cell concentrate utilisation at Kimberley Hospital, South Africa.

    PubMed

    Joubert, Jaco; Joubert, Sunette; Raubenheimer, Jacques; Louw, Vernon

    2014-12-01

    This audit in chronically anaemic adult patients assesses whether red cell concentrate is transfused according to guidelines, and evaluates the impact of training interventions, compared with a similar audit conducted in 2010. Retrospectively, 25 transfusion episodes were audited for appropriateness, the investigation of anaemia, threshold achievement, wastage, and informed consent. After training interventions, a further 25 episodes were prospectively analysed. The effects of current training interventions were not shown to have a statistically significant impact. Compared to a 2010 audit, however, a statistically significant improvement was demonstrated in transfusion practice, suggesting that training interventions may lead to sustainable long-term improvements. PMID:25457009

  18. Long-term follow-up of a patient since the acute phase of Chagas disease (South American trypanosomiasis): further treatment and cure of the infection.

    PubMed

    Dias, Joo Carlos Pinto; Dias, Emmanuel; Nbrega, Genard Carneiro da Cunha

    2015-10-01

    A woman had been followed since 1957 for acute phase Chagas disease. Parasitological and serological tests were positive, and treatment included benznidazole in 1974. Following treatment, parasitological test results were negative and conventional serology remained positive until 1994, with subsequent discordant results (1995-1997). The results became consistently negative since 1999. She had an indeterminate chronic form until 1974. Only two minor and transitory nonspecific alterations on electrocardiogram were noted, with the last nine records normal until June 2014. This case confirms the possibility of curing chronic disease and suggests the benefit of specific treatments for preventing long-term morbidity. PMID:26516979

  19. Fifteen Novel EIF2B1-5 Mutations Identified in Chinese Children with Leukoencephalopathy with Vanishing White Matter and a Long Term Follow-Up

    PubMed Central

    Zhang, Haihua; Dai, Lifang; Chen, Na; Zang, Lili; Leng, Xuerong; Du, Li; Wang, Jingmin; Jiang, Yuwu; Zhang, Feng; Wu, Xiru; Wu, Ye

    2015-01-01

    Leukoencephalopathy with vanishing white matter (VWM) is one of the most prevalent inherited childhood white matter disorders, which caused by mutations in each of the five subunits of eukaryotic translation initiation factor 2B (EIF2B1-5). In our study, 34 out of the 36 clinically diagnosed children (94%) were identified to have EIF2B1-5 mutations by sequencing. 15 novel mutations were identified. CNVs were not detected in patients with only one mutant allele and mutation-negative determined by gene sequencing. There is a significantly higher incidence of patients with EIF2B3 mutations compared with Caucasian patients (32% vs. 4%). c.1037T>C (p.Ile346Thr) in EIF2B3 was confirmed to be a founder mutation in Chinese, which probably one of the causes of the genotypic differences between ethnicities. Our average 4.4 years-follow-up on infantile, early childhood and juvenile VWM children suggested a rapid deterioration in motor function. Episodic aggravation was presented in 90% of infantile cases and 71.4% of childhood cases. 10 patients died during the follow-up. The Kaplan-Meier curve showed that the median survival time is 8.83 ± 1.51 years. This is the largest sample of children in a VWM follow-up study, which is helpful for a more depth understanding about the natural course. PMID:25761052

  20. Long-term efficacy of rituximab in IgM anti-myelin-associated glycoprotein neuropathy: RIMAG follow-up study.

    PubMed

    Iancu Ferfoglia, Ruxandra; Guimarães-Costa, Raquel; Viala, Karine; Musset, Lucile; Neil, Jean; Marin, Benoit; Léger, Jean-Marc

    2016-03-01

    The Rituximab vs. Placebo in Polyneuropathy Associated With Anti-MAG IgM Monoclonal Gammopathy (RIMAG) study showed no improvement using the inflammatory neuropathy cause and treatment sensory score (ISS) as primary outcome in patients with IgM anti-myelin-associated glycoprotein neuropathy (IgM anti-MAG neuropathy) treated with rituximab, when compared with placebo. However, some secondary outcomes seemed to improve in the per protocol analysis. Patients from one participating center in the RIMAG study underwent a new evaluation after a median follow-up of 6 (interquartile range (IQR) 4.9; 6.5) years, using the same outcome measures used in the original study. Data were recorded in seven rituximab patients (group 1) and in eight placebo patients (group 2). In group 2, six of eight patients received immunotherapy during follow-up, while only two of seven did in group 1. No significant change was observed in either the ISS or the secondary outcomes in both groups, with the exception of worsening in the 10-m walk time in group 2 (p = 0.016). The RIMAG follow-up study failed to find any significant change in most outcome measures in patients from the RIMAG study, some of them having received new immunotherapies. This study stresses the lack of useful clinical scales sensitive enough to capture small, even meaningful, improvement in IgM anti-MAG neuropathy. PMID:26748872

  1. A Prospective, Long-Term Follow-Up Study of 1,444 nm Nd:YAG Laser: A New Modality for Treating Axillary Bromhidrosis

    PubMed Central

    Jung, Sung Kyu; Jang, Hee Won; Kim, Hee Joo; Lee, Sang Geun; Lee, Kyung Goo; Kim, Sun Yae; Yi, Sang Min; Kim, Jae Hwan

    2014-01-01

    Background Surgery for bromhidrosis has a high risk of complications such as hematoma and necrosis. New nonsurgical methods may reduce the burden on surgery and the risks for the patient. Objective This study was performed to evaluate the efficacy and side-effects of the 1,444 nm Nd:YAG interstitial laser for treating axillary bromhidrosis. Methods Eighteen bromhidrosis patients were treated with a 1,444 nm Nd:YAG laser at Korea University Ansan Hospital. The post-treatment follow-up was 6 months. After the procedure, we confirmed apocrine gland destruction through histopathological examination. At each follow-up, we measured the severity of the remaining odor, postoperative pain, degree of mobility restriction, and overall satisfaction. Results After 180 days of follow-up, malodor elimination was good in 20 axillae, fair in 12 axillae, and poor in four axillae. At the end point of the study, 14 patients were totally satisfied with the laser treatment, three patients were partially satisfied, and one patient was disatisfied. Pain and limitation of mobility were significantly reduced within 1 week post-operatively, and were almost resolved within 4 weeks post-operatively. A histopathological examination revealed decreased density and significant alterations to the apocrine glands. Conclusion Subdermal coagulation treatment with a 1,444 nm Nd:YAG interstitial laser may be a less invasive and effective therapy for axillary bromhidrosis. PMID:24882972

  2. Long-term anti-HBs antibody persistence following infant vaccination against hepatitis B and evaluation of anamnestic response: a 20-year follow-up study in Thailand.

    PubMed

    Poovorawan, Yong; Chongsrisawat, Voranush; Theamboonlers, Apiradee; Crasta, Priya Diana; Messier, Marc; Hardt, Karin

    2013-08-01

    Hepatitis B vaccine has been available worldwide since the mid-1980s. This vaccine was evaluated in a clinical trial in Thailand, conducted on subjects born to hepatitis B surface antigen positive and hepatitis B e-antigen positive mothers and vaccinated according to a 4-dose schedule at 0, 1, 2 and 12 mo of age and a single dose of hepatitis B immunoglobulin concomitantly at birth. All enrolled subjects seroconverted and were followed for 20 y to assess the persistence of antibody to the hepatitis B surface antigen (anti-HBs) (NCT00240539). At year 20, 64% of subjects had anti-HBs antibody concentrations≥10 milli-international units per milli liter (mIU/ml) and 92% of subjects had detectable levels (≥3.3 mIU/ml) of anti-HBs antibodies. At year 20, subjects with anti-HBs antibody titer<100 mIU/ml were offered an additional dose of hepatitis B virus (HBV) vaccine to assess immune memory (NCT00657657). Anamnestic response to the challenge dose was observed in 96.6% of subjects with an 82-fold (13.2 to 1082.4 mIU/ml) increase in anti-HBs antibody geometric mean concentrations. This study confirms the long-term immunogenicity of the 4-dose regimen of the HBV vaccine eliciting long-term persistence of antibodies and immune memory against hepatitis B for up to at least 20 y after vaccination. PMID:23732904

  3. Long-term persistence of the immune response to antipneumococcal vaccines after Allo-SCT: 10-year follow-up of the EBMT-IDWP01 trial.

    PubMed

    Cordonnier, C; Labopin, M; Robin, C; Ribaud, P; Cabanne, L; Chadelat, C; Cesaro, S; Ljungman, P

    2015-07-01

    The guidelines for immunization of hematopoietic SCT (HSCT) recipients recommend three doses of antipneumococcal conjugate vaccine (PCV) from 3 to 6 months after transplant, followed by a dose of polysaccharide 23-valent (PPV23) vaccine at 12 months in the case of no GVHD or an additional PCV dose in the case of GVHD. Due to the lack of long-term data in the literature, there is no recommendation for boosts after 12 months. Our goal was to assess the maintenance of the immune response to pneumococcal vaccines in patients vaccinated 10 years ago according to current guidelines. Thirty surviving patients of the IDWP01 (Infectious Diseases Working Party 1) trial were assessed for antibody levels against the seven antigens of the PCV7 and against two of the PPV23-specific antigens. When compared with 24 months after transplant, the immune response did not significantly decrease but with important serotype-specific variability. There was no evidence that an additional dose of PPV23 given to 11/30 patients 2-11 years after transplant was beneficial. In long-term HSCT survivors with no or few GVHD vaccinated against Streptococcus pneumoniae according to the current guidelines, the specific immunity is not fully maintained a decade later. The optimal schedule of antipneumococcal vaccination in HSCT recipients after 12 months remains to be established. PMID:25867652

  4. The significance of DNA measurements in a histologically defined subset of infiltrating ductal carcinomas of the breast with long-term follow-up.

    PubMed

    Troncoso, P; Dytch, H E; Bibbo, M; Wied, G L; Dawson, P J

    1989-06-01

    The nuclear DNA content and other karyometric parameters were evaluated in a histologically homogeneous group of invasive ductal carcinomas of the breast from 13 patients who survived 25 years after radical mastectomy and from 13 controls matched for histologic tumor grade, lymph node status, tumor size and patient age. The nuclear DNA content and other morphometric features were evaluated by image analysis (using a modified TICAS system) on 12-microns-thick, Feulgen-stained sections. The DNA content of the tumors of both the long-term survivors and the controls varied from the diploid range to highly aneuploid (with a large proportion of the cells having a DNA content above 5N). Overall, the tumors of the controls exhibited a higher ploidy, a greater deviation from the diploid range and a greater variation of nuclear size than did the tumors of the long-term survivors. These results suggest that these measurements may be helpful in yielding prognostic information among sets of histologically identical breast tumors of similar pathologic stage. PMID:2545218

  5. Effect of drastic weight loss after bariatric surgery on renal parameters in extremely obese patients: long-term follow-up.

    PubMed

    Navarro-Daz, Maruja; Serra, Assumpta; Romero, Ramn; Bonet, Josep; Bays, Beatriu; Homs, Merc; Prez, Noelia; Bonal, Jordi

    2006-12-01

    Obesity is a health problem that is reaching epidemic proportions. Extreme obesity (body mass index [BMI] > or =40 kg/m2) is a type of obesity that usually does not respond to medical treatment, with surgery being the current treatment of choice. Extreme obesity is associated with cardiovascular disease, type 2 diabetes, dyslipidemia, and hypertension. Recently, obesity has been related with high rate of renal lesions, but renal function and renal parameters in extreme obesity scarcely are documented. The objective of this study was to evaluate the effect of weight loss after bariatric surgery (BS) on BP, renal parameters, and renal function in 61 extremely obese (EO) patients after 24 mo of follow-up. A total of 61 EO adults (37 women) were studied prospectively before and 24 mo after surgery. Control subjects were 24 healthy, normal-weight adults (15 women). Anthropometric, BP, and renal parameters were determined. Presurgery weight, BMI, GFR, 24-h proteinuria, and 24-h albuminuria were higher in the EO patients than in control subjects (P < 0.001). All parameters improved at 12 mo after BS. However, during the second year of follow-up, only 24-h albuminuria (P = 0.006) and BMI (P = 0.014) continued to improve. At 24 mo after BS, obesity-related renal alterations considerably improved. This improvement was observed mainly in the first year after surgery, when the majority of weight loss occurred. However, 24-h albuminuria still improves during the second year of follow-up. It is possible that this decrease in 24-h albuminuria is not GFR related but rather is attributable to the persistence of the decrease in BMI and to the improvement of other weight-related metabolic factors. PMID:17130264

  6. Unusual orthodontic approach to a maxillary canine-premolar transposition and a missing lateral incisor with long-term follow-up.

    PubMed

    Farret, Milton Meri Benitez; Farret, Marcel Marchiori; Farret, Alessandro Marchiori; Hollweg, Henrique

    2012-11-01

    In this case report, we present an unusual approach that was used to treat a 14-year-old patient with a bilateral canine-premolar transposition and a missing maxillary lateral incisor. The orthodontic treatment involved maintaining the transposition and creating a space for lateral incisor replacement. Toward the end of the treatment, accentuated buccal root torque was performed, and lateral group function was established to improve the treatment outcome. Finally, an ideal esthetic and functional occlusion was achieved. The 8-year posttreatment follow-up records show the stability of this treatment. PMID:23116510

  7. The 10 Year Course of AA Participation and Long-Term Outcomes: A Follow-up Study of Outpatient Subjects in Project MATCH

    PubMed Central

    White, William L.; Kelly, John F.; Stout, Robert L.; Carter, Rebecca R.; Tonigan, J. Scott

    2012-01-01

    This study investigates the 10-year course and impact of AA-related helping (AAH), step-work, and meeting attendance on long-term outcomes. Data were derived from 226 treatment-seeking alcoholics recruited from an outpatient site in Project MATCH and followed for 10 years post-treatment. Alcohol consumption, AA participation, and other-oriented behavior were assessed at baseline, end of the 3-month treatment period, and one year, three years, and 10 years post-treatment. Controlling for explanatory baseline and time-varying variables, results showed significant direct effects of AAH and meeting attendance on reduced alcohol outcomes and a direct effect of AAH on improved other-oriented interest. PMID:23327504

  8. What happens to patients with COPD with long-term oxygen treatment who receive mechanical ventilation for COPD exacerbation? A 1-year retrospective follow-up study.

    PubMed

    Hajizadeh, Negin; Goldfeld, Keith; Crothers, Kristina

    2015-03-01

    We performed a retrospective cohort study of patients with chronic obstructive lung disease (COPD) on long-term oxygen treatment (LTOT) who received invasive mechanical ventilation for COPD exacerbation. Of the 4791 patients, 23% died in the hospital, and 45% died in the subsequent 12 months. 67% of patients were readmitted at least once in the subsequent 12 months, and 26.8% were discharged to a nursing home or skilled nursing facility within 30 days. We conclude that these patients have high mortality rates, both in-hospital and in the 12 months postdischarge. If patients survive, many will be readmitted to the hospital and discharged to nursing home. These potential outcomes may support informed critical care decision making and more preference congruent care. PMID:24826845

  9. Long-term follow-up of the risk for cervical intraepithelial neoplasia grade 2 or worse in HPV-negative women after conization.

    PubMed

    Gosvig, Camilla F; Huusom, Lene D; Andersen, Klaus K; Duun-Henriksen, Anne Katrine; Frederiksen, Kirsten; Iftner, Angelika; Svare, Edith; Iftner, Thomas; Kjaer, Susanne K

    2015-12-15

    Little research has been conducted on the long-term value of human papillomavirus (HPV) testing after conization. We investigated whether cytology adds to the value of a negative HPV test for long-term prediction of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). In addition, we compared risk of CIN2+ following a negative HPV test in women after conization with that in women from the general population. During 2002-2005, 667 women treated for CIN2+ were tested for HPV and cytology 46 months after conization. Only HPV-negative women were included. Women participating in routine screening were age-matched with post-conization HPV-negative women, leaving 13,230 and 477 women, respectively, for analysis. By linkage to the Pathology Data Bank, we identified all cases of CIN2+ by December 2013. The 3-, 5-, 8- and 10-year risks for CIN2+ were 0.7, 0.9, 2.8 and 5.7% after a negative HPV test and 0.5, 0.8, 2.9 and 6.1% in HPV and cytology-negative women. HPV-negative women in the general population had similar 3-year and 5-year risks of 0.4 and 1.0%; thereafter, they had lower risks of 1.9% at 8 years and 2.7% at 10 years. Our results indicate that HPV testing may be used as a test of cure after conization. In the first 5 years after testing, the risk for CIN2+ of women who were HPV-negative at 34 months after conization was similar to that of HPV-negative women in the general population. After 67 years, however, women who have undergone conization may be at higher risk for CIN2+. PMID:26139420

  10. Comparative Study of Photodynamic Therapy with Topical Methyl Aminolevulinate versus 5-Aminolevulinic Acid for Facial Actinic Keratosis with Long-Term Follow-Up

    PubMed Central

    Ko, Dong-Yeob; Kim, Ki-Ho

    2014-01-01

    Background Few studies have compared the efficacy, cosmetic outcomes, and adverse events between 5-aminolevulinic acid photodynamic therapy (ALA-PDT) and methyl aminolevulinate-PDT (MAL-PDT) for actinic keratoses (AKs) in Asian ethnic populations with dark-skin. Objective We retrospectively compared the long-term efficacy, recurrence rates, cosmetic outcomes, and safety of ALA-PDT versus MAL-PDT for facial AKs in Koreans. Methods A total of 222 facial AKs in 58 patients were included in this study. A total of 153 lesions (29 patients) were treated with 5-ALA, and 69 lesions (29 patients) with MAL. ALA and MAL creams were applied for 6 hours and 3 hours, respectively; the lesions were then illuminated with a halogen lamp at 150 J/cm2 for ALA-PDT and a diode lamp at 37 J/cm2 for MAL-PDT. Results The complete response rates of ALA-PDT and MAL-PDT were 56.9% and 50.7%, respectively, with no significant difference at 12 months after treatment. No significant difference in recurrence rates was observed between the 2 PDT modalities at either 6 or 12 months after treatment. There was no significant difference in the cosmetic outcomes between the 2 treatment modalities at 12 months after PDT. However, ALA-PDT caused significantly more painful than MAL-PDT (p=0.005). The adverse events were mild to moderate, transient, and self-limiting for both modalities. Conclusion MAL-PDT was similar to ALA-PDT in terms of long-term efficacy, recurrence rates, cosmetic outcomes, and adverse events; however, it was a significantly less painful procedure than ALA-PDT in our study. PMID:24966631

  11. Long-term follow-up after transoral laser microsurgery and adjuvant radiotherapy for advanced recurrent squamous cell carcinoma of the head and neck

    SciTech Connect

    Christiansen, Hans . E-mail: hchrist@gwdg.de; Hermann, Robert Michael; Martin, Alexios; Florez, Rodrigo; Kahler, Elke; Nitsche, Mirko; Hille, Andrea; Steiner, Wolfgang; Hess, Clemens F.; Pradier, Olivier

    2006-07-15

    Purpose: The aim of this study was to evaluate the efficacy of adjuvant radiotherapy after transoral laser microsurgery for advanced recurrent head-and-neck squamous cell carcinoma (HNSCC). Patients and Methods: Between 1988 and 2000, 37 patients with advanced local recurrences (23 local and 14 locoregional recurrences) of HNSCC without distant metastases were treated in curative intent with organ-preserving transoral laser microsurgery and adjuvant radiotherapy (before 1994 split-course radiotherapy with carboplatinum, after 1994 conventional radiotherapy). Initial therapy of the primary (8.1% oral cavity, 35.1% oropharynx, 13.5% hypopharynx, and 43.3% larynx) before relapse was organ-preserving transoral laser microsurgery without any adjuvant therapy. Results: After a median follow-up of 124 months, the 5-year overall survival rate was 21.3%, the loco-regional control rate 48.3%, respectively. In multivariate analysis, stage of original primary tumor (Stage I/II vs. Stage III/IV), and patient age (<58 years vs. {>=}58 years) showed statistically significant impact on prognosis. In laryngeal cancer, larynx preservation rate after treatment for recurrent tumor was 50% during follow-up. Conclusion: Our data show that organ-preserving transoral laser microsurgery followed by adjuvant radiotherapy is a curative option for patients who have advanced recurrence after transoral laser surgery and is an alternative to radical treatment.

  12. Therapeutic challenge during the long-term follow-up of a patient with indolent systemic mastocytosis with extensive cutaneous involvement.

    PubMed

    Marton, I; Psfai, ; Borbnyi, Z; Bdr, C; Papp, G; Demeter, J; Korom, I; Varga, E; Bata-Csrg?, Z

    2015-01-01

    From a dermatological aspect, it posed a considerable challenge the skin-limited form of mastocytosis, urticaria pigmentosa and indolent systemic mastocytosis (ISM) with cutaneous lesions. Despite the favourable prognosis, lifelong dermatological control is needed, during which the average symptomatic therapy does not always seem adequate. We report here the case of a female ISM patient with recurrent cutaneous symptoms that impaired her quality of life, with a follow-up time of 27 years. During this long follow-up period, the cutaneous lesions could be controlled by antihistamines, leukotriene antagonists, glucocorticoids, local immunosuppressants or local UV radiation for only relatively short periods. Imatinib mesylate was, therefore, introduced in an attempt to control the cutaneous lesions. Tyrosine kinase inhibition is an unusual dermatological therapeutic option. This case illustrates that imatinib mesylate was a good choice with which to achieve a reduction of the skin lesions in this KIT D816V mutation-negative disease: it led to a temporary appreciable improvement of the patient's quality of life. PMID:26004600

  13. Cardiac Function in a Long-Term Follow-Up Study of Moderate and Severe Porcine Model of Chronic Myocardial Infarction

    PubMed Central

    de Jong, Renate; van Hout, Gerardus P. J.; Houtgraaf, Jaco H.; Takashima, S.; Pasterkamp, Gerard; Hoefer, Imo; Duckers, Henricus J.

    2015-01-01

    Background. Novel therapies need to be evaluated in a relevant large animal model that mimics the clinical course and treatment in a reasonable time frame. To reliably assess therapeutic efficacy, knowledge regarding the translational model and the course of disease is needed. Methods. Landrace pigs were subjected to a transient occlusion of the proximal left circumflex artery (LCx) (n = 6) or mid-left anterior descending artery (LAD) (n = 6) for 150 min. Cardiac function was evaluated before by 2D echocardiography or 3D echocardiography and pressure-volume loop analysis. At 12 weeks of follow-up the heart was excised for histological analysis and infarct size calculations. Results. Directly following AMI, LVEF was severely reduced compared to baseline in the LAD group (−17.1 ± 1.6%, P = 0.009) compared to only a moderate reduction in the LCx group (−5.9 ± 1.5%, P = 0.02) and this effect remained unchanged during 12 weeks of follow-up. Conclusion. Two models of chronic MI, representative for different patient groups, can reproducibly be created through clinically relevant ischemia-reperfusion of the mid-LAD and proximal LCx. PMID:25802838

  14. Aggressive Central Giant Cell Granuloma of the Mandible Treated With Conservative Surgical Enucleation and Interferon-?-2a: Complete Remission With Long-Term Follow-Up.

    PubMed

    Tarsitano, Achille; Del Corso, Giacomo; Pizzigallo, Angelo; Marchetti, Claudio

    2015-11-01

    Central giant cell granuloma (CGCG) is a benign tumor of the jaws. Aggressive lesions present a strong tendency toward recurrence after surgical enucleation; thus, en bloc resection and microvascular bone free flap transfer are usually performed. However, in young patients, aggressive surgical treatment is a not always suitable solution. This report describes the case of a young female patient who developed an aggressive recurrence of CGCG after its diagnosis and enucleation from the mandible. Surgical enucleation with subcutaneous injection of interferon-?-2a was performed. The patient was evaluated every 6weeks, and after 6months radiographic evidence of complete bone regeneration was obtained. No sign of recurrence was seen after 8years of follow-up. A review of the literature proved that interferon treatment is an effective strategy to avoid extensive surgery in patients with aggressive CGCG. PMID:25985764

  15. Long-term follow-up trial of oral rifampin-cotrimoxazole combination versus intravenous cloxacillin in treatment of chronic staphylococcal osteomyelitis.

    PubMed

    Euba, G; Murillo, O; Fernndez-Sab, N; Mascar, J; Cabo, J; Prez, A; Tubau, F; Verdaguer, R; Gudiol, F; Ariza, J

    2009-06-01

    Oral therapies alternative to fluoroquinolones against staphylococcal chronic osteomyelitis have not been evaluated in comparative studies. Consecutive nonaxial Staphylococcus aureus chronic osteomyelitis cases were included in a comparative trial after debridement. Fifty patients were randomized: group A (n = 22) was treated with cloxacillin for 6 weeks intravenously plus 2 weeks orally (p.o.), and group B (n = 28) was treated with rifampin-cotrimoxazole for 8 weeks p.o. During follow-up (10 years), five relapses occurred: two (10%) in group A and three (11%) in group B. Foreign-body maintenance was associated with relapse (P = 0.016). Oral rifampin-cotrimoxazole treatment showed outcomes comparable to those for intravenous cloxacillin treatment. PMID:19307354

  16. Long-Term Impact of Battle Injuries; Five-Year Follow-Up of Injured Dutch Servicemen in Afghanistan 2006-2010

    PubMed Central

    Hoencamp, Rigo; Idenburg, Floris J.; van Dongen, Thijs T. C. F.; de Kruijff, Loes G. M.; Huizinga, Eelco P.; Plat, Marie-Christine J.; Hoencamp, Erik; Leenen, Luke P. H.; Hamming, Jaap F.; Vermetten, Eric

    2015-01-01

    Objectives Units deployed to armed conflicts are at high risk for exposure to combat events. Many battle casualties (BCs) have been reported in the recent deployment to Afghanistan. The long-term impact of these combat injuries, at their five-year end point, is currently unknown. To date, no systematic inventory has been performed of an identified group of BCs in comparison to non-injured service members from the same operational theatre. Design Observational cross-sectional cohort study. Setting Open online survey among Dutch BCs that deployed to Afghanistan (20062010). Participants The Dutch BCs (n = 62) were compared to two control groups of non-injured combat groups (battle exposed [n = 53], and non-battle exposed [n = 73]). Main Outcome Measures Participants rated their impact of trauma exposure (Impact of Events [IES]), post deployment reintegration (Post Deployment Reintegration Scale [PDRS]), general symptoms of distress (Symptom Checklist 90 [SCL-90]), as well as their current perceived quality of life (EuroQol-6D [EQ-6D]). Also cost effectiveness (Short From health survey [SF-36]) and care consumption were assessed (Trimbos/iMTA questionnaire). Results Over 90% of BCs were still in active duty. The mean scores of all questionnaires (IES, EQ-6D, SF-36, and SCL-90) of the BC group were significantly higher than in the control groups (p<0.05). The PDRS showed a significantly lower (p<0.05) outcome in the negative subscales. The mean consumption of care was triple that of both control groups. A lower score on quality of life was related to higher levels of distress and impact of trauma exposure. Conclusions This study showed a clear long-term impact on a wide range of scales that contributes to a reduced quality of life in a group of BCs. Low perceived cost effectiveness matched with high consumption of care in the BC group in comparison to the control groups. These results warrant continuous monitoring of BCs. PMID:25643003

  17. Different dosages of intravenous immunoglobulin (IVIg) in treating immune thrombocytopenia with long-term follow-up of three years: Results of a prospective study including 167 cases.

    PubMed

    Zhou, Zeping; Qiao, Zhuoqing; Li, Huiyuan; Luo, Na; Zhang, Xian; Xue, Feng; Yang, Renchi

    2016-02-01

    This study compared the effects of different dosages of intravenous immunoglobulin (IVIg) against immune thrombocytopenia (ITP). A total of 167 patients, 91 adults and 76 children, with ITP, followed-up for three years in the case-control study, were divided into three subgroups according to the dosages of IVIg administered: group A (0.2 g/kg/day), group B (0.3 g/kg/day) and group C (0.4 g/kg/day). The therapeutic response in 91 adult patients did not differ significantly among the three groups of IVIg dosages (p = 0.459). The response rate of IVIg treatment in the three adult groups was 97.1% for group A, 97.2% for group B and 100% for group C. The mean time for raising platelets to 30 × 10(9)/L in group A was 2.5 days, group B 3.2 days and group C 2.9 days (p = 0.324). The median IVIg consumption in group A was 0.83 g/kg, group B 1.22 g/kg and group C 1.64 g/kg (p < 0.01). Similar results were shown in the children groups. The follow-up results showed no significant difference of clinical outcome between groups A, B and C. In conclusion, low-dose IVIg treatment is shown to be as effective as high-dose regimen without increasing the risk of developing the patients into chronic ITP conditions, suggesting that ITP patients could be treated more cost-effectively by lower conventional dosage of IVIg regimen. PMID:26525513

  18. Long-term follow-up of a prospective, double-blind, placebo-controlled randomized trial of clodronate in multiple myeloma.

    PubMed

    McCloskey, E V; Dunn, J A; Kanis, J A; MacLennan, I C; Drayson, M T

    2001-06-01

    Oral clodronate (1600 mg/d) has been shown to significantly reduce the incidence of skeletal complications in multiple myeloma. Preliminary analysis of a double-blind placebo-controlled trial of this treatment indicated that clodronate might prolong survival in patients without vertebral fractures at presentation. This issue was re-examined after further follow-up of the patients recruited into the Medical Research Council (MRC) VIth Myeloma Study. The trial examined the effects of clodronate on the natural history of skeletal disease in multiple myeloma; 619 patients were randomized between June 1986 and May 1992 commencing 15 d after the start of ABCM [adriamycin, BCNU (carmustine), cyclophosphamide, melphalan] chemotherapy or 43 d after ABCMP (ABCM + prenisolone); 535 patients who received clodronate or placebo were included in the analysis. The presence or absence of spinal fractures was assessed centrally from spinal X-rays; long-bone fractures were assessed locally. With a median follow-up of 8.6 years, there was no overall significant difference in survival between the two treatment groups (O/E, chi2 = 0.78, P = 0.38). Among the subgroup of 153 patients with no skeletal fractures at presentation there was a significant survival advantage (O/E, chi2 = 7.52, P = 0.006) in favour of the 73 patients receiving clodronate, with median survivals being, respectively, 59 months (95% CI 43-71 months) and 37 months (95% CI 31-52 months), and 5-year survivals being 46% and 35%. The original analysis of this study shows that there is a benefit in taking 1600 mg clodronate daily for patients with myelomatosis to prevent the development of new skeletal disease. Bearing in mind the limitations of subgroup analysis, the present study indicates that treatment may prolong survival in patients without overt skeletal disease at diagnosis. These observations, however, require confirmation in prospective clinical trials. PMID:11442499

  19. A Phase III Skin Cancer Chemoprevention Study of DFMO: Long-term Follow-up of Skin Cancer Events and Toxicity

    PubMed Central

    Kreul, Sarah M.; Havighurst, Tom; Kim, KyungMann; Mendonça, Eneida A.; Wood, Gary S.; Snow, Stephen; Borich, Abbey; Verma, Ajit; Bailey, Howard H.

    2012-01-01

    Decreasing the incidence of non-melanoma skin cancer (NMSC) is of great importance in regards to future healthcare services. Given the previously reported preventive effects of α-difluoromethylornithine (DFMO) in skin and colon cancer trials, we determined appropriate cause to update the clinical data on the subjects from the recently reported Randomized, Double-Blind, Placebo-Controlled Phase III Skin Cancer Prevention Study of DFMO. Our intention was to retrospectively assess the further incidence of skin cancer, other malignancies, and adverse events of patients accrued to our phase III skin cancer prevention study of DFMO. Clinical records of 209 UW Health subjects were reviewed, and 2092.7 person years of on study (884.3 person years) and post study (1208.4 person years) follow-up for these patients were assessed for new NMSC events and recurrence rates from the on study period, the post study period, and the two study periods combined. No evidence of increased significant diagnoses or serious adverse events was observed in the DFMO participants. The initially observed, marginally significant reduction (p=0.069) in NMSC rates for DFMO subjects relative to placebo continued without evidence of rebound. Event rates after discontinuation from study for total NMSCs (DFMO 0.236 NMSC/person/year, placebo 0.297, p=0.48) or the subtypes of BCCs (DFMO 0.179 BCC/person/year, placebo 0.190, p=0.77) and SCCs (DFMO 0.057 SCC/person/year, placebo 0.107, p=0.43) are listed. Follow-up data revealed a persistent but insignificant reduction in new NMSCs occurring in DFMO subjects without evidence of latent or cumulative toxicity relative to placebo subjects. PMID:23060038

  20. Long-Term Follow-Up of Dose-Adapted and Reduced-Field Radiotherapy With or Without Chemotherapy for Central Nervous System Germinoma

    SciTech Connect

    Jensen, Ashley W.; Issa Laack, Nadia N.; Buckner, Jan C.; Schomberg, Paula J.; Wetmore, Cynthia J.; Brown, Paul D.

    2010-08-01

    Purpose: To update our institutional experience with neoadjuvant chemotherapy and minimized radiotherapy vs. radiation monotherapy for intracranial germinoma. Methods and Materials: We retrospectively reviewed records of 59 patients with diagnosis of primary intracranial germinoma between 1977 and 2007. Treatment was irradiation alone or neoadjuvant platinum-based chemotherapy and local irradiation (initial tumor plus margin) for patients with localized complete response and reduced-dose craniospinal irradiation for others. Results: For the chemoradiotherapy group (n = 28), median follow-up was 7 years. No patient died. The freedom from progression (FFP) rate was 88% at 5 years and 80% at 10 years. In 4 patients, disease recurred 1.1 to 6.8 years after diagnosis. All were young male patients who received 30.6 Gy to local fields after complete response to chemotherapy. The FFP rate was 88% for local irradiation vs. 100% for more extensive fields (p = .06). For the radiotherapy-alone group (n = 31), median follow-up was 15 years. Overall and disease-free survival rates were 93% and 93% at 5 years and 90% and 87% at 15 years. In 5 patients, disease recurred 1.1 to 4.9 years after diagnosis. Most patients in this group were young men 18 to 23 years of age with suprasellar primary disease treated with about 50 Gy to local fields. The FFP rate was 44% for local irradiation vs. 100% for more extensive fields (p < .01). Conclusions: The addition of neoadjuvant chemotherapy to local-field radiotherapy reduced central nervous system cancer recurrence when high-risk patients were excluded by thorough pretreatment staging. There was trend toward improved central nervous system tumor control when larger fields (whole brain, whole ventricle, or craniospinal axis) were used.

  1. Long-term follow-up of lenalidomide in relapsed/refractory mantle cell lymphoma: subset analysis of the NHL-003 study

    PubMed Central

    Zinzani, P. L.; Vose, J. M.; Czuczman, M. S.; Reeder, C. B.; Haioun, C.; Polikoff, J.; Tilly, H.; Zhang, L.; Prandi, K.; Li, J.; Witzig, T. E.

    2013-01-01

    Background Mantle cell lymphoma (MCL) is an uncommon type of non-Hodgkin lymphoma with poor overall prognosis, requiring the development of new therapies. Lenalidomide is an immunomodulatory agent demonstrating antitumor and antiproliferative effects in MCL. We report results from a long-term subset analysis of 57 patients with relapsed/refractory MCL from the NHL-003 phase II multicenter study of single-agent lenalidomide in patients with aggressive lymphoma Design Lenalidomide was administered orally 25 mg daily on days 121 every 28 days until progressive disease (PD) or intolerability. The primary end point was overall response rate (ORR). Results Fifty-seven patients with relapsed/refractory, advanced-stage MCL had a median of three prior therapies. The ORR was 35% [complete response (CR)/CR unconfirmed (CRu) 12%], with a median duration of response (DOR) of 16.3 months (not yet reached in patients with CR/CRu) by blinded independent central review. The median time to first response was 1.9 months. Median progression-free survival was 8.8 months, and overall survival had not yet been reached. The most common grade 3/4 adverse events (AEs) were neutropenia (46%), thrombocytopenia (30%), and anemia (13%). Conclusions These results show the activity of lenalidomide in heavily pretreated, relapsed/refractory MCL. Responders had a durable response with manageable side-effects. Clinical trial number posted on www.clinicaltrials.gov NCT00413036. PMID:24030098

  2. Photometric follow-up of the transiting planetary system TrES-3: transit timing variation and long-term stability of the system

    NASA Astrophysics Data System (ADS)

    Va?ko, M.; Maciejewski, G.; Jakubk, M.; Krej?ov, T.; Budaj, J.; Pribulla, T.; Ohlert, J.; Raetz, St.; Parimucha, .; Bukowiecki, L.

    2013-06-01

    We present new observations of the transiting system TrES-3 obtained from 2009 to 2011 at several observatories. The orbital parameters of the system were redetermined and a new linear ephemeris was calculated. The best quality light curve was used for light-curve analysis, and other data sets were used to determine mid-transit times (TC) and study transit time variation (TTV). For planet parameter determination we used two independent codes and finally, we concluded that our parameters are in agreement with previous studies. Based on our observations, we determined 14 mid-transit times. Together with published TC, we found that the timing residuals showed no significant deviation from the linear ephemeris. We concluded that a periodic TTV signal with an amplitude greater than 1 min over a 4 yr time span seems to be unlikely. Our analysis of an upper mass limit allows us to exclude an additional Earth-mass planet close to inner 3:1, 2:1 and 5:3 and outer 3:5, 1:2 and 1:3 mean-motion resonances. Using the long-term integration and applying the method of maximum eccentricity, the region from 0.015 au to 0.05 au was found unstable and the region beyond the 0.05 au was found to have a chaotic behaviour and its depletion increases with increasing values of the initial eccentricity as well as inclination.

  3. Long-term clinical and molecular follow-up of large animals receiving retrovirally transduced stem and progenitor cells: no progression to clonal hematopoiesis or leukemia.

    PubMed

    Kiem, Hans-Peter; Sellers, Stephanie; Thomasson, Bobbie; Morris, Julia C; Tisdale, John F; Horn, Peter A; Hematti, Peiman; Adler, Rima; Kuramoto, Ken; Calmels, Boris; Bonifacino, Aylin; Hu, Jiong; von Kalle, Christof; Schmidt, Manfred; Sorrentino, Brian; Nienhuis, Arthur; Blau, C Anthony; Andrews, Robert G; Donahue, Robert E; Dunbar, Cynthia E

    2004-03-01

    There has been significant progress toward clinically relevant levels of retroviral gene transfer into hematopoietic stem cells (HSC), and the therapeutic potential of HSC-based gene transfer has been convincingly demonstrated in children with severe combined immunodeficiency syndrome (SCID). However, the subsequent development of leukemia in two children with X-linked SCID who were apparently cured after transplantation of retrovirally corrected CD34+ cells has raised concerns regarding the safety of gene therapy approaches utilizing integrating vectors. Nonhuman primates and dogs represent the best available models for gene transfer safety and efficacy and are particularly valuable for evaluation of long-term effects. We have followed 42 rhesus macaques, 23 baboons, and 17 dogs with significant levels of gene transfer for a median of 3.5 years (range 1-7) after infusion of CD34+ cells transduced with retroviral vectors expressing marker or drug-resistance genes. None developed abnormal hematopoiesis or leukemia. Integration site analysis confirmed stable, polyclonal retrovirally marked hematopoiesis, without progression toward mono- or oligoclonality over time. These results suggest that retroviral integrations using replication-incompetent vectors, at copy numbers achieved using standard protocols, are unlikely to result in leukemogenesis and that patient- or transgene-specific factors most likely contributed to the occurrence of leukemia in the X-SCID gene therapy trial. PMID:15006605

  4. Low testosterone and sexual symptoms in men with acute coronary syndrome can be used to predict major adverse cardiovascular events during long-term follow-up.

    PubMed

    Chmiel, A; Mizia-Stec, K; Wierzbicka-Chmiel, J; Rychlik, S; Muras, A; Mizia, M; Bienkowski, J

    2015-11-01

    Low total testosterone (TT) and sexual symptoms are common among men with coronary artery disease, however its impact on major adverse cardiovascular events (MACE) is still debatable. We investigated whether low TT and coexisting sexual symptoms in men with acute coronary syndrome (ACS) can be used to predict the incidence of MACE. In the prospective study 120 consecutive men (mean age 58 ± 9 years; diabetes 27%; current smokers 58%; left ventricular ejection fraction 50 ± 10%) with ACS were included. The group of men with the presence of three sexual symptoms (decreased frequency of morning erections, a lack of sexual thoughts and erectile dysfunction) and with TT serum concentration <3.2 ng/mL was distinguished. All of the patients had their prognosis assessed according to the Global Registry of Acute Coronary Events (GRACE Score 2.0). Primary composite endpoint - MACE (recurrent ischaemia, non-fatal myocardial infarction, stroke and death) and secondary endpoint - in stent restenosis (ISR) were registered during the 18.3 month follow-up period. The mean TT level in the entire group was 3.7 ± 0.5 ng/mL. Low TT was diagnosed in 63 (52.5%) men. Both low TT and sexual symptoms were diagnosed in 57 (47%) participants. During the follow-up, 29 (24.2%) participants experienced MACE, 20 (16.6%) men ISR. In the Cox proportional hazards regression, high risk of death on the GRACE score (HR 3.16; 95% CI: 1.5-6.6; p = 0.002), the presence of low TT and sexual symptoms (HR 2.75; 95% CI: 1.26-6.04; p = 0.02) independently predicted an incidence of a MACE (p = 0.006). For the secondary endpoint only low TT and sexual symptoms (HR 2.68; 95% CI: 1.03-6.94; p = 0.034) were independent covariates which predicted IRS. Low TT which coexists with sexual symptoms in males with ACS can be used to predict MACE, especially IRS independently of classic cardiovascular risk factors. PMID:26460501

  5. Polyarthritis in primary Sjgren's syndrome represents a distinct subset with less pronounced B cell proliferation a Dutch cohort with long-term follow-up.

    PubMed

    Ter Borg, E J; Kelder, J C

    2016-03-01

    The primary goal was to investigate the differences in patients with and without polyarthritis (PA) in primary Sjgren's syndrome (pSS) in a clinical-based (real-life) setting, with respect to demographic characteristics, cumulative prevalence of other extra-glandular manifestations (EGM), hypergammaglobulinaemia and serological profile. The secondary goal was to describe the characteristics of polyarthritis in our pSS cohort. Patients diagnosed with pSS and polyarthritis but without rheumatoid arthritis (RA)-like changes on X-rays were followed up prospectively from June 1991 until August 2014, with at least one check-up each year. Patients fulfilling the criteria for concomitant connective tissue disorders were excluded. Data were collected with respect to the prevalence of systemic auto-antibodies (anti-nuclear antibodies (ANA), anti-Sjgren's syndrome-related antigen A (anti-SSA), anti-Sjgren's syndrome type B (anti-SSB) and immunoglobulin M-rheumatoid factor (IgM-RF)) and other EGM related to pSS. A total of 134 patients were included for the final analysis. The median follow-up was 86months (range 0-368months). Twenty-two patients (16.4%) had polyarthritis. The prevalence of systemic auto-antibodies including rheumatoid factor did not differ between the two groups. Anti-cyclic citrullinated peptide (CCP) occurred much more frequently in the polyarthritis-positive (PA+) patients (13.7 vs 0.9%; p?=?0.015). Hypergammaglobulinaemia (p?=?0.002) and increased levels of IgG (p?=?0.013) occurred much less frequently in the PA+ group compared to the polyarthritis-negative (PA-) group. The mean total number of EGM or of any specific EGM did not differ between the two groups. Most patients had a mild, symmetrical PA predominantly involving the finger joints (proximal interphalangeal joints/metacarpophalangeal joints (PIP/MCP)) and/or wrists and/or metatarsophalangeal (MTP) joints. Significant morning stiffness lasting ?1h was found infrequently (32%). All patients were treated with a classic (c) disease-modifying antirheumatic drug (DMARD), but in two cases, treatment was necessary with a tumour necrosis factor (TNF) inhibitor. PA+ pSS patients are more frequently anti-CCP positive and have a less pronounced B cell proliferation than PA- patients. PSS patients with PA seem to have a relatively mild articular expression with a favourable course. PMID:26791875

  6. Long-Term Follow-Up and Risk of Cancer Death After Radiation for Post-Prostatectomy Rising Prostate-Specific Antigen

    SciTech Connect

    Swanson, Gregory P.; Du, Fei; Michalek, Joel E.; Hermans, Michael

    2011-05-01

    Purpose: The results of salvage radiation therapy for rising prostate-specific antigen (PSA) levels after radical prostatectomy appear favorable, but the ultimate outcome is uncertain, given the relatively short follow-up in most studies. We report on a group of patients at a median follow-up of 13.9 years after salvage radiation therapy. Methods and Materials: From 1990 to 1995, 92 patients were referred postoperatively for radiation for a rising PSA level. PSA level at the time of referral ranged from 0.1 to 30.5 ng/ml (median, 1.5 ng/ml). The median time from surgery to radiation was 2.1 years (range,, 0.3-7.4 years). Radiation was directed to the prostatic fossa only with a median dose of 6,500 cGy (range, 6,000-7,000 cGy). Results: Eighty-five patients experienced a PSA drop after radiation, as predicted by Gleason score and PSA level at the start of radiation. Five- and 10-year biochemical failure free survival (BFFS) was 35% and 26%, respectively, and overall survival was 86% and 67%, respectively. Median survival was 12.0 years, and median BFF was 2.3 years. The presurgery PSA level was not predictive, but the PSA level at the start of radiation predicted a response. Patients with Gleason 8 to 9 cancers had a significantly higher progression rate than those with lower Gleason scores. There were no significant differences in outcomes based on pathology findings (none vs. positive margins vs. positive seminal vesicles). Overall, 22 (24%) patients died directly from prostate cancer, resulting in a 10-year cancer-specific survival rate of 82%. Multivariate analysis risk factors for dying of cancer were Gleason's score (8 to 9) and PSA at the start of radiation therapy (>1.0 ng/ml). Conclusions: Patients have a good response to salvage radiation therapy. A small but durable subgroup appears to have permanent control. In those for whom therapy fails, radiation delays the need for other salvage therapy, indicating at least a transient benefit to most patients.

  7. Long-term follow-up of bone density, general and reproductive health in female survivors after treatment for haematological malignancies.

    PubMed

    Naessn, Sabine; Bergstrm, Ingrid; Ljungman, Per; Landgren, Britt-Marie

    2014-08-01

    The purpose of this study was to assess the ovarian function, fertility and bone mineral density in women who previously had treatment for different haematological malignancies (HMs). The overall survival and cure rates of patients with HMs have improved dramatically. The treatment affects fertility and bone density. Fifty-two premenopausal women, from Stockholm region, were included in the study between 1998 and 2002, followed until 2011. The diagnoses were acute lymphoblastic leukaemia (n = 6), acute myeloid leukaemia (n = 10), chronic lymphocytic leukaemia (n = 1), chronic myeloid leukaemia (n = 12), Hodgkin lymphoma (n = 12) and non-Hodgkin lymphoma (n = 11). Before treatment, women without children (43/52), when possible, were offered fertility preservation options. The mean age at diagnosis was 27, at final evaluation 39 yr. Thirty-seven patients received HSCT; 26 allogeneic, 11 autologous. Before allogeneic HSCT, nineteen patients had myeloablative conditioning; seven had reduced-intensity conditioning. Eleven patients got total body irradiation. Eight patients were transplanted with grafts from an HLA-identical sibling donor, while 18 had unrelated donors. All women were in a menopausal state post-therapy. Hormone replacement therapy (HRT) was given, and bone mineral density (BMD) was measured every other year. The serum levels of parathyroid hormone (PTH), free and bound calcium was within normal range. BMD measurements showed a slight increase over time in the spine with a mean of 0.015 g/cm(2) /yr. Four spontaneous pregnancies resulted in two babies and two discontinued pregnancies; two pregnancies were achieved with oocyte donation and surrogacy and one woman adopted a child. HRT sustains BMD in long-term survivors from HMs. This study highlights the importance of HRT and fertility issues in this patient group. PMID:24649942

  8. Long-term Changes in Pulmonary Function After Incidental Lung Irradiation for Breast Cancer: A Prospective Study With 7-Year Follow-up

    SciTech Connect

    Jaen, Javier; Vazquez, Gonzalo; Alonso, Enrique; De Las Penas, Maria D.; Diaz, Laura; De Las Heras, Manuel; Perez-Regadera, Jose F.

    2012-12-01

    Purpose: To evaluate late pulmonary function changes after incidental pulmonary irradiation for breast cancer. Methods and Materials: Forty-three consecutive female patients diagnosed with breast carcinoma and treated with postoperative radiation therapy (RT) at the same dose (50 Gy) and fractionation (2 Gy/fraction, 5 days/week) were enrolled. Pulmonary function tests (PFT) and ventilation/perfusion scans were performed before RT and 6, 12, 24, and 84 months afterward. Results: Forty-one patients, mean age 55 years, were eligible for the analysis. No differences were found in the baseline PFT values for age, smoking status and previous chemotherapy; women undergoing mastectomy showed baseline spirometric PFT values lower than did women treated with conservative surgery. The mean pulmonary dose was 10.9 Gy, being higher in women who also received lymph node RT (15.8 vs 8.6, P<.01). Only 1 patient experienced symptomatic pneumonitis. All PFT values showed a reduction at 6 months. From then on, the forced vital capacity and forced expiratory volume in 1 second began their recovery until reaching, and even exceeding, their baseline values at 7 years. Diffusing capacity of the lungs for carbon monoxide and ventilation/perfusion scans continued to reduce for 24 months and then partially recovered their baseline values (-3.5%, -3.8%, and -5.5%, respectively). Only the percentage difference at 7 years in the ventilation scan correlated with the dosimetric parameters studied. Other variables, such as age, smoking status, previous chemotherapy, and concomitant tamoxifen showed no significant relation with changes in PFT ({Delta}PFT) values at 7 years. Conclusions: The study of reproducible subclinical parameters, such as PFT values, shows how their figures decrease in the first 2 years but practically recover their baseline values in the long term. The extent of the reduction in PFT values was small, and there was no clear association with several dosimetric and clinical parameters.

  9. Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

    PubMed Central

    2014-01-01

    Background During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded. Results Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures. Conclusion The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and internal fixation is the treatment of choice for patients with neck and sub-condylar mandibular fractures. PMID:25196114

  10. Low Dose Infliximab for Prevention of Postoperative Recurrence of Crohns Disease: Long Term Follow-Up and Impact of Infliximab Trough Levels and Antibodies to Infliximab

    PubMed Central

    Sorrentino, Dario; Marino, Marco; Dassopoulos, Themistocles; Zarifi, Dimitra; Del Bianco, Tiziana

    2015-01-01

    Objective In patients with postoperative recurrence of Crohns disease endoscopic and clinical remission can be maintained for up to 1 year with low infliximab doses (3 mg/Kg). However, in theory low-dose infliximab treated patients could develop subtherapeutic trough levels, infiximab antibodies, and might loose response to therapy. To verify this hypothesis infliximab pharmacokinetics and clinical/endoscopic response were checked in a group of patients treated in the long term with low infliximab doses. Design Infliximab antibodies, infliximab levels, highly-sensitive CRP and fecal calprotectin were measured during the 8-week interval in 5 consecutive patients in clinical (Crohns Disease Activity Index < 150) and endoscopic (Rutgeerts scores 01) remission after one year of therapy with infliximab 3 mg/Kg. For comparison with reported standards, infliximab pharmacokinetics and inflammatory parameters were also tested in 6 Crohns disease patients who did not undergo surgery and who were in clinical remission while on infliximab 5 mg/Kg. Patients on low infliximab dose also underwent colonoscopy after 18 additional months of therapy. Results Highly sensitive CRP and fecal calprotectin increased in all patients during the 8-week interval. Infliximab trough levels were lower in patients treated with the low dose compared to controls (meanSE: 2.00.3 vs 4.750.83 ?g/mL respectively p<0.05). Infliximab antibodies were present in two of the subjects treated with low infliximab dose and in none of the controls. However, in low dose-treated patients after 18 additional months of therapy endoscopy continued to show mucosal remission and none of them developed clinical recurrence or side effects. Conclusions Patients treated with low infliximab doses had lower trough levels compared to patients treated with 5 mg/Kg and some developed antibodies to infliximab. However, low infliximab doses sustained clinical and endoscopic remission for a total of 30 months of treatment. PMID:26670274

  11. Molecular Genetics and Metabolism Report Long-term follow-up of post hematopoietic stem cell transplantation for Hurler syndrome: clinical, biochemical, and pathological improvements

    PubMed Central

    Yasuda, Eriko; Mackenzie, William; Ruhnke, Kristen; Shimada, Tsutomu; Mason, Robert W.; Zustin, Jozef; Martin, Paul L.; Thacker, Mihir; Orii, Tadao; Sai, Yoshimichi; Tomatsu, Shunji

    2015-01-01

    Mucopolysaccharidosis type I (MPS I; Hurler Syndrome) is a lysosomal storage disease caused by a deficiency of the enzyme α-L-iduronidase which affects multiple organs such as central nervous system (CNS), skeletal system, and physical appearance. Hematopoietic stem cell transplantation (HSCT) is recommended as a primary therapeutic option at an early stage of MPS I with a severe form to ameliorate CNS involvement; however, no description of pathological improvement in skeletal dysplasia has been investigated to date. We here report a 15-year-old male case with MPS I post-HSCT. This patient received successful HSCT at the age of 2 years and 1 month, followed for over 10 years. His activity of daily living including cognitive performance has been kept normal and the present height and weight are 162 cm and 55 kg. Bone deformity has been still developed, resulting in hemiepiphysiodesis of bilateral medial proximal tibia at 12 years of age and successive arthrodesis of thoraco-lumbar spine at 13 years of age; however, skeletal histopathology from surgical remnants showed substantial improvement in bone lesion with markedly reduced occurrence and cell size of vacuolated cells. After a series of surgical procedures, he became ambulant and independent in daily activity. The levels of GAGs in blood were substantially reduced. 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 skeletal system in combination of appropriate surgical procedures. PMID:25709894

  12. Effects in Short and Long Term of Global Postural Reeducation (GPR) on Chronic Low Back Pain: A Controlled Study with One-Year Follow-Up

    PubMed Central

    Cecchi, Francesca; Del Canto, Antonio; Paperini, Anita; Boni, Roberta; Pasquini, Guido; Vannetti, Federica; Macchi, Claudio

    2015-01-01

    Objective. Comparing global postural reeducation (GPR) to a standard physiotherapy treatment (PT) based on active exercises, stretching, and massaging for improving pain and function in chronic low back pain (CLBP) patients. Design. Prospective controlled study. Setting. Outpatient rehabilitation facility. Participants. Adult patients with diagnosis of nonspecific, chronic (>6 months) low back pain. Interventions. Both treatments consisted of 15 sessions of one hour each, twice a week including patient education. Measures. Roland Morris Disability Questionnaire to evaluate disability, and Numeric Analog Scale for pain. A score change >30% was considered clinically significant. Past treatments, use of medications, smoking habits, height, weight, profession, and physical activity were also recorded on baseline, on discharge, and 1 year after discharge (resp., T0, T1, and T2). Results. At T0 103 patients with cLBP (51 cases and 52 controls) were recruited. The treatment (T1) has been completed by 79 (T1) of which 60 then carried out the 1-year follow-up (T2). Both GPR and PT at T1 were associated with a significant statistical and clinical improvement in pain and function, compared to T0. At T2, only pain in GPR still registered a statistically significant improvement. PMID:25945360

  13. A long-term follow-up of a randomized controlled trial of mother-infant psychoanalytic treatment: outcomes on the children.

    PubMed

    Salomonsson, Majlis Winberg; Sorjonen, Kimmo; Salomonsson, Bjrn

    2015-01-01

    A randomized controlled trial (RCT) compared two groups of mother-infant dyads in a Stockholm sample. One had received mother-infant psychoanalytic treatment (MIP group) and the other Child Health Center care (CHCC group). Effects were found on mother-reported depression and expert-rated mother-infant relationship qualities and maternal sensitivity. When the children were 4 years old, they were followed up with assessments of attachment representations, socioemotional development, and global functioning. They also were divided into two types according to individual characteristics and psychological well-being: the "OK" and the "Troubled" children. Of 80 dyads in the mother-infant RCT, data were gathered from 66 cases approximately 3 years after treatment. The children in the MIP group had better results on global functioning. There were more OK children in the MIP group and more Troubled children in the CHCC group. No other between-group differences were found. A relatively brief mother-infant psychotherapy seemed to help the children function better and be less troubled 3 years after therapy. PMID:25451617

  14. Effects of Polyphenol, Measured by a Biomarker of Total Polyphenols in Urine, on Cardiovascular Risk Factors After a Long-Term Follow-Up in the PREDIMED Study

    PubMed Central

    Guo, Xiaohui; Tresserra-Rimbau, Anna; Estruch, Ramón; Martínez-González, Miguel A.; Medina-Remón, Alexander; Castañer, Olga; Corella, Dolores; Lamuela-Raventós, Rosa M.

    2016-01-01

    Several epidemiological studies have shown an inverse association between the consumption of polyphenol-rich foods and risk of cardiovascular diseases. However, accuracy and reliability of these studies may be increased using urinary total polyphenol excretion (TPE) as a biomarker for total polyphenol intake. Our aim was to assess if antioxidant activity, measured by a Folin-Ciocalteu assay in urine, is correlated with an improvement in cardiovascular risk factors (blood pressure and serum glucose, cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride concentrations) in an elderly population at high risk. A longitudinal study was performed with 573 participants (aged 67.3 ± 5.9) from the PREDIMED study (ISRCTN35739639). We used Folin-Ciocalteu method to determine TPE in urine samples, assisting with solid phase extraction. Participants were categorized into three groups according to changes in TPE. Multiple linear regression models were used to assess relationships between TPE and clinical cardiovascular risk factors, adjusting for potential confounders. After a 5-year follow-up, significant inverse correlations were observed between changes in TPE and plasma triglyceride concentration (β = −8.563; P = 0.007), glucose concentration (β = −4.164; P = 0.036), and diastolic blood pressure (β = −1.316; P = 0.013). Our results suggest that the consumption of more polyphenols, measured as TPE in urine, could exert a protective effect against some cardiovascular risk factors. PMID:26881019

  15. Evolution of aortic wall thickness and stiffness with atherosclerosis: long-term follow up from the multi-ethnic study of atherosclerosis.

    PubMed

    Liu, Chia-Ying; Chen, Doris; Bluemke, David A; Wu, Colin O; Teixido-Tura, Gisela; Chugh, Atul; Vasu, Sujethra; Lima, Joo A C; Hundley, W Gregory

    2015-05-01

    The study was performed to determine age, sex, and time-dependent changes in aortic wall thickness (AWT) and to evaluate cross-sectional associations between AWT and arterial stiffness in older adults. Three hundred seventy-one longitudinal and 426 cross-sectional measurements of AWT from cardiovascular magnetic resonance imaging studies conducted within the Multi-Ethnic Study of Atherosclerosis were analyzed at 2 points in time, in 2000 to 2002 and then again from follow-up examinations in 2010 to 2012. Aortic wall thickness was determined from a double inversion recovery black-blood fast spin-echo sequence, and aortic stiffness was measured from a phase-contrast cine gradient echo sequence. The thickness of the midthoracic descending aortic wall was measured and correlated to distensibility of the ascending aorta and aortic pulse wave velocity. The average rate of AWT change was 0.032 mm/y. The increase in AWT was greater for those aged 45 to 54 years relative to individuals older than 55 years (P trend<0.001). Ascending aortic distensibility was lower (P<0.001) and pulse wave velocity was higher (P=0.012) for hypertensive subjects. After adjustment for traditional risk factors, distensibility of the ascending aorta was significantly related to AWT in participants without hypertension. Hypertension was associated with increased aortic stiffness independent of aortic wall thickness. PMID:25776078

  16. A LONG-TERM FOLLOW-UP STUDY OF A RANDOMIZED CONTROLLED TRIAL OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: OUTCOMES ON MOTHERS AND INTERACTIONS.

    PubMed

    Salomonsson, Majlis Winberg; Sorjonen, Kimmo; Salomonsson, Bjrn

    2015-11-01

    An earlier randomized controlled trial (RCT) compared 80 mother-infant dyads in a Stockholm sample. One had received mother-infant psychoanalytic treatment [mother-infant psychoanalytic therapies (MIP) group], and the other received Child Health Center care (CHCC group). Effects were found on mother-reported depression and expert-rated mother-infant relationship qualities and maternal sensitivity. When the children were 412 years, the dyads were followed up with assessments of the children's attachment representations, social and emotional development, and global functioning, and the mothers' psychological well-being and representations of the child as well as the mother-child interactions. We gathered data from 66 cases approximately 312 years' posttreatment. All scores involving the mothers had now approached community levels. We found effects on maternal depression in favor of MIP, but no other between-group differences. The MIP treatments seemed to have helped the mothers to recover more quickly on personal well-being, to become more sensitive to their babies' suffering, and to better support and appreciate their children throughout infancy and toddlerhood. If so, this would explain why the MIP children had a better global functioning and were more often "OK" and less often "Troubled" at 412 years. PMID:26551600

  17. Tumor Shrinkage Assessed by Volumetric MRI in Long-Term Follow-Up After Fractionated Stereotactic Radiotherapy of Nonfunctioning Pituitary Adenoma

    SciTech Connect

    Kopp, Christine; Theodorou, Marilena; Poullos, Nektarios; Jacob, Vesna; Astner, Sabrina T.; Molls, Michael; Grosu, Anca-Ligia

    2012-03-01

    Purpose: To evaluate tumor control and side effects associated with fractionated stereotactic radiotherapy (FSRT) in the management of residual or recurrent nonfunctioning pituitary adenomas (NFPAs). Methods and Materials: We assessed exact tumor volume shrinkage in 16 patients with NFPA after FSRT. All patients had previously undergone surgery. Gross tumor volume (GTV) was outlined on contrast-enhanced magnetic resonance imaging (MRI) before and median 63 months (range, 28-100 months) after FSRT. MRI was performed as an axial three-dimensional gradient echo T1-weighted sequence at 1.6-mm slice thickness without gap (3D MRI). Results: Mean tumor size of all 16 pituitary adenomas before treatment was 7.4 mL (3.3-18.9 mL). We found shrinkage of the treated pituitary adenoma in all patients. Within a median follow-up of 63 months (28-100 months) an absolute mean volume reduction of 3.8 mL (0.9-12.4 mL) was seen. The mean relative size reduction compared with the volume before radiotherapy was 51% (22%-95%). Shrinkage measured by 3D MRI was greater at longer time intervals after radiotherapy. A strong negative correlation between the initial tumor volume and the absolute volume reduction after FSRT was found. There was no correlation between tumor size reduction and patient age, sex, or number of previous surgeries. Conclusions: By using 3D MRI in all patients undergoing FSRT of an NFPA, tumor shrinkage is detected. Our data demonstrate that volumetric assessment based on 3D MRI adds additional information to routinely used radiological response measurements. After FSRT a mean relative size reduction of 51% can be expected within 5 years.

  18. Long-Term Follow-Up of a Homozygous Familial Hypercholesterolemic Patient Receiving Regular Double Filtration Plasmapheresis - Case Report and Literature Review.

    PubMed

    Tsai, Jun-Li; Wu, Ming-Ju; Shu, Kuo-Hsiung; Tsai, Shang-Feng

    2016-01-01

    Homozygous familial hypercholesterolemia (HoFH) is a very rare condition (1 case per 1 million people) with a dismal outcome due to inevitable coronary artery disease that occurs when left untreated. Lipoprotein apheresis (LA), previously known as low-density lipoprotein (LDL) apheresis, is very effective in reducing LDL-cholesterol (LDL-C) if HoFH is refractory to aggressive drug therapy and diet control. In this study, we report a case with HoFH, who presented with xanthomata over the 4 limbs when she was 3 years old. When she was 11 years old, she began treatment with semi-selective LA with double filtration plasmapheresis (DFPP) once per week because HoFH was refractory to high-dose statin and diet control. LDL-C was reduced from 8.2 ± 0.9 to 2.69 ± 0.75 mmol/l (reduction rate = 67.3 ± 6.1%). The xanthomata over the 4 limbs were nearly completely resolved after 2 years of DFPP. Two years later, after the initiation of DFPP, we performed coronary angiography and echocardiography for regular checkup in the absence of chest pain, and the result was negative. To date (11 years after initiation of DFPP), she has not complained of any chest pain, shown intolerance to exercise, or exhibited ST-T change on electrocardiography. At the age of 20, multidetector computed tomography showed no significant stenosis over the coronary arteries. At the most recent follow-up visit, she was found to have good heart function and no xanthomata. LA is effective in the treatment of HoFH when drug therapy and diet control fail. With this treatment, pre-existing xanthomata can regress and coronary artery disease can be prevented. PMID:26731699

  19. Adverse Events in the Long-Term Follow-Up of Patients Treated With Samarium Sm 153 Lexidronam for Osseous Metastases

    SciTech Connect

    Paravati, Anthony J.; Russo, Andrea L.; Aitken, Candice

    2011-10-01

    Purpose: To investigate adverse events after samarium Sm 153 lexidronam and the effect of pre- and post-samarium Sm 153 lexidronam external beam radiation therapy (EBRT) and/or chemotherapy on myelosuppression in patients who received samarium Sm 153 lexidronam for osseous metastases. Methods and Materials: We performed a single-institution retrospective review of 139 patients treated with samarium Sm 153 lexidronam between November 1997 and February 2008. New-onset adverse events after samarium Sm 153 lexidronam were reported. The effect of samarium Sm 153 lexidronam on platelet and peripheral white blood cell counts and the duration of myelosuppression after samarium Sm 153 lexidronam plus EBRT and/or chemotherapy were calculated. Differences in the prevalence of adverse events among patients with varying treatment histories were evaluated with the Pearson chi-square test. Results: Hematologic follow-up was available for 103 patients. Chemotherapy and/or EBRT had no effect on the magnitude or duration of myelosuppression. The most common nonhematologic adverse events were acute lower extremity edema (n = 27) and acute and transient neuropathy (n = 29). Patients treated with chemotherapy after samarium Sm 153 lexidronam had a higher prevalence of lower extremity edema (9 of 18 [50%]) than those who were not treated with chemotherapy after samarium Sm 153 lexidronam (18 of 85 [21.2%]) (p = 0.01, chi-square test). No adverse events were correlated with EBRT. Conclusions: Our observation of new-onset, acute and transient edema and neuropathy after samarium Sm 153 lexidronam and of a relationship between edema and post-samarium Sm 153 lexidronam chemotherapy suggests the need for re-examination of patients in past series or for a prospective investigation with nonhematologic adverse events as a primary endpoint.

  20. Cohort profile: The Japan diabetes complications study: a long-term follow-up of a randomised lifestyle intervention study of type 2 diabetes.

    PubMed

    Tanaka, Shiro; Tanaka, Sachiko; Iimuro, Satoshi; Yamashita, Hidetoshi; Katayama, Shigehiro; Ohashi, Yasuo; Akanuma, Yasuo; Yamada, Nobuhiro; Sone, Hirohito

    2014-08-01

    The Japan Diabetes Complications Study, a randomised lifestyle intervention study of type 2 diabetes conducted at 59 institutes throughout Japan that enrolled 2033 eligible patients from January 1995 to March 1996, was directed at: (i) determining the incidence and progression rates of complications of diabetes; (ii) exploring clinical risk factors for complications of diabetes; and (iii) determining the association between lifestyle factors, including diet and physical activity, and complications of diabetes, in addition to comparing, in a randomised manner, the effects on type 2 diabetes of an extensive lifestyle intervention and conventional treatment. The protocol for the study originally specified four study populations according to primary outcomes, consisting of: (1) a macroangiopathy group (N = 1771); (ii) a nephropathy group (N = 1607); (iii) a retinopathy-incident group (N = 1221); and (iv) a retinopathy-progression group (N = 410). The primary outcomes were: (i) development of retinopathy; (ii) progression of retinopathy; (iii) development of overt nephropathy; and (iv) occurrence of macroangiopathic events including proven coronary heart disease and stroke. The study was originally planned to follow patients for 8 years, and an extended follow-up is ongoing. Information about primary outcomes, laboratory tests, and other clinical variables for each patient was collected at a central data centre through an annual report from each investigator. Additionally, extensive lifestyle surveys were conducted at baseline and 5 years after the beginning of the study intervention in both the intervention and conventional treatment groups. A description of the occurrence of complications of diabetes and of all-cause mortality, provided in this paper, demonstrated a clear gender-based difference in cardiovascular disease and all-cause mortality. PMID:23687126

  1. Thymus and Mediastinal Node Involvement in Childhood Langerhans Cell Histiocytosis: Long-Term Follow-Up From the French National Cohort

    PubMed Central

    Ducassou, Stephane; Seyrig, Fanny; Thomas, Caroline; Lambilliotte, Anne; Marec-Berard, Perrine; Berger, Claire; Plat, Genevieve; Brugiere, Laurence; Ouache, Marie; Barkaoui, Mohamed; Armari-Alla, Corinne; Lutz, Patrick; Leverger, Guy; Rialland, Xavier; Mansuy, Ludovic; Pacquement, Helene; Jeziorski, Eric; Gandemer, Virginie; Chalard, Franois; Chateil, Jean Franois; Tazi, Abdellatif; Emile, Jean Franois; Donadieu, Jean

    2013-01-01

    Background Mediastinal involvement (MI) in Langerhans cell histiocytosis (LCH) has been rarely reported. Here, we describe the clinical, radiological, and biological presentation, and the outcome of childhood LCH with MI. Method From the French LCH register, which includes 1,423 patients aged less than 18 years, we retrieved the medical charts of patients with mediastinal enlargement detected on chest X-rays. Results Thirty-seven patients were retrieved, including 18 males; median age of diagnosis was 0.7 years, and median follow-up time was 6.2 years. The prevalence of MI varied with the age at diagnosis, ranging from 7% below 1 year old to less than 1% at >5 years. Thirteen cases (35%) were diagnosed because of MI-related symptoms, including respiratory distress (N?=?4), superior venous cava syndrome (N?=?2), and/or cough and polypnea (N?=?10). CT scans performed in 32 cases at diagnosis showed tracheal compression (N?=?5), cava thrombosis (N?=?2), and/or calcification (N?=?16). All patients presented multi-system disease at LCH diagnosis, and 35/37 were initially treated with vinblastine and corticosteroids. Death occurred in five cases, due to MI (N?=?1) or hematological refractory involvement (N?=?4). The overall 5-year survival was 87.1%, and immunodeficiency was not detected as a sequel. Conclusions MI in LCH mainly occurs in young children, and diagnosis was based on CT showing thymus enlargement and calcifications. Pediatr Blood Cancer 2013;60:17591765. 2013 Wiley Periodicals, Inc. PMID:23813854

  2. Standardized web-based cognitive behavioural therapy of mild to moderate depression: a randomized controlled trial with a long-term follow-up.

    PubMed

    Ruwaard, Jeroen; Schrieken, Bart; Schrijver, Menno; Broeksteeg, Janneke; Dekker, Jack; Vermeulen, Hans; Lange, Alfred

    2009-01-01

    Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions. PMID:19221919

  3. Piriformis Syndrome: Long-Term Follow-up in Patients Treated with Percutaneous Injection of Anesthetic and Corticosteroid Under CT Guidance

    SciTech Connect

    Masala, Salvatore Crusco, Sonia Meschini, Alessandro Taglieri, Amedeo Calabria, Eros Simonetti, Giovanni

    2012-04-15

    Purpose: This study was designed to evaluate the efficacy of CT-guided injection of anesthetic and corticosteroid for the treatment of pain in patients with piriformis syndrome unresponsive to conservative treatment. Methods: We enrolled 23 patients with piriformis syndrome, proposing a percutaneous intramuscular injection of methylprednisone-lidocaine. Among them, 13 patients accepted and 10 refused to undergo the procedure; the second group was used as a control group. Clinical evaluation was performed with four maneuvers (Lasegue sign, FAIR test, Beatty and Freiberg maneuver) and a VAS questionnaire before the injection, after 5-7 days, and after 2 months. A telephonic follow-up was conducted to 3, 6, and 12 months. Results: Procedural success was achieved in all patients who were treated without any complications. After 2 months, among 13 treated subjects, 2 of 13 patients showed positivity to FAIR test (hip flexion, adduction, and internal rotation), 2 of 13 were positive to Lasegue sign, and the Beatty maneuver was positive in 1 patient. Patients who underwent conservative treatment were positive respectively in 7 of 10 (p = 0.01), 6 of 10 (p = 0.03), and 6 of 10 (p = 0.01). The VAS score showed a difference between patients treated with percutaneous approach and those managed with conservative therapy at the baseline evaluation (p = 0.04), after 2 months (p = 0.02), and 12 months (p = 0.002). We observed a significant reduction in pain for patients treated percutaneously, who were evaluated with the VAS scale at 5-7 days, 2 months, 3, 6, and 12 months (p < 0.001). Conclusions: Our findings suggested potential benefit from the percutaneous injection of anesthetics and corticosteroids under CT guidance for the treatment of piriformis syndrome.

  4. Serum Proenkephalin A Levels and Mortality After Long-Term Follow-Up in Patients with Type 2 Diabetes Mellitus (ZODIAC-32)

    PubMed Central

    van Hateren, Kornelis J. J.; Landman, Gijs W. D.; Arnold, Jarinke F. H.; Joosten, Hanneke; Groenier, Klaas H.; Navis, Gerjan J.; Sparwasser, Andrea; Bakker, Stephan J. L.; Bilo, Henk J. G.; Kleefstra, Nanne

    2015-01-01

    Background Two previous studies concluded that proenkephalin A (PENK-A) had predictive capabilities for stroke severity, recurrent myocardial infarction, heart failure and mortality in patients with stroke and myocardial infarction. Objectives This study aimed to investigate the value of PENK-A as a biomarker for predicting mortality in patients with type 2 diabetes mellitus. Methods Patients with type 2 diabetes mellitus were included from the prospective observational ZODIAC (Zwolle Outpatient Diabetes project Integrating Available Care) study. The present analysis incorporated two ZODIAC cohorts (1998 and 2001). Since blood was drawn for 1204 out of 1688 patients (71%), and information on relevant confounders was missing in 47 patients, the final sample comprised 1157 patients. Cox proportional hazard models were used for evaluating the relationship between PENK-A and (cardiovascular) mortality. Risk prediction capabilities were assessed with Harrell’s C statistics and the integrated discrimination improvement (IDI). Results After a follow-up period of 14 years, 525 (45%) out of 1157 patients had died, of which 224 (43%) were attributable to cardiovascular factors. Higher Log PENK-A levels were not independently associated with increased (cardiovascular) mortality. Patients with PENK-A values in the highest tertile had a 49% (95%CI 1%-121%) higher risk of cardiovascular mortality compared to patients in the reference category (lowest tertile). C-values were not different after removing PENK-A from the Cox models and there were no significant differences in IDI values. Conclusions The associations between PENK-A and mortality were strongly attenuated after accounting for all traditional risk factors. Furthermore, PENK-A did not seem to have additional value beyond conventional risk factors when predicting all-cause and cardiovascular mortality. PMID:26218633

  5. Prognostic analysis of Chinese patients with metastasis renal cell cancer receiving sorafenib: results from a multicenter long-term follow-up retrospective study

    PubMed Central

    Guo, Fang; Han, Tao; Liu, Zhaozhe; Song, Xishuang; Zhang, Qifu; Kong, Xiangbo; Li, Changfu; Li, Zhenhua; Li, Chengge; Qu, Shuxian; Zheng, Zhendong; Piao, Ying; Han, Yaling; Xie, Xiaodong

    2015-01-01

    The effects of sorafenib for Chinese patients with metastatic renal cell cancer (mRCC) were evaluated to figure out the relationship between clinical variables and prognosis. The data were analyzed retrospectively from six comprehensive cancer centers in Northeast China. All cases were diagnosed as mRCC histopathologically without exception. Patients were taken 400 mg sorafenib orally twice daily until progression of disease or intolerable toxic reaction occurred. Overall survival (OS), progression-free survival (PFS), and the influence of clinical variables on survival were appointed as main outcome measures. Clinical data were analyzed using SPSS statistical software. P<0.05 was considered as statistically significant. A total of 131 patients were available for survival analysis. The median follow-up periods were 16.9 months, and the median OS and PFS were 16.1 months and 10.5 months, respectively. Univariate analysis showed that Eastern Cooperative Oncology Group performance status (ECOG PS), metastatic sites, and previous therapy were significantly associated with OS, whereas PFS was merely associated with ECOG PS and previous therapy. The multivariate analysis suggested that ECOG PS, metastatic sites, and previous therapy were the independent prognostic factors for OS, and ECOG PS and previous therapy as the independent prognostic factors for PFS. In the subgroup analysis for patients with visceral metastasis, the prognosis of patients with lung metastasis alone was better than those cases with liver metastasis alone or multiple organs metastasis. In our study, sorafenib shows a higher curative activity for patients with mRCC in Northeast China. ECOG PS, metastatic lesions, and previous therapy may be important parameters for OS and PFS prediction. Lung metastases alone may be a more sensitive indicator for sorafenib than other organ metastases. PMID:26170693

  6. Initial studies on active immunization of HIV-infected subjects using a gp120-depleted HIV-1 Immunogen: long-term follow-up.

    PubMed

    Levine, A M; Groshen, S; Allen, J; Munson, K M; Carlo, D J; Daigle, A E; Ferre, F; Jensen, F C; Richieri, S P; Trauger, R J; Parker, J W; Salk, P L; Salk, J

    1996-04-01

    In 1987, exploratory clinical studies were initiated to determine whether the development of AIDS in HIV-infected individuals might be delayed or prevented by immunization with an inactivated HIV preparation. Preclinical studies had shown the preparation to be safe and immunogenic. Twenty-three patients with biopsy-confirmed persistent generalized lymphadenopathy (CDC III) and two with asymptomatic HIV infection and CD4 lymphocyte counts between 135 and 769/mm3 were studied, of whom eight (32%) had additional HIV-related symptoms. Over a 3-year period, they received a median of eight open-label inoculations of 100 micrograms of inactivated gp 120-depleted HIV-1 Immunogen in incomplete Freund's adjuvant (IFA). Clinical, general laboratory, immunologic, and virologic parameters were followed for up to 6 years. No serious treatment-related adverse experiences were reported, nor was accelerated HIV disease progression seen. Twelve patients developed a delayed-type hypersensitivity response (HIV-DTH) to the immunogen and nine showed fourfold or greater increases in anti-p24 antibody titers. In the follow-up period, 10 of the 25 patients developed AIDS and one with Kaposi's sarcoma (KS) at baseline progressed. Of the 12 patients who became HIV-DTH-responsive, one developed an opportunistic infection (OI), occurring approximately 5 years from study onset, and subsequently died. One additional HIV-DTH responder developed KS. Of the 13 patients who remained HIV-DTH-nonresponsive, nine (69%) progressed to AIDS and seven of these have died. Differences were also observed in terms of HIV-DNA copy number, CD4 percentages, and anti-p24 antibody patterns between the HIV-DTH-responsive and -nonresponsive groups, suggesting a more favorable clinical course in the former. HIV-1 Immunogen in IFA appears to be safe and immunogenic. Further studies are indicated to determine clinical efficacy of the HIV Immunogen as well as the significance of the apparent correlation between HIV-DTH responsivity and a more favorable clinical course. PMID:8601221

  7. Extracorporeal detoxification for hepatic failure using molecular adsorbent recirculating system: depurative efficiency and clinical results in a long-term follow-up.

    PubMed

    Donati, Gabriele; La Manna, Gaetano; Cianciolo, Giuseppe; Grandinetti, Valeria; Carretta, Elisa; Cappuccilli, Maria; Panicali, Laura; Iorio, Mario; Piscaglia, Fabio; Bolondi, Luigi; Col, Luigi; Stefoni, Sergio

    2014-02-01

    Acute liver failure and acute-on-chronic liver failure still show a poor prognosis. The molecular adsorbent recirculating system (MARS) has been extensively used as the most promising detoxifying therapy for patients with these conditions. Sixty-four patients with life-threatening liver failure were selected, and 269 MARS treatments were carried out as a bridge for orthotopic liver transplantation (OLT) or for liver function recovery. All patients were grouped according to the aim of MARS therapy. Group A consisted of 47 patients treated for liver function recovery (median age 59 years, range 23-82). Group B consisted of 11 patients on the waiting list who underwent OLT (median age 47 years, range 32-62). Group C consisted of 6 patients on the waiting list who did not undergo OLT (median age 45.5 years, range 36-54, P?=?0.001). MARS depurative efficiency in terms of liver toxins, cytokines, and growth factors was assessed together with the clinical outcome of the patients during a 1-year follow-up. Total bilirubin reduction rate per session (RRs) for each MARS session was 23% (range 17-29); direct bilirubin RRs was 28% (21-35), and indirect bilirubin RRs was 8% (3-21). Ammonia RRs was 34% (12-86). Conjugated cholic acid RRs was 58% (48-61); chenodeoxycholic acid RRs was 34% (18-48). No differences were found between groups. Hepatocyte growth factor (HGF) values on starting MARS were 4.1?ng/mL (1.9-7.9) versus 7.9?ng/mL (3.2-14.1) at MARS end (P?

  8. Growth Assessment and the Risk of Growth Retardation in Congenital Diaphragmatic Hernia: A Long-Term Follow-Up Study from the Japanese Congenital Diaphragmatic Hernia Study Group.

    PubMed

    Terui, Keita; Nagata, Kouji; Hayakawa, Masahiro; Okuyama, Hiroomi; Goishi, Keiji; Yokoi, Akiko; Tazuke, Yuko; Takayasu, Hajime; Yoshida, Hideo; Usui, Noriaki

    2016-02-01

    Introduction?Little information exists about the physical growth of patients with congenital diaphragmatic hernia (CDH). This study aimed to assess the growth of patients with CDH during long follow-up periods, and to identify growth retardation (GR) risk factors. Patients and Methods?A multicenter retrospective observational study was conducted in 2013. Of the 228 patients with CDH born between 2006 and 2010, 182 (79.8%) survived to discharge, and 174 cases were included in the study. Body weights and heights were measured at 1.5, 3, and 6 years of age. GR was defined as a Z-score relating to the weight or height of?

  9. The search and destroy strategy prevents spread and long-term carriage of methicillin-resistant Staphylococcus aureus: results from the follow-up screening of a large ST22 (E-MRSA 15) outbreak in Denmark.

    PubMed

    Bcher, S; Skov, R L; Knudsen, M A; Guardabassi, L; Mlbak, K; Schouenborg, P; Srum, M; Westh, H

    2010-09-01

    In the aftermath of a methicillin-resistant Staphylococcus aureus (MRSA) ST22 hospital outbreak, we investigated the prevalence of long-term carriage, the efficacy of MRSA decolonization treatment (DT) and the spread of MRSA to households of patients and healthcare workers (HCWs). Furthermore, we evaluated the efficacy of repeated DT in long-term MRSA carriers. Of 250 index persons (58 HCWs and 192 patients), 102 persons (19 HCWs and 83 patients) and 67 household members agreed to participate. Samples from all 169 persons were taken from the nose, throat, wounds and devices/catheters, and urine samples were additionally taken from index persons. Samples from companion animals (n = 35) were taken from the nostrils and anus. Environmental sites (n = 490) screened were telephone, television remote control, toilet flush handle, favourite chair and skirting board beside the bed. Sixteen (19%) patients and two household members, but no HCWs, were ST22-positive. The throat was the most frequent site of colonization. In a multivariate analysis, chronic disease (p <0.001) and pharyngeal carriage (p <0.001) were associated with long-term MRSA carriage. MRSA was found in the environments of four long-term carriers. All animals tested were negative. MRSA-positive households were decolonized using nasal mupirocin TID and daily chlorhexidine body and hair wash for 5 days. Pharyngeal MRSA carriers also received fucidic acid (500 mg TID) combined with rifampicin (600 mg BID) or clindamycin (600 mg BID) for 7 days. The home environment was cleaned on days 2 and 5. At the end of follow-up, ten of 16 long-term carriers and the two household contacts were MRSA-negative. In conclusion, decolonization of MRSA carriers is possible, but should include treatment of household members and the environment. PMID:20041904

  10. Long-term Follow-up Results of a Multi-institutional Phase 2 Study of Concurrent Chemoradiation Therapy for Locally Advanced Cervical Cancer in East and Southeast Asia

    SciTech Connect

    Kato, Shingo; Ohno, Tatsuya; Thephamongkhol, Kullathorn; Chansilpa, Yaowalak; Cao, Jianping; Xu, Xiaoting; Devi, C. R. Beena; Swee, Tang Tieng; Calaguas, Miriam J.C.; Reyes, Rey H. de los; Cho, Chul-Koo; Dung, To Anh; Supriana, Nana; Erawati, Dyah; Mizuno, Hideyuki; Nakano, Takashi; Tsujii, Hirohiko

    2013-09-01

    Purpose: To report the long-term survival and toxicity of a multi-institutional phase 2 study of concurrent chemoradiation therapy (CCRT) for locally advanced cervical cancer in east and southeast Asia. Methods and Materials: Ten institutions from 8 Asian countries participated in the study. Between April 2003 and March 2006, 120 patients (60 with bulky stage IIB and 60 with stage IIIB) were treated with CCRT. Radiation therapy consisted of pelvic external beam radiation therapy and either high-dose-rate or low-dose-rate intracavitary brachytherapy. Five cycles of weekly cisplatin (40 mg/m{sup 2}) were administered during the course of radiation therapy. Treatment results were evaluated by the rates of local control, overall survival, and late toxicities. Results: Median follow-up was 63.7 months, and the follow-up rate at 5 years was 98%. The 5-year local control and overall survival rates for all patients were 76.8% and 55.1%, respectively. The 5-year rates of major late toxicities of the rectum and bladder were 7.9% and 0%, respectively. Conclusions: The long-term results have suggested that CCRT is safe and effective for patients with locally advanced cervical cancer in east and southeast Asia. However, further efforts are needed to improve overall survival.

  11. Sustained High Quality of Life in a 5-Year Long Term Follow-up after Successful Ablation for Supra-Ventricular Tachycardia. Results from a large Retrospective Patient Cohort

    PubMed Central

    Meissner, Axel; Stifoudi, Irini; Weismller, Peter; Schrage, Max-Olav; Maagh, Petra; Christ, Martin; Butz, Thomas; Trappe, Hans-Joachim; Plehn, Gunnar

    2009-01-01

    Introduction: The ablation of supraventricular tachycardias (SVT) using radiofrequency energy (RF) is a procedure with a high primary success rate. However, there is a scarcity of data regarding the long term outcome, particularly with respect to quality of life (QoL). Methods and Results: In this retrospective single-center study, 454 patients who underwent ablation of SVT between 2002 and 2007 received a detailed questionnaire addressing matters of QoL. The questionnaire was a modified version of the SF-36 Health Survey questionnaire and the Symptom Checklist Frequency and Severity Scale. After a mean follow up of 4.51.3 years, 309 (68.1%) of the contacted 454 patients (269 female, 59.2%, mean age 58+/-6.5) completed the questionnaire. Despite of 27% of relapses in the study group, 91.7% considered the procedure a long-term success. The remainder of patients experienced no change in (3.7%) or worsening of (4.7%) symptoms. There were no significant differences between the various types of SVT (p=1). QoL in patients with Atrio-Ventricular Nodal Reentry Tachycardia (AVNRT) and Atrio-Ventricular Reentry Tachycardia (AVRT) improved significantly (p<0.0005 respectively p<0.043), whereas QoL in patients with Ectopic Atrial Tachycardia (EAT) showed a non-significant trend towards improvement. Main symptoms before ablation, such as tachycardia (91.5%), increased incidence of tachycardia episodes over time (78.1%), anxiety (55.5%) and reduced physical capacity in daily life (52%) were significantly improved after ablation (p<0.0001). Conclusion: The high acute ablation success of SVT persists for years in long term follow up and translates into a significant improvement of QoL in most patients. PMID:19158961

  12. Long-Term Effectiveness of a Lifestyle Intervention for the Primary Prevention of Type 2 Diabetes in a Low Socio-Economic Community – An Intervention Follow-Up Study on Reunion Island

    PubMed Central

    Fianu, Adrian; Bourse, Léa; Naty, Nadège; Le Moullec, Nathalie; Lepage, Benoît; Lang, Thierry; Favier, François

    2016-01-01

    In type 2 diabetes (T2D) prevention research, evidence for maintenance of risk factor reduction after three years of follow-up is needed. The objective of this study was to evaluate the long-term effectiveness of a combined lifestyle intervention aiming at controlling body weight (BW) and waist circumference (WC) in non-diabetic, overweight/obese adults living in a low socio-economic community. On Reunion Island, 445 adults living in deprived areas, aged 18–40 and at high-risk for T2D, were included in an intervention versus control trial for primary prevention (2001–2002). The intervention promoted a healthy diet and moderate regular physical activity, through actions strengthening individuals or community and improving living conditions. The control group received a one-shot medical information and nutritional advices. After the end of the trial (2003), 259 of the subjects participated in a follow-up study (2010–2011). The outcomes were the nine-year changes from baseline in BW, body mass index (BMI) and WC measurements, separately. Statistical analyses were performed on an intention-to-treat basis, using available and imputed datasets. At inclusion, T2D risk factors were prevalent: family history of diabetes in first-degree relatives (42%), women with a personal history of gestational diabetes (11%), total obesity (43%, median BMI 29.1 kg/m²) and central obesity (71%). At follow-up, the adjusted effect on imputed dataset was significant for WC -2.4 cm (95% confidence interval: -4.7 to -0.0 cm, p = 0.046), non-significant for BW -2.2 kg (-4.6 to +0.2 kg, p = 0.073) and BMI -0.81 kg/m² (-1.69 to +0.08 kg/m², p = 0.074). A specific long-term effect was the increased likelihood of reduction in adiposity: BW loss, BMI reduction, and WC reduction were more frequent in the intervention group. In the context of low socio-economic communities, our data support the assumption of long-term effect of lifestyle interventions targeting total obesity and central obesity two major drivers of T2D. PMID:26731676

  13. Long-Term Safety and Longevity of a Mixture of Polymethyl Methacrylate and Cross-Linked Dextran (Lipen-10®) after Penile Augmentation: Extension Study from Six to 18 Months of Follow-Up

    PubMed Central

    Kim, Ma Tae; Ko, Kyungtae; Lee, Won Ki; Kim, Sae Chul

    2015-01-01

    Purpose The goal of this study was to investigate the long-term efficacy and safety of a mixture of polymethyl methacrylate (PMMA) and cross-linked dextran Lipen-10® used for penile augmentation under the physical impact generated during sexual intercourse. Materials and Methods From March 2010 to October 2011, a total of 20 patients with a mean age of 44 years (interquartile range, 20~70 years) who requested penile augmentation participated in this study. Lipen-10® filler is a mixture of 75% cross-linked dextran, 15% PMMA, and 10% hypromellose solution. With the patient in the supine position, Lipen-10® was injected into the subcutaneous tissue between the dartos fascia and Buck's fascia of the penis using a fanning technique. Penile length and circumference were measured before the procedure and six, 12, and 18 months after the procedure. Values were compared using the Student's t-test and the paired t-test. Results A total of 15 patients completed this study. The increases in circumference and length observed six months after the procedure were found to have been maintained without change at 12 and 18 months of follow-up. At 12 and 18 months of follow-up, no abnormal findings were observed. Pelvic magnetic resonance imaging conducted at 18 months of follow-up showed no trace of the injected filler having migrated to other sites, and the volume was well maintained. Conclusions Lipen-10®, a mixture of PMMA and cross-linked dextran, showed good durability and tolerability over 18 months of follow-up during which the participants were sexually active. PMID:26770941

  14. Long-Term Follow-Up of Preoperative Pelvic Radiation Therapy and Concomitant Boost Irradiation in Locally Advanced Rectal Cancer Patients: A Multi-Institutional Phase II Study (KROG 04-01)

    SciTech Connect

    Lee, Jong Hoon; Department of Radiation Oncology, St. Vincent's Hospital, Catholic University of Korea, Suwon ; Kim, Dae Yong; Nam, Taek-Keun; Yoon, Sei-Chul; Lee, Doo Seok; Park, Ji Won; Oh, Jae Hwan; Chang, Hee Jin; Yoon, Mee Sun; Jeong, Jae-Uk; Jang, Hong Seok

    2012-11-15

    Purpose: To perform a prospective phase II study to investigate the efficacy and safety of preoperative pelvic radiation therapy and concomitant small-field boost irradiation with 5-fluorouracil and leucovorin for 5 weeks in locally advanced rectal cancer patients. Methods and Materials: Sixty-nine patients with locally advanced, nonmetastatic, mid-to-lower rectal cancer were prospectively enrolled. They had received preoperative chemoradiation therapy and total mesorectal excision. Pelvic radiation therapy of 43.2 Gy in 24 fractions plus concomitant boost radiation therapy of 7.2 Gy in 12 fractions was delivered to the pelvis and tumor bed for 5 weeks. Two cycles of 5-fluorouracil and leucovorin were administered for 3 days in the first and fifth week of radiation therapy. The pathologic response, survival outcome, and treatment toxicity were evaluated for the study endpoints. Results: Of 69 patients, 8 (11.6%) had a pathologically complete response. Downstaging rates were 40.5% for T classification and 68.1% for N classification. At the median follow-up of 69 months, 36 patients have been followed up for more than 5 years. The 5-year disease-free survival (DFS) and overall survival rates were 66.0% and 75.3%, respectively. Higher pathologic T (P = .045) and N (P = .032) classification were significant adverse prognostic factors for DFS, and high-grade histology was an adverse prognostic factor for both DFS (P = .025) and overall survival (P = .031) on the multivariate analysis. Fifteen patients (21.7%) experienced grade 3 or 4 acute toxicity, and 7 patients (10.1%) had long-term toxicity. Conclusion: Preoperative pelvic radiation therapy with concomitant boost irradiation with 5-fluorouracil and leucovorin for 5 weeks showed acceptable acute and long-term toxicities. However, the benefit of concomitant small-field boost irradiation for 5 weeks in rectal cancer patients was not demonstrated beyond conventional irradiation for 6 weeks in terms of tumor response and survival.

  15. High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up

    PubMed Central

    Ishiyama, Hiromichi; Satoh, Takefumi; Kitano, Masashi; Tabata, Ken-ichi; Komori, Shouko; Ikeda, Masaomi; Soda, Itaru; Kurosaka, Shinji; Sekiguchi, Akane; Kimura, Masaki; Kawakami, Shogo; Iwamura, Masatsugu; Hayakawa, Kazushige

    2014-01-01

    The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent 192Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ≥6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25–94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach. PMID:24222312

  16. High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up.

    PubMed

    Ishiyama, Hiromichi; Satoh, Takefumi; Kitano, Masashi; Tabata, Ken-ichi; Komori, Shouko; Ikeda, Masaomi; Soda, Itaru; Kurosaka, Shinji; Sekiguchi, Akane; Kimura, Masaki; Kawakami, Shogo; Iwamura, Masatsugu; Hayakawa, Kazushige

    2014-05-01

    The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent (192)Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ? 6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25-94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach. PMID:24222312

  17. Nonresected Non-Small-Cell Lung Cancer in Stages I Through IIIB: Accelerated, Twice-Daily, High-Dose Radiotherapy-A Prospective Phase I/II Trial With Long-Term Follow-Up

    SciTech Connect

    Wurstbauer, Karl; Deutschmann, Heinz; Kopp, Peter; Kranzinger, Manfred; Merz, Florian; Nairz, Olaf; Studnicka, Michael; Sedlmayer, Felix

    2010-08-01

    Purpose: Our purpose was to investigate the tolerability of accelerated, twice-daily, high-dose radiotherapy. The secondary endpoints were survival and locoregional tumor control. Methods and Materials: Thirty consecutive patients with histologically/cytologically proven non-small-cell lung cancer were enrolled. Tumor Stage I, II, IIIA, and IIIB was found in 7, 3, 12, and 8 patients, respectively. We applied a median of 84.6 Gy (range, 75.6-90.0 Gy) to the primary tumors, 63.0 Gy (range, 59.4-72.0 Gy) to lymph nodes, and 45 Gy to nodes electively (within a region of about 6 cm cranial to macroscopically involved sites). Fractional doses of 1.8 Gy twice daily, with an interval of 11 hours, were given, resulting in a median treatment time of 35 days. In the majority of patients the conformal target-splitting technique was used. In 19 patients (63%) two cycles of induction chemotherapy were given. The median follow-up time of survivors is 72 months (range, 62-74 months). Results: We found Grade 1, 2 and 3 acute esophageal toxicity in 11 patients (37%), 2 patients (7%), and 2 patients (7%), respectively. Grade 2 acute pneumonitis was seen in 2 patients (7%). No late toxicity greater than Grade 1 was observed. The actual overall survival rates at 2 and 5 years are 63% and 23%, respectively; the median overall survival, 27.7 months. In 9 patients a local failure occurred, 7 of them presenting initially with an atelectasis without availability of 18-fluorodeoxyglucose-positron emission tomography staging at that time. In 4 patients recurrence occurred regionally. Conclusions: This Phase I/II trial with long-term follow-up shows low toxicity with promising results for survival and locoregional tumor control.

  18. Long-term Follow-up of the RTOG 9501/Intergroup Phase III Trial: Postoperative Concurrent Radiation Therapy and Chemotherapy in High-Risk Squamous Cell Carcinoma of the Head and Neck

    SciTech Connect

    Cooper, Jay S.; Zhang Qiang; Pajak, Thomas F.; Forastiere, Arlene A.; Jacobs, John; Saxman, Scott B.; Kish, Julie A.; Kim, Harold E.; Cmelak, Anthony J.; Rotman, Marvin; Lustig, Robert; Ensley, John F.; Thorstad, Wade; Schultz, Christopher J.; Yom, Sue S.; Ang, K. Kian

    2012-12-01

    Purpose: Previous analysis of this Intergroup trial demonstrated that with a median follow-up among surviving patients of 45.9 months, the concurrent postoperative administration of cisplatin and radiation therapy improved local-regional control and disease-free survival of patients who had high-risk resectable head-and-neck carcinomas. With a minimum of 10 years of follow-up potentially now available for all patients, these results are updated here to examine long-term outcomes. Methods and Materials: A total of 410 analyzable patients who had high-risk resected head-and-neck cancers were prospectively randomized to receive either radiation therapy (RT: 60 Gy in 6 weeks) or identical RT plus cisplatin, 100 mg/m{sup 2}i.v. on days 1, 22, and 43 (RT + CT). Results: At 10 years, the local-regional failure rates were 28.8% vs 22.3% (P=.10), disease-free survival was 19.1% vs 20.1% (P=.25), and overall survival was 27.0% vs 29.1% (P=.31) for patients treated by RT vs RT + CT, respectively. In the unplanned subset analysis limited to patients who had microscopically involved resection margins and/or extracapsular spread of disease, local-regional failure occurred in 33.1% vs 21.0% (P=.02), disease-free survival was 12.3% vs 18.4% (P=.05), and overall survival was 19.6% vs 27.1% (P=.07), respectively. Conclusion: At a median follow-up of 9.4 years for surviving patients, no significant differences in outcome were observed in the analysis of all randomized eligible patients. However, analysis of the subgroup of patients who had either microscopically involved resection margins and/or extracapsular spread of disease showed improved local-regional control and disease-free survival with concurrent administration of chemotherapy. The remaining subgroup of patients who were enrolled only because they had tumor in 2 or more lymph nodes did not benefit from the addition of CT to RT.

  19. New Dimensional Staging of Bisphosphonate-Related Osteonecrosis of the Jaw Allowing a Guided Surgical Treatment Protocol: Long-Term Follow-Up of 266 Lesions in Neoplastic and Osteoporotic Patients from the University of Bari

    PubMed Central

    Franco, Simonetta; Miccoli, Simona; Limongelli, Luisa; Tempesta, Angela; Favia, Giorgio; Maiorano, Eugenio; Favia, Gianfranco

    2014-01-01

    Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is the most serious side effect in patients receiving bisphosphonates (BPs) for neoplastic disease and osteoporosis. The aim of this study is to propose a new dimensional stage classification, guiding the surgical treatment of BRONJ patients, and to evaluate the success rate of this new management. From 2004 to 2013, 203 neoplastic and osteoporotic patients with 266 BRONJ lesions were referred to the Odontostomatology Unit of the University of Bari. All patients underwent surgery after suspension of BPs therapy and antibiotic treatment. The surgical procedure was complemented by piezosurgery and followed by the application of hyaluronate and amino acids. The new dimensional staging suggests the choice of the surgical approach, and allows the prediction of postoperative complications and soft and hard tissues healing time, guiding the surgical treatment protocol. This protocol could be a successful management strategy for BRONJ, considering the low recurrences rate and the good stabilisation of the surgical sites observed after a long-term follow-up. PMID:24995017

  20. Long-term follow-up of dose-adjusted EPOCH plus rituximab (DA-EPOCH-R) in untreated patients with poor prognosis large B-cell lymphoma. A phase II study conducted by the Spanish PETHEMA Group.

    PubMed

    Purroy, Noelia; Bergua, Juan; Gallur, Laura; Prieto, Julio; Lopez, Luis A; Sancho, Juan M; García-Marco, Jose A; Castellví, Josep; Montes-Moreno, Santiago; Batlle, Ana; de Villambrosia, Sonia Gonzalez; Carnicero, Fernando; Ferrando-Lamana, Lucía; Piris, Miguel A; Lopez, Andrés

    2015-04-01

    This prospective multi-institutional phase II study was designed to assess the efficacy and safety of dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide and doxorubicin) plus rituximab (DA-EPOCH-R) in untreated patients with poor prognosis large B-cell lymphomas. Eighty-one patients diagnosed with diffuse large B-cell lymphoma (DLBCL, n = 68), primary mediastinal DLBCL (n = 6) and follicular lymphoma Grade 3b (n = 7), with an age-adjusted International Prognostic Index >1, were eligible for analysis. Median age was 60 years (range: 21-77). Sixty-five patients (80·2%) achieved complete response. After a median follow-up time of 64 months, 10-year event-free survival and overall survival (OS) were 47·8% and 63·6%, respectively. None of the studied clinical and biological characteristics were associated with poorer outcome. Interestingly, patients with BCL6 rearrangement achieved a 10-year OS of 100%, while patients with BCL2 rearrangement exhibited a poorer outcome compared to activated B-cell tumours and germinal centre B-cell without BCL2 rearranged tumours. Results achieved with DA-EPOCH-R showed a good long-term outcome and a tolerable toxicity profile in high-risk large B cell lymphoma patients. Outcome was not affected by tumour cell proliferation or by cell of origin, highlighting the requirement of new biological markers for patient subclassification of high-risk DLBCL patients. PMID:25521006

  1. Long-term Survival Outcomes Following Internal Mammary Node Irradiation in Stage II-III Breast Cancer: Results of a Large Retrospective Study With 12-Year Follow-up

    SciTech Connect

    Chang, Jee Suk; Park, Won; Kim, Yong Bae; Lee, Ik Jae; Keum, Ki Chang; Lee, Chang Geol; Choi, Doo Ho; Suh, Chang-Ok; Huh, Seung Jae

    2013-08-01

    Purpose: To examine the effect of internal mammary node irradiation (IMNI) on disease-free survival (DFS) and overall survival (OS) in breast cancer patients treated with modified radical mastectomy and postoperative radiation therapy. Methods and Materials: Between 1994 and 2002, 396 patients with stage II-III breast cancer were treated with postmastectomy radiation therapy with (n=197) or without (n=199) IMNI. Patients who received neoadjuvant chemotherapy were excluded. IMNI was administered at the clinical discretion of the treating physician. Median RT dose was 50.4 Gy (range, 45.0-59.4 Gy) in 28 fractions, with inclusion of the supraclavicular fossa in 96% of patients. Adjuvant chemotherapy was administered to 99.7% of the patients and endocrine therapy to 53%. Results: The median follow-up was 149 months (range, 124-202). IMNI patients had more advanced nodal stage and non-high grade tumors than those without IMNI (P<.001). Otherwise, disease and treatment characteristics were well balanced. The 10-year DFS with and without IMNI was 65% and 57%, respectively (P=.05). Multivariate analysis demonstrated that IMNI was an independent, positive predictor of DFS (hazard ratio [HR], 0.70; P=.02). Benefits of IMNI in DFS were seen most apparently in N2 patients (HR, 0.44; 95% confidence interval [CI], 0.26-0.74) and inner/central tumors (HR, 0.55; 95% CI, 0.34-0.90). The 10-year OS with and without IMNI was 72% and 66%, respectively (P=.62). The 10-year DFS and OS were 61%, and 69%, respectively. Conclusions: Internal mammary node irradiation significantly improved DFS in postmastectomy breast cancer patients. Pending long-term results from randomized trials, treatment of internal mammary nodes should be considered in postmastectomy radiation therapy.

  2. Long-term (6 and 12 months) follow-up of two prospective, randomized, controlled phase III trials of photodynamic therapy with BF-200 ALA and methyl aminolaevulinate for the treatment of actinic keratosis

    PubMed Central

    Dirschka, T; Radny, P; Dominicus, R; Mensing, H; Brning, H; Jenne, L; Karl, L; Sebastian, M; Oster-Schmidt, C; Klvekorn, W; Reinhold, U; Tanner, M; Grne, D; Deichmann, M; Simon, M; Hbinger, F; Hofbauer, G; Krhn-Senftleben, G; Borrosch, F; Reich, K; Berking, C; Wolf, P; Lehmann, P; Moers-Carpi, M; Hnigsmann, H; Wernicke-Panten, K; Hahn, S; Pabst, G; Voss, D; Foguet, M; Schmitz, B; Lbbert, H; Szeimies, R-M

    2013-01-01

    Background Two phase III trials of photodynamic therapy (PDT) with BF-200 ALA, a recently approved nanoemulsion formulation of 5-aminolaevulinic acid (ALA) demonstrated high clearance rates in mild-to-moderate actinic keratosis (AK). The comparison to a registered methyl aminolaevulinate (MAL) cream demonstrated significantly superior total patient clearance rates. Objectives To evaluate long-term efficacy and safety of PDT for AK 6 and 12 months after the last PDT with BF-200 ALA, MAL or placebo. Methods The follow-up phase (FUP) was performed with patients of two phase III studies. Both studies compared BF-200 ALA with placebo, one of the studies additionally with MAL. Overall recurrence rates and various subgroups (light source, lesion severity, lesion location, complete responders after first PDT) were assessed 6 and 12 months after the last PDT. Results Recurrence rates were similar for BF-200 ALA and MAL, with a tendency to lower recurrence rates for BF-200 ALA. The proportion of patients who were fully cleared during PDT and remained completely clear for at least 12 months after PDT were 47% for BF-200 ALA (both studies) and 36% for MAL treatment. The subgroup that was illuminated with narrow wavelength LED lamps reached 69% and 53% for BF-200 ALA (both studies, respectively) and 41% for MAL. No safety concerns were reported. Conclusions The FUP data confirmed the high efficacy and safety of PDT with BF-200 ALA. The slightly lower recurrence rates after BF-200 ALA treatment compared with MAL treatment enhanced the better treatment outcome due to the significantly superior efficacy. PMID:23252768

  3. Primary and secondary cutaneous CD30(+) lymphoproliferative disorders: a report from the Dutch Cutaneous Lymphoma Group on the long-term follow-up data of 219 patients and guidelines for diagnosis and treatment.

    PubMed

    Bekkenk, M W; Geelen, F A; van Voorst Vader, P C; Heule, F; Geerts, M L; van Vloten, W A; Meijer, C J; Willemze, R

    2000-06-15

    To evaluate our diagnostic and therapeutic guidelines, clinical and long-term follow-up data of 219 patients with primary or secondary cutaneous CD30(+) lymphoproliferative disorders were evaluated. The study group included 118 patients with lymphomatoid papulosis (LyP; group 1), 79 patients with primary cutaneous CD30(+) large T-cell lymphoma (LTCL; group 2), 11 patients with CD30(+) LTCL and skin and regional lymph node involvement (group 3), and 11 patients with secondary cutaneous CD30(+) LTCL (group 4). Patients with LyP often did not receive any specific treatment, whereas most patients with primary cutaneous CD30(+) LTCL were treated with radiotherapy or excision. All patients with skin-limited disease from groups 1 and 2 who were treated with multiagent chemotherapy had 1 or more skin relapses. The calculated risk for systemic disease within 10 years of diagnosis was 4% for group 1, 16% for group 2, and 20% for group 3 (after initial therapy). Disease-related 5-year-survival rates were 100% (group 1), 96% (group 2), 91% (group 3), and 24% (group 4), respectively. The results confirm the favorable prognoses of these primary cutaneous CD30(+) lymphoproliferative disorders and underscore that LyP and primary cutaneous CD30(+) lymphomas are closely related conditions. They also indicate that CD30(+) LTCL on the skin and in 1 draining lymph node station has a good prognosis similar to that for primary cutaneous CD30(+) LTCL without concurrent lymph node involvement. Multiagent chemotherapy is only indicated for patients with full-blown or developing extracutaneous disease; it is never or rarely indicated for patients with skin-limited CD30(+) lymphomas. (Blood. 2000;95:3653-3661) PMID:10845893

  4. Gender, Living Arrangements, and Social Circumstances as Determinants of Entry into and Exit from Long-Term Institutional Care at Older Ages: A 6-Year Follow-Up Study of Older Finns

    ERIC Educational Resources Information Center

    Martikainen, Pekka; Moustgaard, Heta; Murphy, Michael; Einio, Elina K.; Koskinen, Seppo; Martelin, Tuija; Noro, Anja

    2009-01-01

    Purpose: Due to population aging, the need for long-term institutional care is increasing. We study the potentially modifiable sociodemographic factors that affect the rate of entry into and exit from long-term care. Design and Methods: A 40% sample from the population registration data of Finns aged 65 and older living in private households at

  5. Gender, Living Arrangements, and Social Circumstances as Determinants of Entry into and Exit from Long-Term Institutional Care at Older Ages: A 6-Year Follow-Up Study of Older Finns

    ERIC Educational Resources Information Center

    Martikainen, Pekka; Moustgaard, Heta; Murphy, Michael; Einio, Elina K.; Koskinen, Seppo; Martelin, Tuija; Noro, Anja

    2009-01-01

    Purpose: Due to population aging, the need for long-term institutional care is increasing. We study the potentially modifiable sociodemographic factors that affect the rate of entry into and exit from long-term care. Design and Methods: A 40% sample from the population registration data of Finns aged 65 and older living in private households at…

  6. Impact of exposure to interferon beta-1a on outcomes in patients with relapsingremitting multiple sclerosis: exploratory analyses from the PRISMS long-term follow-up study

    PubMed Central

    Uitdehaag, Bernard; Constantinescu, Cris; Cornelisse, Peter; Jeffery, Douglas; Kappos, Ludwig; Li, David; Sandberg-Wollheim, Magnhild; Traboulsee, Anthony; Verdun, Elisabetta; Rivera, Victor

    2011-01-01

    Objective: To explore the effects of exposure to subcutaneous (sc) interferon (IFN) beta-1a on efficacy in patients with relapsingremitting multiple sclerosis (RRMS) enrolled in the PRISMS (Prevention of Relapses and disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) study. Methods: Patients with RRMS received IFN beta-1a, 44 or 22?g sc three times weekly (tiw), or placebo, for 2 years, at which point placebo recipients were re-randomized to IFN beta-1a, 44 or 22?g sc tiw, for a further 24 years. Long-term follow-up visits occurred 78 years after enrolment and allowed participation of patients who had previously discontinued treatment. Post hoc descriptive analyses were conducted within the lower (MIN) and upper (MAX) quartiles of patients divided according to cumulative dose of IFN beta-1a and cumulative time on treatment. Outcomes were explored in patients initially randomized to IFN beta-1a, 44?g sc tiw, who had received continuous or noncontinuous therapy during the study. Results: For both cumulative dose and time analyses, the MIN and MAX groups comprised 96 and 95 patients, respectively. The continuous and noncontinuous groups included 45 and 91 patients, respectively. The MAX DOSE and MAX TIME groups had lower annualized relapse rates, lower rates of conversion to secondary progressive MS, lower percentages of patients with Expanded Disability Status Scale progression, higher percentages of relapse-free patients, and less T2 burden of disease than the MIN groups. The continuous therapy group had a lower annualized relapse rate and lower percentages of patients with Expanded Disability Status Scale progression or conversion to secondary progressive MS than the noncontinuous therapy group. Conclusions: The findings of these post hoc analyses suggest that high exposure to sc IFN beta-1a may be associated with better clinical outcomes than low exposure, and also highlight the importance of maximizing adherence. Additional prospective investigation is warranted to evaluate further the effects of treatment exposure on outcomes and to determine the benefits of interventions to improve adherence. PMID:21339904

  7. What sort of follow-up services would Australian breast cancer survivors prefer if we could no longer offer long-term specialist-based care? A discrete choice experiment

    PubMed Central

    Bessen, T; Chen, G; Street, J; Eliott, J; Karnon, J; Keefe, D; Ratcliffe, J

    2014-01-01

    Background: Early diagnosis and improved treatment outcomes have increased breast cancer survival rates that, in turn, have led to increased numbers of women undergoing follow-up after completion of primary treatment. The current workload growth is unsustainable for breast cancer specialists who also provide care for women newly diagnosed or with a recurrence. Appropriate and acceptable follow-up care is important; yet, currently we know little about patient preferences. The aim of this study was to explore the preferences of Australian breast cancer survivors for alternative modes of delivery of follow-up services. Methods: A self-administered questionnaire (online or paper) was developed. The questionnaire contained a discrete choice experiment (DCE) designed to explore patient preferences with respect to provider, location, frequency and method of delivery of routine follow-up care in years 3, 4 and 5 after diagnosis, as well as the perceived value of ‘drop-in' clinics providing additional support. Participants were recruited throughout Australia over a 6-month period from May to October 2012. Preference scores and choice probabilities were used to rank the top 10 most preferred follow-up scenarios for respondents. Results: A total of 836 women participated in the study, of whom 722 (86.4%) completed the DCE. In the absence of specialist follow-up, the 10 most valued surveillance scenarios all included a Breast Physician as the provider of follow-up care. The most preferred scenario is a face-to-face local breast cancer follow-up clinic held every 6 months and led by a Breast Physician, where additional clinics focused on the side effects of treatment are also provided. Conclusion: Beyond the first 2 years from diagnosis, in the absence of a specialist led follow-up, women prefer to have their routine breast cancer follow-up by a Breast Physician (or a Breast Cancer Nurse) in a dedicated local breast cancer clinic, rather than with their local General Practitioner. Drop-in clinics for the management of treatment related side effects and to provide advice to both develop and maintain good health are also highly valued by breast cancer survivors. PMID:24423927

  8. Long-term outcomes of anthroposophic treatment for chronic disease: a four-year follow-up analysis of 1510 patients from a prospective observational study in routine outpatient settings

    PubMed Central

    2013-01-01

    Background Anthroposophic treatment includes special artistic and physical therapies and special medications. We here report an update to a previously published study of anthroposophic treatment for chronic diseases, including more patients and a longer follow up. The Anthroposophic Medicine Outcomes Study (AMOS) was a prospective observational cohort study of anthroposophic treatment for chronic indications in routine outpatient settings in Germany. Anthroposophic treatment was associated with improvements of symptoms and quality of life. Previous follow-up-analyses have been performed after 24months or, in subgroups of patients enrolled in the period 1999-2001, after 48months. We conducted a 48-month follow-up analysis of all patients enrolled in AMOS in the period 1999-2005. Methods 1,510 outpatients aged 1-75years, starting anthroposophic treatment for chronic conditions in routine German outpatient settings, participated in a prospective cohort study. Main outcomes were Symptom Score (primary outcome, mean symptom severity on numerical rating scales), SF-36 Physical and Mental Component scores in adults, and disease-specific outcomes in the six most common diagnosis groups: asthma, anxiety disorders and migraine (numerical rating scales), depression (Center for Epidemiological Studies Depression Scale), attention deficit hyperactivity symptoms (FBB-HKS Total score), and low back pain (Hanover Functional Ability Questionnaire, Low Back Pain Rating Scale). Results Median disease duration at baseline was 3.5years. From baseline to 48-month follow-up all ten outcomes improved significantly (p?follow-up analysis confirmed previous analyses from the AMOS study. Outpatients receiving anthroposophic treatment for chronic indications had sustained, clinically relevant improvements of symptoms and quality of life. PMID:23849335

  9. Effect of Prehospital Induction of Mild Hypothermia on 3?Month Neurological Status and 1?Year Survival Among Adults With Cardiac Arrest: Long?Term Follow?up of a Randomized, Clinical Trial

    PubMed Central

    Maynard, Charles; Longstreth, W. T.; Nichol, Graham; Hallstrom, Al; Kudenchuk, Peter J.; Rea, Thomas; Copass, Michael K.; Carlbom, David; Deem, Steven; Olsufka, Michele; Cobb, Leonard A.; Kim, Francis

    2015-01-01

    Background Randomized trials of prehospital cooling after cardiac arrest have shown that neither prehospital cooling nor targeted temperature management differentially affected short?term survival or neurological function. In this follow?up study, we assess the association of prehospital hypothermia with neurological function at least 3 months after cardiac arrest and survival 1 year after cardiac arrest. Methods and Results There were 508 individuals who were discharged alive from hospitals in King County, Washington; 373 (73%) were interviewed by telephone 12343 days after the initial event. Overall, 59% of the treatment group and 58% of the control group had Cerebral Performance Category (CPC) 1 or 2 (P=0.70), and 50% of the treatment group and 49% of the control group had slight disability or better by the Modified Rankin Scale (MRS; (P=0.35). One?year survival was 87% in the treatment group and 84% in the control group (P=0.42). Of those with CPC 1 at hospital discharge, 68% had CPC 1 or 2 at follow?up, and 59% had MRS of slight disability or better. Of 41 patients with CPC 3 or 4 at discharge, only 12% had CPC 2 at follow?up, and just 5% had MRS of slight disability or better. One?year survival was 92% for CPC 1 at discharge, but only 40% for CPC 4. Conclusion In addition to excellent survival, patients who had good neurological function at discharge continued to have good function at least 3 months after the event. Clinical Trial Registration URL: Clinicaltrials.gov. Unique identifier: NCT00391469 PMID:25762805

  10. A retrospective comparative study of mortality and causes of death among patients with metal-on-metal and metal-on-polyethylene total hip prostheses in primary osteoarthritis after a long-term follow-up

    PubMed Central

    2010-01-01

    Background All patients with total hip arthroplasty (THA), especially those with metal-on-metal (MM) THA, are exposed to metallic particles and ions, which may cause total or site-specific mortality. We analyzed the causes of total and site-specific mortality among a cohort of patients with MM and with metal-on-polyethylene (MP) THA after a long follow-up time. Methods Standardized mortality ratios (SMR) of total and site-specific causes of death were calculated for 579 patients with MM (McKee-Farrar) and 1585 patients with MP (Brunswik, Lubinus) THA for primary osteoarthritis. Results Mean follow-up time was 17.9 years for patients with MM and 16.7 years for patients with MP. Overall SMR was 0.95 for the MM cohort and 0.90 for the MP cohort, as compared to the normal population. Both cohorts showed significantly decreased mortality for the first decade postoperatively, equal mortality over the next 10 years, and significantly increased mortality after 20 years. Patients with MM THA had higher cancer mortality (SMR 1.01) than those with MP THA (SMR 0.66) during the first 20 years postoperatively, but not thereafter. Conclusion Both MM and MP prostheses are safe based on total and site-specific mortality of recipients during the first 20 postoperative years in comparison with the general population. PMID:20416065

  11. Long-term follow-up of moderately hypercholesterolemic hypertensive patients following randomization to pravastatin vs. usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)

    PubMed Central

    Margolis, Karen L.; Davis, Barry R.; Baimbridge, Charles; Ciocon, Jerry O.; Cuyjet, Aloysius B.; Dart, Richard A.; Einhorn, Paula T.; Ford, Charles E.; Gordon, David; Hartney, Thomas J; Haywood, L. Julian; Holtzman, Jordan; Mathis, David E.; Oparil, Suzanne; Probstfield, Jeffrey L.; Simpson, Lara M.; Stokes, John D.; Wiegmann, Thomas B.; Williamson, Jeff D.

    2015-01-01

    A randomized, controlled, multicenter trial assigned well-controlled hypertensive participants ?55 years, with moderate hypercholesterolemia to receive pravastatin (n=5170) or usual care (n=5185) for 4-8 years, when trial therapy was discontinued. Passive surveillance using national databases to ascertain deaths and hospitalizations continued for total follow-up of 8-13 years to assess whether mortality and morbidity differences persisted or new differences developed. During the post-trial period, fatal and nonfatal outcomes were available for 98% and 64% of participants, respectively. Primary outcome was all-cause mortality; secondary outcomes included cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, cardiovascular disease, and end-stage renal disease. No significant differences appeared in mortality for pravastatin versus usual care (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.89-1.03), or other secondary outcomes. Similar to the previously reported in-trial result, there was a significant treatment effect for CHD in Blacks (HR, 0.79; 95% CI, 0.64-0.98). However, the in-trial result showing a significant treatment by race effect did not remain significant over the entire follow-up (P=.08). These findings are consistent with evidence from other large trials that show statins prevent CHD and add evidence that they are effective for CHD prevention in Blacks. PMID:23889716

  12. Long-term follow-up of moderately hypercholesterolemic hypertensive patients following randomization to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT).

    PubMed

    Margolis, Karen L; Davis, Barry R; Baimbridge, Charles; Ciocon, Jerry O; Cuyjet, Aloysius B; Dart, Richard A; Einhorn, Paula T; Ford, Charles E; Gordon, David; Hartney, Thomas J; Julian Haywood, L; Holtzman, Jordan; Mathis, David E; Oparil, Suzanne; Probstfield, Jeffrey L; Simpson, Lara M; Stokes, John D; Wiegmann, Thomas B; Williamson, Jeff D

    2013-08-01

    The authors conducted a randomized, controlled, multicenter trial, in which they assigned well-controlled hypertensive participants aged 55years and older with moderate hypercholesterolemia to receive pravastatin (n=5170) or usual care (n=5185) for 4 to 8years, when trial therapy was discontinued. Passive surveillance using national databases to ascertain deaths and hospitalizations continued for a total follow-up of 8 to 13years to assess whether mortality and morbidity differences persisted or new differences developed. During the post-trial period, fatal and nonfatal outcomes were available for 98% and 64% of participants, respectively. The primary outcome was all-cause mortality and the secondary outcomes included cardiovascular mortality, coronary heart disease (CHD), stroke, heart failure, cardiovascular disease, and end-stage renal disease. No significant differences appeared in mortality for pravastatin vs usual care (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.89-1.03) or other secondary outcomes. Similar to the previously reported in-trial result, there was a significant treatment effect for CHD in black patients (HR, 0.79; 95% CI, 0.64-0.98). However, the in-trial result showing a significant treatment by race effect did not remain significant during the entire follow-up (P=.08). These findings are consistent with evidence from other large trials that show statins prevent CHD and add evidence that they are effective for CHD prevention in black patients. PMID:23889716

  13. Long-Term Follow-Up of a Prospective Trial of Trimodality Therapy of Weekly Paclitaxel, Radiation, and Androgen Deprivation in High-Risk Prostate Cancer With or Without Prior Prostatectomy

    SciTech Connect

    Hussain, Arif; Wu, Yin; Mirmiran, Alireza; DiBiase, Steven; Goloubeva, Olga; Bridges, Benjamin; Mannuel, Heather; Engstrom, Christine; Dawson, Nancy; Amin, Pradip; Kwok, Young

    2012-01-01

    Purpose: Weekly paclitaxel, concurrent radiation, and androgen deprivation (ADT) were evaluated in patients with high-risk prostate cancer (PC) with or without prior prostatectomy (RP). Methods and Materials: Eligible post-RP patients included: pathological T3 disease, or rising prostate-specific antigen (PSA) {>=}0.5 ng/mL post-RP. Eligible locally advanced PC (LAPC) patients included: 1) cT2b-4N0N+, M0; 2) Gleason score (GS) 8-10; 3) GS 7 + PSA 10-20 ng/mL; or 4) PSA 20-150 ng/mL. Treatment included ADT (4 or 24 months), weekly paclitaxel (40, 50, or 60 mg/m{sup 2}/wk), and pelvic radiation therapy (total dose: RP = 64.8 Gy; LAPC = 70.2 Gy). Results: Fifty-nine patients were enrolled (LAPC, n = 29; RP, n = 30; ADT 4 months, n = 29; 24 months, n = 30; whites n = 29, African Americans [AA], n = 28). Baseline characteristics (median [range]) were: age 67 (45-86 years), PSA 5.9 (0.1-92.1 ng/mL), GS 8 (6-9). At escalating doses of paclitaxel, 99%, 98%, and 95% of doses were given with radiation and ADT, respectively, with dose modifications required primarily in RP patients. No acute Grade 4 toxicities occurred. Grade 3 toxicities were diarrhea 15%, urinary urgency/incontinence 10%, tenesmus 5%, and leukopenia 3%. Median follow-up was 75.3 months (95% CI: 66.8-82.3). Biochemical progression occurred in 24 (41%) patients and clinical progression in 11 (19%) patients. The 5- and 7-year OS rates were 83% and 67%. There were no differences in OS between RP and LAPC, 4- and 24-month ADT, white and AA patient categories. Conclusions: In addition to LAPC, to our knowledge, this is the first study to evaluate concurrent chemoradiation with ADT in high-risk RP patients. With a median follow-up of 75.3 months, this trial also represents the longest follow-up of patients treated with taxane-based chemotherapy with EBRT in high-risk prostate cancer. Concurrent ADT, radiation, and weekly paclitaxel at 40 mg/m{sup 2}/week in RP patients and 60 mg/m{sup 2}/week in LAPC patients is feasible and well-tolerated.

  14. Long-term oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer: Systemic review and meta-analysis of 5-year and 10-year follow-up data

    PubMed Central

    Ku, Ja Yoon; Lee, Chan Ho

    2015-01-01

    Purpose To evaluate the oncologic outcomes between adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) in patients with locally advanced prostate cancer or with adverse pathologic factors including positive surgical margin and high Gleason score. Materials and Methods We searched the literature published from January 2000 until December 2014 at MEDLINE, PubMed, Web of Science, Embase, ProQuest, and Cochrane Library. To be specific, included were studies comparing ART and SRT settings if they followed up oncologic outcomes more than 5 years. Results Overall, 3 retrospective, nonrandomized, observational studies, 1 matched control analysis, and 3 prospective randomized controlled studies met our inclusion criteria including a total of 2,380 patients (1,192 ART vs. 1,188 SRT). Higher favorable results were found in ART than in SRT was seen in the 5-year and 10-year biochemical recurrence (BCR)-free survival (risk ratio [RR], 0.61 and 0.70; 95% confidence interval [CI], 0.54-0.69 and 0.63-0.76). ART had a significantly higher 5-year progression-free survival rate than that in SRT (RR, 0.64; 95% CI, 0.51-0.80), but this was not the same for the 10-year progression-free survival rate (RR, 0.88; 95% CI, 0.72-1.08). There was no significant difference for the 5-year and 10-year overall survival rates between ART and SRT (RR, 0.80 and 0.94; 95% CI, 0.59-1.07 and 0.80-1.11). Conclusions ART showed favorable results in BCR-free survival during the 5-year follow-up period. However, the 10-year progression-free survival and overall survival did not show any difference between ART and SRT. PMID:26568790

  15. Lateral orbitotomy approach for removing hyperostosing en plaque sphenoid wing meningiomas. Description of surgical strategy and analysis of findings in a series of 88 patients with long-term follow up

    PubMed Central

    Amirjamshidi, Abbas; Abbasioun, Kazem; Amiri, Rouzbeh Shams; Ardalan, Ali; Hashemi, Seyyed Mahmood Ramak

    2015-01-01

    Background: Sphenoid wing meningiomas extending to the orbit (ePMSW) are currently removed through several transcranial approaches. Presenting the largest surgical cohort of hyperostosing ePMSW with the longest follow up period, we will provide data supporting minilateral orbitotomy with excellent exposure for wide resection of all compartments of the tumor. Methods: A retrospective survival analysis is made of the data cumulated prospectively during a period of 34 years, including 88 cases of ePMSW with a mean follow up period of 136.4 months. The impact of preoperative variables upon different outcome measures is evaluated. Standard pterional craniotomy was performed in 12 patients (C) while the other 76 cases underwent the proposed modified lateral miniorbitotomy (LO). Results: There were 31 men and 57 women. The age range varied between 12 and 70 years. Patients presented with unilateral exophthalmos (Uex) ranging between 3 and 16 mm. Duration of proptosis before operation varied between 6 months and 16 years. The status of visual acuity (VA) prior to operation was: no light perception (NLP) in 16, light perception (LP) up to 0.2 in 3, 0.3–0.5 in 22, 0.6–0.9 in 24, and full vision in 23 patients. Postoperatively, acceptable cosmetic appearance of the eyes was seen in 38 cases and in 46 mild inequality of < 2 mm was detected. Four cases had mild enophthalmos (En). Among those who had the worst VA, two improved and one became almost blind after operation. The cases with VA in the range of 0.3–0.5 improved. Among those with good VA (0.5 to full vision), 2 became blind, vision diminished in 10, and improved or remained full in the other 35 cases. Tumor recurrence occurred in 33.3% of group C and 10.5% of group LO (P = 0.05). The major determinant of tumor regrowth was the technique of LO (P = 0.008). Conclusion: Using LO technique, the risky corners involved by the tumor is visualized from the latero-inferior side rather than from the latero-superior avenue. This is the crucial milestone to achieve aggressive removal of all the involved compartments of the lesion. Satisfactory cosmetic result is reported using mini LO technique after widely exposing and removing the hyperostotic bone down to the subtemporal fossa with only simple repair of the dura without cranioplasty. PMID:26005574

  16. Differential efficacy of three cycles of CMF followed by tamoxifen in patients with ER-positive and ER-negative tumors: Long-term follow up on IBCSG Trial IX

    PubMed Central

    Aebi, S.; Sun, Z.; Braun, D.; Castiglione-Gertsch, M.; Rabaglio, M.; Gelber, R. D.; Crivellari, D.; Lindtner, J.; Snyder, R.; Karlsson, P.; Simoncini, E.; Gusterson, B. A.; Viale, G.; Regan, M. M.; Coates, A. S.; Goldhirsch, A.

    2011-01-01

    Background: The benefit of adjuvant chemotherapy in postmenopausal patients with estrogen receptor (ER)-positive lymph node-negative breast cancer is being reassessed. Patients and methods: After stratification by ER status, 1669 postmenopausal patients with operable lymph node-negative breast cancer were randomly assigned to three 28-day courses of classical CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy followed by tamoxifen for 57 months (CMF?tamoxifen) or to tamoxifen alone for 5 years. Results: ERs were positive in 81% of tumors. At a median follow-up of 13.1 years, patients with ER-positive breast cancers did not benefit from CMF [13-year disease-free survival (DFS) 64% CMF?tamoxifen, 66% tamoxifen; P = 0.99], whereas CMF substantially improved the prognosis of patients with ER-negative breast cancer (13-year DFS 73% versus 57%, P = 0.001). Similarly, breast cancer-free interval (BCFI) was identical in the ER-positive cohort but significantly improved by chemotherapy in the ER-negative cohort (13-year BCFI 80% versus 63%, P = 0.001). CMF had no influence on second nonbreast malignancies or deaths from other causes. Conclusion: CMF is not beneficial in postmenopausal patients with node-negative ER-positive breast cancer but is highly effective within the ER-negative cohort. In the future, other markers of chemotherapy response may define a subset of patients with ER-positive tumors who may benefit from adjuvant chemotherapy. PMID:21282282

  17. Long-term follow-up of allogeneic hematopoietic stem cell transplantation for patients with Philadelphia chromosome positive acute lymphoblastic leukemia: Impact of tyrosine kinase inhibitors on treatment outcomes

    PubMed Central

    Kebriaei, Partow; Saliba, Rima; Rondon, Gabriela; Chiattone, Alexandre; Luthra, Rajyalakshmi; Anderlini, Paolo; Andersson, Borje; Shpall, Elizabeth; Popat, Uday; Jones, Roy; Worth, Laura; Ravandi, Farhad; Thomas, Deborah; OBrien, Susan; Kantarjian, Hagop; de Lima, Marcos; Giralt, Sergio; Champlin, Richard

    2014-01-01

    Purpose The introduction of tyrosine kinase inhibitors (TKI) has revolutionized therapy for patients with acute lymphoblastic leukemia (ALL) who have the Philadelphia (Ph) chromosome. Patients and methods A retrospective analysis was conducted on 102 adults and 11 children who received a first matched related (n =60), matched unrelated (n =40), mismatched cord blood (n=12), or haplo-identical (n=1) allogeneic hematopoietic stem cell transplant (HSCT) for Ph+ ALL in first complete remission (n=71), second complete remission (n=11) or with active disease (n=31) between 1990 and 2009. Sixtyseven patients received TKI with upfront ALL therapy, and 32 patients received TKI maintenance following HSCT. Results With median follow-up of 5 years among survivors (range, 1.120.4 years), overall survival (OS) was significantly better for patients transplanted in first remission compared with HSCT in advanced disease: 43% vs. 16%, p=0.002. Disease stage and age at time of HSCT, the development of acute GVHD, and decade of HSCT were found to significantly impact OS, progression-free survival (PFS) and non-relapse mortality (NRM) in multivariate analyses. Conclusion Allogeneic HSCT provides durable remission for patients with Ph+ ALL in first remission. Neither TKI use pre- nor post HSCT were found to significantly impact transplant outcomes in univariate and multivariate analyses. PMID:21867666

  18. [Evaluation of sick leave notification II--a certificate for more than eight weeks sick leave. From the project Evaluation of follow-up of long-term sick leave patients].

    PubMed

    Melsom, H; Noreik, K

    1990-04-30

    An increase in sick leave has been registered by both the National Insurance Administration and by the Confederation of Norwegian Business and Industry. In 1988, expenditure on sick leave was NOK 20.7 billion. The same year the National Insurance Institution found that the average length of each sick leave was 49 days. An arrangement for notification of sick leave was enforced in order to strengthen follow up of persons in receipt of sick pay who had been off work for more than eight weeks. Our survey in Skedsmo shows that this arrangement is not commonly known among the public. In view of the increasing public consciousness about national insurance in general, the doctors who are required to submit notification of sick leave are of the opinion that this arrangement is a useful venture. It is difficult to conclude, however, that this arrangement has been of any benefit to the individual patient. The national insurance office has registered a decrease in expenditure on sick leave, but the work load of officials in the administration has increased. PMID:2339387

  19. Impact of Screening and Risk Factors for Local Recurrence and Survival After Conservative Surgery and Radiotherapy for Early Breast Cancer: Results From a Large Series With Long-Term Follow-Up

    SciTech Connect

    Kunkler, Ian H.; Kerr, Gillian R.; Thomas, Jeremy S.; Jack, Wilma J.L.; Bartlett, John M.S.; Pedersen, Hans C.; Cameron, David A.; Dixon, J. Michael; Chetty, Udi

    2012-07-01

    Purpose: To investigate conventional prognostic factors for ipsilateral breast tumor recurrence (IBTR), distant metastasis (DM), and survival after breast-conserving therapy (BCT) in screen-detected and symptomatic cases on surveillance up to 25 years. Patients and Methods: A total of 1812 consecutive patients in three cohorts (1981-1989, 1990-1992, and 1993-1998) with T12N01M0 invasive breast cancer were treated with BCT (median follow-up, 14 years). Tumor type and grade were reviewed by a single pathologist. Hormone receptor status was measured by immunohistochemistry on tissue microarrays. A Cox proportional hazards model was used to assess independent prognostic variables for relapse and survival. Results: A total of 205 IBTR occurred, with 5-, 10-, 15-, and 20-year actuarial relapse rates of 4.5% (95% confidence interval [CI] 3.35-5.5%), 8.4% (95% CI 7.1-9.8%), 14.1% (95% CI 12.0-16%), and 17.4% (95% CI 14.5-20.2%). Number of nodes, young age, pathologic tumor size, and multifocality were significant factors for IBTR. Three hundred seventy-eight patients developed DM. The actuarial metastatic rate was 12% at 5 years and 17.9% at 10 years. Young age, number of positive nodes, pathologic tumor size, and tumor grade were significant factors for DM relapse. When conventional prognostic indices were taken into account screen-detected cancers showed no improvement in overall relapse or survival rate compared with symptomatic cases but did show a reduced risk of DM after IBTR. After 10 years IBTR relapse continued at a constant rate of 0.87% per annum. Conclusions: The Edinburgh BCT series has shown that screen-detected invasive breast cancers do not have significantly different clinical outcomes compared with symptomatic cases when pathologic risk factors are taken into account. This suggests that these patients be managed in a similar way.

  20. Long-term clinical evaluation of endodontically treated teeth by 15 F CO2 laser microprobe: three years clinical follow-up of 1512 root canals--in-vivo study

    NASA Astrophysics Data System (ADS)

    Kesler, Gavriel; Koren, Rumelia; Kesler, Anat; Hay, Nissim; Gal, Rivka

    1999-05-01

    The purpose of this study was to determine the efficiency of 15 F CO2 laser microprobe, in cases of periapical lesions, by eliminating the pathological reaction caused by certain species of bacteria, reduction of reinfection and stimulation of osteogenesis in the periapical region. Until now, no suitable delivery fiber existed for CO2 laser endodontic radiation in the apical region where it is most difficult to eliminate the pulp tissue using conventional methods. To overcome this problem, Sharplan laser designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal, thus favorably increasing the thermal effects. The study was conducted on 900 teeth, divided in two groups. 468 were new case, carefully selected according to strict parameters such as: wide periapical translucency over 1mm, supported by digital x-ray, with a lesion of 3mm and more. All root canals were mechanically prepared in the conventional method up to size 35, Physiological saline solution served as finding solution and were treated by 15 F CO2 laser microprobe for 60 pulses repeatedly. The temperature at the surrounding tissue of the root did not exceed 38 degrees C filling of the canal was possible at the same appointment, without antibiotical treatment. 432 of the cases, which were referred to us by other dentists, after an unsuccessful treatment according to the classical therapy, were treated by the same laser therapy. Follow up was performed by clinical examination, and digital x-ray taken, during and after treatment as well as after 3, 6, 9, 12 month. The result demonstrate 98% success rate in both study groups, according to objective criteria for a successful treatment such as: reduction of apical translucency after 2- 6 months, freedom form clinical complains, and no need for periapical surgery.

  1. The effect of timing of radiotherapy after breast-conserving surgery in patients with positive or close resection margins, young age, and node-negative disease, with long term follow-up

    SciTech Connect

    Vujovic, Olga . E-mail: olga.vujovic@lhsc.on.ca; Cherian, Anil; Yu, Edward; Dar, A. Rashid; Stitt, Larry; Perera, Francisco

    2006-11-01

    Purpose: The aim of this study was to determine the effect of timing of radiotherapy after conservative breast surgery on local recurrence in women with positive resection margins and young age, treated without systemic therapy. Methods and Materials: A total of 568 patients with T1 and T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, between January 1, 1985, and December 31, 1992, at the London Regional Cancer Centre. 63 patients (11.1%) had positive/close resection margins (<2 mm) and 48 patients (8.4%) were age {<=}40 years. For patients with positive resection margins, the time intervals from breast surgery to breast irradiation used for analysis were, 0 to 8 weeks, >8 to 12 weeks and >12 weeks. For patients {<=}40 years, the intervals used for analysis were 0 to 8 weeks and >8 weeks. Results: Median follow up was 11.2 years. For patients {<=}40 years, local recurrence rate at 5 and 10 years was 17.2% and 19.8% respectively. Four patients (17.4%) treated in the 0-week to 8-week interval and 7 patients (28.0%) treated in the >8 week interval had local recurrences. For patients {<=}40 years with positive resection margins, the local recurrence rate was 25.0%. For patients with positive resection margins, 5-year and 10-year local recurrence rates were as follows: 0 to 8 weeks, 0% and 10.5% respectively; >8 to 12 weeks, 10.3% and 10.3% respectively; and >12 weeks, 13.3% and 20.0% respectively. Conclusion: Patients {<=}40 years have an increased local recurrence rate which occurs early. Patients with positive resection margins have higher local recurrence rates that become apparent when breast irradiation is delayed.

  2. Hypertension may be transplanted with the kidney in humans: a long-term historical prospective follow-up of recipients grafted with kidneys coming from donors with or without hypertension in their families.

    PubMed

    Guidi, E; Menghetti, D; Milani, S; Montagnino, G; Palazzi, P; Bianchi, G

    1996-08-01

    In several genetic hypertensive rat strains, transplantation studies have established that the kidney carries at least a portion of the genetic message for hypertension. In man it has, of course, been more difficult to obtain clearcut results. This historical prospective observational study, double-blinded for knowledge of donors' and recipients' family history for hypertension, concerns 85 transplanted patients, not treated with cyclosporine and with stable renal function, followed up for an average of 8 yr. Both the donors' and the recipients' families were carefully characterized for presence or absence of hypertension. After transplantation, in recipients without hypertension in their own families, a kidney coming from a "hypertensive" family determines less withdrawal and more introduction of antihypertensive therapy (AHT) than a kidney from a "normotensive" family (odds ratio for AHT introduction 5.0, confidence interval, 1.4 to 17.8; P = 0.017). In recipients with familial hypertension, the origin of the kidney does not influence the prevalence of hypertension after transplantation. More detailed analyses show that, in recipients without familial hypertension, the transplantation of a "hypertensive" kidney determines a tenfold larger increase in the requirement of antihypertensive therapy than the transplantation of a "normotensive" kidney, to obtain a similar blood pressure control (P = 0.003). This results is confirmed by the analysis of time-profile trends for antihypertensive therapy, adjusted for missing data, in the most clinically stable period (2nd to 10th yr after transplantation). The transmission of familial hypertension with the kidney is thus seen only in recipients coming from "normotensive" families, because a familial tendency for hypertension blunts the effect of receiving a "hypertensive" kidney. PMID:8866403

  3. Activity of Topotecan 21-Day Infusion in Patients with Previously Treated Large Cell Lymphoma: Long-term follow-up of an Eastern Cooperative Oncology Group Study (E5493)

    PubMed Central

    Wiernik, Peter H.; Li, Hailun; Weller, Edie; Hochster, Howard S.; Horning, Sandra J.; Nazeer, Tipu; Gordon, Leo I.; Habermann, Thomas M.; Minniti, Carl J.; Shapiro, Gary R.; Cassileth, Peter A.

    2013-01-01

    The purpose of this study was to determine the activity of topotecan given by 21-day continuous infusion in patients previously treated with one prior therapy for a diffuse large cell lymphoma or immunoblastic lymphoma. Patients with appropriate histology and measurable disease who had been treated with one prior chemotherapy regimen were eligible for study. Slides of tumor biopsies were submitted for central review of pathology. Patients were required to have ECOG performance status of 0, 1, or 2 and adequate bone marrow function. Patients were treated with continuous infusion topotecan, 0.4 mg/m2/day 21 days. Therapy could be escalated to 0.5 and then 0.6 mg/m2/day in subsequent cycles if there was no dose limiting toxicity at the initial dose level. Patients were treated with 2 cycles after achieving complete response or until disease progression or unacceptable toxicity occurred. Thirty seven patients were enrolled, however, only 26 cases were eligible due to performance status of > 2 (2), more than one prior chemotherapy (1), and wrong histology on review (8). Due to the unexpectedly high ineligibility rate, two sets of analysis were done for all the 37 patients enrolled and for the 26 eligible patients, respectively. Of the 37 patients (15 males and 22 females), international prognostic index included 11% low risk, 30% low-intermediate risk; 46% high-intermediate risk, and 8% high risk. The median follow up was 77 months. A total of 136 cycles of therapy were given with a median of 3 cycles per patient. Grade 4 toxicities included: 14% grade 4 thrombocytopenia; 14% grade 4 granulocytopenia, 8% leukopenia, 3% each anemia, hemorrhage, infection, vomiting, thrombosis, liver toxicity, and neuromotor toxicity. The response analysis including all 37 patients showed 5 complete remissions (CR) and 4 partial remissions (PR) for a total response rate of 24% (90% two-stage confidence interval 1339%). Median progression free survival (PFS) was 3.7 months, with one and two year PFS of 21% and 6% respectively (90% confidence interval 1134% and 215%). Median overall survival (OS) was 10.5 months, with one and two year OS 41% and 27% respectively (90% confidence interval 2753% and 1639%). Analysis including only eligible patient showed similar response rates and survival outcomes. Single agent topotecan has moderate activity for previously treated high grade lymphoma equivalent to that of several newer agents, and should be considered for incorporation into multi-drug salvage chemotherapy programs. PMID:22111940

  4. Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German Speaking Society of Pediatric Oncology and Hematology.

    PubMed

    Gnekow, Astrid K; Falkenstein, Fabian; von Hornstein, Stephan; Zwiener, Isabella; Berkefeld, Susanne; Bison, Brigitte; Warmuth-Metz, Monika; Driever, Pablo Herniz; Soerensen, Niels; Kortmann, Rolf-D; Pietsch, Torsten; Faldum, Andreas

    2012-10-01

    The Hirntumorstudien (HIT)-LGG-1996 protocol offered a comprehensive treatment strategy for pediatric patients with low-grade glioma (LGG), ie, observation, surgery, adjuvant radiotherapy, and chemotherapy to defer the start of irradiation in young children. In this current study, we sought to determine clinical factors for progression and survival. Between October 1, 1996 and March 31, 2004, 1031 patients were prospectively recruited into an observation arm (n = 668) and a nonsurgical arm stratifying 12 months of vincristine-carboplatin chemotherapy (n = 216) and conventional radiotherapy/brachytherapy (n = 147) in an age-dependent manner. Median patient age was 6.9 years; 28 patients had diencephalic syndrome, 44 had dissemination, and 108 had neurofibromatosis type 1(NF-1). Main tumor location was the supratentorial midline (40.4%), and the main histology was pilocytic astrocytoma (67.9%). Following a median observation of 9.3 years, 10-year overall survival (OS) was 0.94 and 10-year event-free survival (EFS) was 0.47. Ten-year progression-free survival was 0.62 following radiotherapy and 0.44 following chemotherapy. Sixty-one of 216 chemotherapy patients received radiotherapy 0.3-8.7 years after initial diagnosis. By multivariate analysis, diencephalic syndrome and incomplete resection were found to be unfavorable factors for OS and EFS, age ?11 years for OS, and supratentorial midline location for EFS. Dissemination, age <1 year, and nonpilocytic histology were unfavorable factors for progression following radiotherapy (138 patients); and diencephalic syndrome, dissemination, and age ?11 years were unfavorable factors following chemotherapy (210 patients). NF-1 patients and boys experienced prolonged tumor stabilization with chemotherapy. A nationwide multimodal treatment strategy is feasible for pediatric LGG. Extended follow-up yielded results comparable to single-institution series for the treatment groups. Three-quarters of surviving chemotherapy patients have not yet received radiation therapy. Infants with or without diencephalic syndrome and dissemination bear the highest risk for death and progression following diagnosis or treatment. PMID:22942186

  5. Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German Speaking Society of Pediatric Oncology and Hematology

    PubMed Central

    Gnekow, Astrid K.; Falkenstein, Fabian; von Hornstein, Stephan; Zwiener, Isabella; Berkefeld, Susanne; Bison, Brigitte; Warmuth-Metz, Monika; Driever, Pablo Hernáiz; Soerensen, Niels; Kortmann, Rolf-D.; Pietsch, Torsten; Faldum, Andreas

    2012-01-01

    The Hirntumorstudien (HIT)-LGG-1996 protocol offered a comprehensive treatment strategy for pediatric patients with low-grade glioma (LGG), ie, observation, surgery, adjuvant radiotherapy, and chemotherapy to defer the start of irradiation in young children. In this current study, we sought to determine clinical factors for progression and survival. Between October 1, 1996 and March 31, 2004, 1031 patients were prospectively recruited into an observation arm (n = 668) and a nonsurgical arm stratifying 12 months of vincristine-carboplatin chemotherapy (n = 216) and conventional radiotherapy/brachytherapy (n = 147) in an age-dependent manner. Median patient age was 6.9 years; 28 patients had diencephalic syndrome, 44 had dissemination, and 108 had neurofibromatosis type 1(NF-1). Main tumor location was the supratentorial midline (40.4%), and the main histology was pilocytic astrocytoma (67.9%). Following a median observation of 9.3 years, 10-year overall survival (OS) was 0.94 and 10-year event-free survival (EFS) was 0.47. Ten-year progression-free survival was 0.62 following radiotherapy and 0.44 following chemotherapy. Sixty-one of 216 chemotherapy patients received radiotherapy 0.3–8.7 years after initial diagnosis. By multivariate analysis, diencephalic syndrome and incomplete resection were found to be unfavorable factors for OS and EFS, age ≥11 years for OS, and supratentorial midline location for EFS. Dissemination, age <1 year, and nonpilocytic histology were unfavorable factors for progression following radiotherapy (138 patients); and diencephalic syndrome, dissemination, and age ≥11 years were unfavorable factors following chemotherapy (210 patients). NF-1 patients and boys experienced prolonged tumor stabilization with chemotherapy. A nationwide multimodal treatment strategy is feasible for pediatric LGG. Extended follow-up yielded results comparable to single-institution series for the treatment groups. Three-quarters of surviving chemotherapy patients have not yet received radiation therapy. Infants with or without diencephalic syndrome and dissemination bear the highest risk for death and progression following diagnosis or treatment. PMID:22942186

  6. Long-Term Follow-Up of Patients with Hypoparathyroidism

    PubMed Central

    Mitchell, Deborah M.; Regan, Susan; Cooley, Michael R.; Lauter, Kelly B.; Vrla, Michael C.; Becker, Carolyn B.; Burnett-Bowie, Sherri-Ann M.

    2012-01-01

    Context: Despite tremendous interest in hypoparathyroidism, large cohort studies describing typical treatment patterns, laboratory parameters, and rates of complications are lacking. Objective: Our objective was to characterize the course of disease in a large cohort of hypoparathyroid patients. Design and Setting: We conducted a chart review of patients with permanent hypoparathyroidism identified via a clinical patient data registry. Patients were seen at a Boston tertiary-care hospital system between 1988 and 2009. Patients: We identified 120 patients. Diagnosis was confirmed by documented hypocalcemia with a simultaneous low or inappropriately normal PTH level for at least 1 yr. Mean age at the end of the observation period was 52 19 (range 287) yr, and the cohort was 73% female. Main Outcome Measure: We evaluated serum and urine laboratory results and renal and brain imaging. Results: We calculated time-weighted average serum calcium measurements for all patients. The time-weighted average for calcium was between 7.5 and 9.5 mg/dl for the majority (88%) of patients. Using linear interpolation, we estimated the proportion of time within the target calcium range for each patient with a median of 86% (interquartile range 6798%). Of those with a 24-h urine collection for calcium (n = 53), 38% had at least one measurement over 300 mg/d. Of those with renal imaging (n = 54), 31% had renal calcifications, and 52% of those with head imaging (n = 31) had basal ganglia calcifications. Rates of chronic kidney disease stage 3 or higher were 2- to 17-fold greater than age-appropriate norms. Conclusions: Hypoparathyroidism and its treatment carry a large burden of disease. Renal abnormalities are particularly common. PMID:23043192

  7. Long Term Follow-up of Near Earth Objects

    NASA Astrophysics Data System (ADS)

    Trueblood, Mark; Crawford, Robert; Lebofsky, Larry

    2013-02-01

    We will use the KPNO 2.1-m telescope to recover Near Earth Objects (NEOs) by adding astrometric observations at one or more orbits since discovery. Recovery observations place the strongest constraints on the orbital solution and can be expected to improve the impact risk assessment for Virtual Impactors (VIs). Many NEOs will be observable in the range 21

  8. Long Term Follow-up of Near Earth Objects

    NASA Astrophysics Data System (ADS)

    Trueblood, Mark; Bell, David; Lebofsky, Larry

    2013-08-01

    Recently-discovered Near Earth Objects (NEOs) will be observed using the KPNO 2.1-m telescope to add astrometric observations at arcs as long as 20-80 days from discovery. These extended arcs place strong constraints on the orbital solution and can greatly reduce the ephemeris uncertainty at the next recovery opportunity. Many recently-discovered NEOs will be observable in the range 21

  9. Follow up of phenylketonuria patients.

    PubMed

    Demirkol, M; Giżewska, M; Giovannini, M; Walter, J

    2011-01-01

    In recent years our understanding of the follow up policies for PKU has increased substantially. In particular, we now understand the importance of maintaining control of blood phenylalanine (phe) concentrations life-long to achieve the best long-term neuropsychological outcomes. The concordance with the follow up strategy remains a key challenge for the future, especially with respect to adolescents and young adults. The recent therapies could ease the burden of the dietary phe restriction for PKU patients and their families. The time may be right for revisiting the guidelines for follow up of PKU in order to address a number of important issues related to PKU management: promotion of breastfeeding to complementary feeding up to 2 years of age for prevention of early growth retardation and later overweight development, treatment advancements for metabolic control, blood phe and tyr variability, routine screening measures for nutritional biomarkers, neurocognitive and psychological assessments, bone pathology, understanding the challenges of compliance and transitioning into adulthood as an individual with PKU and addressing unmet needs in this population. PMID:22018725

  10. Complications and follow up of subarachnoid hemorrhages.

    PubMed

    Danire, F; Gascou, G; Menjot de Champfleur, N; Machi, P; Leboucq, N; Riquelme, C; Ruiz, C; Bonaf, A; Costalat, V

    2015-01-01

    Complications of subarachnoid hemorrhage are the major life threatening and functional components of the follow up of a ruptured aneurysm. Knowing how to identify these is a key challenge. They vary in type throughout the postoperative follow up period. The aim of this article is firstly to list the main complications of the acute phase (rebleeding, acute hydrocephalus, acute ischemic injury and non-neurological complications), the subacute phase (vasospasm) and the chronic phase of subarachnoid hemorrhages: (chronic hydrocephalus and cognitive disorders) and to describe their major clinical and radiological features. Secondly, we describe the long-term follow up strategy for patients who have suffered a subarachnoid hemorrhage and have been treated endovascularly or by surgery. This follow up involves a combination of clinical consultations, cerebral MRI and at least one review angiogram. PMID:26119863

  11. Long-Term Care

    MedlinePLUS

    ... this page please turn Javascript on. Long-Term Care What Is Long-Term Care? Long-term care involves a variety of services ... 8 sec Click to watch this video Most Care Provided at Home Click for more information Long- ...

  12. Long-term symptom relief after septoplasty.

    PubMed

    Sundh, Carolina; Sunnergren, Ola

    2015-10-01

    The results for long-term symptom relief after septoplasty are contradictory in reviewed publications but the findings suggest that results are unsatisfactory. In this study, we analyzed and compared short- and long-term symptom relief after septoplasty and factors possibly associated with symptom relief. 111 patients that underwent septoplasty between 2008 and 2010 were included in the study. Medical charts were reviewed for preoperative characteristics and assessments. Data on short-term symptom relief (6 months) were retrieved from the Swedish National Quality Registry for Septoplasty; data on long-term symptom relief (34-70 months) were collected through a questionnaire. Upon the 34-70 month follow-up, 53% of the patients reported that symptoms either remained or had worsened and 83% reported nasal obstruction. Degree of symptom relief was significantly higher among patients not reporting nasal obstruction than among patients reporting nasal obstruction at long-term follow-up. The proportion of patients that reported "my symptoms are gone" declined from 53% after 6 months to 18% after 34-70 months. None of the factors taken into consideration, age at surgery, gender, follow-up time, primary operation/reoperation, history of nasal trauma, self-reported allergy, rhinometric obstruction, or same sided rhinometric, clinical and subjective nasal obstruction were associated with symptom relief. The long-term results after septoplasty are unsatisfactory. A majority of patients report that their symptoms remain after septoplasty. PMID:25432640

  13. First-line chemotherapy improves the resection rate and long-term survival of locally advanced (T4, any N, M0) squamous cell carcinoma of the thoracic esophagus: final report on 163 consecutive patients with 5-year follow-up.

    PubMed Central

    Ancona, E; Ruol, A; Castoro, C; Chiarion-Sileni, V; Merigliano, S; Santi, S; Bonavina, L; Peracchia, A

    1997-01-01

    OBJECTIVE: The objective of this prospective, nonrandomized study was to evaluate the immediate and long-term results of first-line chemotherapy and possible surgery in locally advanced, presumably T4 squamous cell esophageal cancer. SUMMARY BACKGROUND DATA: Locally advanced esophageal cancer is rarely operable and has a dismal prognosis. For this reason, neoadjuvant cytoreductive treatments are more and more frequently used with the aim of downstaging the tumor, increasing the resection rate, and possibly improving survival. Methods: From January 1983 to December 1991, 163 consecutive patients with a presumedly T4 squamous cell carcinoma of the thoracic esophagus (group A) received on average 2.5 cycles (range, 1-6) of first-line chemotherapy with cisplatin (100 mg/m2 on day 1) and 5-fluorouracil (1000 mg/m2 per day, in continuous infusion from day 1 through day 5). Chemotherapy was followed by surgery when adequate downstaging of the tumor was obtained. RESULTS: Chemotherapy toxicity was WHO grade 0 to 2 in 80% of cases, but 3 toxic deaths (1.9%) occurred. Restaging suggested a downstaging of the tumor in 101 of 163 patients (62%), but only 85 patients (52%) underwent resection surgery; it was complete or R0 in 52 (32%) and incomplete or R1-2 in 33. Overall postoperative mortality was 11.7% (10 of 85), morbidity 41% (35 of 85). Complete pathologic response was documented in 6 patients, and significant downstaging to pStage I, IIA, or IIB occurred in 25 more patients. The overall 5-year survival was 11 % (median, 11 months). After resection surgery, the 5-year survival was 20% (median, 16 months); none of the nonresponders survived 4 years after palliative treatments without resection (median survival, 5 months). The 5-year survival rate of the 52 patients undergoing an R0 resection was 29% (median, 23 months). Stratifying patients according to the R, pT, pN, and pStage classifications, the survival curves were comparable to the corresponding data obtained in the 587 group B patients with "potentially resectable" esophageal cancer who underwent surgery alone during the same period. Furthermore, the results were improved in comparison with 136 previous or subsequent patients with a locally advanced tumor who did not undergo neoadjuvant treatments (group C). In these patients, the R0 resection rate was 7%, and the overall 5-year survival was 3% (median, 5 months). CONCLUSION: Although nonrandomized, these results suggest that in locally advanced esophageal carcinoma, first-line chemotherapy increases the resection rate and improves the overall long-term survival. In responding patients who undergo R0 resection surgery, the prognosis depends on the final pathologic stage and not on the initial pretreatment stage. PMID:9409570

  14. Long term mortality in burned children

    PubMed Central

    Stamboulian, Daniel; Lede, Roberto

    2015-01-01

    Studies about risk factors for mortality in burn children are scarce and are even less in the follow up of this population across time. Usually, after complete event attendance, children are not follow-up as risk patients, burn injury affects all facets of life. Integration of professionals from different disciplines has enabled burn centers to develop collaborative methods of assessing the quality of care delivered to patients with burns. In this editorial we comment the paper of Duke et al. The authors highlight the importance of maintaining a long-term monitoring of children who suffered burns. The importance of this original study is to promote the reconsideration of clinical guides of long-term follow-up of burn patients. PMID:26835375

  15. The LCOGT NEO Follow-up Network

    NASA Astrophysics Data System (ADS)

    Lister, Tim A.; Greenstreet, S.; Gomez, E.; Christensen, E.; Larson, S.

    2016-01-01

    Las Cumbres Observatory Global Telescope Network (LCOGT) has deployed a homogeneous telescope network of nine 1-meter telescopes to four locations in the northern and southern hemispheres, with a planned network size of twelve 1-meter telescopes at 6 locations. This network is very versatile and is designed to respond rapidly to target of opportunity events and also to perform long term monitoring of slowly changing astronomical phenomena. The global coverage of the network and the apertures of telescope available make LCOGT ideal for follow-up and characterization of Solar System objects (e.g. asteroids, Kuiper Belt Objects, comets, Near-Earth Objects (NEOs)) and additionally for the discovery of new objects. We are using the LCOGT network to confirm newly detected NEO candidates produced by the major sky surveys such as Catalina Sky Survey (CSS) and PanSTARRS (PS1&2) and several hundred targets are now being followed per year. An increasing amount of time is being spent to obtain follow-up astrometry and photometry for radar-targeted objects and those on the Near-Earth Object Human Space Flight Accessible Targets Study (NHATS) or Asteroid Retrieval Mission (ARM) lists in order to improve the orbits, determine the light curves and rotation periods and improve the characterization. This will be extended to obtain more light curves of other NEOs which could be targets. Recent results have included the first period determinations for several of the Goldstone-targeted NEOs. We are in the process of building a NEO follow-up portal which will allow professionals, amateurs and Citizen Scientists to plan, schedule and analyze NEO imaging and spectroscopy observations and data using the LCOGT Network and to act as a co-ordination hub for the NEO follow-up efforts.

  16. Extended Follow-Up | Division of Cancer Prevention

    Cancer.gov

    NCI supports the continued follow-up of participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) to strengthen the PLCO as a valuable resource for molecular epidemiologic research as well as provide long-term data on the trial’s primary endpoints. |

  17. Extended Follow-Up | Division of Cancer Prevention

    Cancer.gov

    NCI supports the continued follow-up of participants in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) to strengthen the PLCO as a valuable resource for molecular epidemiologic research as well as provide long-term data on the trials primary endpoints. |

  18. Three Year Follow-Up of 1974 Graduates.

    ERIC Educational Resources Information Center

    Baratta, Mary Kathryne

    To evaluate the long-term benefits of attendance at Moraine Valley Community College (MVCC), a three-year follow-up study was conducted of the 620 1974 graduates (324 transfer and 296 occupational students). Each graduate was sent a questionnaire collecting information on involvement with MVCC after graduation, present educational status,…

  19. [Bariatric surgery - significance, risks, long term consequences].

    PubMed

    Schubert, T; Jahn, U; Eben, E; Deuber, H J

    2013-03-21

    In recent years the number of bariatric surgery has markedly increased in industrial nations. Surgery provides a more rapid decrease of body weight than conservative approach. However a long term conservative follow up therapy is mandatory to stabilize reduced weight. Due to increasing knowledge from long term follow up of surgically treated obese patients there is a growing body of evidence that frequently there is necessity of reoperations and of substitution both of trace elementsand of minerals or vitamins due to their hampered enteral resorption. Additionally therapy of surgery induced endocrine alterations not seldom is necessary.These insight