Science.gov

Sample records for 2-year follow-up patients

  1. Impact of involuntary out-patient commitment on reducing hospital services: 2-year follow-up.

    PubMed

    Castells-Aulet, Laura; Hernández-Viadel, Miguel; Jiménez-Martos, Jesús; Cañete-Nicolás, Carlos; Bellido-Rodríguez, Carmen; Calabuig-Crespo, Roman; Asensio-Pascual, Pedro; Lera-Calatayud, Guillem

    2015-08-01

    Aims and method To evaluate whether involuntary out-patient commitment (OPC) in patients with severe mental disorder reduces their use of hospital services. This is a retrospective case-control study comparing a group of patients on OPC (n = 75) and a control group (n = 75) which was composed of patients whose sociodemographic variables and clinical characteristics were similar to those of the OPC group. Each control case is paired with an OPC case, so the control case must have an involuntary admission in the month that the index OPC case admission occurred. Emergency room visits, admissions and average length of hospital stay over a 2-year follow-up after the initiation of OPC were compared. Results No statistically significant evidence was found in the use of mental healthcare services between the two groups. Different reasons for admission found between the groups limit similarity when comparing the two. Clinical implications The findings cast doubt over the effectiveness of this legal measure to reduce emergency visits, the number of admissions and the length of stay in the hospital.

  2. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study

    PubMed Central

    Miravitlles, M; Ferrer, M; Pont, A; Zalacain, R; Alvarez-Sala, J; Masa, F; Verea, H; Murio, C; Ros, F; Vidal, R

    2004-01-01

    Background: A study was undertaken to evaluate exacerbations and their impact on the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD). Methods: A 2 year follow up study was performed in 336 patients with COPD of mean (SD) age 66 (8.2) years and mean (SD) forced expiratory volume in 1 second (FEV1) 33 (8)% predicted. Spirometric tests, questions regarding exacerbations of COPD, and HRQL measurements (St George's Respiratory Questionnaire (SGRQ) and SF-12 Health Survey) were conducted at 6 month intervals. Results: A total of 1015 exacerbations were recorded, and 103 (30.7%) patients required at least one hospital admission during the study. After adjustment for baseline characteristics and season of assessment, frequent exacerbations had a negative effect on HRQL in patients with moderate COPD (FEV1 35–50% predicted); the change in SGRQ total score of moderate patients with ⩾3 exacerbations was almost two points per year greater (worse) than those with <3 exacerbations during the follow up (p = 0.042). For patients with severe COPD (FEV1 <35% predicted) exacerbations had no effect on HRQL. The change in SGRQ total score of patients admitted to hospital was almost 2 points per year greater (worse) than patients not admitted, but this effect failed to show statistical significance in any severity group. There was a significant and independent seasonal effect on HRQL since SGRQ total scores were, on average, 3 points better in measurements performed in spring/summer than in those measured in the winter (p<0.001). Conclusions: Frequent exacerbations significantly impair HRQL of patients with moderate COPD. A significant and independent effect of seasonality was also observed. PMID:15115864

  3. Patients with Fabry Disease after Enzyme Replacement Therapy Dose Reduction and Switch-2-Year Follow-Up.

    PubMed

    Lenders, Malte; Canaan-Kühl, Sima; Krämer, Johannes; Duning, Thomas; Reiermann, Stefanie; Sommer, Claudia; Stypmann, Jörg; Blaschke, Daniela; Üçeyler, Nurcan; Hense, Hans-Werner; Brand, Stefan-Martin; Wanner, Christoph; Weidemann, Frank; Brand, Eva

    2016-03-01

    Because of the shortage of agalsidase-β supply between 2009 and 2012, patients with Fabry disease either were treated with reduced doses or were switched to agalsidase-α. In this observational study, we assessed end organ damage and clinical symptoms with special focus on renal outcome after 2 years of dose-reduction and/or switch to agalsidase-α. A total of 89 adult patients with Fabry disease who had received agalsidase-β (1.0 mg/kg body wt) for >1 year were nonrandomly assigned to continue this treatment regimen (regular-dose group, n=24), to receive a reduced dose of 0.3-0.5 mg/kg and a subsequent switch to 0.2 mg/kg agalsidase-α (dose-reduction-switch group, n=28), or to directly switch to 0.2 mg/kg agalsidase-α (switch group, n=37) and were followed-up for 2 years. We assessed clinical events (death, myocardial infarction, severe arrhythmia, stroke, progression to ESRD), changes in cardiac and renal function, Fabry-related symptoms (pain, hypohidrosis, diarrhea), and disease severity scores. Determination of renal function by creatinine and cystatin C-based eGFR revealed decreasing eGFRs in the dose-reduction-switch group and the switch group. The Mainz Severity Score Index increased significantly in these two groups (P=0.02 and P<0.001, respectively), and higher frequencies of gastrointestinal pain occurred during follow-up. In conclusion, after 2 years of observation, all groups showed a stable clinical disease course with respect to serious clinical events. However, patients under agalsidase-β dose-reduction and switch or a direct switch to agalsidase-α showed a decline of renal function independent of the eGFR formula used.

  4. How Sublaminar Bands Affect Postoperative Sagittal Alignment in AIS Patients with Preoperative Hypokyphosis? Results of a Series of 34 Patients with 2-Year Follow-Up

    PubMed Central

    Chalopin, Antoine; Peltier, Emilie; Choufani, Elie; Ollivier, Matthieu; Fuentes, Stéphane; Jouve, Jean-Luc

    2016-01-01

    Hypokyphosis is currently observed in thoracic idiopathic scoliosis. The use of sublaminar bands allows a good restoration of sagittal balance of the spine. The aim of the study was to provide a middle-term radiographic analysis of patients with adolescent idiopathic scoliosis with preoperative hypokyphosis treated by posterior arthrodesis with sublaminar bands. This retrospective study included 34 patients with Lenke 1 scoliosis associated with hypokyphosis (TK < 20°). A radiographic evaluation was performed with a 2-year follow-up. Cobb angle, cervical lordosis, thoracic kyphosis, lumbar lordosis, and pelvic parameters were measured preoperatively, postoperatively, and at 6-month and 2-year follow-up. The mean preoperative thoracic kyphosis was 10.5° versus 24.1° postoperatively (p < 0.001), representing a mean gain of 13°. Cobb angle ranged from 59.3° to 17.9° postoperatively (mean correction 69%, p < 0.001). Cobb angle increased between the immediate postoperative measurement and the 6-month follow-up (17.9 versus 19.9, p = 0.03). Cervical curvature changed from a 5.6° kyphosis to a 3.5° lordosis (p = 0.001). Concerning lumbar lordosis, preoperative measurement was 39.7° versus 41.3° postoperatively (p = 0.27). At 6-month follow-up, lumbar lordosis significantly increased to 43.6° (p = 0.03). All parameters were stable at final follow-up. Correction performed by sublaminar bands is efficient for both fontal and sagittal planes. Moreover, the restoration of normal thoracic kyphosis is followed by an adaptation of the adjacent curvatures with improved cervical lordosis and lumbar lordosis. PMID:27999791

  5. Evaluation of patient-reported outcomes data in structured diabetes education intervention: 2-year follow-up data of patient empowerment programme.

    PubMed

    Wong, Carlos K H; Lam, Cindy L K; Wan, Eric Y F; Chan, Anca K C; Pak, C H; Chan, Frank W K; Wong, William C W

    2016-11-01

    To examine the effects of a structured group-based education programme, patient empowerment programme (PEP), compared with usual care on 2-year changes in patient-reported outcomes (PRO) in patients with diabetes mellitus (DM). A prospective observational study of 715 patients (PEP/non-PEP: 390/325) was conducted to complete the baseline PRO survey and followed up for 2 years. Health-related quality of life (HRQOL) was measured using the short-form 12 at baseline and annually at two follow-up assessments, which yielded physical and mental component summary and SF-6D preference-based scores. Perceived control over diabetes and general health status were measured using the patient enablement instrument (PEI) and global rating scale (GRS) at follow-ups. When compared with non-PEP, PEP participants significantly reported improvement in health condition (GRS score > 0; 24.55 % vs 10.16 %; odds ratio = 2.502; P = 0.018) in 2 years and enabled the self-perceived control over diabetes (PEI score > 0; 72.20 % vs 38.40 %; odds ratio = 3.25; P < 0.001) in 1-year follow-up but no sustained effects in year 2 (52.65 % vs 39.04 %; odds ratio = 1.366; P = 0.265). There were no significant differences between PEP and non-PEP groups in the changes in quality of life scores (all P > 0.05) at 1 year. Although HRQOL scores deteriorated over 2-year period in both groups, PEP participants reported similar changes in HRQOL scores to that of non-PEP. PEP for DM patients preserved self-perceived disease control and health condition, whereas PEP participants perceived their HRQOL similar to that of non-PEP participants. Findings of PRO should be considered alongside clinical outcomes when evaluating the overall benefits of PEP.

  6. Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis

    PubMed Central

    Gåfvels, Catharina; Hägerström, Margareta; Rane, Kristina; Wajngot, Alexandre; Wändell, Per E

    2016-01-01

    We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18–65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy “protest” were important risk factors for depression and anxiety after 2 years. PMID:28070410

  7. Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up.

    PubMed

    Smith, Justin S; Shaffrey, Christopher I; Klineberg, Eric; Lafage, Virginie; Schwab, Frank; Lafage, Renaud; Kim, Han Jo; Hostin, Richard; Mundis, Gregory M; Gupta, Munish; Liabaud, Barthelemy; Scheer, Justin K; Diebo, Bassel G; Protopsaltis, Themistocles S; Kelly, Michael P; Deviren, Vedat; Hart, Robert; Burton, Doug; Bess, Shay; Ames, Christopher P

    2017-02-17

    OBJECTIVE Although 3-column osteotomy (3CO) can provide powerful alignment correction in adult spinal deformity (ASD), these procedures are complex and associated with high complication rates. The authors' objective was to assess complications associated with ASD surgery that included 3CO based on a prospectively collected multicenter database. METHODS This study is a retrospective review of a prospectively collected multicenter consecutive case registry. ASD patients treated with 3CO and eligible for 2-year follow-up were identified from a prospectively collected multicenter ASD database. Early (≤ 6 weeks after surgery) and delayed (> 6 weeks after surgery) complications were collected using standardized forms and on-site coordinators. RESULTS Of 106 ASD patients treated with 3CO, 82 (77%; 68 treated with pedicle subtraction osteotomy [PSO] and 14 treated with vertebral column resection [VCR]) had 2-year follow-up (76% women, mean age 60.7 years, previous spine fusion in 80%). The mean number of posterior fusion levels was 12.9, and 17% also had an anterior fusion. A total of 76 early (44 minor, 32 major) and 66 delayed (13 minor, 53 major) complications were reported, with 41 patients (50.0%) and 45 patients (54.9%) affected, respectively. Overall, 64 patients (78.0%) had at least 1 complication, and 50 (61.0%) had at least 1 major complication. The most common complications were rod breakage (31.7%), dural tear (20.7%), radiculopathy (9.8%), motor deficit (9.8%), proximal junctional kyphosis (PJK, 9.8%), pleural effusion (8.5%), and deep wound infection (7.3%). Compared with patients who did not experience early or delayed complications, those who had these complications did not differ significantly with regard to age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, smoking status, history of previous spine surgery or spine fusion, or whether the 3CO performed was a PSO or VCR (p ≥ 0.06). Twenty-seven (33

  8. Patient reported outcomes for patients who returned to sport compared with those who did not after hip arthroscopy: minimum 2-year follow-up

    PubMed Central

    Domb, Benjamin G.; Dunne, Kevin F.; Martin, Timothy J.; Gui, Chengcheng; Finch, Nathan A.; Vemula, S. Pavan; Redmond, John M.

    2016-01-01

    Previous studies assessed elite athletes’ return to sport (RTS) after hip arthroscopy, but few investigated a cohort including athletes from all levels of sport. This study compared athletes who returned to sport to those who did not, based on four patient-reported outcome (PRO) scores, including the Hip Outcome Score—Sports Specific Subscale (HOS-SSS). Between September 2008 and April 2012, hip arthroscopies were performed on 157 patients (168 hips) who reported playing a sport preoperatively and indicated their level of sports activity post-operatively. Two-year follow-up was available for 148 (94%) amateur and professional athletes with a total of 158 hips. Of these 60 cases (65 hips) did not return to sports (NRTS) and were in the NRTS group. The remaining 88 cases (93 hips) constituted the RTS group. The modified Harris Hip Score, Non-Arthric Hip Score, Hip Outcome-Activities of Daily Living (HOS-ADL), and HOS-SSS were used to assess outcomes. The HOS-SSS was used to assess specific sport-related movement. Both groups demonstrated significant improvement at 2 years post-operatively in visual analog score and four PRO scores (P < 0.001). There was no significant preoperative differences in HOS-SSS scores between groups; however, the RTS group had significantly higher HOS-SSS scores at 1 and 2 years post-surgery. Post-operatively, the RTS group had significantly better ability to jump, land from a jump, stop quickly and perform cutting/lateral movements (P < 0.05). In summary, patients who indicated RTSs demonstrated significantly higher PRO scores and abilities to perform several sport-related movements, compared with patients who did not. PMID:27583148

  9. Medication persistence over 2 years of follow-up in a cohort of early rheumatoid arthritis patients: associated factors and relationship with disease activity and with disability

    PubMed Central

    Pascual-Ramos, Virginia; Contreras-Yáñez, Irazú; Villa, Antonio R; Cabiedes, Javier; Rull-Gabayet, Marina

    2009-01-01

    Introduction Aggressive treatment with disease-modifying antirheumatic drugs (DMARDs) plays a major role in improving early rheumatoid arthritis (RA) patient outcomes. Persistence and adherence with medication occurs variably (20% to 70%). The objectives of the study were to determine medication persistence (MP) in early RA patients over 13 consecutive visits each 2 months apart, to investigate the relationship between MP and disease activity, disability and structural damage, and to identify baseline prognosticators. Methods Charts from 75 patients of an early RA cohort were reviewed. At each visit, a rheumatologist interviewed patients regarding therapy, scored disease activity with the 28-joint disease activity score (DAS28) and disability with the health assessment questionnaire (HAQ), and recorded comorbidities and treatment. A complete medical history was obtained at baseline. MP was defined as the duration of time from initiation to discontinuation of at least one DMARD and/or corticosteroids for at least 1 week and was reported as a dichotomous variable at consecutive evaluations. Structural damage was defined by detection of new erosions on radiography. Descriptive statistics, Student's t test, the chi-squared test, and logistic regression analyses were used. Results The proportion of MP patients decreased from 98% at 2 months to 34% at 2 years. MP patients (n = 32) had similar DAS28 to non-MP patients (n = 53) at initial visits, lower DAS28 and greater DAS28 improvements at follow-ups (P ≤ 0.05 at visits 4, 6, 7 and 9) and reached sustained remission (≥ 3 consecutive visits with DAS28 < 2.6) more frequently (82.8% versus 46.5%, P = 0.003) and earlier (7.7 ± 4.6 versus 13.6 ± 5.7 months, P = 0.001) than non-MP patients. MP patients had similar baseline HAQ scores, but lower HAQ scores at follow-up (P ≤ 0.05 at visits 3, 5, 6, 7, 9, 10 and 13). More non-MP patients developed erosive disease than MP patients (26.8% versus 17.9%, P = 0.56). Older age

  10. Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up.

    PubMed

    Oh, Taemin; Scheer, Justin K; Eastlack, Robert; Smith, Justin S; Lafage, Virginie; Protopsaltis, Themistocles S; Klineberg, Eric; Passias, Peter G; Deviren, Vedat; Hostin, Richard; Gupta, Munish; Bess, Shay; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher P

    2015-06-01

    OBJECT Alignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically. METHODS The authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV ≥ L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2-7 cervical lordosis (CL), C2-7 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2-12 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS). RESULTS Fifty-seven patients with a mean age of 49.1 ± 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15°) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2-7 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV ≥ L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK ≥ 60° (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen. CONCLUSION Increased CL is common in adult spinal deformity patients with thoracic deformities

  11. Posterior dynamic stabilization of the lumbar spine with the Accuflex rod system as a stand-alone device: experience in 20 patients with 2-year follow-up

    PubMed Central

    Reyes-Sánchez, Alejandro; Ramírez-Mora, Isabel; Rosales-Olivarez, Luis Miguel; Alpizar-Aguirre, Armando; Sánchez-Bringas, Guadalupe

    2010-01-01

    Decompression surgery for lumbar spinal stenosis is a common procedure. After surgery, segmental instability sometimes occurs, therefore, different methods for restabilization have been developed. Dynamic stabilization systems have been designed to improve segmental stability. In this study, clinical results of patients with lumbar spinal stenosis that underwent decompression and stabilization with the Accuflex dynamic system are presented; clinical, radiographic, and magnetic resonance imaging (MRI) findings are fully described. Improvements in all clinical measurements, including visual analog scale for back and leg pain, Oswestry disability index, and SF-36 health status survey were noticed. At a 2-year follow-up, 22.22% of patients required hardware removal due to fatigue while in 83% of them no progression of disk degeneration was observed after implantation of the Accuflex system. Additionally, as demonstrated by the MRI images at follow up, three patients (16%) showed disk rehydration with one grade higher on the Pfirmann classification. Although a relatively high hardware failure was observed (22.22%), the use of the dynamic stabilization system Accuflex posterior to decompression procedures, showed clinical benefits and stopped the degenerative process in 83% the patients. PMID:20496039

  12. Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.

    PubMed

    Bakhsheshian, Joshua; Scheer, Justin K; Gum, Jeffrey L; Hostin, Richard; Lafage, Virginie; Bess, Shay; Protopsaltis, Themistocles S; Burton, Douglas C; Keefe, Malla Kate; Hart, Robert A; Mundis, Gregory M; Shaffrey, Christopher I; Schwab, Frank; Smith, Justin S; Ames, Christopher P

    2017-01-01

    OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression

  13. Observation on therapeutic efficacy of ursodeoxycholic acid in Chinese patients with primary biliary cirrhosis: a 2-year follow-up study.

    PubMed

    Zhu, Jiangyi; Shi, Yongquan; Zhou, Xinmin; Li, Zengshan; Huang, Xiaofeng; Han, Zheyi; Wang, Jianhong; Wang, Ruian; Ding, Jie; Wu, Kaichun; Han, Ying; Fan, Daiming

    2013-06-01

    The efficacy of ursodeoxycholic acid (UDCA) on long-term outcome of primary biliary cirrhosis (PBC) has been less documented in Chinese cohort. We aimed to assess the therapeutic effect of UDCA on Chinese patients with PBC. In the present study, 67 patients with PBC were treated with UDCA (13-15 mg·kg(-1)·day(-1)) and followed up for 2 years to evaluate the changes of symptoms, laboratory values and histological features. As the results indicated, fatigue and pruritus were obviously improved by UDCA, particularly in patients with mild or moderate symptoms. The alkaline phosphatase and γ-glutamyl transpetidase levels significantly declined at year 2 comparing to baseline values, with the most profound effects achieved in patients at stage 2. The levels of alanine aminotransferase and aspartate aminotransferase significantly decreased whereas serum bilirubin and immunoglobulin M levels exhibited no significant change. Histological feature was stable in patients at stages 1-2 but still progressed in patients at stages 3-4. The biochemical response of patients at stage 2 was much better than that of patients at stages 3-4. These data suggest that, when treated in earlier stage, patients in long-term administration of UDCA can gain favorable results not only on symptoms and biochemical responses but also on histology. It is also indicated that later histological stage, bad biochemical response and severe symptom may be indicators of poor prognosis for UDCA therapy.

  14. Rationale for a 'Male Lumpectomy,' a Prostate Cancer Targeted Approach Using Cryoablation: Results in 21 Patients with at Least 2 Years of Follow-Up

    SciTech Connect

    Onik, Gary

    2008-01-15

    Background. Prostate cancer in men raises many of the same issues that breast cancer does in women. Complications of prostate cancer treatment, including impotence and incontinence, affect the self-image and psyche of a man no less than does the loss of a breast in a woman. We present a pilot study in which 21 patients were treated with a focal cryoablation procedure. Methods. Focal cryoablation was performed using biplane transrectal ultrasound if the tumor was confined to only one prostate lobe. Preoperative PSA values were recorded. Cryoablation was planned to encompass the area of known tumor. PSA values were obtained every 3 months for 2 years and every 6 months thereafter. Potency and continence status was obtained at the same intervals. Routine biopsy was obtained at 1 year. Results. Twenty-one patients had focal cryoablation. Follow-up ranged from 24 to 105 months with a mean of 50 months. Twenty of 21 (95%) patients have stable PSA values with no evidence for cancer, despite 10 patients being at medium to high risk for recurrence. All patients biopsied (n = 19) were negative for tumor. Potency was maintained in 17 of 21 patients (80%). No other complications, including incontinence or fistula formation, were noted. Conclusion. These preliminary results indicate a 'male lumpectomy,' in which the prostate tumor region itself is destroyed, appears to preserve potency in a majority of patients and limits other complications, without compromising cancer control. If these results are confirmed by further studies and long-term follow-up, this treatment approach could have a profound effect on prostate cancer management.

  15. Time to remission for eating disorder patients: a 2(1/2)-year follow-up study of outcome and predictors.

    PubMed

    Clausen, Loa

    2008-01-01

    The aim of the present study was to analyse outcome, time to remission, and predictors of time to remission in a cohort of Danish eating disorder patients. Seventy-eight patients (35 anorexic, 30 bulimic and 13 unspecified eating disorder patients) were interviewed 2(1/2) years after initial assessment. Method of assessment was Eating Disorder Examination (EDE), Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II), Eating Disorder Inventory (EDI), Symptom Check List (SCL-90R), Present State Examination (PSE) and the Structured Clinical Interview for DSM-III-R Axis-II (SCID-II). Method of analysis was Kaplan-Meier estimate of survival, Log Rank test and Cox regression analysis. In total 48.7% reached remission with mean time to remission at 27 months. A trend difference between the diagnostic groups when measuring time to remission was found, i.e. patients with unspecified eating disorders remitted faster than bulimic (BN) patients who in turn remitted faster than anorexic (AN) patients. Body mass index (BMI) at baseline was the best predictor of time to remission for the total sample. Predictors differed when looking at diagnostic groups separately. Final outcome was comparable with earlier studies while relapse frequency was low. Patients with AN remitted faster than found in earlier survival analysis studies, while the remission rate for BN patients was comparable with earlier studies. Despite the prognostic value of BMI for the total sample, predictor analysis implied more disorder diversity than homogeneity.

  16. How the neck affects the back: changes in regional cervical sagittal alignment correlate to HRQOL improvement in adult thoracolumbar deformity patients at 2-year follow-up.

    PubMed

    Protopsaltis, Themistocles S; Scheer, Justin K; Terran, Jamie S; Smith, Justin S; Hamilton, D Kojo; Kim, Han Jo; Mundis, Greg M; Hart, Robert A; McCarthy, Ian M; Klineberg, Eric; Lafage, Virginie; Bess, Shay; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher P

    2015-08-01

    C-7 SVA, the C2-7 SVA correlated significantly with baseline ODI (r = 0.211, p = 0.002), PCS (r = -0.178, p = 0.009), and SRS Activity (r = -0.145, p = 0.034) for the entire cohort. In the subset of operative patients with larger thoracolumbar deformities, the change in C2-7 SVA correlated with change in ODI (r = -0.311, p = 0.03). CONCLUSIONS Changes in cervical lordosis correlate to HRQOL improvements in thoracolumbar deformity patients at 2-year follow-up. Regional cervical sagittal parameters such as CL and C2-7 SVA are correlated with clinical measures of regional disability and health status in patients with adult thoracolumbar scoliosis. This effect may be direct or a reciprocal effect of the underlying global deformities on regional cervical alignment. However, the partial correlation analysis, controlling for the magnitude of the thoracolumbar deformity, suggests that there is a direct effect of cervical alignment on health measures. Improvements in regional cervical alignment postoperatively correlated positively with improved HRQOL.

  17. Variability of NT-proBNP and Its Relationship with Inflammatory Status in Patients with Stable Essential Hypertension: A 2-Year Follow-Up Study

    PubMed Central

    Roselló-Lletí, Esther; Calabuig, Jose R.; Morillas, Pedro; Cortés, Raquel; Martínez-Dolz, Luis; Almenar, Luis; González-Juanatey, Jose R.; Lauwers, Catheline; Salvador, Antonio; Portolés, Manuel; Bertomeu, Vicente; Rivera, Miguel

    2012-01-01

    Background The variability of NT-proBNP levels has been studied in heart failure, yet no data exist on these changes over time in hypertensive patients. Furthermore, studies on the relationship between natriuretic peptides and inflammatory status are limited. Methodology/Principal Findings 220 clinically and functionally asymptomatic stable patients (age 59±13, 120 male) out of 252 patients with essential hypertension were followed up, and NT-proBNP was measured at baseline, 12 and 24 months. No differences in NT-proBNP were found with respect to the basal stage in the hypertrophic group, but significant changes were found in non-hypertrophic subjects. The reproducibility of NT-proBNP measurements was better in patients with hypertrophy than in the non-hypertrophic group for the three intervals (stage I-basal; stage II-stage I; stage II-basal) with a reference change value of 34%, 35% and 41%, respectively, in the hypertrophic group. A more elevated coefficient of correlation was obtained in the hypertrophic group than in patients without hypertrophy: basal versus stage I (r = 0.79, p<0.0001 and r = 0.59, p<0.0001) and stage I versus stage II (r = 0.86, p<0.0001 and r = 0.56, p<0.0001). Finally, levels of NT-proBNP significantly correlated with sTNF-R1 (p<0.0001) and IL-6 (p<0.01) during follow-up. A multivariate linear regression analysis showed that sTNF-R1 is an independent factor of NT-proBNP. Conclusions/Significance This work shows that there is good stability in NT-proBNP levels in a follow-up study of asymptomatic patients with stable hypertension and left ventricular hypertrophy. As a consequence, assessment of NT-proBNP concentrations may be a useful tool for monitoring the follow-up of hypertensive patients with hypertrophy. Measured variations in peptide levels, exceeding 35% in a 12-month follow-up and 41% in a 24-month follow-up, may indicate an increase in cardiovascular risk, and therefore implies adjustment in the medical treatment

  18. Lack of effects of vagus nerve stimulation on drug-resistant epilepsy in eight pediatric patients with autism spectrum disorders: a prospective 2-year follow-up study.

    PubMed

    Danielsson, Susanna; Viggedal, Gerd; Gillberg, Christopher; Olsson, Ingrid

    2008-02-01

    Vagus nerve stimulation (VNS) therapy has been reported to reduce seizure frequency in some children with drug-resistant epilepsy who are not suitable candidates for epilepsy surgery. It has been suggested that there may be positive cognitive and/or behavioral effects independent of seizure control. We describe the effects of VNS with respect to seizure frequency, cognition, and autistic symptoms and behavior in eight children and adolescents with medically intractable epilepsy and autism. In comparison to baseline, seizure frequency had not decreased in anyone in our series at the 2-year follow-up. In three cases, minor improvements in general functioning were noted, but there were no positive cognitive effects. This open prospective pilot study highlights the need for more prospective studies to prevent false expectations of improvement in this severely disabled group.

  19. An 8-Week Knee Osteoarthritis Treatment Program of Hyaluronic Acid Injection, Deliberate Physical Rehabilitation, and Patient Education is Cost Effective at 2 Years Follow-up: The OsteoArthritis Centers of AmericaSM Experience

    PubMed Central

    Miller, Larry E; Block, Jon E

    2014-01-01

    Numerous nonsurgical interventions have been reported to improve symptoms of knee osteoarthritis (OA) over the short term. However, longer follow-up is required to accurately characterize outcomes such as cost effectiveness and delayed arthroplasty. A total of 553 patients with symptomatic knee OA who previously underwent a single 8-week multimodal treatment program were contacted at 1 year (n = 336) or 2 years (n = 217) follow-up. The percentage of patients who underwent knee arthroplasty was 10% at 1 year and 18% at 2 years following program completion. The treatment program was highly cost effective at $12,800 per quality-adjusted life year at 2 years. Cost effectiveness was maintained under a variety of plausible assumptions and regardless of gender, age, body mass index, disease severity, or knee pain severity. In summary, a single 8-week multimodal knee OA treatment program is cost effective and may lower knee arthroplasty utilization through 2 years follow-up. PMID:25574144

  20. Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients.

    PubMed

    Pajarinen, Jarkko; Björkenheim, Jan-Magnus

    2002-01-01

    We reviewed the results of internal fixation in a series of 18 patients (mean age, 44.4 years; SD, 19.1 years; range, 16-81 years) with type C intraarticular fractures of the distal humerus after a mean follow-up of 24.7 months (range, 10-41 months; SD, 9.3 months). An excellent or good result was observed in 10 patients (56%), according to the rating system of the Orthopaedic Trauma Association. All patients younger than 40 years (n = 8) had an excellent or good result, whereas those rates were found in only 2 of 10 patients older than 50 years. Low range of elbow motion (extension-flexion) and, consequently, inferior postoperative score were also correlated to male sex, the triceps-splitting approach, and immobilization exceeding 3 weeks. When stability of the humeral columns is achieved and the articular platform is reconstructed, satisfactory results can be obtained, even in comminuted supracondylar fractures. However, age over 50 years, poor bone quality, and open fracture are correlated with increased risk for an inferior postoperative result. Early mobilization, when possible, and the use of an olecranon osteotomy are recommended.

  1. Effects of enzyme replacement therapy on five patients with advanced late-onset glycogen storage disease type II: a 2-year follow-up study.

    PubMed

    Furusawa, Yoshihiko; Mori-Yoshimura, Madoka; Yamamoto, Toshiyuki; Sakamoto, Chikako; Wakita, Mizuki; Kobayashi, Yoko; Fukumoto, Yutaka; Oya, Yasushi; Fukuda, Tokiko; Sugie, Hideo; Hayashi, Yukiko K; Nishino, Ichizo; Nonaka, Ikuya; Murata, Miho

    2012-03-01

    We examined the efficacy of 2-year enzyme replacement therapy (ERT) using recombinant human α-glucosidase (GAA; Myozyme®) in five long-term ventilator-dependent adults and aged patients with advanced, late-onset glycogen storage disease type II (GSDII, also known as Pompe disease). Although all patients had advanced respiratory failure and were ventilator-dependent for more than 6 years, four showed obvious improvements in muscle strength, pulmonary function, and activities of daily living after ERT. Improvement in each parameter was more prominent in the first year than in the second year. Values in the second year were still significantly better than those at study entry and indicate stabilization in the clinical status of all patients. These results suggest that ERT continues to be effective in the second year of treatment even in patients suffering from advanced late-onset GSDII disease with severe respiratory failure.

  2. Cytokines as a predictor of clinical response following hip arthroscopy: minimum 2-year follow-up

    PubMed Central

    Shapiro, Lauren M.; Safran, Marc R.; Maloney, William J.; Goodman, Stuart B.; Huddleston, James I.; Bellino, Michael J.; Scuderi, Gaetano J.; Abrams, Geoffrey D.

    2016-01-01

    Hip arthroscopy in patients with osteoarthritis has been shown to have suboptimal outcomes. Elevated cytokine concentrations in hip synovial fluid have previously been shown to be associated with cartilage pathology. The purpose of this study was to determine whether a relationship exists between hip synovial fluid cytokine concentration and clinical outcomes at a minimum of 2 years following hip arthroscopy. Seventeen patients without radiographic evidence of osteoarthritis had synovial fluid aspirated at time of portal establishment during hip arthroscopy. Analytes included fibronectin–aggrecan complex as well as a multiplex cytokine array. Patients completed the modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index and the International Hip Outcomes Tool pre-operatively and at a minimum of 2 years following surgery. Pre and post-operative scores were compared with a paired t-test, and the association between cytokine values and clinical outcome scores was performed with Pearson’s correlation coefficient with an alpha value of 0.05 set as significant. Sixteen of seventeen patients completed 2-year follow-up questionnaires (94%). There was a significant increase in pre-operative to post-operative score for each clinical outcome measure. No statistically significant correlation was seen between any of the intra-operative cytokine values and either the 2-year follow-up scores or the change from pre-operative to final follow-up outcome values. No statistically significant associations were seen between hip synovial fluid cytokine concentrations and 2-year follow-up clinical outcome assessment scores for those undergoing hip arthroscopy. PMID:27583163

  3. Clinical Outcomes of Posterior Lumbar Interbody Fusion for Patients 80 Years of Age and Older with Lumbar Degenerative Disease: Minimum 2 Years' Follow-Up

    PubMed Central

    Hayashi, Kazunori; Matsumura, Akira; Konishi, Sadahiko; Kato, Minori; Namikawa, Takashi; Nakamura, Hiroaki

    2016-01-01

    Study Design Retrospective study. Objective To compare clinical outcomes, radiographic evaluations including bony union rate and incidence of osteoporotic vertebral fractures (OVFxs), and perioperative complications following posterior lumbar interbody fusion (PLIF) between patients ≥80 years of age and those <80 years. Methods Ninety-six patients ≥70 years old who underwent PLIF were reviewed. We divided the patients into the two age groups, ≥80 group (n = 19) and <80 group (n = 77), and compared the clinical outcomes using Japanese Orthopaedics Association (JOA) scores and the Short-Form Health Survey (SF-36). We also evaluated bony union and the incidence of OVFxs in the both groups. Results The JOA score improved 47.6% in the ≥80 group and 49.1% in the <80 group. There were no significant differences between the two groups. Only the bodily pain component of the SF-36 improved significantly in the ≥80 group, and seven of eight components (exception was general health) improved significantly in the <80 group. Bony union rate was significantly superior in the <80 group (94.8%) compared with that of the ≥80 group (73.7%, p = 0.013). OVFx prevalence and incidence were not significantly different between the two groups, although postoperative OVFx worsened the JOA score improvement in the ≥80 group (38.8%, p = 0.02). Conclusions The present study indicated that surgical outcomes of PLIF in patients ≥80 years were comparable to those < 80 years. However, bony union rate was significantly lower and postoperative OVFx worsened the clinical outcomes in patients ≥80 years. PMID:27781186

  4. Infantile Amnesia across the Years: A 2-Year Follow-Up of Children's Earliest Memories

    ERIC Educational Resources Information Center

    Peterson, Carole; Warren, Kelly L.; Short, Megan M.

    2011-01-01

    Although infantile amnesia has been investigated for many years in adults, only recently has it been investigated in children. This study was a 2-year follow-up and extension of an earlier study. Children (4-13 years old) were asked initially and 2 years later for their earliest 3 memories. At follow-up, their age at the time of these memories…

  5. Successful ABO-incompatible living-related intestinal transplantation: a 2-year follow-up.

    PubMed

    Fan, D M; Zhao, Q C; Wang, W Z; Shi, H; Wang, M; Chen, D L; Zheng, J Y; Li, M B; Wu, G S

    2015-05-01

    ABO-incompatible intestinal transplantation has rarely been performed due to poor patient outcomes. Herein we present a case of successful ABO-incompatible intestinal transplantation with a 2-year follow-up. A 16-year-old female with a history of extensive bowel resection received an ABO-incompatible living donor bowel graft from her father (blood type AB graft into a type A recipient). Posttransplant immunosuppression consisted of an initial anti-CD20, plasmapheresis/intravenous immunoglobulin before transplantation, followed by an anti-thymocyte globulin (ATG) induction and splenectomy, and maintenance with tacrolimus and prednisone. Her postoperative course was remarkable for a single episode of rejection on day 14 which responded promptly to treatment with methyprednisolone and ATG. Three months after transplantation, the patient developed an abdominal abscess requiring open surgical drainage. No viral infections were encountered. Posttransplant anti-B antibody titers and anti-B7 donor-specific antibody levels remained low. At a 2-year follow-up, the patient showed a progressive weight gain of 5.0 kg. This case illustrates that ABO-incompatible living-related bowel transplantation is immunologically feasible and is associated with good outcomes for the recipient. The management of blood type antibodies and the use of adequate immunosuppression in the early period of the procedure may be the keys to the success of future cases.

  6. Management of hereditary gingival fibromatosis: A 2 years follow-up case report

    PubMed Central

    Tripathi, Amitandra Kumar; Dete, Gopal; Saimbi, Charanjeet Singh; Kumar, Vivek

    2015-01-01

    Hereditary gingival fibromatosis (HGF) is a rare hereditary condition characterized by slow, progressive, nonhemorrhagic, fibrous enlargement of gingiva due to increase in sub-mucosal connective tissue component. This paper presents a case report of an 18-year-old female suffering from HGF with positive family history. Her 42-year-old mother also have enlargement of the gums. After through clinical examination of both the patients, routine blood investigation was advised. All the investigations were within normal physiological limits of both the patients. Surgical excision of enlarged gingival tissue was planned after meticulous scaling and root planing. Patients were recalled 1 week after surgery. Postoperative healing were good and desired crown lengthening was achieved with significant improvement in speech and masticatory problems in both the patients. There was no recurrence of the disease even after 2 years follow-up. PMID:26229281

  7. Management of hereditary gingival fibromatosis: A 2 years follow-up case report.

    PubMed

    Tripathi, Amitandra Kumar; Dete, Gopal; Saimbi, Charanjeet Singh; Kumar, Vivek

    2015-01-01

    Hereditary gingival fibromatosis (HGF) is a rare hereditary condition characterized by slow, progressive, nonhemorrhagic, fibrous enlargement of gingiva due to increase in sub-mucosal connective tissue component. This paper presents a case report of an 18-year-old female suffering from HGF with positive family history. Her 42-year-old mother also have enlargement of the gums. After through clinical examination of both the patients, routine blood investigation was advised. All the investigations were within normal physiological limits of both the patients. Surgical excision of enlarged gingival tissue was planned after meticulous scaling and root planing. Patients were recalled 1 week after surgery. Postoperative healing were good and desired crown lengthening was achieved with significant improvement in speech and masticatory problems in both the patients. There was no recurrence of the disease even after 2 years follow-up.

  8. Functional outcomes of proximal row carpectomy: 2-year follow-up

    PubMed Central

    Mandarano-Filho, Luiz Garcia; Campioto, Débora Schalge; Bezuti, Márcio Takey; Mazzer, Nilton; Barbieri, Cláudio Henrique

    2015-01-01

    ABSTRACT OBJECTIVE : To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tis METHODS : This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this technique RESULTS : Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patients CONCLUSION : Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series. PMID:27057144

  9. Delta Reverse Polarity Shoulder Replacement: Single Surgeon Experience with a Minimum 2-Year Follow-up

    PubMed Central

    Eltayeb, Magid; Javaid, Mohammad Muddassir Mahmood

    2015-01-01

    Background The delta reverse shoulder replacement system was developed for the treatment of rotator cuff arthropathy so that the deltoid can substitute for the deficient rotator cuff. To evaluate the results of delta reverse shoulder replacement for functional improvement and complications in a consecutive series by a single surgeon over a period of six years with a minimum follow-up of 2 years. Methods The data were collected retrospectively from electronic theatre records. Over a period of 6 years (2006-2012), 46 cases that fulfilled the inclusion criteria were identified. There were 34 females and 12 males. The average age of patients was 76.2 years (range, 58 to 87 years). A single surgeon performed all procedures using the anterosuperior approach. The mean follow-up time was 49 months (range, 24 to 91 months). All cases had preoperative and postoperative Constant scores. We collected the data on indications, hospital stay, and change in the Constant score, complications, and reoperation rates. Results The main indication for surgery was rotator cuff arthropathy (52.2%), followed by massive rotator cuff tear (28.3%), osteoarthritis (8.7%), fractures (6.5%), and rheumatoid arthritis (4.3%). Also, 65.2% of the cases were referred by general practitioners, 26% of the cases were referred by other consultants, and 8.8% of the cases were already under the care of a shoulder surgeon. The average preoperative Constant score was 23.5 (range, 8 to 59). The average Constant score at the final follow-up was 56 (range, 22 to 83). On average, there was an improvement of 33 points in the Constant score. The improvement in the Constant score was significant (p < 0.001). We observed complications in four patients (8.6%). Three of four patients (6.5%) needed reoperation. The first complication was pulmonary embolism in the early postoperative period. The other complications included dissociation of the glenosphere from the metaglene, deltoid detachment, and stitch abscess

  10. Clinical Results of Lateral Unicompartmental Knee Arthroplasty: Minimum 2-Year Follow-up

    PubMed Central

    Kim, Kyung Tae; Lee, Song; Kim, Jin Woo; Kang, Min Su

    2016-01-01

    Background We investigated the clinical results and early complications after lateral unicompartmental knee arthroplasty (UKA) using the Zimmer unicompartmental high-flex knee (ZUK) prosthesis with a minimum follow-up of 2 years. Methods Twenty-seven patients (30 cases) who underwent lateral UKA with the ZUK prosthesis between January 2011 and February 2014 were selected for this study. The mean age of the patients was 63.3 years at the time of surgery, and the mean followup was 3 years and 2 months (range, 24 to 48 months). A retrospective investigation method was used to evaluate the clinical and radiographic results with use of the Knee Society (KS) clinical rating system and plain radiography. Results The mean KS pain score was improved from 17.9 points (range, 10 to 30 points) preoperatively to 40.5 points (range, 30 to 45 points) at the final follow-up (p < 0.001). The mean KS knee score and function score significantly increased from 63.2 points (range, 48 to 70 points) and 68.6 points (range, 35 to 80 points), respectively, preoperatively to 86.0 points (range, 74 to 95 points) and 92.4 points (range, 60 to 100 points), respectively, at the final follow-up (p < 0.001). The mean range of motion of the knee was recovered from 127.1° (range, 110° to 135°) preoperatively to 131.6° (range, 120° to 135°) at the final follow-up. The mean tibiofemoral angle changed from 6.2° of valgus (range, 0.1° to 11.4° of valgus) preoperatively to 3.4°of valgus (range, 0.2° to 9.5° of valgus) at the final follow-up. The overall results classified based on the KS knee score were "excellent" in 21 cases and "good" in 8 cases. Revision total knee arthroplasty was required in one case because of consistent pain on the medial side of the knee after surgery. Conclusions The early clinical results of lateral UKA using the ZUK prosthesis were satisfactory for improvement of pain, knee score, function score, and recovery of knee motion. Therefore, the lateral UKA could be a

  11. Expression of Calcineurin Activity after Lung Transplantation: A 2-Year Follow-Up

    PubMed Central

    Sanquer, Sylvia; Amrein, Catherine; Grenet, Dominique; Guillemain, Romain; Philippe, Bruno; Boussaud, Veronique; Herry, Laurence; Lena, Celine; Diouf, Alphonsine; Paunet, Michelle; Billaud, Eliane M.; Loriaux, Françoise; Jais, Jean-Philippe; Barouki, Robert; Stern, Marc

    2013-01-01

    The objective of this pharmacodynamic study was to longitudinally assess the activity of calcineurin during the first 2 years after lung transplantation. From March 2004 to October 2008, 107 patients were prospectively enrolled and their follow-up was performed until 2009. Calcineurin activity was measured in peripheral blood mononuclear cells. We report that calcineurin activity was linked to both acute and chronic rejection. An optimal activity for calcineurin with two thresholds was defined, and we found that the risk of rejection was higher when the enzyme activity was above the upper threshold of 102 pmol/mg/min or below the lower threshold of 12 pmol/mg/min. In addition, we report that the occurrence of malignancies and viral infections was significantly higher in patients displaying very low levels of calcineurin activity. Taken together, these findings suggest that the measurement of calcineurin activity may provide useful information for the management of the prevention therapy of patients receiving lung transplantation. PMID:23536885

  12. Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction.

    PubMed

    Scheer, Justin K; Smith, Justin S; Clark, Aaron J; Lafage, Virginie; Kim, Han Jo; Rolston, John D; Eastlack, Robert; Hart, Robert A; Protopsaltis, Themistocles S; Kelly, Michael P; Kebaish, Khaled; Gupta, Munish; Klineberg, Eric; Hostin, Richard; Shaffrey, Christopher I; Schwab, Frank; Ames, Christopher P

    2015-05-01

    OBJECT Back and leg pain are the primary outcomes of adult spinal deformity (ASD) and predict patients' seeking of surgical management. The authors sought to characterize changes in back and leg pain after operative or nonoperative management of ASD. Outcomes were assessed according to pain severity, type of surgical procedure, Scoliosis Research Society (SRS)-Schwab spine deformity class, and patient satisfaction. METHODS This study retrospectively reviewed data in a prospective multicenter database of ASD patients. Inclusion criteria were the following: age > 18 years and presence of spinal deformity as defined by a scoliosis Cobb angle ≥ 20°, sagittal vertical axis length ≥ 5 cm, pelvic tilt angle ≥ 25°, or thoracic kyphosis angle ≥ 60°. Patients were grouped into nonoperated and operated subcohorts and by the type of surgical procedure, spine SRS-Schwab deformity class, preoperative pain severity, and patient satisfaction. Numerical rating scale (NRS) scores of back and leg pain, Oswestry Disability Index (ODI) scores, physical component summary (PCS) scores of the 36-Item Short Form Health Survey, minimum clinically important differences (MCIDs), and substantial clinical benefits (SCBs) were assessed. RESULTS Patients in whom ASD had been operatively managed were 6 times more likely to have an improvement in back pain and 3 times more likely to have an improvement in leg pain than patients in whom ASD had been nonoperatively managed. Patients whose ASD had been managed nonoperatively were more likely to have their back or leg pain remain the same or worsen. The incidence of postoperative leg pain was 37.0% at 6 weeks postoperatively and 33.3% at the 2-year follow-up (FU). At the 2-year FU, among patients with any preoperative back or leg pain, 24.3% and 37.8% were free of back and leg pain, respectively, and among patients with severe (NRS scores of 7-10) preoperative back or leg pain, 21.0% and 32.8% were free of back and leg pain, respectively

  13. Emotionally Focused Interventions for Couples with Chronically Ill Children: A 2-Year Follow-Up

    ERIC Educational Resources Information Center

    Cloutier, Paula F.; Manion, Ian G.; Walker, Jan Gordon; Johnson, Susan M.

    2002-01-01

    Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with…

  14. Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients

    PubMed Central

    Wang, Ya-peng; Zhang, Wei; Zhang, Jian; Sun, Ya-peng; An, Ji-long; Ding, Wen-yuan

    2017-01-01

    Background Very few studies have discussed transforaminal endoscopic discectomy (TED) in the treatment of common peroneal nerve paralysis induced by lumbar disk herniation (LDH). This study aimed to evaluate the efficacy of TED in the treatment of LDH combined with common peroneal nerve paralysis. Materials and methods The clinical and follow-up data of 32 patients with common peroneal nerve paralysis induced by LDH undergoing TED from March 2011 to April 2014 were retrospectively analyzed in this study. Follow-up was conducted immediately after the surgery, as well as 3, 12, and 24 months postoperatively. The parameters (including muscle strength recovery of the anterior tibial muscle, leg pain visual analog scale score, neurological function Japanese Orthopaedic Association [JOA] score, MacNab scores in the last follow-up, and the intraoperative and postoperative complications) were recorded. Results Three patients (9.4%) had the anterior tibial muscle strength recovered to ≥ grade 4 immediately after the surgery. The anterior tibial muscle strength of patients recovered to basically stable form in the 6-month postoperative follow-up and that in the last follow-up were as follows: one case of grade 1, one case of grade 2, 28 cases of grade 4, and two cases of grade 5. The visual analog scale scores of leg pain were significantly reduced immediately after the surgery and also on 3, 12, and 24 months compared with preoperative period (all P<0.05). The postoperative JOA scores in the last follow-up were significantly higher than the preoperative JOA scores (P<0.05), and there were nine excellent cases (28.2%), 21 good cases (65.6%), one fair case (3.1%) and one poor case (3.1%) in the last follow-up, with an overall excellent and good rate of 93.8%. Conclusion TED, which can offer sufficient decompression of the nerve root, has excellent overall clinical effects in treating common peroneal nerve paralysis induced by LDH. PMID:28115870

  15. Saliva in perimenopausal and early postmenopausal women. A 2-year follow-up study.

    PubMed

    Tarkkila, Laura; Furuholm, Jussi; Tiitinen, Aila; Meurman, Jukka H

    2012-06-01

    This study aims to investigate salivary flow and biochemical constituents of menopausal-age women with the hypothesis that women using hormone therapy (HT) might present better saliva values than non-users. Two hundred HT users and 200 non-users were selected at random from a cohort study of 3,173 peri- and postmenopausal women and invited to a 2-year clinical follow-up study. Clinical examination with saliva sampling was made at baseline and 2 years later. Salivary total protein, albumin, and immunoglobulin (Ig) concentrations were analyzed. Final material included 106 consistent HT users and 55 non-users. Backward logistic regression analysis was made to determine the risk factors for higher or lower than medium salivary protein values. No difference was seen in salivary flow rate, total protein, and IgA values between baseline and follow-up measurements or between the groups. Albumin, IgG, and IgM concentrations were significantly lower in the 2-year samples of the HT group when compared with baseline. IgA and IgM values were higher in the non-HT 2-year samples when compared with the corresponding HT samples. The only significant explanatory factor for higher than median salivary albumin concentration was the number of teeth both at baseline and 2 years later. HT possibly improved epithelial integrity since the concentrations of serum components albumin, IgG, and IgM decreased during the follow-up. HT as such does not seem to affect saliva, although it may modify it. The clinical relevance of these results needs to be assessed in future studies.

  16. Clinical outcomes and mortality after hip fracture: a 2-year follow-up study.

    PubMed

    Baudoin, C; Fardellone, P; Bean, K; Ostertag-Ezembe, A; Hervy, F

    1996-03-01

    The aim of this study was to evaluate the burden of hip fractures, which occurred in the French region of Picardie, in 1992, among 1103 women and 356 men, whether the fractures occurred at home or in a community (i.e., patients who depended on a collective service). The data are part of the PICAROS study, which was designed to assess prospectively the outcome of patients as judged by clinical, economical, and quality of life factors. Patients and/or proxies were questioned during the 2nd or 3rd week following the fracture, and again at 3, 6, 12, and 24 months after the fracture. The survey was conducted by home interview. Recruitment criteria were: 1) all patients with a hip fracture as defined by the International Classification of Disease (ICD); 2) 20 years of age and over; 3) admitted to one of the 34 surgical units from the region, public and private, and had an operation or not. Patients with metastatic or myelomatous fractures or fractures on prothesis device were not included. For the present analysis, patients under 50 years of age were excluded. Among people aged 50 years and over, 3% of the general population lived in a community; 32% of hip fractures were from a community. Patients in a community, aged 60-69, had 15 times more risk of having a hip fracture than subjects of the same age at home. The excess risk decreased with age and stabilized over 85 years of age at two to threefold. During the 24 month follow-up, 394 women and 173 men died. Among those surviving, 87% were interviewed at 2 years. We analysed seven classes of complications, according to the ICD: (1) pressure sores and blisters; (2) pulmonary infections; (3) urinary infections; (4) surgical complications; (5) orthopedic complications; (6) thrombosis and embolisms; and (7) secondary hip fractures. Patients coming from a community had a higher risk of mortality, pressure sores, surgical complications, and pulmonary and urinary infections. From an economical perspective, the

  17. Antenatal renal pelvis dilatation: 2-year follow-up with DMSA scintigraphy.

    PubMed

    Lidefelt, Karl-Johan; Herthelius, Maria; Soeria-Atmadja, Sandra

    2009-03-01

    The aim of this study was to determine whether a postnatal ultrasound (US) can detect infants with antenatal renal pelvis dilatation (ARPD) who run a minimal risk of renal damage 2 years after birth. The study cohort consisted of 14,000 pregnant women who consecutively underwent routine US examinations during the second trimester. Subsequent examinations were performed on the basis of obstetrical indications. In total, 106 foetuses were diagnosed with ARPD > or =5 mm. Two postnatal US were performed on the newborns: on postpartum days 5-7 and during the third week of life. The findings were considered to be normal when the renal pelvis diameter (RPD) was < or = 7 mm and when there was no calyceal or ureteric dilatation or signs of renal dysplasia or other anomalies. Voiding cystourethrography (VCUG) was done at 6-8 weeks after birth. When the children reached 2 years of age, renal status was evaluated with DMSA scintigraphy or, if not possible, US. In 53 of the 103 children available for evaluation, the postnatal US findings were normal; 49 of the 53 children were also given a DMSA, and the results were normal in all cases. An US scan (all normal) only was performed in three children because the families refused a DMSA. One family refused any form of examination at the 2-year follow-up. Based on our results, we conclude that postnatal US can detect infants who do not require follow-up assessments of renal development.

  18. Learning, Memory, and Executive Function in New MDMA Users: A 2-Year Follow-Up Study

    PubMed Central

    Wagner, Daniel; Tkotz, Simon; Koester, Philip; Becker, Benjamin; Gouzoulis-Mayfrank, Euphrosyne; Daumann, Joerg

    2015-01-01

    3,4-Methylenedioxymethamphetamine (MDMA) is associated with changes in neurocognitive performance. Recent studies in laboratory animals have provided additional support for the neurodegeneration hypothesis. However, results from animal research need to be applied to humans with caution. Moreover, several of the studies that examine MDMA users suffer from methodological shortcomings. Therefore, a prospective cohort study was designed in order to overcome these previous methodological shortcomings and to assess the relationship between the continuing use of MDMA and cognitive performance in incipient MDMA users. It was hypothesized that, depending on the amount of MDMA taken, the continued use of MDMA over a 2-year period would lead to further decreases in cognitive performance, especially in visual paired association learning tasks. Ninety-six subjects were assessed, at the second follow-up assessment: 31 of these were non-users, 55 moderate-users, and 10 heavy-users. Separate repeated measures analyses of variance were conducted for each cognitive domain, including attention and information processing speed, episodic memory, and executive functioning. Furthermore, possible confounders including age, general intelligence, cannabis use, alcohol use, use of other concomitant substances, recent medical treatment, participation in sports, level of nutrition, sleep patterns, and subjective well-being were assessed. The Repeated measures analysis of variance (rANOVA) revealed that a marginally significant change in immediate and delayed recall test performances of visual paired associates learning had taken place within the follow-up period of 2 years. No further deterioration in continuing MDMA-users was observed in the second follow-up period. No significant differences with the other neuropsychological tests were noted. It seems that MDMA use can impair visual paired associates learning in new users. However, the groups differed in their use of concomitant use of

  19. Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients

    PubMed Central

    Daas, M.; Assaf, A.; Dada, K.; Makzoumé, J.

    2015-01-01

    Statement of Problem. Low scientific evidence is identified in the literature for combining implant placement in fresh extraction sockets with immediate function. Moreover, the few studies available on immediate implants in postextraction sites supporting immediate full-arch rehabilitation clearly lack comprehensive protocols. Purpose. The purpose of this study is to report outcomes of a comprehensive protocol using CAD-CAM technology for surgical planning and fabrication of a surgical template and to demonstrate that immediate function can be easily performed with immediate implants in postextraction sites supporting full-arch rehabilitation. Material and Methods. 14 subjects were consecutively rehabilitated (13 maxillae and 1 mandible) with 99 implants supporting full-arch fixed prostheses followed between 6 and 24 months (mean of 16 months). Outcome measures were prosthesis and implant success, biologic and prosthetic complications, pain, oedema evaluation, and radiographic marginal bone levels at surgery and then at 6, 12, 18, and 24 months. Data were analyzed with descriptive statistics. Results. The overall cumulative implant survival rate at mean follow-up time of 16 months was 97.97%. The average marginal bone loss was 0,9 mm. Conclusions. Within the limitations of this study, the results validate this treatment modality for full-arch rehabilitations with predictable outcomes and high survival rate after 2 years. PMID:26064119

  20. Quality of life after laparoscopic gastric banding: Prospective study (152 cases) with a follow-up of 2 years.

    PubMed

    Champault, Axèle; Duwat, Olivier; Polliand, Claude; Rizk, Nabil; Champault, Gérard G

    2006-06-01

    To evaluate influence of laparoscopic gastric banding (LGB) on quality of life (QOL) in patients with morbid obesity. Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. The objectives of surgical therapy in patients with morbid obesity are reduction of body weight, and a positive influence on the obesity-related comorbidity as well the concomitant psychologic and social restrictions of these patients. In a prospective clinical trial, development of the individual patient QOL was analyzed, after LGB in patients with morbid obesity. From October 1999 to January 2001, 152 patients [119 women, 33 men, mean age 38.4 y (range 24 to 62), mean body mass index 44.3 (range 38 to 63)] underwent evaluation for LGB according the following protocol: history of obesity; concise counseling of patients and relative on nonsurgical treatment alternatives, risk of surgery, psychologic testing, questionnaire for eating habits, necessity of lifestyle change after surgery; medical evaluation including endocrinologic and nutritionist work-up, upper GI endoscopy, evaluation of QOL using the Gastro Intestinal Quality of Life Index (GIQLI). Decision for surgery was a multidisciplinary consensus. This group was follow-up at least 2 years, focusing on weight loss and QOL. Mean operative time was 82 minutes; mean hospital stay was 2.3 days and the mean follow-up period was 34 months. The BMI dropped from 44.3 to 29.6 kg/m and all comorbid conditions improved markedly: diabetes melitus resolved in 71% of the patients, hypertension in 33%, and sleep apnea in 90%. However, 26 patients (17%) had late complications requiring reoperation. Preoperative global GIQLI score was 95 (range 56 to 140), significant different of the healthy volunteers score (120) (70 to 140) P < 0.001. Correlated with weight loss (percentage loss of overweight and BMI), the global score of the group increased to 100 at 3 months, 104 at 6, 111 at 1 year to reach 119 at 2 years which is no

  1. Changing Network Support for Drinking: Network Support Project 2-Year Follow-up

    ERIC Educational Resources Information Center

    Litt, Mark D.; Kadden, Ronald M.; Kabela-Cormier, Elise; Petry, Nancy M.

    2009-01-01

    The Network Support Project was designed to determine whether a treatment could lead patients to change their social network from one that supports drinking to one that supports sobriety. This study reports 2-year posttreatment outcomes. Alcohol-dependent men and women (N = 210) were randomly assigned to 1 of 3 outpatient treatment conditions:…

  2. Reduced prepulse inhibition in adolescents at risk for psychosis: a 2-year follow-up study

    PubMed Central

    Ziermans, Tim; Schothorst, Patricia; Magnée, Maurice; van Engeland, Herman; Kemner, Chantal

    2011-01-01

    Background Reduced prepulse inhibition (PPI) of the auditory startle reflex is a hallmark feature of attention-processing deficits in patients with schizophrenia and other psychotic disorders. Recent evidence suggests that these deficits may also be present before the onset of psychosis in individuals at ultra-high risk (UHR) and become progressively worse as psychosis develops. We conducted a longitudinal follow-up study to observe the development of PPI over time in UHR adolescents and healthy controls. Methods Two-year follow-up data of PPI measures were compared between UHR adolescents and a matched control group of typically developing individuals. Results We included 42 UHR adolescents and 32 matched controls in our study. Compared with controls, UHR individuals showed reduced PPI at both assessments. Clinical improvement in UHR individuals was associated with an increase in PPI parameters. Limitations A developmental increase in startle magnitude partially confined the interpretation of the association between clinical status and PPI. Furthermore, post hoc analyses for UHR individuals who became psychotic between assessments had limited power owing to a low transition rate (14%). Conclusion Deficits in PPI are present before the onset of psychosis and represent a stable vulnerability marker over time in UHR individuals. The magnitude of this marker may partially depend on the severity of clinical symptoms. PMID:21266126

  3. Ligneous conjunctivitis in a plasminogen-deficient dog: clinical management and 2-year follow-up.

    PubMed

    Torres, María-Dolores; Leiva, Marta; Tabar, María-Dolores; Naranjo, Carolina; Pastor, Josep; Peña, Teresa

    2009-01-01

    A 1-year-old-female Yorkshire Terrier was referred to the Veterinary Teaching Hospital of the Autonomous University of Barcelona (VTH-UAB) (Spain) with a 6-month history of unilateral chronic proliferative conjunctivitis and intermittent vomiting and cough. Several medical and surgical treatment efforts to manage conjunctival lesions had resulted in no improvement of the clinical signs. Complete general and ophthalmic examinations revealed several proliferative 'wood-like' masses in the conjunctiva, oral cavity and an interscapular subcutaneous nodule. Conjunctival and buccal biopsies were performed as diagnostic procedures. A diagnosis of ligneous conjunctivitis was made on the basis of histopathology findings and clinical presentation. The only biochemical abnormalities found were severe proteinuria and low plasminogen activity in plasma. No other analytical abnormalities were observed. Topical treatment with heparin and anti-inflammatory and immunosuppressive drugs have controlled the ophthalmological clinical signs. To our knowledge, this is the first case report of a dog with plasminogen deficiency and ligneous conjunctivitis with a long survival period and 2-year follow-up.

  4. Risk Factors of Proximal Junctional Kyphosis after Multilevel Fusion Surgery: More Than 2 Years Follow-Up Data

    PubMed Central

    Kim, Do Keun; Kim, Ji Yong; Kim, Do Yeon; Rhim, Seung Chul; Yoon, Seung Hwan

    2017-01-01

    Objective Proximal junctional kyphosis (PJK) is radiologic finding, and is defined as kyphosis of >10° at the proximal end of a construct. The aim of this study is to identify factors associated with PJK after segmental spinal instrumented fusion in adults with spinal deformity with a minimum follow-up of 2 years. Methods A total of 49 cases of adult spinal deformity treated by segmental spinal instrumented fusion at two university hospitals from 2004 to 2011 were enrolled in this study. All enrolled cases included at least 4 or more levels from L5 or the sacral level. The patients were divided into two groups based on the presence of PJK during follow-up, and these two groups were compared to identify factors related to PJK. Results PJK was observed in 16 of the 49 cases. Age, sex and mean follow-up duration were not statistically different between two groups. However, mean bone marrow density (BMD) and mean back muscle volume at the T10 to L2 level was significantly lower in the PJK group. Preoperatively, the distance between the C7 plumb line and uppermost instrumented vertebra (UIV) were no different in the two groups, but at final follow-up a significant intergroup difference was observed. Interestingly, spinal instrumentation factors, such as, receipt of a revision operation, the use of a cross-link, and screw fracture were no different in the two groups at final follow-up. Conclusion Preoperative BMD, sagittal imbalance at UIV, and thoracolumbar muscle volume were found to be strongly associated with the presence of PJK. PMID:28264237

  5. Femoro Patella Vialla patellofemoral arthroplasty: An independent assessment of outcomes at minimum 2-year follow-up

    PubMed Central

    Halai, Mansur; Ker, Andrew; Anthony, Iain; Holt, Graeme; Jones, Bryn; Blyth, Mark

    2016-01-01

    AIM To determine outcomes using the Femoro-Patella Vialla (FPV) arthroplasty and if there is an ideal patient for this implant. METHODS A total of 41 FPV patellofemoral joint replacements were performed in 31 patients (22 females, 9 males, mean age 65 years). Mean follow-up was 3.2 years (minimum 2 years). Radiographs were reviewed preoperatively and postoperatively. We assessed whether gender, age, previous surgery, patella atla or trochlear dysplasia influenced patient satisfaction or patient functional outcome. RESULTS The median Oxford Knee Score was 40 and the median Melbourne Patellofemoral Score was 21 postoperatively. Seventy-six percent of patients were satisfied, 10% unsure and 14% dissatisfied postoperatively. There was no radiological progression of tibiofemoral joint arthritis, using the Ahlback grading, in any patient. One patient, who was diagnosed with rheumatoid arthritis postoperatively, underwent revision to total knee replacement. There were no intraoperative lateral releases and no implant failures. Gender, age, the presence of trochlear dysplasia, patella alta or bilateral surgery did not influence patient outcome. Previous surgery did not correlate with outcome. CONCLUSION In contrast to the current literature, the FPV shows promising early results. However, we cannot identify a subgroup of patients with superior outcomes. PMID:27622149

  6. Battered Women's Process of Leaving: A 2-Year Follow-Up

    ERIC Educational Resources Information Center

    Brown, Chris; Trangsrud, Heather B.; Linnemeyer, Rachel M.

    2009-01-01

    This study is a follow-up investigation of the career and life experiences of battered women two years after shelter exit. Using consensual qualitative research, we interviewed 6 women from our original sample of 13 regarding their career and life adjustments and future aspirations. Results indicated that participants generally reported both…

  7. Primary Sjögren syndrome in a 2-year-old patient: role of the dentist in diagnosis and dental management with a 6-year follow-up.

    PubMed

    De Oliveira, Marcio Augusto; De Rezende, Nathalie Pepe Medeiros; Maia, Célia Márcia Fernandes; Gallottini, Marina

    2011-11-01

    BACKGROUND. Primary Sjögren syndrome is a rare autoimmune disease, especially in children, mainly affecting girls (77%), and usually diagnosed around 10 years of age. Diagnosis during childhood is difficult, especially because of the diversity of the clinical presentation and difficulty obtaining reliable history data, accounting for a higher frequency of underdiagnosed cases. Differential conditions should be considered, especially the ones that promote xerostomia, such as diabetes, ectodermal dysplasia, rheumatoid arthritis, scleroderma, systemic lupus erythematosus, sarcoidosis, lymphoma, HIV and HTLV infection. Conditions associated with parotid enlargement should also be excluded, including juvenile recurrent parotitis (JRP), sialadenosis, sarcoidosis, lymphoma, infectious parotitis caused by streptococcal and staphylococcal infections, viral infections (paramyxovirus, Epstein-Barr virus, cytomegalovirus, and parvovirus), and diffuse infiltrative lymphocytosis syndrome (associated with HIV infection), and rare congenital conditions, such as polycystic parotid disease. CASE REPORT. A paediatric female patient was referred to our clinic for dental treatment complaining about dry mouth, oral discomfort, and dysphagia. The patient presented five of the required criteria to establish the diagnosis of pSS, including ocular symptoms, oral symptoms, evidence of keratoconjunctivitis sicca, focal sialadenitis confirmed by minor salivary gland biopsy, and evidence of major salivary gland involvement. Our patient did not have positive SS-A and SS-B autoantibodies. According to the literature, about 29% of individuals with pSS can present seronegativity for SS-A (anti-Ro) antibodies and about 33% can present seronegativity for SS-B (anti-La) antibodies. CONCLUSION. To the best of our knowledge, this is the youngest patient reported in the scientific English literature with pSS. Primary Sjögren syndrome has a wide clinical and immunologic spectrum and may progress with

  8. Acromegalic patients lost to follow-up: a pilot study.

    PubMed

    Kasuki, Leandro; Marques, Nelma Verônica; Nuez, Maria José Braga La; Leal, Vera Lucia Gomes; Chinen, Renata N; Gadelha, Mônica R

    2013-06-01

    Approximately 50 % of all acromegalic patients will require lifelong medical treatment to normalize mortality rates and reduce morbidity. Thus, adherence to therapy is essential to achieve treatment goals. To date, no study has evaluated the frequency and reasons for loss to follow-up in the acromegalic population. The current study aimed at evaluating the frequency of acromegalic patient loss to follow-up in three reference centers and the reasons responsible for their low compliance with treatment. All of the files for the acromegalic patients in the three centers were reviewed. Those patients, who had not followed up with the hospital for more than a year, were contacted via phone and/or mail and invited to participate. Patients who agreed to participate were interviewed, and blood samples were collected. A total of 239 files were reviewed; from these 42 patients (17.6 %) were identified who were lost to follow-up. It was possible to contact 27 of these patients, 10 of whom did not attend the appointments for more than one time and 17 of whom agreed to participate in the study. Fifteen of these 17 patients had active disease (88.2 %), and all of the patients restarted treatment in the original centers. The main reason for loss to follow-up was an absence of symptoms. High-quality follow-up is important in acromegaly to successfully achieve the aims of the treatment. An active search for patients may allow the resumption of treatment in a significant proportion of these cases, contributing to reduced morbidity and mortality in this patient population.

  9. Temporal Stability of Obsessive-Compulsive Symptom Dimensions in an Undergraduate Sample: A Prospective 2-Year Follow-Up Study

    ERIC Educational Resources Information Center

    Fullana, Miquel A.; Tortella-Feliu, Miquel; Caseras, Xavier; Taberner, Joan; Torrubia, Rafael; Mataix-Cols, David

    2007-01-01

    The temporal stability of obsessive-compulsive symptom dimensions was studied in a nonclinical student sample. The Obsessive-Compulsive Inventory--Revised was administered twice to 132 undergraduate students during a 2-year period. There were no significant changes in symptom dimension scores between the baseline and follow-up, except for the…

  10. Involvement in bullying and suicidal ideation in middle adolescence: a 2-year follow-up study.

    PubMed

    Heikkilä, Hanna-Kaisa; Väänänen, Juha; Helminen, Mika; Fröjd, Sari; Marttunen, Mauri; Kaltiala-Heino, Riittakerttu

    2013-02-01

    The objective of the study was to ascertain whether involvement in bullying increases the risk for subsequent suicidal ideation. A total of 2,070 Finnish girls and boys aged 15 were surveyed in the ninth grade (age 15) in schools, and followed up 2 years later in the Adolescent Mental Health Cohort Study. Involvement in bullying was elicited at age 15 by two questions focusing on being a bully and being a victim of bullying. Suicidal ideation was elicited by one item of the short Beck Depression Inventory at age 17. Baseline depressive symptoms and externalizing symptoms, age and sex were controlled for. Statistical analyses were carried out using cross-tabulations with Chi-square/Fisher's exact test and logistic regression. Suicidal ideation at age 17 was 3-4 times more prevalent among those who had been involved in bullying at age 15 than among those not involved. Suicidal ideation at age 17 was most prevalent among former victims of bullying. Being a victim of bullying at age 15 continued to predict subsequent suicidal ideation when depressive and externalizing symptoms were controlled for. Being a bully at age 15 also persisted as borderline significantly predictive of suicidal ideation when baseline symptoms were controlled for. Findings indicate adolescent victims and perpetrators of bullying alike are at long-term risk for suicidal ideation.

  11. Evaluation of laparoscopic skills: a 2-year follow-up during residency training

    PubMed Central

    Derossis, Anna M.; Antoniuk, Maureen; Fried, Gerald M.

    1999-01-01

    Objective To evaluate laparoscopic technical skill in surgical residents over a 2-year period. Design The laparoscopic technical skills of general surgical residents were evaluated using the MISTELS program. This provides an objective evaluation of laparoscopic skill, taking into account precision and speed. Setting Inanimate laparoscopic skills centre. Participants Ten general surgical residents (5 PGY1, 3 PGY2 and 2 PGY3 residents) who were required to complete 3 structured laparoscopic tasks. Outcome measures A composite score incorporating precision and timing was assigned to each task. The paired t-test was used to compare performance of each resident at the 2 levels of their residency training for each task. Linear regression analysis was used to correlate level of training and total score (sum of all tasks). Results Linear regression analysis demonstrated a highly significant correlation between level of training and total score (r = 0.82, p < 0.01). There was a significant increase in scores in the cutting and suturing task over the 2-year period (p < 0.01). Transferring skills did not improve significantly (p = 0.11). Conclusions Performance in the simulator improved over residency training and was correlated highly with postgraduate year. This simulator model is a valuable teaching tool for training and evaluation of basic laparoscopic tasks in laparoscopic surgery. PMID:10459330

  12. Testicular Microlithiasis: Patient Compliance in a Two-Year Follow-Up Program

    PubMed Central

    Pedersen, M. R.; Osther, P. J. S.; Soerensen, F. B.; Rafaelsen, S. R.

    2016-01-01

    Introduction: We present a retrospective 2-year follow-up cohort of 103 men with testicular microlithiasis (TML) and discuss patient compliance and the value of surveillance. Methods: A retrospective analysis of patients examined with scrotal ultrasonography (US) in the period from 2008 through 2010 was performed. A total of 103 men with TML were diagnosed and offered US follow-up every 6 months for 2 years. They were retrospectively analyzed regarding demographics and follow-up details, including the development of any kind of malignancy until March 2015, using the Danish Electronic Pathology Registry. Results: The prevalence of TML was 10.3%. Of the 103 men with TML, 23 (22.3%) had TML in the left testicle, 38 (36.9%) in the right (p=0.002), and 42 (40.8%) had bilateral TML. Patient compliance was low with 11.7% participating in all US follow-up examinations. 5 men presented risk factors (testicular atrophy (N=1) and previous testicular cancer (N=4)), but no cases of testicular malignancy were found in the follow-up period. Conclusion: The low patient compliance conflicts with the ESUR Scrotal Imaging Subcommittee guidelines that recommend scrotal US follow-up annually for TML until the age of 55 years. The fact that no cancers were found during follow-up using the pathology registry calls the value of follow-up into question. PMID:27921092

  13. Intermediate clinical and radiological results of cervical TDR (Mobi-C®) with up to 2 years of follow-up

    PubMed Central

    Beaurain, J.; Bernard, P.; Dufour, T.; Fuentes, J. M.; Hovorka, I.; Huppert, J.; Steib, J. P.; Vital, J. M.; Aubourg, L.

    2009-01-01

    The interest in cervical total disc replacement (TDR) as an alternative to the so-far gold standard in the surgical treatment of degenerative disc disease (DDD), e.g anterior cervical discectomy and fusion (ACDF), is growing very rapidly. Many authors have established the fact that ACDF may result in progressive degeneration in adjacent segments. On the contrary, but still theoretically, preservation of motion with TDR at the surgically treated level may potentially reduce the occurrence of adjacent-level degeneration (ALD). The authors report the intermediate results of an undergoing multicentre prospective study of TDR with Mobi-C® prosthesis. The aim of the study was to assess the safety and efficacy of the device in the treatment of DDD and secondary to evaluate the radiological status of adjacent levels and the occurrence of ossifications, at 2-year follow-up (FU). 76 patients have performed their 2-year FU visit and have been analyzed clinically and radiologically. Clinical outcomes (NDI, VAS, SF-36) and ROM measurements were analyzed pre-operatively and at the different post-operative time-points. Complications and re-operations were also assessed. Occurrences of heterotopic ossifications (HOs) and of adjacent disc degeneration radiographic changes have been analyzed from 2-year FU X-rays. The mean NDI and VAS scores for arm and neck are reduced significantly at each post-operative time-point compared to pre-operative condition. Motion is preserved over the time at index levels (mean ROM = 9° at 2 years) and 85.5% of the segments are mobile at 2 years. HOs are responsible for the fusion of 6/76 levels at 2 years. However, presence of HO does not alter the clinical outcomes. The occurrence rate of radiological signs of ALD is very low at 2 years (9.1%). There has been no subsidence, no expulsion and no sub-luxation of the implant. Finally, after 2 years, 91% of the patients assume that they would undergo the procedure again. These intermediate

  14. Longitudinal follow-up of occupational status in tinnitus patients.

    PubMed

    Andersson, G

    2000-01-01

    In this study, the long-term outcome of tinnitus patients was studied in terms of changes in occupational status from admission to follow-up for an average duration of 5 years. A consecutive series of 189 tinnitus patients seen between the years 1988 and 1995 were sent a postal questionnaire booklet; 146 provided usable responses (a 77% response rate). Results showed a significant change in occupational status, which was explained partly by retirement because of old age. Few were unemployed at follow-up, and relatively few were on sick leave. These data suggest that tinnitus patients may be less of a demand for the sickness benefit system in Sweden, but it may reflect also that tinnitus is not accepted as a cause for sick absenteeism.

  15. [Guidelines for the follow up of patients with bronchopulmonary dysplasia].

    PubMed

    Pérez Tarazona, S; Rueda Esteban, S; Alfonso Diego, J; Barrio Gómez de Agüero, M I; Callejón Callejón, A; Cortell Aznar, I; de la Serna Blázquez, O; Domingo Miró, X; García García, M L; García Hernández, G; Luna Paredes, C; Mesa Medina, O; Moreno Galdó, A; Moreno Requena, L; Pérez Pérez, G; Salcedo Posadas, A; Sánchez Solís de Querol, M; Torrent Vernetta, A; Valdesoiro Navarrete, L; Vilella Sabaté, M

    2016-01-01

    Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth, and remains a major problem in pediatric pulmonology units. The decision of discharging from the Neonatal Unit should be based on a thorough assessment of the condition of the patient and compliance with certain requirements, including respiratory and nutritional stability, and caregiver education on disease management. For proper control of the disease, a schedule of visits and complementary tests should be established prior to discharge, and guidelines for prevention of exacerbations and appropriate treatment should be applied. In this paper, the Working Group in Perinatal Respiratory Diseases of the Spanish Society of Pediatric Pulmonology proposes a protocol to serve as a reference for the follow up of patients with BPD among different centers and health care settings. Key factors to consider when planning discharge from the Neonatal Unit and during follow up are reviewed. Recommendations on treatment and prevention of complications are then discussed. The final section of this guide aims to provide a specific schedule for follow-up and diagnostic interventions to be performed in patients with BPD.

  16. Triangular Titanium Implants for Minimally Invasive Sacroiliac Joint Fusion: 2-Year Follow-Up from a Prospective Multicenter Trial

    PubMed Central

    Bitan, Fabien; Lockstadt, Harry; Kovalsky, Don; Cher, Daniel; Hillen, Travis

    2016-01-01

    Background Sacroiliac joint (SIJ) dysfunction is an underdiagnosed condition. Several published cohorts have reported favorable mid-term outcomes after SIJ fusion using titanium implants placed across the SIJ. Herein we report long-term (24-month) results from a prospective multicenter clinical trial. Methods One hundred and seventy-two subjects at 26 US sites with SI joint dysfunction were enrolled and underwent minimally invasive SI joint fusion with triangular titanium implants. Subjects underwent structured assessments preoperatively and at 1, 3, 6, 12, 18 and 24 months postoperatively, including SIJ pain ratings (0-100 visual analog scale), Oswestry Disability Index (ODI), Short Form-36 (SF-36), EuroQOL-5D (EQ-5D), and patient satisfaction. Adverse events were collected throughout follow-up. All participating patients underwent a high-resolution pelvic CT scan at 1 year. Results Mean subject age was 50.9 years and 69.8% were women. SIJ pain was present for an average of 5.1 years prior to surgical treatment. SIJ pain decreased from 79.8 at baseline to 30.4 at 12 months and remained low at 26.0 at 24 months (p<.0001 for change from baseline). ODI decreased from 55.2 at baseline to 31.5 at 12 months and remained low at 30.9 at 24 months (p<.0001 for change from baseline). Quality of life (SF-36 and EQ-5D) improvements seen at 12 months were sustained at 24 months. The proportion of subjects taking opioids for SIJ or low back pain decreased from 76.2% at baseline to 55.0% at 24 months (p <.0001). To date, 8 subjects (4.7%) have undergone one or more revision SIJ surgeries. 7 device-related adverse events occurred. CT scan at one year showed a high rate (97%) of bone adherence to at least 2 implants on both the iliac and sacral sides with modest rates of bone growth across the SIJ. Conclusions In this study of patients with SIJ dysfunction, minimally invasive SI joint fusion using triangular titanium implants showed marked improvements in pain, disability and

  17. Drug-induced gingival enlargement: biofilm control and surgical therapy with gallium-aluminum-arsenide (GaAlAs) diode laser-A 2-year follow-up.

    PubMed

    de Oliveira Guaré, Renata; Costa, Soraya Carvalho; Baeder, Fernando; de Souza Merli, Luiz Antonio; Dos Santos, Maria Teresa Botti Rodrigues

    2010-01-01

    Drug-induced gingival enlargement has been reported in patients treated with various types of anticonvulsant drugs, and is generally associated with the presence of plaque, gingival inflammation, and a genetic predisposition. Effective treatment includes daily oral hygiene and periodic professional prophylaxis. However, in some patients, surgical removal of the gingival tissue overgrowth becomes necessary. The patient in this case report was mentally impaired and had severe drug-induced gingival enlargement. This report describes the initial protocol, the gingivectomy, and a 2-year follow-up. A diode laser was used as an effective and safe method to remove the patient's overgrown gingival tissue.

  18. Prevalence and comorbidity of eating disorders among a community sample of adolescents: 2-year follow-up.

    PubMed

    Rojo-Moreno, Luis; Arribas, Pilar; Plumed, Javier; Gimeno, Natalia; García-Blanco, Ana; Vaz-Leal, Francisco; Luisa Vila, María; Livianos, Lorenzo

    2015-05-30

    The previous literature about comorbidity between eating disorders (ED) and other DSM-IV psychiatric disorders in adolescence has employed cross-sectional studies with clinical samples, where the comorbid disorders were diagnosed retrospectively. The present study aims to overcome these limitations by the analysis of comorbidity in a community population during 2-year follow-up. A semi-structured interview was applied to a teenager sample. Firstly, a cross-sectional and non-randomized study on psychiatric morbidity was conducted with 993 teenagers between the ages of 12 and 16 from five schools. Secondly, 326 students between 14 and 17 years old of one school were reassessed 2 years later in order to detect ED new cases and find associations with previous psychiatric disorders. The ED prevalence was 3.6%. Cross-sectional analysis revealed that 62.9% of individuals with an ED had comorbid disorders: anxiety disorders (51.4%), Attention Deficit Hyperactivity Disorder (31.4%), oppositional defiant disorder (11.4%), and obsessive compulsive disorder (8.6%). Prospective longitudinal analysis showed an ED incidence rate of 2.76% over the course of 2 years. 22.2% of new cases had received previous psychiatric diagnoses, of which all were anxiety disorders. Thus, ED exhibited a high comorbidity rate among adolescent populations and anxiety disorders were the most common comorbid diagnosis.

  19. [Patient education: the way for long-term follow up].

    PubMed

    Ruiz, J

    2008-06-04

    Therapeutic education is now perfectly integrated in caring and medicine. Its field of application is primarily in chronic diseases for the acquisition of competences in the management of treatments, in co-operation with health professionals. In ambulatory medicine, patients and health professionals are currently running up against the difficulties of the long-term follow-up with its part of uncertainty, lassitude and economic pressure. EBM and the various models of health psychology light us only partially the way. A new type of reflexive step is emerging. This way of thinking should place in its center the concept of therapeutic relation: between science and being. We summarize here our reflexive process in the course of an interdisciplinary team gathering social sciences, art and medicine.

  20. Y Shape Osteotomy in Ankylosing Spondylitis, a Prospective Case Series with Minimum 2 Year Follow-Up

    PubMed Central

    Liu, Huawei; Zhang, Xuesong; Wang, Yan

    2016-01-01

    The aim of the study is to evaluate the efficacy of a spinal osteotomy technique, Y shape osteotomy, for correcting kyphosis in AS patients planned preoperatively with computer software-assistance. 36 consecutive AS patients with thoracolumbar kyphosis were treated with one-stage posterior Y shape osteotomy and preoperative surgical planning was done with the aid of the Surgimap Spine. Radiological parameters of simulation and immediate postoperation were documented. Clinical and radiological results were evaluated in the preoperative, the early postoperative periods and during the last follow-up. The lumbar lordosis was found as 40.7 ± 4.1 degrees in the surgical planning and 49.7 ± 3.9 degrees postoperatively (p<0.01). PI-LL was 3.8± 0.9°in the simulation procedure and 6.6± 1.5°postoperatively (p<0.01). At the final follow-up, Global sagittal balance was restored and Both Oswestry Disability Index and Scoliosis Research Society scores improved largely. In conclusion, Y shape osteotomy is a safe and effective treatment option for AS patients with kyphosis deformity. PMID:27936020

  1. Refractive, Topographic, and Aberrometric Results at 2-Year Follow-Up for Accelerated Corneal Cross-Link for Progressive Keratoconus

    PubMed Central

    Bozkurt, Ercüment; Akcay, Betul Ilkay Sezgin; Kurt, Tugba; Yildirim, Yusuf; Günaydin, Zehra Karaagaç; Demirok, Ahmet

    2017-01-01

    Purpose. To report the visual, refractive, and corneal topography and wavefront aberration results of accelerated corneal cross-linking (CXL) during a 24-month follow-up. Methods. Forty-seven eyes underwent riboflavin-ultraviolet A-induced accelerated CXL treatment (30 mW/cm2 with a total dose of 7.2 joules/cm2). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical values, keratometry (K) measurements (Ksteep, Kflat, Kavg, and Kapex), central corneal thickness, and anterior corneal aberrometric analyses including total wavefront error (WFE), total high order aberration (HOA), astigmatism, trefoil, coma, quadrafoil, secondary astigmatism, and spherical aberration were evaluated. Results. The mean UDVA and CDVA were significantly improved at 1 (p = 0.003 and p = 0.004, resp.) and 2 years after treatment (p = 0.001 and p = 0.001, resp.). The mean Ksteep, Kflat, Kaverage, and Kapex values were significantly lower than baseline at 12 months (p = 0.008, p = 0.024, p = 0.001, and p = 0.014, resp.) and 24 months (p = 0.014, p = 0.017, p = 0.001, and p = 0.012, resp.). Corneal thickness showed a significant decrease at 1 month. Total HOA and coma decreased significantly at the 12-month (p = 0.001 and p = 0.009, resp.) and 24-month visits (p = 0.001 and p = 0.007, resp.). Conclusion. Accelerated CXL (30 mW/cm2) was found to be effective in improving UDVA, CDVA, corneal topography readings, total HOA, and coma aberrations during the 24-month follow-up. PMID:28197339

  2. How to shorten patient follow-up after treatment for Trypanosoma brucei gambiense sleeping sickness.

    PubMed

    Mumba Ngoyi, Dieudonné; Lejon, Veerle; Pyana, Pati; Boelaert, Marleen; Ilunga, Médard; Menten, Joris; Mulunda, Jean Pierre; Van Nieuwenhove, Simon; Muyembe Tamfum, Jean Jacques; Büscher, Philippe

    2010-02-01

    BACKGROUND. Clinical management of human African trypanosomiasis requires patient follow-up of 2 years' duration. At each follow-up visit, cerebrospinal fluid (CSF) is examined for trypanosomes and white blood cells (WBCs). Shortening follow-up would improve patient comfort and facilitate control of human African trypanosomiasis. METHODS. A prospective study of 360 patients was performed in the Democratic Republic of the Congo. The primary outcomes of the study were cure, relapse, and death. The WBC count, immunoglobulin M level, and specific antibody levels in CSF samples were evaluated to detect treatment failure. The sensitivity and specificity of shortened follow-up algorithms were calculated. RESULTS. The treatment failure rate was 37%. Trypanosomes, a WBC count of > or = 100 cells/microL, and a LATEX/immunoglobulin M titer of 1:16 in CSF before treatment were risk factors for treatment failure, whereas human immunodeficiency virus infection status was not a risk factor. The following algorithm, which had 97.8% specificity and 94.4% sensitivity, is proposed for shortening the duration of follow-up: at 6 months, patients with trypanosomes or a WBC count of > or = 50 cells/microL in CSF are considered to have treatment failure, whereas patients with a CSF WBC count of > or = 5 cells/microL are considered to be cured and can discontinue follow-up. At 12 months, the remaining patients (those with a WBC count of > or = 6-49 cells/microL) need a test of cure, based on trypanosome presence and WBC count, applying a cutoff value of > or = 20 cells/microL. CONCLUSION. Combining criteria for failure and cure allows follow-up of patients with second-stage human African trypanosomiasis to be shortened to a maximum duration of 12 months.

  3. Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings.

    PubMed

    Radanov, B P; Sturzenegger, M; Di Stefano, G

    1995-09-01

    With the increased incidence of whiplash injury following the introduction of compulsory car seat belts, a large number of reports have dealt with the aftermath of this condition. Previous studies, however, focused on somatic symptoms on the one hand or considered only psychological or neuropsychological variables on the other hand, often in loosely defined or selected groups of patients. No study so far has analyzed the long-term outcome in a nonselected group of patients using a clear injury definition considering patient history; somatic, radiologic, and neuropsychological findings; and features of the injury mechanisms assessed soon after trauma and during follow-up. the present investigation was designed to assess these combined factors. According to a strict definition of whiplash injury, we assessed a consecutive nonselected sample of 117 patients with recent injury who had similar sociocultural and educational backgrounds. The patients had been in automobile crashes and were all equally covered by accident insurance according to the country-wide scheme. Initial examination was performed 7.2 +/- 4.2 days after trauma, and follow-up examinations 3, 6, 12, and 24 months later. At baseline, features of injury mechanism, subjective complaints, and different aspects of patient history were documented and cervical spine X rays performed. At all examinations patients underwent neurologic examination and cognitive and psychosocial factor assessment. At 2 years, patients were divided into symptomatic and asymptomatic groups and then compared with regard to the initial findings. In addition, symptomatic patients who were disabled at the 2-year follow-up examination and symptomatic patients not disabled (that is, they were able to work at the pretraumatic level) were compared regarding initial and 2-year findings. At 2 years, 18% of patients still had injury-related symptoms. With regard to baseline findings the following significant differences were found: Symptomatic

  4. Use of Ergonomic Measures Related to Musculoskeletal Complaints among Construction Workers: A 2-year Follow-up Study

    PubMed Central

    Boschman, Julitta S.; Frings-Dresen, Monique H.W.; van der Molen, Henk F.

    2015-01-01

    Background The physical work demands of construction work can be reduced using ergonomic measures. The aim of this study was to evaluate the use of ergonomic measures related to musculoskeletal disorders (MSDs) among construction workers. Methods A questionnaire was sent at baseline and 2 years later to 1,130 construction workers. We established (1) the proportion of workers reporting an increase in their use of ergonomic measures, (2) the proportion of workers reporting a decrease in MSDs, (3) the relative risk for an increase in the use of ergonomic measures and a decrease in MSDs, and (4) workers' knowledge and opinions about the use of ergonomic measures. Results At follow-up, response rate was 63% (713/1,130). The proportion of workers using ergonomic measures for vertical transport increased (34%, 144/419, p < 0.01); for measures regarding horizontal transport and the positioning of materials, no change was reported. The proportion of workers reporting shoulder complaints decreased (28%, 176/638, p = 0.02). A relationship between the use of ergonomic measures and MSDs was not found; 83% (581/704) of the workers indicated having sufficient knowledge about ergonomic measures. Lightening the physical load was reported to be the main reason for using them. Conclusion Only the use of ergonomic measures for vertical transport increased over a 2-year period. No relationship between the use of ergonomic measures and MSDs was found. Strategies aimed at improving the availability of ergonomic equipment complemented with individualized advice and training in using them might be the required next steps to increase the use of ergonomic measures. PMID:26106507

  5. [Cardiological follow-up in patients with Fabry disease].

    PubMed

    Pieruzzi, Federico; Pieroni, Maurizio; Chimenti, Cristina; Frustaci, Andrea; Sarais, Cristiano; Cecchi, Franco

    2010-01-01

    Fabry disease is a rare tesaurismosis due to a deficit of the lysosomal enzyme activity of alpha-galactosidase, needed for the normal catabolism of globotriaosylceramides (GL3). Fabry cardiac involvement has several clinical manifestations: concentric left ventricular hypertrophy without left ventricular dilation and severe loss of left ventricular systolic function, mitral and aortic valvulopathy, disorders of the atrioventricular conduction or repolarization, and compromised diastolic function. Differentiating Fabry disease from similar conditions is often quite straightforward, e.g., cardiac amyloidosis is often associated with low electrocardiographic voltages, and systemic symptoms are usually associated with hemochromatosis and sarcoidosis. However, sometimes second-level (genetic analysis, alpha-galactosidase levels) or invasive investigations are required, which can include endomyocardial biopsy. Diagnostic imaging techniques have been described, but they lack specificity. Echocardiographic imaging with tissue Doppler analysis and/or strain rate analysis can allow diagnosis of Fabry disease even before left ventricular hypertrophy becomes apparent. This review illustrates the techniques for staging cardiac involvement and damage in Fabry disease and for the long-term follow-up of Fabry patients with or without cardiac involvement. Careful cardiac monitoring is especially important in elderly female carriers, who often develop renal disorders and/or left ventricular hypertrophy as the only manifestations of their late Fabry disease. In some clinical series, Fabry disease was diagnosed in 12% of women with adult-onset hypertrophic cardiomyopathy. Cardiological problems and outcomes of enzyme replacement therapy, associated with or without other cardiological treatments, are also discussed.

  6. Posterolateral instrumented fusion with and without transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis: A randomized clinical trial with 2-year follow-up

    PubMed Central

    Etemadifar, Mohammad Reza; Hadi, Abdollah; Masouleh, Mehran Feizi

    2016-01-01

    Background: Spondylolisthesis is a common cause of surgery in patients with lower back pain. Although posterolateral fusion and pedicle screw fixation are a relatively common treatment method for the treatment of spondylolisthesis, controversy exists about the necessity of adding interbody fusion to posterolateral fusion. The aim of our study was to assess the functional disability, pain, and complications in patients with spondylolisthesis treated by posterolateral instrumented fusion (PLF) with and without transforaminal lumbar interbody fusion (TLIF) in a randomized clinical trial. Materials and Methods: From February 2007 to February 2011, 50 adult patients with spondylolisthesis were randomly assigned to be treated with PLF or PLF+TLIF techniques (25 patients in each group) by a single surgeon. Back pain, leg pain, and disability were assessed before treatment and until 2 years after surgical treatment using visual analog scale (VAS) and oswestry disability index (ODI). Patients were also evaluated for postoperative complications such as infection, neurological complications, and instrument failure. Results: All patients completed the 24 months of follow-up. Twenty patients were females and 30 were males. Average age of the patients was 53 ± 11 years for the PLF group and 51 ± 13 for the PLF + TLIF group. Back pain, leg pain, and disability score were significantly improved postoperatively compared to preoperative scores (P < 0.001). At 3 months of follow-up, there was no statistically significant difference in VAS score for back pain and leg pain in both groups; however, after 6 months and 1 year and 2 years follow-up, the reported scores for back pain and leg pain were significantly lower in the PLF+TLIF group (P < 0.05). The ODI score was also significantly lower in the PLF+TLIF group at 1 year and 2 years of follow-up (P < 0.05). One screw breakage and one superficial infection occurred in the PLF+TLIF group, which had no statistical significance (P = 0

  7. Total disc replacement compared to lumbar fusion: a randomised controlled trial with 2-year follow-up

    PubMed Central

    Tullberg, Tycho; Branth, Björn; Olerud, Claes; Tropp, Hans

    2009-01-01

    The study design includes a prospective, randomised controlled study comparing total disc replacement (TDR) with posterior fusion. The main objective of this study is to compare TDR with lumbar spinal fusion, in terms of clinical outcome, in patients referred to a spine clinic for surgical evaluation. Fusion is effective for treating chronic low back pain (LBP), but has drawbacks, such as stiffness and possibly adjacent level degradation. Motion-preserving options have emerged, of which TDR is frequently used because of these drawbacks. How the results of TDR compare to fusion, however, is uncertain. One hundred and fifty-two patients with a mean age of 40 years (21–55) were included: 90 were women, and 80 underwent TDR. The patients had not responded to a conservative treatment programme and suffered from predominantly LBP, with varying degrees of leg pain. Diagnosis was based on clinical examination, radiographs, MRI, and in unclear cases, diagnostic injections. Outcome measures were global assessment (GA), VAS for back and leg pain, Oswestry Disability Index, SF36 and EQ5D at 1 and 2 years. Follow-up rate was 100%, at both 1 and 2 years. All outcome variables improved in both groups between preoperative and follow-up assessment. The primary outcome measure, GA, revealed that 30% in the TDR group and 15% in the fusion group were totally pain-free at 2 years (P = 0.031). TDR patients had reached maximum recovery in virtually all variables at 1 year, with significant differences compared to the fusion group. The fusion patients continued to improve and at 2 years had results similar to TDR patients apart from numbers of pain-free. Complications and reoperations were similar in both groups, but pedicle screw removal as additive surgery, was frequent in the fusion group. One year after surgery, TDR was superior to spinal fusion in clinical outcome, but this difference had diminished by 2 years, apart from (VAS for back pain and) numbers of pain-free. The

  8. Anterior cervical fusion with interbody cage containing beta-tricalcium phosphate augmented with plate fixation: a prospective randomized study with 2-year follow-up.

    PubMed

    Dai, Li-Yang; Jiang, Lei-Sheng

    2008-05-01

    A variety of bone graft substitutes, interbody cages, and anterior plates have been used in cervical interbody fusion, but no controlled study was conducted on the clinical performance of beta-tricalcium phosphate (beta-TCP) and the effect of supplemented anterior plate fixation. The objective of this prospective, randomized clinical study was to evaluate the effectiveness of implanting interbody fusion cage containing beta-TCP for the treatment of cervical radiculopathy and/or myelopathy, and the fusion rates and outcomes in patients with or without randomly assigned plate fixation. Sixty-two patients with cervical radiculopathy and/or myelopathy due to soft disc herniation or spondylosis were treated with one- or two-level discectomy and fusion with interbody cages containing beta-TCP. They were randomly assigned to receive supplemented anterior plate (n = 33) or not (n = 29). The patients were followed up for 2 years postoperatively. The radiological and clinical outcomes were assessed during a 2-year follow-up. The results showed that the fusion rate (75.0%) 3 months after surgery in patients treated without anterior cervical plating was significantly lower than that (97.9%) with plate fixation (P < 0.05), but successful bone fusion was achieved in all patients of both groups at 6-month follow-up assessment. Patients treated without anterior plate fixation had 11 of 52 (19.2%) cage subsidence at last follow-up. No difference (P > 0.05) was found regarding improvement in spinal curvature as well as neck and arm pain, and recovery rate of JOA score at all time intervals between the two groups. Based on the findings of this study, interbody fusion cage containing beta-TCP following one- or two-level discectomy proved to be an effective treatment for cervical spondylotic radiculopathy and/or myelopathy. Supplemented anterior plate fixation can promote interbody fusion and prevent cage subsidence but do not improve the 2-year outcome when compared with those treated

  9. Assessment of effectiveness of percutaneous adhesiolysis and caudal epidural injections in managing post lumbar surgery syndrome: 2-year follow-up of a randomized, controlled trial

    PubMed Central

    Manchikanti, Laxmaiah; Singh, Vijay; Cash, Kimberly A; Pampati, Vidyasagar

    2012-01-01

    Background The literature is replete with evaluations of failed surgery, illustrating a 9.5%–25% reoperation rate. Speculated causes of post lumbar surgery syndrome include epidural fibrosis, acquired stenosis, recurrent disc herniation, sacroiliac joint pain, and facet joint pain among other causes. Methods Patients (n = 120) were randomly assigned to two groups with a 2-year follow-up. Group I (control group, n = 60) received caudal epidural injections with catheterization up to S3 with local anesthetic (lidocaine 2%, 5 mL), nonparticulate betamethasone (6 mg, 1 mL), and 6 mL of 0.9% sodium chloride solution. Group II (intervention group, n = 60) received percutaneous adhesiolysis of the targeted area, with targeted delivery of lidocaine 2% (5 mL), 10% hypertonic sodium chloride solution (6 mL), and nonparticulate betamethasone (6 mg). The multiple outcome measures included the Numeric Rating Scale, the Oswestry Disability Index 2.0, employment status, and opioid intake with assessments at 3, 6, 12, 18, and 24 months posttreatment. Primary outcome was defined as 50% improvement in pain and Oswestry Disability Index scores. Results Significant improvement with at least 50% relief with pain and improvement in functional status was illustrated in 82% of patients at the 2-year follow-up in the intervention group compared to 5% in the control group receiving caudal epidural injections. The average number of procedures over a period of 2 years in Group II was 6.4 ± 2.35 with overall total relief of approximately 78 weeks out of 104 weeks. Conclusion The results of this study show significant improvement in 82% of patients over a period of 2 years with an average of six to seven procedures of 1-day percutaneous adhesiolysis in patients with failed back surgery syndrome. PMID:23293536

  10. A 2-year follow-up study on muscle size and dynamic strength in teenage tennis players.

    PubMed

    Kanehisa, H; Kuno, S; Katsuta, S; Fukunaga, T

    2006-04-01

    Growth trends in the cross-sectional area of the quadriceps femoris (CSA(QF)) and its dynamic strength in 12 teenage tennis players (six boys and six girls), aged from 10.7 to 13.2 years at the onset of the study, were investigated through a 2-year follow-up survey. CSA(QF) values at the three levels (proximal, mid, and distal to the knee joint) and dynamic torques during knee extensions at three pre-set velocities (1.05, 3.14, and 5.24 rad/s) were determined year by year, i.e., three times (T1, T2, and T3), using magnetic resonance imaging and an isokinetic dynamometer, respectively. In both genders, the CSA(QF) values at the three levels tended to increase across the measurement times, with greater gains in the boys than in the girls at the levels mid and distal to the knee joint. Among these changes, only the CSA(QF) at the level proximal to the knee joint significantly increased regardless of changes in both skeletal age and body height. The ratios of torque to the sum of CSA(QF) at the three levels (T/CSA) at 3.14 and 5.24 rad/s for the boys and at 5.24 rad/s for the girls were significantly higher in T2 and T3 than T1. Further, the relative increases in torque and T/CSA values at 3.14 and 5.24 rad/s were greater in the boys than the girls. The findings presented here indicate that young tennis players who are in the earlier stage of adolescence increase the CSA of the QF muscle beyond normally expected growth change at the level proximal to the knee joint and show a predominant development in torque generation capability during high-velocity knee extensions, with a greater gain in boys compared with girls.

  11. Dynamic stabilization for L4-5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up.

    PubMed

    Kuo, Chao-Hung; Chang, Peng-Yuan; Wu, Jau-Ching; Chang, Hsuan-Kan; Fay, Li-Yu; Tu, Tsung-Hsi; Cheng, Henrich; Huang, Wen-Cheng

    2016-01-01

    OBJECTIVE In the past decade, dynamic stabilization has been an emerging option of surgical treatment for lumbar spondylosis. However, the application of this dynamic construct for mild spondylolisthesis and its clinical outcomes remain uncertain. This study aimed to compare the outcomes of Dynesys dynamic stabilization (DDS) with minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the management of single-level spondylolisthesis at L4-5. METHODS This study retrospectively reviewed 91 consecutive patients with Meyerding Grade I spondylolisthesis at L4-5 who were managed with surgery. Patients were divided into 2 groups: DDS and MI-TLIF. The DDS group was composed of patients who underwent standard laminectomy and the DDS system. The MI-TLIF group was composed of patients who underwent MI-TLIF. Clinical outcomes were evaluated by visual analog scale for back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores at each time point of evaluation. Evaluations included radiographs and CT scans for every patient for 2 years after surgery. RESULTS A total of 86 patients with L4-5 spondylolisthesis completed the follow-up of more than 2 years and were included in the analysis (follow-up rate of 94.5%). There were 64 patients in the DDS group and 22 patients in the MI-TLIF group, and the overall mean follow-up was 32.7 months. Between the 2 groups, there were no differences in demographic data (e.g., age, sex, and body mass index) or preoperative clinical evaluations (e.g., visual analog scale back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores). The mean estimated blood loss of the MI-TLIF group was lower, whereas the operation time was longer compared with the DDS group (both p < 0.001). For both groups, clinical outcomes were significantly improved at 6, 12, 18, and 24 months after surgery compared with preoperative clinical status. Moreover, there were no differences between the 2

  12. Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up.

    PubMed

    Rao, Nalini; Cannella, Barbara A; Crossett, Lawrence S; Yates, Adolph J; McGough, Richard L; Hamilton, Cindy W

    2011-12-01

    We quantified surgical site infections (SSIs) after preoperative screening/selective decolonization before elective total joint arthroplasty (TJA) with 2-year follow-up and 2 controls. Concurrent controls (n = 2284) were patients of surgeons not participating in screening/decolonization. Preintervention controls (n = 741) were patients of participating surgeons who underwent TJA the previous year. Staphylococcus aureus nasal carriers (321/1285 [25%]) used intranasal mupirocin and chlorhexidine baths as outpatients. Staphylococcal SSIs occurred in no intervention patients (0/321) and 19 concurrent controls. If all SSIs occurred in carriers and 25% of controls were carriers, staphylococcal SSI rate would have been 3.3% in controls (19/571; P = .001). Overall SSI rate decreased from 2.7% (20/741) in preintervention controls to 1.2% (17/1440) in intervention patients (P = .009). Preoperative screening/selective decolonization was associated with fewer SSIs after elective TJA.

  13. Risk Factors Associated with Adjacent and Remote- Level Pathologic Vertebral Compression Fracture Following Balloon Kyphoplasty: 2-Year Follow-Up Comparison Versus Conservative Treatment.

    PubMed

    Faloon, Michael J; Ruoff, Mark; Deshpande, Chetan; Hohman, Donald; Dunn, Conor; Beckloff, Nicholas; Patel, Dipak V

    2015-01-01

    Vertebral compression fractures are a significant source of morbidity and mortality among patients of all age groups. These fractures result in both acute and chronic pain. Patients who sustain such fractures are known to suffer from more comorbidities and have a higher mortality rate compared with healthy people in the same age group. In recent years, balloon kyphoplasty has become a popular method for treating vertebral compression fractures. However, as longer-term follow-up becomes available, the effects of cement augmentation on adjacent spinal segments require investigation. Here, we have performed a retrospective chart review of 258 consecutive patients with pathologic vertebral compression fractures secondary to osteoporosis, treated by either conservative measures or balloon kyphoplasty with polymethylmethacrylate cement augmentation. Multivariate analysis of patient comorbidities was performed to assess the risks associated with subsequent adjacent and remote compression fracture at a minimum of 2 years follow-up. A total of 258 patients had 361 vertebral compression fractures. A total of 121 patients were treated nonoperatively and 137 underwent balloon kyphoplasty with polymethylmethacrylate cement augmentation. The mean follow-up for both cohorts was 2.7 years (range, 2-6 years). The kyphoplasty cohort was significantly older than the nonoperative cohort (mean age, 78.5 versus 74.2 years; p = 0.02), had 24 more patients with diabetes mellitus (37 versus 13; p = 0.05), and had 34 more patients with a history of smoking (50 versus 16; p = 0.05). However, the kyphoplasty cohort had less patients with a history of non-steroidal anti-inflammatory drug (NSAID) use (45 versus 71; p = 0.07). There were no demographic differences between groups in patients with secondary fractures. Nonoperative treatment was identified as a statistically significant independent risk factor for subsequent vertebral compression fracture [odds ratio (OR), 2.28]. Univariate

  14. Perceived outcomes and satisfaction of Saudi parents and their children following dental rehabilitation under general anesthesia: A 2-year follow-up

    PubMed Central

    El Batawi, Hisham Yehia; Panigrahi, Priyankar; Awad, Manal A.

    2014-01-01

    Purpose: To investigate the perceived clinical outcome and parents’ satisfaction after dental rehabilitation under general anesthesia over a follow-up period of 2 years. Materials and Methods: A prospective study of questionnaire data obtained from 352 pediatric patients before and after treatment of early childhood caries with full dental rehabilitation under general anesthesia. Questionnaires focused on oral symptoms, functional limitations, and emotional and social well-being before and after dental treatment. Cases were followed up for 2 years postoperatively. Results: A dramatic disappearance of symptoms was reported from parents’ perspective. There was a high satisfaction rate (99.14%) also among parents of the children included in the study. Conclusion: Children with early childhood caries do not necessarily express it verbally as pain. The disease has a lot of other expressions affecting children's behavior and habits, including the ability to sleep, thrive, and socialize. This study contributes to the existing literature that full dental rehabilitation under general anesthesia [dental general anesthesia (DGA)] has an immediate positive impact on the physical and social quality of life of children suffering from early childhood caries as well as on their families. Postoperative preventive care, early diagnosis, and treatment of recurrent caries are key factors to maintain postoperative outcome of DGA. PMID:25625072

  15. Lexical access changes in patients with multiple sclerosis: a two-year follow-up study.

    PubMed

    Sepulcre, Jorge; Peraita, Herminia; Goni, Joaquin; Arrondo, Gonzalo; Martincorena, Inigo; Duque, Beatriz; Velez de Mendizabal, Nieves; Masdeu, Joseph C; Villoslada, Pablo

    2011-02-01

    The aim of the study was to analyze lexical access strategies in patients with multiple sclerosis (MS) and their changes over time. We studied lexical access strategies during semantic and phonemic verbal fluency tests and also confrontation naming in a 2-year prospective cohort of 45 MS patients and 20 healthy controls. At baseline, switching lexical access strategy (both in semantic and in phonemic verbal fluency tests) and confrontation naming were significantly impaired in MS patients compared with controls. After 2 years follow-up, switching score decreased, and cluster size increased over time in semantic verbal fluency tasks, suggesting a failure in the retrieval of lexical information rather than an impairment of the lexical pool. In conclusion, these findings underline the significant presence of lexical access problems in patients with MS and could point out their key role in the alterations of high-level communications abilities in MS.

  16. Soft tissue stability in segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up.

    PubMed

    Joss, C U; Triaca, A; Antonini, M; Kiliaridis, S; Kuijpers-Jagtman, A M

    2012-05-01

    This study evaluated soft tissue changes in adult patients treated with distraction osteogenesis (DOG) of the anterior mandibular alveolar process and related it to different parameters. 33 patients (27 females; 6 males) were analysed retrospectively before surgery at T1 (17.0 days), after surgery at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Statistical analysis was carried out using Kolmogorov-Smirnov test, paired t test, Pearson's correlation coefficient, and linear backward regression analysis. 2 years postoperatively (T4), the net effect of the soft tissue at point B' was 100% of the advancement at point B whilst the lower lip (labrale inferior) followed the advancement of incision inferior to 46%. Increased preoperative age was correlated (p<0.05) with more horizontal backward movement (T4-T3) for labrale superior and pogonion'. Higher NL/ML' angles were significantly correlated (p<0.05) with smaller horizontal soft tissue change at point B'. Gender and the amount of skeletal and dental advancement were not correlated with postoperative soft tissue changes (T4-T3). DOG of the anterior mandibular alveolar process is a valuable alternative for mandibular advancement regarding soft tissue change and predictability.

  17. Outcomes of a New Residential Scheme for Adults with Intellectual Disabilities in Taiwan: A 2-Year Follow-Up

    ERIC Educational Resources Information Center

    Chou, Y-C.; Pu, C.; Kroger, T.; Lee, W.; Chang, S.

    2011-01-01

    Background: The Taiwanese government launched a new programme in November 2004 to support adults with intellectual disabilities living in smaller facilities. This paper aims to evaluate the service outcomes of this new residential scheme over 2 years including those residents who moved from an institution and those who moved from their family.…

  18. Efficacy Trial of a Selective Prevention Program Targeting Both Eating Disorders and Obesity among Female College Students: 1- and 2-Year Follow-Up Effects

    ERIC Educational Resources Information Center

    Stice, Eric; Rohde, Paul; Shaw, Heather; Marti, C. Nathan

    2013-01-01

    Objective: Evaluate the effects of a prevention program targeting both eating disorders and obesity at 1- and 2-year follow-ups. Method: Female college students at risk for these outcomes because of body image concerns (N = 398) were randomized to the "Healthy Weight 2" group-based 4-hr prevention program, which promotes lasting healthy…

  19. Efficacy Trial of a Brief Cognitive-Behavioral Depression Prevention Program for High-Risk Adolescents: Effects at 1- and 2-Year Follow-Up

    ERIC Educational Resources Information Center

    Stice, Eric; Rohde, Paul; Gau, Jeff M.; Wade, Emily

    2010-01-01

    Objective: To evaluate the effects of a brief group cognitive-behavioral (CB) depression prevention program for high-risk adolescents with elevated depressive symptoms at 1- and 2-year follow-up. Method: In this indicated prevention trial, 341 at-risk youths were randomized to a group CB intervention, group supportive expressive intervention, CB…

  20. Clinical and Radiographic Results of Indirect Decompression and Posterior Cervical Fusion for Single-Level Cervical Radiculopathy Using an Expandable Implant with 2-Year Follow-Up.

    PubMed

    Siemionow, Kris; Janusz, Piotr; Phillips, Frank M; Youssef, Jim A; Isaacs, Robert; Tyrakowski, Marcin; McCormack, Bruce

    2016-11-01

    Background Indirect posterior cervical nerve root decompression and fusion performed by placing bilateral posterior cervical cages in the facet joints from a posterior approach has been proposed as an option to treat select patients with cervical radiculopathy. The purpose of this study was to report 2-year clinical and radiologic results of this treatment method. Methods Patients who failed nonsurgical management for single-level cervical radiculopathy were recruited. Surgical treatment involved a posterior approach with decortication of the lateral mass and facet joint at the treated level followed by placement of the DTRAX Expandable Cage (Providence Medical Technology, Lafayette, California, United States) into both facet joints. Iliac crest bone autograft was mixed with demineralized bone matrix and used in all cases. The Neck Disability Index (NDI), visual analog scale (VAS) for neck and arm pain, and SF-12 v.2 questionnaire were evaluated preoperatively and 2 years postoperatively. Segmental (treated level) and overall C2-C7 cervical lordosis, disk height, adjacent segment degeneration, and fusion were assessed on computed tomography scans and radiographs acquired preoperatively and 2 years postoperatively. Results Overall, 53 of 60 enrolled patients were available at 2-year follow-up. There were 35 females and 18 males with a mean age of 53 years (range: 40-75 years). The operated level was C3-C4 (N = 3), C4-C5 (N = 6), C5-C6 (N = 36), and C6-C7 (N = 8). The mean preoperative and 2-year scores were NDI: 32.3 versus 9.1 (p < 0.0001); VAS Neck Pain: 7.4 versus 2.6 (p < 0.0001); VAS Arm Pain: 7.4 versus 2.6 (p < 0.0001); SF-12 Physical Component Summary: 34.6 versus 43.6 (p < 0.0001), and SF-12 Mental Component Summary: 40.8 versus 51.4 (p < 0.0001). No significant changes in overall or segmental lordosis were noted after surgery. Radiographic fusion rate was 98.1%. There was no device failure, implant lucency, or

  1. Cognitive evolution in hypertensive patients: a six-year follow-up

    PubMed Central

    Vicario, Augusto; del Sueldo, Mildren A; Zilberman, Judith M; Cerezo, Gustavo H

    2011-01-01

    Background: Several studies have examined the links between hypertension, vascular damage, and cognitive impairment. The functions most commonly involved seem to be those associated with memory and executive function. Aims: 1) to report the cognitive evolution in a cohort of hypertensive patients, 2) to identify the affected domains, and 3) to correlate the results obtained with blood pressure measurements. Materials and Methods: Observational 6-year follow-up cohort study including both males and females aged ≥65 and ≤80 years, and hypertensive patients under treatment. Patients with a history of any of the following conditions were excluded: stroke, transient ischemic attack, diabetes mellitus, atrial fibrillation, cardiac surgery, dementia, or depression. Four neurocognitive evaluations were performed (at baseline and every 2 years). The tests used evaluated memory and executive function domain. Blood pressure was measured on every cognitive evaluation. Results: Sixty patients were followed for 76.4 ± 2.8 months. The average age at baseline was 72.5 ± 4.2 and 77.9 ± 4.6 at 6 years (65% were women). Two patients were lost to follow up (3.3%) and 8 patients died (13.3%).The density incidence for dementia was 0.6% patients per year (pt/y) (n = 3) and for depression was 1.6% pt/y (n = 12). No changes were observed in either memory impairment or the Mini Mental State Examination (MMSE) results (p = ns) during follow-up. A progressive impairment of the executive function was shown regardless of the blood pressure measurements. Conclusion: 1) the incidence of dementia doubled to general population, 2) the initial memory impairment did not change during the evaluation period, 3) cognitive impairment worsened in the areas related to executive function (prefrontal cortex) regardless of the adequacy of anti-hypertensive treatment and blood pressure values. PMID:21603597

  2. Influence of Anti-TNF and Disease Modifying Antirheumatic Drugs Therapy on Pulmonary Forced Vital Capacity Associated to Ankylosing Spondylitis: A 2-Year Follow-Up Observational Study

    PubMed Central

    Rocha-Muñoz, Alberto Daniel; Brambila-Tapia, Aniel Jessica Leticia; Zavala-Cerna, María Guadalupe; Vásquez-Jiménez, José Clemente; De la Cerda-Trujillo, Liliana Faviola; Vázquez-Del Mercado, Mónica; Rodriguez-Jimenez, Norma Alejandra; Díaz-Rizo, Valeria; Díaz-González, Viviana; Cardona-Muñoz, Ernesto German; Dávalos-Rodríguez, Ingrid Patricia; Salazar-Paramo, Mario; Gamez-Nava, Jorge Ivan; Nava-Zavala, Arnulfo Hernan; Gonzalez-Lopez, Laura

    2015-01-01

    Objective. To evaluate the effect of anti-TNF agents plus synthetic disease modifying antirheumatic drugs (DMARDs) versus DMARDs alone for ankylosing spondylitis (AS) with reduced pulmonary function vital capacity (FVC%). Methods. In an observational study, we included AS who had FVC% <80% at baseline. Twenty patients were taking DMARDs and 16 received anti-TNF + DMARDs. Outcome measures: changes in FVC%, BASDAI, BASFI, 6-minute walk test (6MWT), Borg scale after 6MWT, and St. George's Respiratory Questionnaire at 24 months. Results. Both DMARDs and anti-TNF + DMARDs groups had similar baseline values in FVC%. Significant improvement was achieved with anti-TNF + DMARDs in FVC%, at 24 months, when compared to DMARDs alone (P = 0.04). Similarly, patients in anti-TNF + DMARDs group had greater improvement in BASDAI, BASFI, Borg scale, and 6MWT when compared to DMARDs alone. After 2 years of follow-up, 14/16 (87.5%) in the anti-TNF + DMARDs group achieved the primary outcome: FVC% ≥80%, compared with 11/20 (55%) in the DMARDs group (P = 0.04). Conclusions. Patients with anti-TNF + DMARDs had a greater improvement in FVC% and cardiopulmonary scales at 24 months compared with DMARDs. This preliminary study supports the fact that anti-TNF agents may offer additional benefits compared to DMARDs in patients with AS who have reduced FVC%. PMID:26078986

  3. Knowledge, use of and attitudes towards peer support: a 2-year follow-up to the Prince's Trust survey.

    PubMed

    Cowie, Helen; Naylor, Paul; Talamelli, Lorenzo; Chauhan, Preeti; Smith, Peter

    2002-10-01

    This present study investigated how school peer support systems studied 2 years earlier in a survey funded by The Prince's Trust have evolved. In all, 413 pupils (actual and potential users of the systems) aged 13-14 (Year 9--Y9) and 15-16 (Year 11--Y11), 34 teachers in charge of systems and 80 peer supporters in 35 secondary schools were interviewed using structured schedules for the pupils and semi-structured ones for the teachers and peer supporters. All of these interviews focussed on the respondents' perceptions and experiences of the school's peer support system, including: the perceived benefits to users of the system; benefits to peer supporters; problems with the system and the attempts made to overcome them. There was widespread support for the systems and a strong sense that both teachers and peer supporters were increasingly confident about the value of their service. However, some problems remain, notably with regard to gender. The study documents difficulties in the recruitment and retention of boys as peer supporters because of peer pressure to conform to a "macho" image. The issue is discussed and some solutions presented.

  4. Skeletal and dental stability of segmental distraction of the anterior mandibular alveolar process. A 2-year follow-up.

    PubMed

    Joss, C U; Triaca, A; Antonini, M; Kiliaridis, S; Kuijpers-Jagtman, A M

    2012-05-01

    33 patients (27 females; 6 males) were retrospectively analysed for skeletal and dental relapse before distraction osteogenesis (DOG) of the mandibular anterior alveolar process at T1 (17.0 days), after DOG at T2 (mean 6.5 days), at T3 (mean 24.4 days), and at T4 (mean 2.0 years). Lateral cephalograms were traced by hand, digitized, superimposed, and evaluated. Skeletal correction (T3-T1) was mainly achieved through the distraction of the anterior alveolar segment in a rotational manner where the incisors were more proclined. The horizontal backward relapse (T4-T3) measured -0.8mm or 19.0% at point B (p<0.001) and -1.6mm or 25.0% at incision inferior (p<0.001). Age, gender, amount and type (rotational versus translational) of advancement were not correlated with the amount of relapse. High angle patients (NL/ML'; p<0.01) and patients with large gonial angle (p<0.05) showed significantly smaller relapse rates at point B. Overcorrection of the overjet achieved by the distraction was seen in a third of the patients and could be a reason for relapse. Considering the amount of skeletal relapse the DOG could be an alternative to bilateral sagittal split osteotomy for mandibular advancement in selected cases.

  5. NTRDC retainer: a novel approach for both retention and habit control--a follow up of 2 years.

    PubMed

    Mathur, Ajay; Thakur, Arvind; Toshniwal, N G; Misal, Abhiit; Kharbanda, O P

    2014-01-01

    Many methods have been used to correct abnormal tongue habits. A mechanical device such as tongue spurs or cribs offers help till they are in the mouth, but the habit often returns when the device is removed. Patients with tongue thrusting habits complain to their clinician, of reopening of spaces, proclination of anteriors and contraction of arch, though the clinician successfully treated the case.

  6. Effect of Workplace Noise on Hearing Ability in Tile and Ceramic Industry Workers in Iran: A 2-Year Follow-Up Study

    PubMed Central

    Mirmohammadi, Seyyed Jalil; Mehrparvar, Amir Houshang; Mollasadeghi, Abolfazl

    2013-01-01

    Introduction. Noise as a common physical hazard may lead to noise-induced hearing loss, an irreversible but preventable disorder. Annual audiometric evaluations help detect changes in hearing status before clinically significant hearing loss develops. This study was designed to track hearing threshold changes during 2-year follow-up among tile and ceramic workers. Methods. This follow-up study was conducted on 555 workers (totally 1110 ears). Subjects were divided into four groups according to the level of noise exposure. Hearing threshold in conventional audiometric frequencies was measured and standard threshold shift was calculated for each ear. Results. Hearing threshold was increased during 2 years of follow-up. Increased hearing threshold was most frequently observed at 4000, 6000, and 3000 Hz. Standard threshold shift was observed in 13 (2.34%), 49 (8.83%), 22 (3.96%), and 63 (11.35%) subjects in the first and second years of follow-up in the right and left ears, respectively. Conclusions. This study has documented a high incidence of noise-induced hearing loss in tile and ceramic workers that would put stress on the importance of using hearing protection devices. PMID:24453922

  7. A case of mucinous cystic neoplasm of the pancreas misdiagnosed as a pancreatic pseudocyst at the initial exam and resected after a 2-year follow-up.

    PubMed

    Ishikawa, Takuya; Haruta, Jun-Ichi; Yamaguchi, Takeo; Doisaki, Masao; Yama, Tsuyoki; Murate, Kentarou; Hattori, Shun; Hayakawa, Fumihiro; Yamada, Kenta; Yashika, Jun

    2015-04-01

    A 44-year-old woman was referred to our hospital because of a cystic lesion in the pancreatic body that was found by computed tomography (CT) as a result of a screening for impaired liver function after the patient presented with a high fever in 2011. Trans-abdominal ultrasonography (US) revealed a 33-mm unilocular cyst within the pancreatic body and a 5-mm hypoechoic mass in the pancreatic neck. Contrast-enhanced CT showed a slight enhancement around the cyst and a mild dilation of the main pancreatic duct, but neither septum nor nodule was detected inside. Contrast-enhanced endoscopic ultrasonography (CE-EUS) revealed a hyperechoic elevated lesion inside the cystic lesion without enhancement in the pancreatic body; CE-EUS also revealed a 5-mm homogeneous hypoechoic mass with a remarkable enhancement in the pancreatic neck with the use of Sonazoid(®) as a contrast medium. These lesions were diagnosed as a pancreatic pseudocyst and a neuroendocrine tumor (NET), respectively, and were followed up with periodic examinations. The cystic lesion showed contraction 6 months after the initial exam. However, US revealed an enlargement of the cystic lesion to 40 mm in diameter 2 years after the initial exam, and EUS showed irregular thickening of the wall with a cyst-in-cyst appearance. The diagnoses of a mucinous cystic neoplasm (MCN) and a concomitant small NET were made after a distal pancreatectomy. We herein report a rare case of MCN that showed various morphological changes over 2 years of observation.

  8. Feasibility of tailored follow-up for patients with early breast cancer.

    PubMed

    van Hezewijk, Marjan; Smit, Dennis J F; Bastiaannet, Esther; Scholten, Astrid N; Ranke, Gemma M C; Kroep, Judith R; Marijnen, Corrie A M; van de Velde, Cornelis J H

    2014-12-01

    As the number of breast cancer survivors increases, this study prospectively examined whether tailored follow-up with differentiated number of visits per risk group, based on a prognostic index for local recurrence, is feasible and acceptable for patients and professionals. Between March 2007 and March 2010, 180 breast cancer patients (pT1-2N0-2cM0) were included. Primary endpoint was feasibility of tailored follow-up, based on the number of follow-up visits, patient satisfaction, anxiety and attitude towards follow-up. Secondary endpoints were reasons for visits, incidence, time to detection of local recurrences and the use of alternative care. In the second and third year of follow-up, the results show a 22% reduction in visits per patient in the low-risk group compared to the intermediate-risk group; 2.8 versus 3.6 visits. The majority of interval visits in both groups was initiated by the professional. No significant differences were found in attitude towards follow-up, patient satisfaction, anxiety and depression, alternative health care use or local recurrences between the risk groups. In conclusion, implementation of a tailored follow-up programme with decreased number of visits for low-risk patients is feasible and acceptable to patients. Appointing one coordinating professional, possibly a nurse practitioner, could further reduce the number of follow-up visits.

  9. Prognostic value of subdivisions of nighttime blood pressure fall in hypertensives followed up for 8.2 years. Does nondipping classification need to be redefined?

    PubMed

    Bastos, José Mesquita; Bertoquini, Susana; Polónia, Jorge

    2010-07-01

    To evaluate the long-term prognostic significance of different ranges of the percentage fall in nighttime blood pressure (BP) of the nondipping pattern, 1200 hypertensive patients (645 women, age 51+/-12 years) underwent ambulatory BP monitoring under stabilized therapy. The occurrence of cardiovascular (CV) events was followed for 9833 patient-years and analyzed by the Cox hazard model. There were 152 CV fatal/nonfatal events (79 strokes, 51 coronary events, 22 others) during the 15.2 years of follow-up. According to nighttime BP fall (%) the authors noted: <0% (reverse-dippers [RD], n=83); 0%-4.9% (nondippers 1 [ND1], n=207); 5%-9.9% (nondippers 2 [ND2], n=311), 10%-19.9% (dippers [D], n=523); and > or =20% (extreme dippers [ED], n=76). After adjustment for confounding variables, hazard ratios (95% confidence interval) of CV event and stroke in RD vs D were 2.29 (1.31-3.99) and 2.46 (1.11-5.49); of ND1 vs D were 1.42 (1.12-1.79) and 1.62 (1.17-2.23); and of ND1 vs ND2 were 2.24 (1.33-3.75) and 2.30 (1.15-4.58). No differences were found in RD vs ND1 and ND2 vs D. Nondippers have a higher CV risk than dippers but only for a nighttime BP fall <5% suggesting that the limits for nondipping should be redefined for a stratification of CV risk.

  10. [Secondary ambulatory prophylaxis of venous thromboembolism: outcome of patients who were lost to follow-up].

    PubMed

    Wawrzyńska, L; Hajduk, B; Kober, J; Filipecki, S

    1998-01-01

    We have attempted to determine the outcome of 87 out-patients who were lost from follow-up. Several factors have been assessed: causes of lost from follow-up duration of oral anticoagulation, recurrent venous thromboembolic events, cause of death (if applicable).

  11. Effectiveness Trial of an Indicated Cognitive-Behavioral Group Adolescent Depression Prevention Program versus Bibliotherapy and Brochure Control at 1- and 2-Year Follow-Up

    PubMed Central

    Rohde, Paul; Stice, Eric; Shaw, Heather; Gau, Jeff M.

    2015-01-01

    Objective Evaluate the longterm effects of a brief group cognitive-behavioral (CB) adolescent depression indicated prevention program through 2-year follow-up, relative to CB bibliotherapy and brochure control, when high school personnel recruited students and delivered the program. Method 378 adolescents (M age = 15.5, SD = 1.2; 68% female, 72% White) with elevated self-assessed depressive symptoms who were randomized to CB group, CB bibliotherapy, or educational brochure control were assessed at pre, post, 6-, 12-, 18-, and 24-month follow-up. Results By 2 years post-intervention, CB group participants showed significantly lower major depressive disorder (MDD) onset versus CB bibliotherapy (10% vs. 25%, respectively; HR = 2.48, p = .006), but the incidence difference relative to brochure controls (17%) was nonsignificant; MDD incidence for bibliotherapy and brochure controls did not differ. Although CB group participants showed lower depressive symptoms at post versus brochure controls, there were no effects for this outcome or for social adjustment or substance use over 2-year follow-up. Moderator analyses suggested that participants with higher baseline depressive symptoms showed greater longterm symptom reductions in the CB group intervention versus bibliotherapy. Conclusions The evidence that a brief CB group intervention delivered by real-world providers significantly reduced MDD onset versus CB bibliotherapy is potentially encouraging. However, the lack of MDD prevention effects relative to brochure control and lack of longterm symptom effects (though consistent with results from other depression prevention trials), suggest that the delivery of CB group should be refined to strengthen its effectiveness. PMID:25894666

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

    PubMed Central

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

    2017-01-01

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

  13. Did successfully treated pulmonary tuberculosis patients undergo all follow-up sputum smear examinations?

    PubMed

    Satyanarayana, S; Nagaraja, S B; Kelamane, S; Jaju, J; Chadha, S S; Chander, K; Vishnu, H; Wilson, N C; Harries, A D

    2011-12-21

    To assess response to anti-tuberculosis treatment as per national guidelines, a retrospective record review was undertaken in four districts of Andhra Pradesh, India, in December 2009 to determine whether pulmonary tuberculosis (PTB) patients reported as successfully treated (cured or treatment completed) underwent all scheduled follow-up sputum smear examinations. In a quarterly cohort of 3000 PTB patients reported as successfully treated, 1847 (61.5%) underwent all follow-up sputum examinations, with a higher proportion of new cases (65%) than retreatment cases (45%). The mid-continuation phase follow-up sputum examinations were commonly missed, and 11% patients had not undergone end-of-treatment follow-up sputum examinations.

  14. Respiratory symptoms and ventilatory function among health-care workers exposed to cleaning and disinfectant chemicals, a 2-year follow-up study.

    PubMed

    El-Helaly, Mohamed; Balkhy, Hanan H; Waseem, Khan; Khawaja, Sahdia

    2016-12-01

    Previous cross-sectional studies have shown that exposure to cleaning chemicals among health-care workers (HCWs) is associated with respiratory disorders and ventilatory function changes. This study aimed to further explore this association using a longitudinal approach. A prospective 2-year follow-up study was carried out at a tertiary care hospital in Saudi Arabia from June 2012 to June 2014 among 56 nurses who were responsible for disinfection and sterilization of medical instruments and equipment. The workplaces of the participants were assessed for engineering, environmental, and safety control measures. Self-administered questionnaires were distributed to all participants to assess their exposure to cleaning chemicals and their medical history. Spirometric parameters were measured for all nurses in 2012 (baseline) and again in 2014 (follow-up). The prevalence of work-related respiratory symptoms did not increase significantly over this time. Among all the spirometric parameters, only forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio decreased significantly, and only 10.7% of participants who were exposed to cleaning chemicals for more than 10 years had FEV1 and FVC less than their longitudinal normal limits at the end of the study. Smoking and gender were associated with statistically significant decreases in some of the spirometric parameters. Our 2-year follow-up study did not demonstrate significant association between exposure to cleaning chemicals among HCWs and changes in the prevalence of work-related respiratory symptoms, but indicated early effects on ventilatory function among them. The study highlights the importance of periodic spirometry, proper work practices, and effective control measures to protect HCWs against potentially harmful workplace chemicals for disinfection and sterilization.

  15. Treatment of Visceral Aneurysm Using Multilayer Stent: Two-Year Follow-Up Results in Five Consecutive Patients

    SciTech Connect

    Balderi, Alberto Antonietti, Alberto Pedrazzini, Fulvio Sortino, Davide Vinay, Claudia Grosso, Maurizio

    2013-10-15

    Purpose: The present study was performed to analyze the midterm results (five consecutive patients, 2-year follow-up) of the endovascular management of visceral artery aneurysms using the Cardiatis Multilayer Flow Modulator (CMFM) (Cardiatis, Isnes, Belgium), a self-expandable stent. Materials and Methods: From August 2009 to January 2011, we implanted five CMFMs in five patients (all men; mean age 73 years) to treat two common hepatic artery aneurysms, one celiac trunk aneurysm, one splenic artery aneurysm, and one superior mesenteric artery aneurysm (diameter 25-81 mm). The primary end point was technical success. The secondary end point was stent patency, absence of aneurysm rupture or reperfusion, and shrinking of the sac at 6-, 12-, and 24-month follow-up using computed tomography angiography. Follow-up ranged from 24 to 48 months (mean 31.2). Results: Technical success was achieved in all patients. Complete exclusion of the aneurysm with sac shrinking was achieved in two patients. Two stents became occluded at 6- and 24-month follow-up, respectively; both patients were asymptomatic and were not retreated. One patient developed sac reperfusion due to incomplete aneurysm exclusion. Conclusion: Long-term results in a wider population are needed to validate the effectiveness of the CMFM.

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

    PubMed

    Ingber, A; Feuerman, E J

    1986-11-01

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

  17. The Experience of Melanoma Follow-Up Care: An Online Survey of Patients in Australia

    PubMed Central

    Street, Jackie; Neuhaus, Susan; Bessen, Taryn

    2014-01-01

    Investigating patients' reports on the quality and consistency of melanoma follow-up care in Australia would assist in evaluating if this care is effective and meeting patients' needs. The objective of this study was to obtain and explore the patients' account of the technical and interpersonal aspects of melanoma follow-up care received. An online survey was conducted to acquire details of patients' experience. Participants were patients treated in Australia for primary melanoma. Qualitative and quantitative data about patient perceptions of the nature and quality of their follow-up care were collected, including provision of melanoma specific information, psychosocial support, and imaging tests received. Inconsistencies were reported in the provision and quality of care received. Patient satisfaction was generally low and provision of reassurance from health professionals was construed as an essential element of quality of care. “Gaps” in follow-up care for melanoma patients were identified, particularly provision of adequate psychosocial support and patient education. Focus on strategies for greater consistency in the provision of support, information, and investigations received, may generate a cost dividend which could be reinvested in preventive and supportive care and benefit patient well-being. PMID:25535589

  18. Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: a 2-year MRI follow-up

    PubMed Central

    Bokor, Desmond John; Sonnabend, David; Deady, Luke; Cass, Ben; Young, Allan; Van Kampen, Craig; Arnoczky, Steven

    2016-01-01

    Summary Background partial-thickness rotator cuff tears frequently enlarge due to increased local strain and often progress to full-thickness tears. Studies suggest the addition of new tendinous tissue to injured cuff tendons would significantly decrease peak strain, possibly protecting against tear progression. The aim of this study was to assess the ability of a highly-porous collagen implant to induce new tissue formation and limit tear progression when placed on the bursal surface of partial-thickness cuff tears. Methods following arthroscopic subacromial decompression, the implant was attached to the bursal surface of the supraspinatus tendon in a prospective series of 13 consecutive patients with intermediate – (3–6 mm) to high-grade (>6 mm) partial – thickness cuff tears (5 articular, 3 bursal, 5 intra-substance). Tendon thickness, defect size, and tendon quality were evaluated using magnetic resonance imaging (MRI) preoperatively and at 3, 6, 12, and 24 months postoperatively. Clinical outcomes were assessed using the Constant and American Shoulder and Elbow Society scores at the same preoperative and follow-up times. All 13 patients completed all follow-up exams (mean length of follow-up 27.0 months, range 23.3–32.0); no patients were lost to follow-up. Results the implant induced significant new tissue formation in all patients by 3 months (mean increase in tendon thickness 2.2 ± 0.26 mm). This tissue matured over time and became radiologically indistinguishable from the underlying tendon. The partial-thickness cuff tears showed consistent filling of the defects, with complete healing in 7 patients at 12 months, and a progressive improvement in tendon quality in the remaining patients. No tear progression was observed by MRI in any of the patients at 24 months. All clinical scores improved significantly over time. At 24 months, 12 of 13 patients (92%) had satisfactory or better results. Conclusions the results of this clinical study demonstrated

  19. A review of 145 234 ophthalmic patient episodes lost to follow-up.

    PubMed

    Davis, A; Baldwin, A; Hingorani, M; Dwyer, A; Flanagan, D

    2017-03-01

    PurposeLost to follow-up and delays in follow-up care are a major problem in chronic diseases, particularly when irreversible progression precedes symptoms. The NPSA Glaucoma Safety Alert in 2009 highlighted the risk and requirements for consistent robust review systems in ophthalmology. In response, Moorfields Eye Hospital reviewed the records of all patients in all subspecialties without review appointments booked. The purpose of this study was to determine whether ophthalmic patients lost to follow-up had come to harm and develop investigation techniques to optimise safety, which do not put excessive demands on clinical staff time.MethodsThe health records of all patients lost to follow-up (LTFU) between July 2007 and November 2012 were reviewed for evidence of clinical harm using a risk-based strategy involving an initial administrative review, then a clinician led electronic patient record review, followed by a review of paper records by clinicians. The final stage was a clinical outpatient review where required determined by clinical risk.ResultsPatients identified as lost to follow-up were 145 234; 79 562 episodes were closed following administrative review; 50 519 were discharged following clinician examination of paper records; 12 316 patients required clinical review; and 16 serious incidents were identified, of which 14 patients had glaucoma, 1 a medical retinal condition with secondary glaucoma, and 1 an oculoplastic condition. A number of actions implemented hospital wide are described which minimise future risk.ConclusionRisk from delays or lost to follow-up care continue and require better capacity and more accurate data nationally.

  20. A multidisciplinary follow-up clinic after patients' discharge from ITU.

    PubMed

    Crocker, Cheryl

    Follow-up clinics following discharge from intensive care are not a new phenomenon - Whiston Hospital in Liverpool has been running a clinic since 1990. Its pioneering work has set a precedent and has inspired Nottingham City Hospital to set up its own clinic. The Department of Health (2000) recommended that all NHS trusts 'review the provision of follow-up services and ensure there is appropriate provision for those patients who will benefit'. Nottingham City Hospital set up a multidisciplinary follow-up clinic without funding, with great success, over a year ago. This service has been extremely valuable to patients and their carers and has helped staff understand the needs of patients once they have left intensive care. This article will describe the clinic's work and case studies are utilized in order to illustrate key points.

  1. Carotenoderma in a young woman of normal body mass index with hypothalamic amenorrhoea: a 2-year follow-up case report.

    PubMed

    Nyekiova, M; Ghaderi, S; Han, T S

    2014-12-01

    Hypothalamic amenorrhoea has been shown to be associated with hypercarotenaemia, but no causal link has been established. Many people are unaware of the health implications of carotenoderma. We report on a 36-year-old woman with normal body mass index and with a history of secondary amenorrhoea for 2 years and carotenoderma for 5 years. She had a history of practising a fixed-menu diet of predominantly leafy greens, exercised intensively and had a stressful job. Blood tests confirmed the presence of hypercarotenaemia and hypogonadotrophic hypogonadism. Carotenoderma subsided after 6 months of lifestyle modification, but she remained amenorrhoeic up to 12 months later. Since then, her condition had relapsed up to the time of 2 years of follow-up. We conclude that hypercarotenaemia/carotenoderma and hypothalamic amenorrhoea are manifestations of a constrained lifestyle rather than causally linked. The presence of carotenoderma should alert public individuals and clinicians, especially in primary care, alike for signs of potential health complications including reproductive dysfunction even without weight problems.

  2. Patient relationship management: an overview and study of a follow-up system.

    PubMed

    Oinas-Kukkonen, Harri; Räisänen, Teppo; Hummastenniemi, Niko

    2008-01-01

    Customer relationship management research is utilized to explain the need for a more patient-oriented support in patient care. This article presents a European study on how various hospital units of a single healthcare organization have utilized a patient relationship management system--in particular a patient treatment follow-up system--and how it affects patient care and the knowledge work performed by the medical staff. Eight physicians were interviewed at a university hospital on whether patient treatment was improved through a follow-up system that had been in use in the case organization for three years. The interviewees represented various hospital units, and all of them had used the system at their own unit. The results indicate that it is possible to improve patient care through more personalized treatment. The follow-up treatment system seems to be a tool to create and maintain better communication with the patients rather than just a technological solution. It may help better understand and analyze both individual patients and patient groups. For individual physicians it provides a way to reflect professional skills. The system was lacking in its support for one-to-one communication with patients. Nevertheless, the system is an example of patient relationship management which may help healthcare units to move towards a more patient-oriented care.

  3. Proliferative retinopathy predicts nephropathy: a 25-year follow-up study of type 1 diabetic patients.

    PubMed

    Karlberg, Charlotte; Falk, Christine; Green, Anders; Sjølie, Anne Katrin; Grauslund, Jakob

    2012-08-01

    We wanted to examine proliferative retinopathy as a marker of incident nephropathy in a 25-year follow-up study of a population-based cohort of Danish type 1 diabetic patients and to examine cross-sectional associations between nephropathy and retinopathy in long-term surviving patients of the same cohort. All type 1 diabetic patients from Fyn County, Denmark, were identified as of 1 July 1973. One hundred and eighty four patients were examined in 1981-1982 (baseline) and in 2007-2008 (follow-up). The level of retinopathy was graded by ophthalmoscopy at baseline and nine-field digital colour fundus photographs at follow-up. Single spot urine was used to evaluate nephropathy at both examinations. Proliferative retinopathy was present in 29 patients (15.8%) at baseline. At follow-up, these patients were more likely to macroalbuminuria (20.7% vs. 6.5%) than patients without proliferative retinopathy at baseline. In a multivariate logistic regression adjusted for baseline age, sex, duration of diabetes, smoking, HbA(1,) systolic and diastolic blood pressure, odds ratio of nephropathy (micro- and macroalbuminuria combined) was 2.98 (95% confidence interval 1.18-7.51, p = 0.02) for patients with proliferative retinopathy at baseline as compared to those without. At follow-up, there was a close relation between retinopathy and nephropathy. The level of macroalbuminuria was 4.3, 4.6 and 13.0% for patients with no or mild non-proliferative retinopathy, moderate non-proliferative retinopathy and proliferative retinopathy, respectively. In conclusion, proliferative retinopathy is an independent marker of long-term nephropathy in type 1 diabetes. Upcoming studies should examine whether these microvascular complications are also causally linked in type 1 diabetes.

  4. Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results

    PubMed Central

    2015-01-01

    Purpose We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. Materials and Methods Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. Results Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. Conclusion Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up. PMID:27536632

  5. [Evaluation of depressive symptoms and resilience in patients on pharmacotherapeutic follow-up].

    PubMed

    Gomes, N C; Abrão, P H O; Fernandes, M R; Beijo, L A; Marques, L A M

    2017-03-07

    This study aimed to carry out the pharmacotherapeutic follow-up of patients with depression and to assess its impact on the resilience of the patients. Patients were followed-up for 8 months. The pharmacist evaluated depressive symptoms, resilience, and the need for pharmaceutical intervention. The measurement tools used were the Dader method, PHQ-9, and a resilience scale. Data were analysed using BioStat 5.0 software and the performing of the Wilcoxon and Pearson correlation tests. There was a reduction in the rate of depressive symptoms from 12.9 to 5.2 (P<.0001), and an increase in the resilience score from 112.4 to 149.0 (P<.0001). Pharmaceutical interventions were made to resolve the drug related problems in the form of oral communication between pharmacist-patient or pharmacist-patient-doctor. The pharmaceutical care was effective in decreasing depression and contributed to the increased resilience of patients.

  6. High-Dose Rate Brachytherapy Using Inverse Planning Simulated Annealing for Locoregionally Advanced Cervical Cancer: A Clinical Report With 2-Year Follow-Up

    SciTech Connect

    Kim, Daniel H.; Wang-Chesebro, Alice; Weinberg, Vivian; Pouliot, Jean; Chen, Lee-May; Speight, Joycelyn; Littell, Ramey; Hsu, I.-Chow

    2009-12-01

    Purpose: We present clinical outcomes of image-guided brachytherapy using inverse planning simulated annealing (IPSA) planned high-dose rate (HDR) brachytherapy boost for locoregionally advanced cervical cancer. Methods and Materials: From February 2004 through December 2006, 51 patients were treated at the University of California, San Francisco with HDR brachytherapy boost as part of definitive radiation for International Federation of Gynecology and Obstetrics Stage IB1 to Stage IVA cervical cancer. Of the patients, 46 received concurrent chemotherapy, 43 with cisplatin alone and 3 with cisplatin/5-fluorouracil. All patients had IPSA-planned HDR brachytherapy boost after whole-pelvis external radiation to a total tumor dose of 85 Gy or greater (for alpha/beta = 10). Toxicities are reported according to National Cancer Institute CTCAE v3.0 (Common Terminology Criteria for Adverse Events version 3.0) guidelines. Results: At a median follow-up of 24.3 months, there were no toxicities of Grade 4 or greater and the frequencies of Grade 3 acute and late toxicities were 4% and 2%, respectively. The proportion of patients having Grade 1 or 2 gastrointestinal and genitourinary acute toxicities was 48% and 52%, respectively. Low-grade late toxicities included Grade 1 or 2 vaginal, gastrointestinal, and hormonal toxicities in 31%, 18%, and 4% of patients, respectively. During the follow-up period, local recurrence developed in 2 patients, regional recurrence developed in 2, and new distant metastases developed in 15. The rates of locoregional control of disease and overall survival at 24 months were 91% and 86%, respectively. Conclusions: Definitive radiation by use of inverse planned HDR brachytherapy boost for locoregionally advanced cervical cancer is well tolerated and achieves excellent local control of disease.

  7. Follow-up study using iodine-131 metaiodobenzylguanidine imaging in a patient with neuroblastoma

    SciTech Connect

    Ikekubo, K.; Habuchi, Y.; Jeong, S.; Yamaguchi, H.; Saiki, Y.; Ito, H.; Hino, M.; Higa, T.

    1986-11-01

    A new radiopharmaceutical, I-131 metaiodobenzylguanidine (I-131 MIBG) was used to determine the location and to follow-up tumors in a 13-month-old girl with neuroblastoma. I-131 MIBG imaging revealed both a primary abdominal tumor and a distant metastatic orbital tumor. Follow-up study with I-131 MIBG imaging demonstrated significant resolution of tumors after external radiotherapy and chemotherapy. I-131 MIBG imaging is a simple, safe, and specific method of determining the location of tumors and also is clinically useful in the evaluation and management of patients with neuroblastoma.

  8. Sixty-year follow-up in an untreated patient with Kienböck disease.

    PubMed

    Meek, Marcel F; Lunn, Peter G

    2011-12-01

    Kienböck disease can be treated either conservatively or by various operations. We describe the findings of the progression of Kienböck disease over 60 years in an 84-year-old man who had had no surgical treatment. This is the longest follow-up ever reported to our knowledge of a patient with avascular necrosis of the lunate.

  9. [A cooperation protocol for the follow-up of patients after bariatric surgery].

    PubMed

    Barbelanne, Alexia; Wolf, Sylvie; Foiry, Anne-Françoise; Guillot, Caroline; Aron Wisnewsky, Judith

    2016-12-01

    Professional cooperation protocols have recently been developed by the French national health authority and regional health agencies. They enable paramedical staff to perform procedures usually carried out by doctors. In the framework of bariatric surgery, the follow-up of patients after surgery is thereby assured by specialist nurses. They can make a diagnosis and prescribe vitamins, minerals and tests.

  10. Is Every Patient Followed up as a Papillary Thyroid Cancer Patient Really That?

    PubMed Central

    Abdulrezzak, Ummuhan; Tutus, Ahmet; Kula, Mustafa; Öztürk, Figen; Soyuer, Işın

    2012-01-01

    We report the case of a 64-year-old man followed up for two years as suffering from differentiated thyroid cancer (DTC). In the patient’s follow up, despite thyroglobulin level and I-131 whole body scan results being normal, metastases were identified at the 4th thoracic vertebra corpus by MR. Histopathological findings were carcinoma metastases. F-18 FDG PET/CT showed increased metabolic activity in the right renal mass, bilaterally in the surrenal gland, multiple lymph nodes in the thoracic and abdominal para-aortic region and in multiple vertebral and pelvic bones. An excisional biopsy of the right renal mass was reported as renal cell carcinoma. Immunohistochemical staining performed retrospectively to the first thyroid preparation showed renal cell carcinoma metastases. Consequently, any patient who presents with a thyroid nodule can also be considered as possibly suffering from metastatic disease. F-18 FDG PET/CT can provide valuable information in finding the primary focus and metastases. Conflict of interest:None declared. PMID:23487501

  11. Effective follow-up consultations: the importance of patient-centered communication and shared decision making.

    PubMed

    Brand, Paul L P; Stiggelbout, Anne M

    2013-12-01

    Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice.

  12. Violence and Abuse Against Women Who Have Attempted Suicide by Deliberate Self-Poisoning: A 2-Year Follow-Up Study in Iran.

    PubMed

    Hassanian-Moghaddam, Hossein; Zamani, Nasim; Sarjami, Saeedeh

    2016-04-01

    Sources of data about the occurrence of domestic violence are scarce in Iran. The aim of this study was to evaluate the behavioral effects of different types of domestic violence on women who had attempted suicide by deliberate self-poisoning (DSP). A total of 195 women who had attempted suicide by DSP in response to "violence and abuse" were followed up for 2 years. The most common type of violence, as mentioned by the women themselves as the motive of self-poisoning, was physical abuse (92%) followed by verbal abuse (2.1%), multi-abuses (2.1%), emotional abuse (1.6%), and sexual abuse (1.1%). Suicidal ideation and attempt were more common in those who were consulted sometime after they had initially presented to the hospital with DSP or those who had suffered repeated domestic abuse. It was concluded that invention of methods other than the current consultation system is necessary to prevent repeated suicide attempts among abused women in Iran.

  13. Treatment of a large periradicular defect using guided tissue regeneration: A case report of 2 years follow-up and surgical re-entry.

    PubMed

    Gurav, Abhijit Ningappa; Shete, Abhijeet Rajendra; Naiktari, Ritam

    2015-01-01

    Periradicular (PR) bone defects are common sequelae of chronic endodontic lesions. Sometimes, conventional root canal therapy is not adequate for complete resolution of the lesion. PR surgeries may be warranted in such selected cases. PR surgery provides a ready access for the removal of pathologic tissue from the periapical region, assisting in healing. Recently, the regeneration of the destroyed PR tissues has gained more attention rather than repair. In order to promote regeneration after apical surgery, the principle of guided tissue regeneration (GTR) has proved to be useful. This case presents the management of a large PR lesion in a 42-year-old male subject. The PR lesion associated with 21, 11 and 12 was treated using GTR membrane, fixated with titanium minipins. The case was followed up for 2 years radiographically, and a surgical re-entry confirmed the re-establishment of the lost labial plate. Thus, the principle of GTR may immensely improve the clinical outcome and prognosis of an endodontically involved tooth with a large PR defect.

  14. Treatment of a large periradicular defect using guided tissue regeneration: A case report of 2 years follow-up and surgical re-entry

    PubMed Central

    Gurav, Abhijit Ningappa; Shete, Abhijeet Rajendra; Naiktari, Ritam

    2015-01-01

    Periradicular (PR) bone defects are common sequelae of chronic endodontic lesions. Sometimes, conventional root canal therapy is not adequate for complete resolution of the lesion. PR surgeries may be warranted in such selected cases. PR surgery provides a ready access for the removal of pathologic tissue from the periapical region, assisting in healing. Recently, the regeneration of the destroyed PR tissues has gained more attention rather than repair. In order to promote regeneration after apical surgery, the principle of guided tissue regeneration (GTR) has proved to be useful. This case presents the management of a large PR lesion in a 42-year-old male subject. The PR lesion associated with 21, 11 and 12 was treated using GTR membrane, fixated with titanium minipins. The case was followed up for 2 years radiographically, and a surgical re-entry confirmed the re-establishment of the lost labial plate. Thus, the principle of GTR may immensely improve the clinical outcome and prognosis of an endodontically involved tooth with a large PR defect. PMID:26941526

  15. [Key points of the follow-up plan in the care of Alzheimer's disease patients].

    PubMed

    Hein, C; Sourdet, S; Piau, A; Villars, H; Nourhashemi, F; Vellas, B

    2011-03-01

    The following article presents the main points of the follow-up plan of Alzheimer's disease (AD) and related syndromes patients. The general objective of this follow-up plan is to improve the quality of live of these subjects and their family. The key points are assessments of cognitive decline, functional decline and complications such as behavioural and psychological symptoms of dementia (BPSD), malnutrition and gait and balance disorders. In clinical practice, different tools are available, but frequency of evaluation is not consensual. However, the aim of this follow-up is to detect, prevent and treat complications and to improve the use of residual functional abilities in basic activities of daily living. The physician also needs to detect and prevent caregiver's exhaustion and to consider the ethical issues raised by the disease. The care plan is based on non pharmacological and pharmacological measures. The non pharmacological approach must be implemented first. The place of anti-dementia drugs is considered. Lastly, this follow-up plan aims to limit iterative admissions to emergency room and to increase the access to geriatric units. Communication and collaboration between specialist, family practitioner and caregivers are needed in order to reach the objective of quality of life improvement in AD patients.

  16. CMS proposes prioritizing patient preferences, linking patients to follow-up care in discharge planning process.

    PubMed

    2016-03-01

    Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule.

  17. A large prospective European cohort study of patients treated with strontium ranelate and followed up over 3 years.

    PubMed

    Audran, M; Jakob, F J; Palacios, S; Brandi, M-L; Bröll, H; Hamdy, N A T; McCloskey, E V

    2013-09-01

    Strontium ranelate has been available as an osteoporosis treatment in Europe since 2004. This article describes a large European observational survey of the use of strontium ranelate in clinical daily practice. A retrospective observational registry included 32,446 women consulting for postmenopausal osteoporosis in seven countries. Within the registry, 12,046 women were receiving strontium ranelate and were followed up over 3 years. The baseline characteristics of the follow-up cohort were similar to those of the whole registry cohort (age, 68.9 ± 10.3 years; body mass index, 25.6 ± 4.3 kg/m(2); lumbar spine T-score, -2.57 ± 0.85 SD; femoral neck T-score, -2.11 ± 0.86 SD). At baseline, 77 % of patients had at least one risk factor for osteoporosis, and 46 % had a previous history of osteoporotic fracture. Mean duration of follow-up was 32.0 ± 9.7 months, and treatment duration was 25.2 ± 13.7 months (24,956 patient-years of treatment). Persistence with strontium ranelate was 80 % at 1 year, 68 % at 2 years, and 64 % at 32 months; most patients (about 80 %) reported rarely omitting a dose. At least one emergent adverse event was reported in 2,674 (22 %) patients, most frequently gastrointestinal side effects. The crude incidence of venous thromboembolic events was 2.1/1,000 patient-years. No cases of hypersensitivity reactions, such as drug rash with eosinophilia and systemic symptoms (DRESS), Steven-Johnson syndrome, or toxic epidermal necrolysis, were reported. During follow-up, a fracture occurred in 890 patients (7 %); 429 of the fractures were nonvertebral fractures. Our observational survey over 32 months indicated good rates of adherence with strontium ranelate and confirmed its good safety profile in the management of postmenopausal osteoporosis.

  18. Postoperative nonsteroidal antiinflammatory drugs and the prevention of heterotopic ossification after cervical arthroplasty: analysis using CT and a minimum 2-year follow-up.

    PubMed

    Tu, Tsung-Hsi; Wu, Jau-Ching; Huang, Wen-Cheng; Chang, Hsuan-Kan; Ko, Chin-Chu; Fay, Li-Yu; Wu, Ching-Lan; Cheng, Henrich

    2015-05-01

    OBJECT Heterotopic ossification (HO) after cervical arthroplasty is not uncommon and may cause immobility of the disc. To prevent HO formation, study protocols of clinical trials for cervical arthroplasty undertaken by the US FDA included perioperative use of nonsteroidal antiinflammatory drugs (NSAIDs). However, there are few data supporting the use of NSAIDs to prevent HO after cervical arthroplasty. Therefore, this study aimed to evaluate the efficacy of NSAIDs in HO formation and clinical outcomes. METHODS Consecutive patients who underwent 1- or 2-level cervical arthroplasty with a minimum follow-up of 24 months were retrospectively reviewed. All patients were grouped into 1 of 2 groups, an NSAID group (those patients who had used NSAIDs postoperatively) and a non-NSAID group (those patients who had not used NSAIDs postoperatively). The formation of HO was detected and classified using CT in every patient. The incidence of HO formation, disc mobility, and clinical outcomes, including visual analog scale (VAS) scores of neck and arm pain, neck disability index (NDI) scores, and complications were compared between the two groups. Furthermore, a subgroup analysis of the patients in the NSAID group, comparing the selective cyclooxygenase (COX)-2 to nonselective COX-2 NSAID users, was also conducted for each of the above-mentioned parameters. RESULTS A total of 75 patients (mean age [± SD] 46.71 ± 9.94 years) with 107 operated levels were analyzed. The mean follow-up duration was 38.71 ± 9.55 months. There were no significant differences in age, sex, and levels of arthroplasty between the NSAID and non-NSAID groups. There was a nonsignificantly lower rate of HO formation in the NSAID group than the non-NSAID group (47.2% vs. 68.2%, respectively; p = 0.129). During follow-up, most of the arthroplasty levels remained mobile, with similar rates of immobile discs in the NSAID and non-NSAID groups (13.2% and 22.7%, respectively; p = 0.318). Furthermore, there was a

  19. MRI in adult patients with aortic coarctation: diagnosis and follow-up.

    PubMed

    Shepherd, B; Abbas, A; McParland, P; Fitzsimmons, S; Shambrook, J; Peebles, C; Brown, I; Harden, S

    2015-04-01

    Aortic coarctation is a disease that usually presents in infancy; however, a proportion of patients present for the first time in adulthood. These lesions generally require repair with either surgery or interventional techniques. The success of these techniques means that increasing numbers of patients are presenting for follow-up imaging in adulthood, whether their coarctation was initially repaired in infancy or as adults. Thus, the adult presenting to the radiologist for assessment of possible coarctation or follow-up of coarctation repair is not an uncommon scenario. In this review, we present details of the MRI protocols and MRI findings in these patients so that a confident and accurate assessment can be made.

  20. Is cytoimmunological monitoring a safe follow-up method for heart transplantation patients?

    PubMed Central

    Gunay, Celalettin; Oz, Bilgehan Savas; Arslan, Mehmet

    2014-01-01

    The aim of the study The aim of the study is to show the effects of cytoimmunological monitoring and its role in the patient's follow-up period after heart transplantation. Material and methods Between 2002 and 2009, 8 patients underwent heart transplantation at Gulhane Military Medical Academy Hospital. Seven patients were male. The average age was 43 ± 12 years. Donor hearts were implanted orthotopically in all patients. The patients were then subjected to cytoimmunological monitoring and endomyocardial biopsy. 431 laboratory blood tests were carried out for all patients to analyze their cytoimmunological profiles and diagnose a possible infection or rejection. Results The total and average follow-up periods were 17.5 patient years and 30 ± 36 months (1-120 months), respectively. The first patient had two rejection episodes in 3 months. A viral infection was diagnosed in the third patient, who had painful muscle spasms in both lower limbs and the CD4/CD8 ratio was below 0.4. In the fourth patient, the CD4/CD8 ratio suddenly increased and a urinary infection was diagnosed. Only one patient passed away in the early period (less than 30 days). Four patients died because of an infection or hemodynamic deterioration within three months. Conclusions Cytoimmunological monitoring is a simple and effective technique of evaluating the patient's immunological profile. It may provide an adjunctive laboratory test and may decrease the number of endomyocardial biopsies. PMID:26336394

  1. Comparison of Retrograde Balloon Dilatation and Laparoscopic Pyeloplasty for Treatment of Ureteropelvic Junction Obstruction: Results of a 2-Year Follow-Up

    PubMed Central

    Xue, Xue-Yi; Zheng, Qing-Shui; Wei, Yong; Jiang, Tao; Li, Xiao-Dong; Huang, Jin-Bei; Cai, Hai

    2016-01-01

    Objective To evaluate the efficacy of laparoscopic pyeloplasty relative to retrograde balloon dilatation for the treatment of ureteropelvic junction obstruction (UPJO). Methods This retrospective study enrolled UPJO patients with stricture length < 2 cm who had been treated with laparoscopic pyeloplasty (LP; 44 cases) or balloon dilatation (BD; 38 cases) from Jan 2010 to Jan 2012, according to patients’ preference after consultation. Demographics and clinical parameters were collected. Patients were followed-up at 3, 6, 12, and 24 months. Ultrasonography, intravenous urography, and diuretic renography were applied to evaluate the remission of hydronephrosis. Results Both groups were comparable with respect to age, UPJO location, gender, and other baseline parameters. Compared to the LP group, patients receiving BD experienced significantly shorter operative time, analgesia time, hospital stay, and urethral catheter indwelling time, and less cost (P<0.001). Three and 6 months after their respective procedures, the success rates of the LP (97.7%, both) and BD (94.7% and 86.8%) groups were similar, and at 12 and 24 months the long-term success rate of LP (95.5%, both) was better than that of BD (78.9% and 71.0%). Conclusions LP showed better long-term success rate than did BD in the management of UPJO with length of stricture < 2 cm. Considering that BD is more minimally invasive, simpler and easier to perform, and costs less, we recommend it for some selective UPJO patients as the first-line therapy. PMID:27019289

  2. Revision Total Knee Arthroplasty with a Cemented Posterior Stabilized, Condylar Constrained or Fully Constrained Prosthesis: A Minimum 2-year Follow-up Analysis

    PubMed Central

    Hwang, Sun-Chul; Kong, Jae-Yeon; Nam, Dae-Cheol; Kim, Dong-Hee; Park, Hyung-Bin; Jeong, Soon-Taek

    2010-01-01

    Background The clinical and radiological outcomes of revision total knee arthroplasty with a cemented posterior stabilized (PS), condylar constrained knee (CCK) or a fully constrained rotating hinge knee (RHK) prosthesis were evaluated. Methods This study reviewed the clinical and radiological results of 36 revision total knee arthroplasties with a cemented PS, CCK, and RHK prosthesis in 8, 25, and 13 cases, respectively, performed between 1998 and 2006. The mean follow-up period was 30 months (range, 24 to 100 months). The reason for the revision was aseptic loosening of one or both components in 15, an infected total knee in 18 and a periprosthetic fracture in 3 knees. The average age of the patients at the time of the revision was 65 years (range, 58 to 83 years). The original diagnosis for all primary total knee arthroplasties was osteoarthritis except for one case of a Charcot joint. All revision prostheses were fixed with cement. The bone deficiencies were grafted with a cancellous allograft in the contained defect and cortical allograft fixed with a plate and screws in the noncontained defect. A medial gastrocnemius flap was needed to cover the wound dehiscence in 6 of the 18 infected cases. Results The mean Knee Society knee score improved from 28 (range, 5 to 43) to 83 (range, 55 to 94), (p < 0.001) and the mean Knee Society function score improved from 42 (range, 10 to 66) to 82 (range, 60 to 95), (p < 0.001) at the final follow-up. Good or excellent outcomes were obtained in 82% of knees. There were 5 complications (an extensor mechanism rupture in 3 and recurrence of infection in 2 cases). Three cases of an extensor mechanism defect (two ruptures of ligamentum patellae and one patellectomy) were managed by the RHK prosthesis to provide locking stability in the heel strike and push off phases, and two cases of recurrent infection used an antibiotic impregnated cement spacer. The radiological tibiofemoral alignment improved from 1.7° varus to 3.0

  3. Follow-up of patients with celiac disease: achieving compliance with treatment.

    PubMed

    Pietzak, Michelle Maria

    2005-04-01

    Celiac disease is the only autoimmune condition for which we know the environmental trigger: gluten. Complete removal of gluten from the diet in a patient with celiac disease should result in symptomatic, serologic, and histologic remission. However, compliance with the gluten-free diet, especially in the United States, is extremely challenging. Compliance can be measured both noninvasively, by dietary history and measurement of serum antibodies, and invasively, by using endoscopic and histologic criteria. The advantages and disadvantages of these various modalities are discussed. The highest rates of compliance are reported in patients who are diagnosed as young children, whereas adolescents and those diagnosed via mass serologic screening have the most transgressions. Barriers to compliance include the poor palatability of gluten-free foods, confusing food-labeling practices, and common comorbid psychologic burdens such as anxiety and depression. Because celiac disease is a multisystemic disorder, physicians need to be aware of the potential autoimmune, nutritional, and malignant complications. An algorithm for the follow-up and management of the newly diagnosed celiac disease patient is presented, which includes regular follow-up; measurement of serum antibodies; eliciting a detailed dietary history; and examination for signs and symptoms of nutritional deficiencies, malignancy, and other autoimmune diseases. Ideally, a team approach to the follow-up of the newly diagnosed patient should include regular supervision by an interested physician, medical nutritional counseling by a registered dietician, and access to local and national support groups knowledgeable about this condition.

  4. Telephone follow-up of patients after radical prostatectomy: a systematic review1

    PubMed Central

    da Mata, Luciana Regina Ferreira; da Silva, Ana Cristina; Pereira, Maria da Graça; de Carvalho, Emilia Campos

    2014-01-01

    Objective to assess and summarize the best scientific evidence from randomized controlled clinical trials about telephone follow-up of patients after radical prostatectomy, based on information about how the phone calls are made and the clinical and psychological effects for the individuals who received this intervention. Method the search was undertaken in the electronic databases Medline, Web of Science, Embase, Cinahl, Lilacs and Cochrane. Among the 368 references found, five were selected. Results two studies tested interventions focused on psychological support and three tested interventions focused on the physical effects of treatment. The psychoeducative intervention to manage the uncertainty about the disease and the treatment revealed statistically significant evidences and reduced the level of uncertainty and anguish it causes. Conclusion the beneficial effects of telephone follow-up could be determined, as a useful tool for the monitoring of post-prostatectomy patients. PMID:26107844

  5. Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

    PubMed Central

    2012-01-01

    Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE), Transesophageal (TEE) and/or Intracardiac echocardiography (ICE). This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography. PMID:22452829

  6. Long-term follow-up of patients after retinal detachment surgery.

    PubMed

    Coakes, R L; Ramsay, J H; Tarbuck, D T

    1978-04-01

    The value of long-term follow-up of patients after retinal detachment surgery depends on the number of further detachments prevented. This in turn depends on the frequency with which predisposing lesions are found and treated and also the risk of leaving them untreated. In a retrospective study of 128 patients who had attended the Retina Clinic at Moorfields, High Holborn, for at least 10 years, the frequency with which asymptomatic retinal breaks were detected was less than two per hundred patients per year of follow-up. The risk of such lesions progressing to detachment if left untreated is estimated to be no more than 12 per cent and on this basis it is likely that no more than four or five detachments were prevented in our series. During the same period 66 new or re-detachments occurred, in spite of regular examination and treatment of predisposing lesions found, and it is concluded that long-term follow-up is of doubtful value in the prevention of further detachments.

  7. Quality of life in the follow-up of uveal melanoma patients after CyberKnife treatment.

    PubMed

    Klingenstein, Annemarie; Fürweger, Christoph; Nentwich, Martin M; Schaller, Ulrich C; Foerster, Paul I; Wowra, Berndt; Muacevic, Alexander; Eibl, Kirsten H

    2013-12-01

    To assess quality of life in uveal melanoma patients within the first and second year after CyberKnife radiosurgery. Overall, 91 uveal melanoma patients were evaluated for quality of life through the Short-form (SF-12) Health Survey at baseline and at every follow-up visit over 2 years after CyberKnife radiosurgery. Statistical analysis was carried out using SF Health Outcomes Scoring Software and included subgroup analysis of patients developing secondary glaucoma and of patients maintaining a best corrected visual acuity (BCVA) of the treated eye of 0.5 log(MAR) or better. Analysis of variance, Greenhouse-Geisser correction, Student's t-test, and Fisher's exact test were used to determine statistical significance. Physical Functioning (PF) and Role Physical (RP) showed a significant decrease after CyberKnife radiosurgery, whereas Mental Health (MH) improved (P=0.007, P<0.0001 and P=0.023). MH and Social Functioning (SF) increased significantly (P=0.0003 and 0.026) in the no glaucoma group, MH being higher compared with glaucoma patients (P=0.02). PF and RP were significantly higher in patients with higher BCVA at the second follow-up (P=0.02). RP decreased in patients with BCVA<0.5 log(MAR) (P=0.013). Vitality (VT) increased significantly in patients whose BCVA could be preserved (P=0.031). Neither tumor localization nor size influenced the development of secondary glaucoma or change in BCVA. Although PF and RP decreased over time, MH improved continuously. Prevention of secondary glaucoma has a significant influence on both SF and MH, whereas preservation of BCVA affects VT. Emotional stability throughout follow-up contributes positively toward overall quality of life. CyberKnife radiosurgery may contribute to attenuation of emotional distress in uveal melanoma patients.

  8. Self-inflicted injury: a follow-up study of 43 patients.

    PubMed Central

    Sneddon, I; Sneddon, J

    1975-01-01

    Forty-three patients, 38 women and 5 men, with self-inflicted skin lesions were studied. Thirty-three were followed up for up to 22 years. In most cases dermatitis artefacta was only one incident in a long history of psychogenic illness. Of the 43 patients, 13 (30%), 12 women and one man, continued to produce lesions or were disabled with other psychiatric disorders more than 12 years after the onset of symptoms. Prognosis was difficult but recovery seemed to occur when the patient's life circumstances changed rather than as a result of treatment. Images FIG. 1 FIG. 2 FIG. 3 PMID:1164617

  9. Long-term follow-up of functioning after spinal surgery in patients with Rett syndrome.

    PubMed

    Larsson, Eva-Lena; Aaro, Stig; Ahlinder, Peter; Normelli, Helena; Tropp, Hans; Oberg, Birgitta

    2009-04-01

    In a prospective study, 23 consecutive girls with Rett syndrome and neuromuscular scoliosis were evaluated for functioning at a long-term follow-up. The patients had mostly improved, which was confirmed by their parents. Rett syndrome is associated with neuromuscular scoliosis and has a typically long C-shaped thoracolumbar kyphoscoliosis. Prospective long-term follow-up studies related to these patients' total situation are sparse. Most studies focus on the Cobb angle of the scoliosis, whereas parents are mainly concerned about the girls' continued functioning. Twenty-three patients with Rett syndrome and neuromuscular scoliosis were evaluated preoperatively from 1993 to 2002. At follow-up, 19 patients remained in the study. Three patients died (not due to surgery), and one patient could not participate because it was too far to travel. Mean follow-up time was 74 months (range 49-99 months). The assessments comprised the sitting balance, seating supports in wheelchair, weight distribution, time used for rest, care given, and angle of scoliosis. Follow-up questionnaires and two-open-ended questions about the positive and negative effects of surgery were sent to parents. Sitting balance, number of seating supports in wheelchair, weight distribution, time used for rest, and the Cobb angle had all improved after surgery. The parents assessed improvement in seating position, daily activities, time used for rest, and cosmetic appearance. We can conclude that the stabilized spine resulted in sufficient strength to keep the body upright with the possibility of looking around at the surroundings more easily. The girls got better seating position with less need for seating adaptations in the wheelchair and with reduced time needed for resting during the day. Finally we can conclude that the indication for surgery is to get a better posture which lead to less risk of pressure sores, and that un upright position lead to better possibility to easily breath with fewer episodes

  10. Transcatheter aortic valve implantation in very elderly patients: immediate results and medium term follow-up

    PubMed Central

    Pascual, Isaac; Muñoz-García, Antonio J; López-Otero, Diego; Avanzas, Pablo; Jimenez-Navarro, Manuel F; Cid-Alvarez, Belén; del Valle, Raquel; Alonso-Briales, Juan H; Ocaranza-Sanchez, Raimundo; Hernández, José M; Trillo-Nouche, Ramiro; Morís, César

    2015-01-01

    Objective To evaluate immediate transcatheter aortic valve implantation (TAVI) results and medium-term follow-up in very elderly patients with severe and symptomatic aortic stenosis (AS). Methods This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly (> 85 years) patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rates from any cause at two years. Results The study included 160 consecutive patients with a mean age of 87 ± 2.1 years (range from 85 to 94 years) and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 (35.6%) patients scoring ≥ 20%. Procedural success rate was 97.5%, with 25 (15.6%) patients experiencing acute complications with major bleeding (the most frequent). Global mortality rate during hospitalization was 8.8% (n = 14) and 30-day mortality rate was 10% (n = 16). Median follow up period was 252.24 ± 232.17 days. During the follow-up period, 28 (17.5%) patients died (17 of them due to cardiac causes). The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique variable associated with overall mortality. Conclusions TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients. PMID:26345138

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

    PubMed Central

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

    2017-01-01

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

  12. Long-term follow-up after bronchoscopic lung volume reduction treatment with coils in patients with severe emphysema

    PubMed Central

    Hartman, Jorine E; Klooster, Karin; Gortzak, Kiki; ten Hacken, Nick HT; Slebos, Dirk-Jan

    2015-01-01

    Background and objective Bronchoscopic lung volume reduction coil (LVR-coil) treatment has been shown to be safe and clinically effective in patients with severe emphysema in the short term; however, long-term safety and effectiveness has not been evaluated. The aim of this study was to investigate the long-term safety and effectiveness of LVR-coil treatment in patients with severe emphysema. Methods Thirty-eight patients with severe emphysema (median age is 59 years, forced expiratory volume in 1 s is 27% predicted) who were treated in LVR-coil clinical trials were invited for a voluntary annual visit. Safety was evaluated by chest X-ray and recording of adverse events and by efficacy by pulmonary function testing, 6-min walk distance (6MWD) and questionnaires. Results Thirty-five patients visited the hospital 1 year, 27 patients 2 years and 22 patients 3 years following coil placement. No coil migrations were observed on X-rays. At 1-year follow-up, all clinical outcomes significantly improved compared with baseline. At 2 years, residual volume % pred, modified Medical Research Council (mMRC) and the SGRQ score were still significantly improved. At 3 years, a significant improvement in mMRC score remained, with 40% of the patients reaching the 6MWD minimal important difference, and 59% for the St George's Respiratory Questionnaire (SGRQ) minimal important difference. Conclusions Follow-up of the patients treated with LVR-coils in our pilot studies showed that the coil treatment is safe with no late pneumothoraces, coil migrations or unexpected adverse events. Clinical benefit gradually declines over time; at 3 years post-treatment, around 50% of the patients maintained improvement in 6MWD, SGRQ and mMRC. PMID:25418910

  13. Treatment adherence in heart failure patients followed up by nurses in two specialized clinics

    PubMed Central

    da Silva, Andressa Freitas; Cavalcanti, Ana Carla Dantas; Malta, Mauricio; Arruda, Cristina Silva; Gandin, Thamires; da Fé, Adriana; Rabelo-Silva, Eneida Rejane

    2015-01-01

    Objectives: to analyze treatment adherence in heart failure (HF) patients followed up by the nursing staff at specialized clinics and its association with patients' characteristics such as number of previous appointments, family structure, and comorbidities. Methods: a cross-sectional study was conducted at two reference clinics for the treatment of HF patients (center 1 and center 2). Data were obtained using a 10-item questionnaire with scores ranging from 0 to 26 points; adherence was considered adequate if the score was ≥ 18 points, or 70% of adherence. Results: a total of 340 patients were included. Mean adherence score was 16 (±4) points. Additionally, 124 (36.5%) patients showed an adherence rate ≥ 70%. It was demonstrated that patients who lived with their family had higher adherence scores, that three or more previous nursing appointments was significantly associated with higher adherence (p<0.001), and that hypertension was associated with low adherence (p=0.023). Conclusions: treatment adherence was considered satisfactory in less than a half of the patients followed up at the two clinics specialized in HF. Living with the family and attending to a great number of nursing appointments improved adherence, while the presence of hypertension led to worse adherence. PMID:26487139

  14. VLCAD deficiency: Follow-up and outcome of patients diagnosed through newborn screening in Victoria.

    PubMed

    Evans, Maureen; Andresen, Brage S; Nation, Judy; Boneh, Avihu

    2016-08-01

    Very long chain acyl-CoA dehydrogenase (VLCAD) deficiency is an inherited metabolic disorder of fatty acid oxidation. Treatment practices of the disorder have changed over the past 10-15years since this disorder was included in newborn screening programs and patients were diagnosed pre-symptomatically. A genotype-phenotype correlation has been suggested but the discovery of novel mutations make this knowledge limited. Herein, we describe our experience in treating patients (n=22) diagnosed through newborn screening and mutational confirmation and followed up over a median period of 104months. We report five novel mutations. In 2013 we formalised our treatment protocol, which essentially follows a European consensus paper from 2009 and our own experience. The prescribed low natural fat diet is relaxed for patients who are asymptomatic when reaching age 5years but medium-chain triglyceride oil is recommended before and after physical activity regardless of age. Metabolic stability, growth, development and cardiac function are satisfactory in all patients. There were no episodes of encephalopathy or hypoglycaemia but three patients had episodes of muscle pain with our without rhabdomyolysis. Body composition studies showed a negative association between dietary protein intake and percent body fat. Larger patient cohort and longer follow up time are required for further elucidation of genotype-phenotype correlations and for establishing the role of dietary protein in metabolic stability and long-term healthier body composition in patients with VLCAD deficiency.

  15. Profile and follow-up of patients with tuberculosis in a priority city in Brazil

    PubMed Central

    Pereira, Jisleny da Cruz; Silva, Marcio Roberto; da Costa, Ronaldo Rodrigues; Guimarães, Mark Drew Crosland; Leite, Isabel Cristina Gonçalves

    2015-01-01

    OBJECTIVE To analyze the cases of tuberculosis and the impact of direct follow-up on the assessment of treatment outcomes. METHODS This open prospective cohort study evaluated 504 cases of tuberculosis reported in the Sistema de Informação de Agravos de Notificação (SINAN – Notifiable Diseases Information System) in Juiz de Fora, MG, Southeastern Brazil, between 2008 and 2009. The incidence of treatment outcomes was compared between a group of patients diagnosed with tuberculosis and directly followed up by monthly consultations during return visits (287) and a patient group for which the information was indirectly collected (217) through the city’s surveillance system. The Chi-square test was used to compare the percentages, with a significance level of 0.05. The relative risk (RR) was used to evaluate the differences in the incidence rate of each type of treatment outcome between the two groups. RESULTS Of the outcomes directly and indirectly evaluated, 18.5% and 3.2% corresponded to treatment default and 3.8% and 0.5% corresponded to treatment failure, respectively. The incidence of treatment default and failure was higher in the group with direct follow-up (p < 0.05) (RR = 5.72, 95%CI 2.65;12.34, and RR = 8.31, 95%CI 1.08;63.92, respectively). CONCLUSIONS A higher incidence of treatment default and failure was observed in the directly followed up group, and most of these cases were neglected by the disease reporting system. Therefore, effective measures are needed to improve the control of tuberculosis and data quality. PMID:25741659

  16. Diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT: a clinical follow up study

    PubMed Central

    Menéndez-González, Manuel; Tavares, Francisco; Zeidan, Nahla; Salas-Pacheco, José M.; Arias-Carrión, Oscar

    2014-01-01

    The [123I]ioflupane—a dopamine transporter radioligand—SPECT (DaT-SPECT) has proven to be useful in the differential diagnosis of tremor. Here, we investigate the diagnoses behind patients with hard-to-classify tremor and normal DaT-SPECT. Therefore, 30 patients with tremor and normal DaT-SPECT were followed up for 2 years. In 18 cases we were able to make a diagnosis. The residual 12 patients underwent a second DaT-SPECT, were then followed for additional 12 months and thereafter the diagnosis was reconsidered again. The final diagnoses included cases of essential tremor, dystonic tremor, multisystem atrophy, vascular parkinsonism, progressive supranuclear palsy, corticobasal degeneration, fragile X–associated tremor ataxia syndrome, psychogenic parkinsonism, iatrogenic parkinsonism and Parkinson's disease. However, for 6 patients the diagnosis remained uncertain. Larger series are needed to better establish the relative frequency of the different conditions behind these cases. PMID:24744729

  17. Optimal delivery of colorectal cancer follow-up care: improving patient outcomes

    PubMed Central

    Jorgensen, Mikaela L; Young, Jane M; Solomon, Michael J

    2015-01-01

    Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. With population aging and increases in survival, the number of CRC survivors is projected to rise dramatically. The time following initial treatment is often described as a period of transition from intensive hospital-based care back into “regular life.” This review provides an overview of recommended follow-up care for people with CRC who have been treated with curative intent, as well as exploring the current state of the research that underpins these guidelines. For patients, key concerns following treatment include the development of recurrent and new cancers, late and long-term effects of cancer and treatment, and the interplay of these factors with daily function and general health. For physicians, survivorship care plans can be a tool for coordinating the surveillance, intervention, and prevention of these key patient concerns. Though much of the research in cancer survivorship to date has focused on surveillance for recurrent disease, many national guidelines differ in their conclusions about the frequency and timing of follow-up tests. Most CRC guidelines refer only briefly to the management of side effects, despite reports that many patients have a range of ongoing physiological, psychosocial, and functional needs. Guidance for surveillance and intervention is often limited by a small number of heterogeneous trials conducted in this patient group. However, recently released survivorship guidelines emphasize the potential for the effectiveness of secondary prevention strategies, such as physical activity, to improve patient outcomes. There is also emerging evidence for the role of primary care providers and nurse coordinated care to support the transition and increase the cost-effectiveness of follow-up. The shift in focus from recurrence alone to the assessment and management of a range of survivorship issues will be important for ensuring that this growing group of

  18. 2-Year follow-up to STeP trial shows sustainability of structured self-monitoring of blood glucose utilization: results from the STeP practice logistics and usability survey (STeP PLUS).

    PubMed

    Friedman, Kevin; Noyes, Jeannette; Parkin, Christopher G

    2013-04-01

    We report findings from a follow-up survey of clinicians from the STeP study that assessed their attitudes toward and current use of the Accu-Chek(®) 360° View tool (Roche Diagnostics, Indianapolis, IN) approximately 2 years after the study was completed. The Accu-Chek 360° View tool enables patients to record/plot a seven-point self-monitoring of blood glucose (SMBG) profile (fasting, preprandial/2-h postprandial at each of the three meals, and bedtime) on 3 consecutive days, document meal sizes and energy levels, and comment on their SMBG experiences. Our findings showed that the majority of these physicians continue to use the tool with their patients, citing enhanced patient understanding and engagement, better discussions with patients regarding the impact of lifestyle behaviors, improved clinical outcomes, and better practice efficiencies as significant benefits of the tool.

  19. Simple Analysis Used in Diagnosis and Follow-up of Schizophrenic Patients (Patent)

    PubMed Central

    Nour El-Dien, Faten A.; El-Nahas, Reham G.; El-Nahas, Ahmed G.

    2006-01-01

    Dopamine acts as neurotransmitter in the central and peripheral sympathetic nervous system. Determination of dopamine (DO) was performed by spectrophotometric analysis depending on the formation of new colored compound. The proposed procedure was efficient in quantitative determination of DO as pure material in pharmaceutical preparations and in urine samples. DO concentration in urine sample of patient confirms the affection with schizophrenia and the proposed procedure was used to facilitate diagnosis and followup of schizophrenic patients. It is recommended to apply the proposed procedures as routine analysis in pharmaceutical companies for quality control and in analytical laboratories to diagnose and follow up schizophrenia. PMID:17671624

  20. 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

  1. Three-Year Follow-up of Conservative Treatments of Shoulder Osteoarthritis in Older Patients.

    PubMed

    Guo, Jiong Jiong; Wu, Kailun; Guan, Huaqing; Zhang, Lei; Ji, Cheng; Yang, Huilin; Tang, Tiansi

    2016-07-01

    Little is known about the mid-term results of nonsurgical treatment for shoulder osteoarthritis (OA), especially in a Chinese population. This study sought to determine the efficacy of nonsurgical management in older patients with shoulder OA. A total of 129 conservatively treated unilateral shoulder OA patients who were older than 65 years were evaluated prospectively at the initial office visit and then subsequently at 3, 6, 12, 18, 24, and 36 months later. During the 36-month follow-up period, all patients could receive conventional therapy, such as nonsteroidal anti-inflammatory medication, corticosteroid injection, sodium hyaluronate, and education, at the discretion of treating physicians. Some patients received physiotherapy, rehabilitation training, and a shoulder strap to improve the range of motion and muscular strength training from a physical therapist. Parameters measured included comparative effectiveness of each therapeutic method, visual analog scale (VAS), Simple Shoulder Test (SST), and Short Form (36) Health Survey (SF-36) scores. At 3-year follow-up, most patients had a significant increase from their pretreatment values in pain, self-assessed shoulder function, mental health, and 5 of 8 SF-36 domains. The study showed a decline in SST and VAS at 6 and 12 months after an initial ascent at 3 months, and then it was rescued and continued at 3-year follow-up. Combined therapy could improve symptoms significantly. This study suggests that a conservative approach may be more appropriate and can produce satisfactory mid-term outcomes in selected cases. The findings of this study suggest that conservative treatments should be extended for longer than 12 months before the decision regarding shoulder arthroplasty is made. [Orthopedics. 2016; 39(4):e634-e641.].

  2. Long term follow-up of patients with prolactinomas and outcome of dopamine agonist withdrawal: a single center experience.

    PubMed

    Anagnostis, Panagiotis; Adamidou, Fotini; Polyzos, Stergios A; Efstathiadou, Zoe; Karathanassi, Eleni; Kita, Marina

    2012-03-01

    Dopamine agonists (DA) are the mainstay of treatment for patients with prolactinomas. To describe the efficacy of treatment and the outcomes of DA withdrawal. Retrospective review of electronic medical records of patients with prolactinomas from 1985 to 2009. Seventy-nine patients (17 men/62 women), aged 35.3 ± 1.6 years at diagnosis were studied. The mean follow-up time was 84.7 ± 9.2 months (range 0-336). The mean initial size of microadenomas was 0.74 ± 0.10 cm (range 2.41 ± 0.39) and of macrodenomas 2.41 ± 0.39 cm (range 1.1-8) and serum prolactin (PRL) levels were 112 ± 19 and 263 ± 59 ng/ml, respectively (normal range 0-40). Fifty-one (65%) prolactinomas were micro- and 28 (35%) were macroadenomas. DA led to a decrease in adenoma size in 71% of them, while 53% of microadenomas were not visible during follow-up. In 26 patients, DA withdrawal was decided. After therapy of >24 months and a mean follow-up time of 49 ± 11 months (range 3-168), 15 subjects (58%) showed no recurrence of hyperprolactinemia. Higher remission rates, although not statistically significant, were observed with cabergoline (75%). The mean PRL levels before DA discontinuation were 12.2 ± 2.3 ng/ml (range 0.5-44.7) and after discontinuation they were significantly lower than pre-treatment values. Recurrence of hypeprolactinemia was evident during the first year in all but one patient. Remission rates were not associated with age or size of adenoma at diagnosis, initial or before DA discontinuation PRL levels and duration of treatment. DA withdrawal was followed by remission of hyperprolactinamia in about half of patients after >2 years of treatment.

  3. Subjective assessment of visual verticality in follow-up of patients with acute vestibular disease.

    PubMed

    Gómez García, Angélica; Jáuregui-Renaud, Kathrine

    2003-06-01

    We conducted a study of 10 patients with acute unilateral peripheral vestibular failure in order to assess their ability to perceive visual verticality during the acute stage of their disease and during recovery. We also evaluated 31 healthy volunteers to test the reproducibility of our assessment methods. The 10 patients were first evaluated within 4 days of the onset of their vestibular failure, and follow-up tests were conducted 2 and 4 weeks later. The healthy subjects were similarly tested at 2 and 4 weeks following their baseline evaluation. All patients and subjects were tested 10 times during each evaluation session, and results from each as well as from the groups as a whole were calculated as a mean of all responses. The mean visual vertical tilt (the amount of deviation from true verticality) among the 10 patients declined from 8.4 degrees (+/- 2.4 degrees) at the first examination to 3.2 degrees (+/- 1.6 degrees) at week 2 and to 1.4 degrees (+/- 0.7 degree) at week 4. These decreases coincided with the pace of the resolution of their vestibular symptoms. The rates of reproducibility among the 31 healthy volunteers at 2 and 4 weeks following their initial assessment were 95 and 97%, respectively. We concluded that repeated measurements of the static visual vertical can be useful as a follow-up tool for patients with vestibular neuritis.

  4. [Model of a prospective follow-up study of patients managed in intensive care].

    PubMed

    Ritz, R

    1988-04-30

    For ethical and economic reasons, follow-up--especially after intensive care--is important as a form of quality control which could serve as a basis for more differentiated indications for patient admission. A follow-up model, involving questionnaires 3 months, 1 year and 3 years after intensive care, and preliminary results of patients in 1985 are presented. Only a few patients described their present health situation as bad, but unstable situations showed little improvement between 3 months and 1 year after intensive care. There was a rather high percentage of rehospitalization and/or need for continued medical care. Only 10% of respondent patients were unable to work 1 year after intensive care, and 12% still depended on help from others. 15-35% described their quality of life as restricted; only 4% had negative memories of intensive care (fear, pain), and only 0.6% of respondent patients thought their previous admission to the intensive care unit had been a wrong decision.

  5. Quality of life in patients with progressive supranuclear palsy: one-year follow-up.

    PubMed

    Pekmezović, Tatjana; Ječmenica-Lukić, Milica; Petrović, Igor; Špica, Vladana; Tomić, Aleksandra; Kostić, Vladimir S

    2015-09-01

    The aim of this prospective cohort study that included 46 patients with progressive supranuclear palsy (PSP) was to estimate which demographic and clinical factors were the main contributors to the health-related quality of life (HRQoL) and how did the HRQoL change over a follow-up period of 1 year in these patients. The hierarchical regression analyses showed that the final models demonstrated that gender, included clinical variables and psychiatric/neuropsychological scales, accounted for 68% of the variance in the Physical Composite Score and 73% of the variance of the Mental Composite Score of the 36-item Short Form Health Survey (SF-36). Among variables in both final models, only the score of the Apathy Evaluation Scale showed statistically significant negative predictive value (p < 0.05). Changes in the HRQoL scores were assessed in 28 PSP patients who completed 1-year follow-up period after the baseline examination. Statistically significant decline in the HRQoL was detected for the following scales of the SF-36: physical functioning, vitality, social functioning, and role emotional, as well as in both composite scores (Physical Composite Score and Mental Composite Score). The analyses of magnitude of changes in the HRQoL during 1-year follow-up period showed large effect size (≥0.80) for total scores, as well as for the physical functioning, vitality, and social functioning. In conclusion, despite certain limitations, our study provided some new insights into potential predictors of the HRQoL and its longitudinal changes in patients with PSP.

  6. Vertebral Augmentation with Nitinol Endoprosthesis: Clinical Experience in 40 Patients with 1-Year Follow-up

    SciTech Connect

    Anselmetti, Giovanni Carlo; Manca, Antonio; Marcia, Stefano; Chiara, Gabriele; Marini, Stefano; Baroud, Gamal; Regge, Daniele; Montemurro, Filippo

    2013-05-08

    PurposeThis study was designed to assess the clinical outcomes of patients treated by vertebral augmentation with nitinol endoprosthesis (VNE) to treat painful vertebral compression fractures.MethodsForty patients with one or more painful osteoporotic VCF, confirmed by MRI and accompanied by back-pain unresponsive to a minimum 2 months of conservative medical treatment, underwent VNE at 42 levels. Preoperative and postoperative pain measured with Visual Analog Scale (VAS), disability measured by Oswestry Disability Index (ODI), and vertebral height restoration (measured with 2-dimensional reconstruction CT) were compared at last follow-up (average follow-up 15 months). Cement extravasation, subsequent fractures, and implant migration were recorded.ResultsLong-term follow-up was obtained in 38 of 40 patients. Both VAS and ODI significantly improved from a median of 8.0 (range 5–10) and 66 % (range 44–88 %) to 0.5 (range 0–8) and 6 % (range 6–66 %), respectively, at 1 year (p < 0.0001). Vertebral height measurements comparing time points increased in a statistically significant manner (ANOVA, p < 0.001). Overall cement extravasation rate was 9.5 %. Discal and venous leakage rates were 7.1 and 0 % respectively. No symptomatic extravasations occurred. Five of 38 (13.1 %) patients experienced new spontaneous, osteoporotic fractures. No device change or migration was observed.ConclusionsVNE is a safe and effective procedure that is able to provide long-lasting pain relief and durable vertebral height gain with a low rate of new fractures and cement leakages.

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

    PubMed

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

    2012-10-01

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

  8. Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients

    PubMed Central

    Messenger, DE; Aroori, S; Vipond, MN

    2010-01-01

    INTRODUCTION Favourable short-term results, with respect to less postoperative pain and earlier return to physical activity, have been demonstrated with laparoscopic totally extraperitoneal (TEP) hernia repair compared with open mesh repair. However, there is limited data regarding long-term results. PATIENTS AND METHODS The study cohort consisted of 275 consecutive patients undergoing TEP repair between 1996 and 2002. Patient demographics, details of surgery, postoperative complications, recurrence and chronic pain were collected from patient records and from a prospective database. All patients were seen at 6 weeks and then annually for 5 years following surgery. RESULTS A total of 430 repairs were performed in the 275 patients (median age, 56 years; range, 20–94 years; men, 97.5%). Bilateral repair was performed in 168 patients (61.1%) and recurrent hernia repair in 79 patients (28.7%). Two patients were converted to an open procedure. Five-year follow-up was achieved in 72% of patients. Eleven patients (4%) died during the follow-up period due to unrelated causes. Hernia recurrence rate at 5 years was 1.1% per patient (three repairs). Recurrences were noted at 7 months, 2 years and 4 years following surgery. Chronic groin pain was reported by 21 patients (7.6%), seven of whom required referral to the pain team. CONCLUSIONS TEP hernia repair is associated with a recurrence rate of 1% at 5 years in this series. Chronic groin symptoms are also acceptably few. This recurrence rate following TEP repair compares extremely favourably with open mesh repair, particularly as it includes a high proportion of recurrent repairs. As well as the proven early benefits, TEP repair can be considered a safe and durable procedure with excellent long-term results. PMID:20412671

  9. Outpatient Follow-Up versus 30-day Readmission among General and Vascular Surgery Patients: A Case for Redesigning Transitional Care

    PubMed Central

    Saunders, Richard Scott; Fernandes-Taylor, Sara; Rathouz, Paul J.; Saha, Sandeep; Wiseman, Jason T.; Havlena, Jeffrey; Matsumura, Jon; Kent, K. Craig

    2014-01-01

    Background The association between early outpatient follow-up and 30-day readmission has not been evaluated in any surgical population. Our study characterizes the relationship between outpatient follow-up and early readmissions among surgical patients. Methods We queried the medical record at a large, tertiary care institution (July 2008-December 2012) to determine rates of 30-day outpatient follow-up and readmission for general or vascular surgical procedures. Results The majority of discharges for general (84% of 7552) and vascular (75% of 2362) surgery had a follow-up visit before readmission or within 30 days of discharge. General surgery patients who were not readmitted had high rates of follow-up (88%) and received follow-up at approximately 2-weeks post-discharge (median time 11 days after discharge). In contrast, readmitted general surgery patients received first follow-up at one week (a median time of 8 days); 49% had follow-up. Vascular surgery patients showed a similar trend. Over half of patients readmitted after follow-up were readmitted within 24 hours of their most recent outpatient visit. Conclusions Current routine follow-up does not occur early enough to detect adverse events and prevent readmission. Early outpatient care may prevent readmission in some patients, but often serves as a conduit for readmission among patients already experiencing complications. PMID:25239351

  10. Assessing Implicit Cognition Among Patients Lost to Follow-up for HIV Care: A Preliminary Study

    PubMed Central

    Houston, Eric; Lyons, Thomas; Wolfe, Brenda; Rolfsen, Norma; Williams, Maryanne; Rucker, Monique; Glick, Nancy

    2016-01-01

    Objective: While a growing body of research indicates that implicit cognitive processes play an important role in a range of health behaviors, the assessment of these impulsive, associative mental processes among patients living with HIV has received little attention. This preliminary study explored how multidimensional scaling (MDS) could be used to assess implicit cognitive processes among patients lost to follow-up for HIV care and develop interventions to improve their engagement. Method: The sample consisted of 33 patients who were identified as lost to follow up for HIV care at two urban hospitals. Participants were randomly assigned to either the MDS assessment program or control group. All participants underwent measures designed to gauge behavioral change intentions and treatment motivation. Assessment group participants were interviewed to determine their reactions to the assessment program. Results: The MDS assessment program identified cognitive processes and their relationship to treatment-related behaviors among assessment group participants. Assessment group participants reported significantly greater behavior change intentions than those in the control group (p =.02; Cohen’s d = 0.84). Conclusion: MDS shows promise as a tool to identify implicit cognitive processes related to treatment-related behaviors. Assessments based on MDS could serve as the basis for patient-centered clinical interventions designed to improve treatment adherence and HIV care engagement in general. PMID:27347274

  11. Driving safety after brain damage: follow-up of twenty-two patients with matched controls.

    PubMed

    Katz, R T; Golden, R S; Butter, J; Tepper, D; Rothke, S; Holmes, J; Sahgal, V

    1990-02-01

    Driving after brain damage is a vital issue, considering the large number of patients who suffer from cerebrovascular and traumatic encephalopathy. The ability to operate a motor vehicle is an integral part of independence for most adults and so should be preserved whenever possible. The physician may estimate a patient's ability to drive safely based on his own examination, the evaluation of a neuropsychologist, and a comprehensive driving evaluation--testing, driving simulation, behind-the-wheel observation--with a driving specialist. This study sought to evaluate the ability of brain-damaged individuals to operate a motor vehicle safely at follow-up. These patients had been evaluated (by a physician, a neuropsychologist, and a driving specialist) and were judged able to operate a motor vehicle safely after their cognitive insult. Twenty-two brain-damaged patients who were evaluated at our institution were successfully followed up to five years (mean interval of 2.67 years). Patients were interviewed by telephone. Their driving safely was compared with a control group consisting of a close friend or spouse of each patient. Statistical analysis revealed no difference between patient and control groups in the type of driving, the incidence of speeding tickets, near accidents, and accidents, and the cost of vehicle damage when accidents occurred. The patient group was further divided into those who had, and those who had not experienced driving difficulties so that initial neuropsychologic testing could be compared. No significant differences were noted in any aspect of the neuropsychologic test battery. We conclude that selected brain-damaged patients who have passed a comprehensive driving assessment as outlined were as fit to drive as were their normal matched controls.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Follow-up status of patients with angiographically normal coronary arteries and panic disorder

    SciTech Connect

    Beitman, B.D.; Kushner, M.G.; Basha, I.; Lamberti, J.; Mukerji, V.; Bartels, K. )

    1991-03-27

    Cardiology patients with normal coronary angiography demonstrate continuing and substantial social, health, and work disability. The authors hypothesized that the diagnosis of panic disorder would mark those for whom continuing disability is most likely. They interviewed 72 such patients at the time of their normal angiogram, and then again an average of 38 months later. Those with panic disorder (n=36) demonstrated significantly more disability at follow-up than did the other study patients. They conclude that those patients with normal angiograms who have panic disorder are more disabled than those who do not have panic disorder. Panic disorder in psychiatric samples has been shown to be highly treatable. Therefore, early identification and treatment of panic disorder in this group is likely to minimize the suffering associated with this condition.

  13. Follow up study of 70 patients with renal artery stenosis treated by percutaneous transluminal dilatation.

    PubMed Central

    Geyskes, G G; Puylaert, C B; Oei, H Y; Mees, E J

    1983-01-01

    Between April 1978 and April 1981, 70 patients with hypertension and renal artery stenosis were treated by percutaneous transluminal arterial dilatation. Selection of the patients was based solely on arteriographic criteria. Arteriography after dilatation showed considerable widening of the stenosed area in all patients. In 65 patients the effect of treatment on the blood pressure was assessed during follow up periods of one to four years. In 14 of these patients the hypertension was cured, in 29 it was improved, and in 22 there was no change. Patients with fibromuscular lesions benefited distinctly more than did those with atheromatous stenosis, only one of the 21 patients with fibromuscular lesions showing no change as compared with 21 of the 44 patients with atheromatous lesions. The only serious complication encountered was microcholesterol emboli, which developed in two patients with severe atheromatous lesions of the aorta. In the atheromatous group age and overall renal function had no influence on the blood pressure response. In the subgroup of patients with a unilateral lesion the renal vein renin ratios and asymmetrical curves obtained by renography had only a very limited predictive value. In experienced hands percutaneous transluminal arterial dilatation is relatively safe, and this study suggests that it should be attempted in all patients with renal artery stenosis. Only in patients with severe atheromatosis of the aorta should the risk associated with the catheterisation be weighed against the 50% or so chance of benefit from the procedure. PMID:6223685

  14. 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

  15. [Dynamic renal echography versus urography in the follow-up of patients who have undergone ureterosigmoidostomy].

    PubMed

    Montanari, E; Tzoumas, S; Deiana, G; Cogni, M; Guarneri, A; Zanetti, G; Austoni, E

    1994-09-01

    The main post uretero-sigmoidostomy complications are stricture of the anastomosis, chronic infection and urolithiasis. In our institution the patients with ureterosigmodostomy undergo a follow-up protocol in which blood chemistry, ultrasonography, intravenous pyelography and C.T. are periodically performed. The aim of the present paper is to compare the accuracy of kidney sonography after diuretic stimulation with intravenous pyelography in the diagnosis of ureteral stenosis. Out of 91 patient with ureterosigmoidostomy 18 patients (34 kidneys) underwent intravenous pyelography, a basal U.S. and then a dynamic one at 5, 10, 15, 30, 45, 60, 90, 120 minutes after administration of furosemide 20 mg i.v. At basal U.S. 27 kidneys were normal and 7 showed a dilations. After diuretic stimulation we observed 16 normal kidneys, 16 dilated units and 2 intermittent hydronephrosis. Out of 16 dilated kidneys 6 became normal in 60 minutes. Out of 10 dilated units 3 were normal in 90 minutes (hipotonic), 2 were normal before 120 minutes (low grade obstruction) and 5 were dilated after 120 minutes (high grade obstruction). With intravenous pyelography we observed 27 normal kidneys and seven dilated units. Dynamic sonography have shown high sensibility (100%), specificity (88.8%) and accuracy (91%) in diagnosis of ureteral obstruction in to I.V.P. in the follow-up of this kind of divesion.

  16. Survival Rates and Risk Factors for Cephalad and L5-S1 Adjacent Segment Degeneration after L5 Floating Lumbar Fusion : A Minimum 2-Year Follow-Up

    PubMed Central

    Lee, Young-Seok; Park, Seung-Won

    2015-01-01

    Objective Although the L5-S1 has distinct structural features in comparison with other lumbar spine segments, not much is known about adjacent segment degeneration (ASD) at the L5-S1 segment. The aim of study was to compare the incidence and character of ASD of the cephalad and L5-S1 segments after L5 floating lumbar fusion. Methods From 2005 to 2010, 115 patients who underwent L5 floating lumber fusion were investigated. The mean follow-up period was 46.1 months. The incidence of radiological and clinical ASD of the cephalad and the L5-S1 segments was compared using survival analysis. Risk factors affecting ASD were analyzed using a log rank test and the Cox proportional hazard model. Results Radiological ASD of the L5-S1 segment had a statistically significant higher survival rate than that of the cephalad segment (p=0.001). However, clinical ASD of the L5-S1 segment was significantly lower survival rates than that of the cephalad segment (p=0.038). Risk factor analysis showed that disc degeneration of the cephalad segment and preoperative spinal stenosis of the L5-S1 segment were risk factors. Conclusion In L5 floating fusion, radiological ASD was more common in the cephalad segment and clinical ASD was more common in the L5-S1 segment. At the L5-S1 segment, the degree of spinal stenosis appears to be the most influential risk factor in ASD incidences, unlike the cephalad segment. PMID:25733991

  17. Positron emission tomography in the follow-up of cutaneous malignant melanoma patients: a systematic review

    PubMed Central

    Danielsen, Maria; Højgaard, Liselotte; Kjær, Andreas; Fischer, Barbara MB

    2014-01-01

    Cutaneous malignant melanoma (CMM) has a high risk of dissemination to regional lymph nodes and visceral organs. Recurrences are most frequently seen within the first 2-3 years after initial treatment, but these patients have a life-long risk of relapse. The prognosis is highly dependent on lymph node involvement and distant metastases, accentuating the importance of close surveillance to identify disease progression at an early stage, and thereby detect recurrences amenable to treatment. Positron emission tomography (PET) has already been proven useful in the staging of CMM, but the utility of PET in follow-up programs for asymptomatic patients in high risk of relapse to detect systemic recurrences has yet to be investigated. We performed a systematic literature search in PUBMED, EMBASE and the Cochrane Controlled Trials Register, and identified 7 original studies on the diagnostic value of FDG-PET in the follow-up of CMM. Sensitivity, specificity, positive and negative predictive values were calculated to examine PET’s diagnostic value in detecting relapse. The mean sensitivity of PET was 96% and the specificity was 92%. The positive and negative predictive values were, respectively, 92% and 95%. Overall, PET has a high diagnostic value and the many advantages of PET indicate utility in the routine follow-up program of CMM. However, the number of prospective studies of high quality is scarce, and as the use of PET and PET/CT is becoming more widespread and the technology is expensive, there is an urgent need for systematic assessment of the diagnostic value. PMID:24380042

  18. Is social inequality related to different patient concerns in routine oral cancer follow-up clinics?

    PubMed

    Allen, Sarah; Lowe, Derek; Harris, Rebecca V; Brown, Steve; Rogers, Simon N

    2017-01-01

    Oral cancer has a higher incidence in the lower social strata, and these patients are less likely to engage in supportive interventions and report a poorer quality of life (QoL). The aim of this paper is to compare the Patient Concerns Inventory (PCI) responses across social groups attending routine oral cancer follow-up clinics with particular focus on the deprivation lower quartile. The PCI package is completed by patients as part of their routine review consultation with SNR. Patients were those diagnosed between 2008 and 2012. Deprivation was stratified using the IMD 2010 from postcode. Of the 106 eligible patients, 85 % used the PCI. Just over half (54 %) were living in the most deprived quartile, with two-thirds (68 %) of males in the most deprived quartile, compared with 35 % of females (p = 0.004). In regard to number and type of PCI items selected by patients at their first PCI clinic, there were no notable differences in respect of IMD classification. The two commonest concerns were fear of recurrence (43 %) and sore mouth (43 %). The most deprived quartile reported significant problems in regard to mood (p = 0.004) and recreation (p = 0.02), and a non-significant trend (36 vs 18 %, p = 0.09) in stating their overall QoL as being less than good. It is possible to identify the concerns of patients from lower socioeconomic strata as part of routine follow-up clinics. This allows for targeted multi-professional intervention and supports to improve the outcome in this hard to reach group.

  19. Mitochondrial Myopathy in Follow-up of a Patient With Chronic Fatigue Syndrome

    PubMed Central

    Galán, Fernando; de Lavera, Isabel; Cotán, David; Sánchez-Alcázar, José A.

    2015-01-01

    Introduction. Symptoms of mitochondrial diseases and chronic fatigue syndrome (CFS) frequently overlap and can easily be mistaken. Methods. We report the case of a patient diagnosed with CFS and during follow-up was finally diagnosed with mitochondrial myopathy by histochemical study of muscle biopsy, spectrophotometric analysis of the complexes of the mitochondrial respiratory chain, and genetic studies. Results. The results revealed 3% fiber-ragged blue and a severe deficiency of complexes I and IV and several mtDNA variants. Mother, sisters, and nephews showed similar symptoms, which strongly suggests a possible maternal inheritance. The patient and his family responded to treatment with high doses of riboflavin and thiamine with a remarkable and sustained fatigue and muscle symptoms improvement. Conclusions. This case illustrates that initial symptoms of mitochondrial disease in adults can easily be mistaken with CFS, and in these patients a regular reassessment and monitoring of symptoms is recommended to reconfirm or change the diagnosis. PMID:26904705

  20. HPV-Testing in Follow-up of Patients Treated for CIN2+ Lesions.

    PubMed

    Mariani, Luciano; Sandri, Maria Teresa; Preti, Mario; Origoni, Massimo; Costa, Silvano; Cristoforoni, Paolo; Bottari, Fabio; Sideri, Mario

    2016-01-01

    Persistent positivity of HPV-DNA testing is considered a prognostic index of recurrent disease in patients treated for CIN2+. HPV detection, and particularly genotyping, has an adequate high rate of sensitivity and specificity (along with an optimal reproducibility), for accurately predicting treatment failure, allowing for an intensified monitoring activity. Conversely, women with a negative HPV-test 6 months after therapy have a very low risk for residual/recurrent disease, which leads to a more individualized follow-up schedule, allowing for a gradual return to the normal screening scheme. HPV testing should be routinely included (with or without cytology) in post-treatment follow-up of CIN2+ patients for early detection of recurrence and cancer progression. HPV genotyping methods, as a biological indicator of persistent disease, could be more suitable for a predictive role and risk stratification (particularly in the case of HPV 16/18 persistence) than pooled HPV-based testing. However, it is necessary to be aware of the performance of the system, adhering to strict standardization of the process and quality assurance criteria.

  1. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients.

    PubMed

    Jeong, Woo Kyoung; Baek, Jung Hwan; Rhim, Hyunchul; Kim, Yoon Suk; Kwak, Min Sook; Jeong, Hyun Jo; Lee, Ducky

    2008-06-01

    This study evaluated the safety and volume reduction of ultrasonography (US)-guided radiofrequency ablation (RFA) for benign thyroid nodules, and the factors affecting the results obtained. A total of 302 benign thyroid nodules in 236 euthyroid patients underwent RFA between June 2002 and January 2005. RFA was carried out using an internally cooled electrode under local anesthesia. The volume-reduction ratio (VRR) was assessed by US and safety was determined by observing the complications during the follow-up period (1-41 months). The correlation between the VRR and several factors (patient age, volume and composition of the index nodule) was evaluated. The volume of index nodules was 0.11-95.61 ml (mean, 6.13 +/- 9.59 ml). After ablation, the volume of index nodules decreased to 0.00-26.07 ml (mean, 1.12 +/- 2.92 ml) and the VRR was 12.52-100% (mean, 84.11 +/- 14.93%) at the last follow-up. A VRR greater than 50% was observed in 91.06% of nodules, and 27.81% of index nodules disappeared. The complications encountered were pain, hematoma and transient voice changes. In conclusion, RFA is a safe modality effective at reducing volume in benign thyroid nodules.

  2. Neurocysticercosis: HP10 Antigen Detection Is Useful for the Follow-up of the Severe Patients

    PubMed Central

    Fleury, Agnès; Garcia, Esperanza; Hernández, Marisela; Carrillo, Roger; Govezensky, Tzipe; Fragoso, Gladis; Sciutto, Edda; Harrison, Leslie J. S.; Parkhouse, R. Michael Evans

    2013-01-01

    Background The most severe clinical form of neurocysticercosis (NC) occurs when cysticerci are located in the subarachnoid space at the base of the brain (SaB). The diagnosis, monitoring and treatment of NC-SaB, constitutes a severe clinical challenge. Herein we evaluate the potential of the HP10 antigen detection enzyme-linked immunosorbent assay (HP10 Ag-ELISA) in the long term follow-up of NC-SaB cases. Assay performance was compared with that of Magnetic Resonance Imaging (MRI). In addition, the robustness of the HP10 Ag-ELISA was evaluated independently at two different institutions. Methodology/Principal Findings A double-blind prospective cohort trial was conducted involving 38 NC-SaB cases and a total of 108 paired serum and cerebrospinal fluid (CSF) samples taken at intervals of 4 to 8 months for up to 43 months. At each medical visit, results of sera and CSF HP10 Ag-ELISA and MRI obtained at last visit were compared and their accuracy was evaluated retrospectively, considering radiological evolution between appointments. In the long-term follow-up study, HP10 Ag-ELISA had a better agreement than MRI with retrospective radiological evaluation. High reproducibility of HP10 Ag-ELISA between laboratories was also demonstrated. Conclusions Results reported in this study establish for the first time the usefulness of the comparatively low cost HP10 Ag-ELISA for long term follow-up of NC-SaB patients. PMID:23505587

  3. Serum ostase in the follow-up of breast cancer patients.

    PubMed

    Marchei, P; Santini, D; Bianco, V; Chiodini, S; Reale, M G; Simeoni, F; Marchei, G G; Vecchione, A

    1995-01-01

    The present study was carried out on 152 patients divided into three groups: A) 73 underwent radical surgery for breast carcinoma without signs of metastases; B) 31 patients with radiologic and scintigraphic evidence of bone metastases originating from malignant mammary neoplasia (14 with only one and 17 with two or more localizations); C) 48 affected by simple mammary cysts. No patients had a previous history of primary or secondary bone pathologies or renal, hepatic or endocrine ones. Besides this, no patient took drugs influencing the metabolic turnover of the bony tissue in the three months preceding the study. After surgery all patients underwent standard clinical and laboratory follow-up, the latter including, every 3 months, the evaluation of serum CA 15.3, CA 27.29 MCA, and ostase. The ostase cut-off, obtained by the statistical elaboration of the serum values of the 48 patients with benign mammary cysts and the 73 disease free patients, was 17 microg./L. The mean concentration in the three groups and two subgroups was: 13.76 microg./L (patients without metastases), 31.84 (patients with metastases), 18.4 (limited bony metastases), 40.04 (diffused bony metastases) and 5.36 (mammary cists). The diagnostic sensitivity of ostase proved superior to that of CA 15.3 (84% vs 75%) except when considering the subgroup with limited metastases (71.4% vs 72.7%), while the specificity was similar (around 78%). CA 27.29 and MCA were not useful as markers of metastasis. In a longitudinal-perspective study it was possible periodically to test these markers in 13 patients, at first, disease free and then with signs of bone progression evidence by skeletal scintigraphy. In 11 of these patients ostase and CA 15.3 showed increased values, an average 136 and 131 days respectively, before instrumental evidence of progression. None of the 13 patients, at the time of bone progression diagnosis, showed clinical, laboratory or instrumental signs of disease in other organs. The

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

    PubMed

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

    2016-03-02

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

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

    PubMed Central

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

    2016-01-01

    This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p = <0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58–97.69) to 20.56 (0.86–40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05–1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF. PMID:26990263

  6. 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.

  7. Course and moderators of emotional eating in anorectic and bulimic patients: a follow-up study.

    PubMed

    Fioravanti, Giulia; Castellini, Giovanni; Lo Sauro, Carolina; Ianni, Sirio; Montanelli, Luca; Rotella, Francesco; Faravelli, Carlo; Ricca, Valdo

    2014-04-01

    Emotion dysregulation has been found to be associated with specific eating attitudes and behavior in Eating Disorder (ED) patients. The present study evaluated whether emotional eating profile of ED patients changes over time and the possible effects of a psychotherapeutic intervention on the emotional eating dimension. One hundred and two ED patients (28 with Anorexia Nervosa restricting type [AN-R], 35 with Anorexia Nervosa binge/purging subtype [AN-B/P] and 39 with Bulimia Nervosa [BN]) were evaluated at baseline, at the end of a Cognitive Behavioral Therapy, at 3 and 6 year follow-up. The Structured Clinical Interview for DSM IV Axis I Disorders, the Emotional Eating Scale (EES) and several self-reported questionnaires for eating specific and general psychopathology were applied. A control group of 86 healthy subjects was also studied, in order to compare psychopathological variables at baseline. A significant EES total score reduction was observed among AN-B/P and BN patients, whereas no significant change was found in the AN-R group. Mixed Models analyses showed that a significant effect on EES total score variation was found for cocaine or amphetamine abuse (b = .25; p < .01). Patients who assumed these substances reported no significant EES reduction across time, unlike other patients. The present results suggest that ED patients with a history of cocaine or amphetamine abuse represent a sub-population of patients with lasting dysfunctional mood modulatory mechanisms.

  8. Genetic Analysis and Follow-Up of 25 Neonatal Diabetes Mellitus Patients in China

    PubMed Central

    Cao, Bingyan; Gong, Chunxiu; Wu, Di; Lu, Chaoxia; Liu, Fang; Liu, Xiaojing; Zhang, Yingxian; Gu, Yi; Qi, Zhan; Li, Xiaoqiao; Liu, Min; Li, Wenjing; Su, Chang; Liang, Xuejun; Feng, Mei

    2016-01-01

    Aims. To study the clinical features, genetic etiology, and the correlation between phenotype and genotype of neonatal diabetes mellitus (NDM) in Chinese patients. Methods. We reviewed the medical records of 25 NDM patients along with their follow-up details. Molecular genetic analysis was performed. We compared the HbA1c levels between PNDM group and infantile-onset T1DM patients. Results. Of 25 NDM patients, 18 (72.0%) were PNDM and 7 (28.0%) were TNDM. Among 18 PNDM cases, 6 (33.3%) had known KATP channel mutations (KATP-PNDM). There were six non-KATP mutations, five novel mutations, including INS, EIF2AK3 (n = 2), GLIS3, and SLC19A2, one known EIF2AK3 mutation. There are two ABCC8 mutations in TNDM cases and one paternal UPD6q24. Five of the six KATP-PNDM patients were tried for glyburide transition, and 3 were successfully switched to glyburide. Mean HbA1c of PNDM was not significantly different from infantile onset T1DM (7.2% versus 7.4%, P = 0.41). Conclusion. PNDM accounted for 72% of NDM patients. About one-third of PNDM and TNDM patients had KATP mutations. The genetic etiology could be determined in 50% of PNDM and 43% of TNDM cases. PNDM patients achieved good glycemic control with insulin or glyburide therapy. The etiology of NDM suggests polygenic inheritance. PMID:26839896

  9. Testicular cancer patients: considerations in long-term follow-up.

    PubMed

    Gospodarowicz, Mary

    2008-04-01

    Over the past 30 years, testicular tumors have become the paradigm for a curable adult cancer. Numerous factors have contributed to this success, including the introduction of newer treatment approaches, such as cisplatin-based combination chemotherapy and curative retroperitoneal lymph node dissection. Moreover, the last three decades have witnessed the evolution of newer diagnostic methods, improvements in staging, the evaluation of patient response, and the monitoring of relapse. These treatment successes have been accompanied by the emergence of the late effects of testicular cancer and its treatment, including second primary cancers, cardiovascular sequelae, the metabolic syndrome, gonadal toxicity, neurotoxicity, and pulmonary sequelae. An overview of these late effects and recommendations for patient follow-up are presented in this article.

  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. Transduodenal sphincteroplasty. 5-25 year follow-up of 89 patients.

    PubMed Central

    Nardi, G L; Michelassi, F; Zannini, P

    1983-01-01

    Between 1957 and 1977, 95 patients underwent transduodenal pancreatic sphincteroplasty (TPS) for a diagnosis of recurrent pancreatitis. Five to twenty-five year follow-up was obtained for 89 patients (94%) and was analyzed by life-table method. Short-term successful outcome was defined as relief of symptoms (e.g., pain) for one to three years; long-term successful outcome was defined as those patients who remained symptom-free at time of last follow-up. Operative mortality was 4.2% (4 patients). Fifty-six patients (66%) had a successful short-term outcome. Of these, 13 patients had recurrence of symptoms: 7 occurred at 4 years, 5 at 5 years and 1 at 6 years. Preoperative factors associated with poor short-term outcome were previous upper abdominal surgery (X2 = 5.67, p less than 0.05) and frequent diarrhea (X2 = 6.18, p less than 0.05). Preoperative factors associated with poor long-term outcome were previous upper abdominal surgery (X2 = 7.82, p less than 0.01), heavy alcohol intake (X2 = 4.71, p less than 0.05), narcotic use (X2 = 5.68, p less than 0.05) and frequent diarrhea (X2 = 4.8, p less than 0.05). Morphine Prostigmin Test (MPT) was performed preoperatively in 78 patients (82%). A significantly greater proportion of patients with a rise in serum pancreatic enzymes secondary to MPT (MPT+) had a successful long-term outcome compared with those without such a rise (MPT-) (61% v 41%, X2 = 5.13, p less than 0.05). Furthermore, of the patients with a successful short-term outcome, 88% with MPT+ remained long-term symptom-free compared to 38.5% with MPT- (X2 = 8.36, p less than 0.01). We conclude that TPS can be a successful operation for acute recurrent pancreatitis. Previous upper abdominal operations, signs of more advanced pancreatic disease, preoperative narcotic use and alcohol abuse, were associated with a worse outcome and probably associated with chronic recurrent pancreatitis. Preoperative use of MPT, coupled with accurate clinical history, defined

  12. Long-term follow-up of vitrectomy in patients with pathologic myopic foveoschisis

    PubMed Central

    Zhang, Ting; Zhu, Ying; Jiang, Chun-Hui; Xu, Ge-Zhi

    2017-01-01

    AIM To report the long-term surgical outcomes of pathologic myopic foveoschisis (MF) following vitrectomy. METHODS We performed a retrospective case series analysis of 50 consecutive patients diagnosed with MF who experienced vision loss due to progression of foveoschisis. The 50 patients (67 eyes) were treated in our hospital with vitrectomy with internal limiting membrane (ILM) peeling from December 2004 to September 2010. Best corrected visual acuity (BCVA), refractive error, optical coherence tomography (OCT), and routine examination results were analysed. The changes of BCVA, foveal anatomical features on OCT scan, and complications were the main outcome measures. RESULTS The mean follow-up duration was 42±17mo (range 24 to 93mo). BCVA improved significantly postoperatively (0.76±0.65 logMAR) compared with preoperative baselines (1.31±0.78 logMAR, P<0.0001), and in 53 eyes (79%) including 3 lines gain in 44 eyes (66%) at the last follow-up visit. OCT scans showed that central retinal thickness decreased from 580.0±270.0 µm preoperatively (n=67) to 179.7±84.7 µm postoperatively (n=58, P<0.0001). Total resolution of foveoschisis occurred in 41 eyes (61%). Preoperative BCVA correlated well with postoperative BCVA, whereas other factors such as age, axial length, and refractive error were not correlated. The most common complications were cataract and full-thickness macular hole formation in 14 and 9 cases, respectively. CONCLUSION Patients with progressive vision loss due to MF who were treated with vitrectomy with ILM peeling show favourable outcomes. In most eyes, visual acuity and foveal structure remain stable during long-term observation. PMID:28251089

  13. Prospective Follow-Up of Patients with Acute Hepatitis C Virus Infection in Brazil

    PubMed Central

    Lewis-Ximenez, Lia L.; Lauer, Georg M.; zur Wiesch, Julian Schulze; de Sousa, Paulo Sergio Fonseca; Ginuino, Cleber F.; Paranhos-Baccalá, Gláucia; Ulmer, Hanno; Pfeiffer, Karl P.; Goebel, Georg; Pereira, João Luiz; de Oliveira, Jaqueline Mendes; Yoshida, Clara Fumiko Tachibana; Lampe, Elisabeth; Velloso, Carlos Eduardo; Pinto, Marcelo Alves; Coelho, Henrique Sergio; Almeida, Adilson José; Fernandes, Carlos Augusto; Kim, Arthur Y.; Strasak, Alexander M.

    2013-01-01

    Background The natural outcome of infection with hepatitis C virus (HCV) varies substantially among individuals. However, little is known about host and viral factors associated with a self-limiting or chronic evolution of HCV infection. Methods From 1 January 2001 through 31 December 2008, a consecutive series of 65 patients from Rio de Janeiro, Brazil, with a well-documented diagnosis of acute HCV infection, acquired via various routes, were enrolled in this study. Patients were prospectively followed up for a median of 40 months after the estimated date of HCV infection with serial measurements of serum alanine aminotransferase, HCV RNA, and anti-HCV antibodies. Spontaneous viral clearance (SVC) was defined as undetectable levels of HCV RNA in serum, in the absence of treatment, for 3 consecutive HCV polymerase chain reaction tests within the first 6 months of follow-up. Cox proportional hazards regression was used to identify host and viral predictors of SVC. Results The cumulative rate of SVC was 44.6% (95% confidence interval, 32.3%–57.5%). Compared with chronic HCV evolution, patients with self-limiting disease had significantly lower peak levels of anti-HCV antibodies (median, 109.0 vs 86.7 optical density–to–cutoff ratio [od/co]; P < .02), experienced disease symptoms more frequently (69.4% vs 100%; P < .001), and had lower viral load at first clinical presentation (median, 4.3 vs 0.0 log copies; P =.01). In multivariate analyses, low peak anti-HCV level (<93.5 od/co) was the only independent predictor for SVC; the hazard ratio compared with high anti-HCV levels (≥93.5 od/co) was 2.62 (95% confidence interval, 1.11–6.19; P =.03). Conclusion Our data suggest that low levels of anti-HCV antibodies during the acute phase of HCV infection are independently related to spontaneous viral clearance. PMID:20235831

  14. Follow-up of patients with systemic lupus erythematosus: what is not found in the guidelines.

    PubMed

    Jiménez-Alonso, J; Vargas-Hitos, J A; Navarrete-Navarrete, N; Zamora-Pasadas, M; Aguilar-Huergo, S; Jáimez, L; Sabio, J M

    2013-12-01

    A series of measures in the management of patients with systemic lupus erythematosus (SLE) which usually are not found in the lupus guidelines are discussed. In the lupus patient who has been well-controlled in the long term, the dose of hydroxychloroquine should be progressively reduced, without decreasing more than approximately 600 mg per week. We recommend taking this drug in the morning in patients with insomnia, at night in those with dyspepsia and to separate the intake of the drug from the shower (and the water should be as cool as possible) in those patients with aquagenic pruritus. We do not use prednisone on alternate days and exceptionally divide the dose into ¾ before breakfast and ¼ before dinner. Twenty to 30 min should be used per patient in every scheduled visit to assure a good clinical and human practice. We analyzed the follow-up of 112 consecutive patients from our systemic disease unit and found that 71.4% of them had symptoms that were unexplained by lupus and we only referred 8.9% of them to other specialists, probably because of our general training as internal medicine doctors. We suggest that knowing the views of SLE specialists might be of interest since, well-designed studies that would allow to progress in the understanding of this disease could be performed based on their experience.

  15. Evaluation of nurse-led follow up for patients undergoing pelvic radiotherapy

    PubMed Central

    Faithfull, S; Corner, J; Meyer, L; Huddart, R; Dearnaley, D

    2001-01-01

    This study reports results from a randomised controlled trial of nurse-led care and was designed to determine whether nurse-led follow up improved patients morbidity and satisfaction with care in men treated with radical radiotherapy for prostate and bladder cancer. The aim was to compare outcomes in terms of toxicity, symptoms experienced, quality of life, satisfaction with care and health care costs, between those receiving nurse-led care and a group receiving standard care. The study population was of men prescribed radical radiotherapy (greater than 60 Gy). Participants completed self-assessment questionnaires for symptoms and quality of life within the first week of radiotherapy treatment, at week 3, 6 and 12 weeks from start of radiotherapy. Satisfaction with clinical care was also assessed at 12 weeks post-treatment. Observer-rated RTOG toxicity scores were recorded pre-treatment, weeks 1, 3, 6 and 12 weeks from start of radiotherapy. The results presented in this paper are on 115 of 132 (87%) of eligible men who agreed to enter the randomised trial. 6 men (4%) refused and 11 (8%) were missed for inclusion in the study. Data were analysed as a comparison at cross-sectional time points and as a general linear model using multiple regression. There was no significant difference in maximum symptom scores over the time of the trial between nurse-led follow-up care and conventional medical care. Differences were seen in scores in the initial self assessment of symptoms (week 1) that may have been as a result of early nursing intervention. Those men who had received nurse-led care were significantly more satisfied (P < 0.002) at 12 weeks and valued the continuity of the service provided. There were also significant (P < 0.001) cost benefits, with a 31% reduction in costs with nurse-led, compared to medically led care. Evidence from this study suggests that a specialist nurse is able to provide safe follow up for men undergoing radiotherapy. The intervention

  16. Suicide intent among parasuicide patients in Nicaragua: a surveillance and follow-up study.

    PubMed

    Caldera, Trinidad; Herrera, Andrés; Kullgren, Gunnar; Renberg, Ellinor Salander

    2007-01-01

    This study examines suicide intent among parasuicide patients in a low-income country, Nicaragua, with special reference to gender patterns and future suicidal behavior. Using the Suicide Intent Scale (SIS), suicide intent was assessed in 204 persons presenting to hospital after parasuicide. Repetition was checked after a mean follow-up period of three years. The total SIS scores did not differ between women and men. However, a higher SIS score among women was significantly associated with older age, having children and use of pesticide as the parasuicide method. The overall method of suicide intent was low in Nicaragua compared to other countries, as was the nonfatal repetition rate (4.8% after three years). Subsequent suicides were found only in three men. Factor structures within the SIS disclosed supported the cross-cultural validity of the instrument. The level of suicide intent at the index attempt did not show any association with future suicidal behavior.

  17. Longitudinal Transient Elastography Measurements Used in Follow-up for Patients with Cystic Fibrosis.

    PubMed

    Van Biervliet, Stephanie; Verdievel, Hugo; Vande Velde, Saskia; De Bruyne, Ruth; De Looze, Danny; Verhelst, Xavier; Geerts, Anja; Robberecht, Eddy; Van Vlierberghe, Hans

    2016-04-01

    Cystic fibrosis-related liver disease (CFLD) is diagnosed using a combination of criteria. Transient elastography (TE), an ultrasonographic method to evaluate liver stiffness, can differentiate patients with and without liver disease. This retrospective study (2007-2013) aimed to detect developing CFLD using consequent TE measurements. All cystic fibrosis patients with TE measurements between 2007 and 2013 (n = 150, median age 17 (9-24) y) were included, of which 118 had a median of three (range, 2-4) measurements with an interval of 1 (1-2) y. Twenty (14%) had CFLD at the first TE measurement; five (3%) developed CFLD during follow-up. The median TE value in CFLD was 14 kPa (8.7-32.2) compared with 5.3 (4.9-5.7) in cystic fibrosis patients without liver disease (CFnoLD; p = 0.0001). In CFnoLD, TE was correlated with age (p = 0.031). A TE result >6.8 kPa had a sensitivity of 91.5% and a specificity of 91.7% in predicting CFLD, according to the receiver operating characteristics analysis. It also has a positive predictive value of 88.6% and a negative predictive value of 86.9%, increasing to 91.7% and 98%, respectively, in patients at risk (<14 y) for developing CFLD. Patients with developing CFLD had progressively increasing consecutive TE measurements.

  18. Melanoma patients under vemurafenib: prospective follow-up of melanocytic lesions by digital dermoscopy.

    PubMed

    Perier-Muzet, Marie; Thomas, Luc; Poulalhon, Nicolas; Debarbieux, Sébastien; Bringuier, Pierre-Paul; Duru, Gerard; Depaepe, Lauriane; Balme, Brigitte; Dalle, Stephane

    2014-05-01

    Second primary melanomas (SPMs) induced by vemurafenib have been recently described. The aim of this study was to define the dermoscopical signs of melanoma in this context. Patients underwent a total body examination before receiving vemurafenib. Each single melanocytic lesion was registered before therapy by digital dermoscopy (DD), and then repeated monthly until therapy disruption. Forty-two patients were included, the mean duration of follow-up was 6.7 months, and a mean number of 51 lesions per patients were captured and followed. A total number of 2,155 lesions were recorded, of which 56.1% presented at least one change during the study. More common changes concerned the color of the lesions (up to 15%) and appearance or disappearance of globules (14.6%). Thirty-six of the melanocytic lesions were surgically excised, 21 were classified as a nevus, 1 was a lentigo, and 14 as a second new primary melanoma (occurring in 21% of our patients). DD allowed us to excise only 36/2,155 (1.6%) of the lesions and permitted us to detect 14 SPM in the 42 patients with a highly efficient malignant/benign ratio of 63.6%. Although vemurafenib is now tested in an adjuvant setting DD should be systematically used in order to accurately detect SPM and reduce the number of unnecessary excisions.

  19. 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.

  20. Anemia on Admission Is an Independent Predictor of Long-Term Mortality in Hip Fracture Population: A Prospective Study With 2-Year Follow-Up.

    PubMed

    Zhang, Licheng; Yin, Pengbin; Lv, Houchen; Long, Anhua; Gao, Yuan; Zhang, Lihai; Tang, Peifu

    2016-02-01

    Anemia is a disputable factor for long-term mortality in hip fracture population in previous studies. Previous studies indicated that the level of hemoglobin (Hb) might fluctuate due to various factors, such as comorbidities and in-hospital interventions, and the changing level of Hb, may lead to discordance diagnosis of anemia and thus to the conflicting conclusions on prognostic value of anemia. So in this study, we aim to compare factors affecting the diagnosis of anemia at different time-points, admission, postoperation, and discharge, and to determine which the time point is most suitable for mortality prediction.This prospective cohort study included 1330 hip fracture patients from 1 January 2000 to 18 November 2012. Hb levels at 3 different time points, such as admission, postoperation, and discharge, were collected and used to stratify the cohort into anemia and nonanemia groups. Candidate factors including commodities, perioperative factors, blood transfusion, and other in-hospital interventions were collected before discharge. Logistic regression analyses were performed to detect risk factors for anemia for the 3 time points separately. Kaplan-Meier and multivariate Cox regression analyses were used to evaluate the association between anemia and 2-year mortality.Factors affecting the diagnosis of anemia were different for the 3 time points. Age, female sex, American Society of Anesthesiologists score (ASA), and intertrochanteric fracture were associated with admission anemia, while surgical procedure, surgical duration, blood transfusion, blood loss during the operation, and drainage volume were major risk factors for postoperation anemia. Cox proportional-hazards regression analysis suggested that the risk of all-cause mortality was higher in the anemia group on admission (1.680, 95%CI: 1.201-2.350, P < 0.01), but not postoperation or on discharge, after adjustment for confounding factors.Our study showed that risk factors for anemia varied at

  1. Outcomes of Hepatic Resection in Intrahepatic Cholangiocarcinoma Patients with Diabetes, Hypertension, and Dyslipidemia: Significance of Routine Follow-Up

    PubMed Central

    Nishioka, Takayoshi; Kubo, Shoji; Tanaka, Shogo; Wakasa, Kenichi; Takemura, Shigekazu; Kinoshita, Masahiko; Hamano, Genya; Kuwae, Yuko; Shibata, Toshihiko; Suehiro, Shigefumi

    2016-01-01

    Background The outcomes of hepatic resection in intrahepatic cholangiocarcinoma (ICC) patients with diabetes mellitus (DM), hypertension (HT), and dyslipidemia (DL) (metabolic components) remain unclear. Methods The outcomes of 43 ICC patients without known risk factors for ICC who underwent hepatic resection were retrospectively reviewed. These patients were divided into three groups: those followed-up for metabolic components at least every 6 months (follow-up group, n=16), those not followed-up for metabolic components (no follow-up group, n=14), and those without metabolic components (control group, n=13). Results In the follow-up group, 13 (81%) patients were further examined for ICC during follow-up because of abnormal screening results, such as elevated serum gamma-glutamyl transpeptidase and carbohydrate antigen 19-9 (CA19-9) concentrations or detection of hepatic tumor on ultrasonography and/or computed tomography, whereas most patients in the other two groups exhibited ICC-related symptoms. No patient in the follow-up group exhibited lymph node metastasis, whereas 43% of those in the no follow-up group and 46% in the control group had lymph node metastasis (p=0.005 and 0.004 vs. the follow-up group, respectively). All 16 patients in the follow-up group were diagnosed as International Union Against Cancer pathologic stage I or II (early stage). There were no significant differences in the incidence of postoperative recurrence between the three groups; however, the incidence of extrahepatic recurrence was lower in the follow-up group than in the no follow-up group and the control group (13% vs. 78% vs. 63%, p=0.0232). The 1-, 3-, and 5-year overall survivalrates in the follow-up group were better than those in the no follow-up and control groups (93/93/66% vs. 77/34/34% and 85/24/0%, p=0.034 and 0.001, respectively). Conclusions Routine measurement of serum gamma-glutamyl transpeptidase and/or CA19-9 levels and imaging examinations every 12 months (or 6

  2. [Follow-up of patients with osteoarthritis. Coordinated management and criteria for referral between healthcare levels].

    PubMed

    Nieto Pol, Enrique

    2014-01-01

    The correct management of osteoarthritis requires an accurate diagnosis, evaluation of its spread and functional repercussions, and the application of comprehensive and effective individually-tailored treatment aimed at relieving pain and improving physical function with a consequent improvement in quality of life; treatment should also aim to prevent or delay disease progression and its effects. In the National Health Service, primary care is the basic level and the first point of access to healthcare; this level guarantees the continuity of care, coordinates patients, and regulates clinical workflow. Family physicians coordinate the healthcare processes related to chronic diseases and are responsible for the management, diagnosis, evaluation, treatment, and follow-up of patients with osteoarthritis. The clinical practice guidelines internationally accepted as the standard of care for the management of osteoarthritis should be adapted by both Spanish health planning strategies and clinical practice guidelines to the Spanish healthcare setting. The comprehensive assessment of osteoarthritis includes evaluation of its effects on the patient's physical function and quality of life; formulating a treatment plan in collaboration with the patient and adapted to his or her comorbidities; providing advice on basic treatments and their risks and benefits; and carrying out an individually-tailored periodic review. Referral criteria are based on diagnostic confirmation, poor treatment response, and surgical evaluation.

  3. Cu isotopic signature in blood serum of liver transplant patients: a follow-up study

    NASA Astrophysics Data System (ADS)

    Lauwens, Sara; Costas-Rodríguez, Marta; van Vlierberghe, Hans; Vanhaecke, Frank

    2016-07-01

    End-stage liver disease (ESLD) is life-threatening and liver transplantation (LTx) is the definitive treatment with good outcomes. Given the essential role of hepatocytes in Cu homeostasis, the potential of the serum Cu isotopic composition for monitoring a patient’s condition post-LTx was evaluated. For this purpose, high-precision Cu isotopic analysis of blood serum of ESLD patients pre- and post-LTx was accomplished via multi-collector ICP-mass spectrometry (MC-ICP-MS). The Cu isotopic composition of the ESLD patients was fractionated in favour of the lighter isotope (by about ‑0.50‰). Post-LTx, a generalized normalization of the Cu isotopic composition was observed for the patients with normal liver function, while it remained light when this condition was not reached. A strong decrease in the δ65Cu value a longer term post-LTx seems to indicate the recurrence of liver failure or cancer. The observed trend in favour of the heavier Cu isotopic composition post-LTx seems to be related with the restored biosynthetic capacity of the liver, the restored hepatic metabolism and/or the restored biliary secretion pathways. Thus, Cu isotopic analysis could be a valuable tool for the follow-up of liver transplant patients and for establishing the potential recurrence of liver failure.

  4. Thyroglobulin levels to follow-up patients with treated differentiated thyroid carcinoma

    SciTech Connect

    Moser, E.; Braun, S.; Bueell, U.; Kirsch, C.M.; Tosch, U.; Wendt, T.

    1984-01-01

    Serum thyroglobulin (hTg) measurements by commercial radioimmunoassay were performed in the follow-up of 118 patients with differentiated thyroid carcinoma undergoing I-131 local and whole-body scans following surgery and I-131 therapy. Patients with positive anti-hTg antibodies (23% of cases) were excluded. In all remaining I-131 accumulating residual, recurrent, or metastatic tumors, hTg levels were elevated (greater than 6.25 ng/ml, minimum detectable value). Twelve patients with neither recurrence nor metastases had elevate hTg levels. Sensitivity and specificity depended on the threshold used for elevate hTg levels. At an hTg-threshold of 6.25 ng/ml sensitivity has 100%, specificity has 82%. As hTg levels were reported to depend on endogenous TSH stimulation, it is not yet advisable to replace I-131 scans totally by hTg determination. After having determined an hTg ''baseline'' below detectable values (less than 6.25 ng/ml), we reduced the number of I-131 scans by half. However, elevated hTg levels were an indication for an I-131 scan. Therefore, on the basis of 23% of our patients who had anti-hTg antibodies the need exists to develop a commercial assay which is independent from antibodies.

  5. Cu isotopic signature in blood serum of liver transplant patients: a follow-up study

    PubMed Central

    Lauwens, Sara; Costas-Rodríguez, Marta; Van Vlierberghe, Hans; Vanhaecke, Frank

    2016-01-01

    End-stage liver disease (ESLD) is life-threatening and liver transplantation (LTx) is the definitive treatment with good outcomes. Given the essential role of hepatocytes in Cu homeostasis, the potential of the serum Cu isotopic composition for monitoring a patient’s condition post-LTx was evaluated. For this purpose, high-precision Cu isotopic analysis of blood serum of ESLD patients pre- and post-LTx was accomplished via multi-collector ICP-mass spectrometry (MC-ICP-MS). The Cu isotopic composition of the ESLD patients was fractionated in favour of the lighter isotope (by about −0.50‰). Post-LTx, a generalized normalization of the Cu isotopic composition was observed for the patients with normal liver function, while it remained light when this condition was not reached. A strong decrease in the δ65Cu value a longer term post-LTx seems to indicate the recurrence of liver failure or cancer. The observed trend in favour of the heavier Cu isotopic composition post-LTx seems to be related with the restored biosynthetic capacity of the liver, the restored hepatic metabolism and/or the restored biliary secretion pathways. Thus, Cu isotopic analysis could be a valuable tool for the follow-up of liver transplant patients and for establishing the potential recurrence of liver failure. PMID:27468898

  6. Two-year follow-up in patients treated with emphysematous lung sealant for advanced emphysema.

    PubMed

    Kramer, Mordechai R; Refaely, Yael; Maimon, Nimrod; Rosengarten, Dror; Fruchter, Oren

    2013-11-01

    Endoscopic lung volume-reduction therapy for emphysema has been associated with therapeutic responses smaller in magnitude and less durable than surgical volume reduction (LVRS). Bronchoscopic emphysematous lung sealant (ELS) therapy has been shown to produce improvements in pulmonary function similar to surgery at 1 year. This case series summarizes safety and efficacy data of all patients from the initial ELS study out to 2 years. Between 1 and 2 years, there were three all-cause adverse events requiring hospitalization. One patient went on to successful lung transplant. Improvements relative to baseline in spirometry (change in FEV1: + 14.3 ± 33.1%; change in FVC: + 5.8 ± 23.2%) and diffusing capacity (change in diffusing capacity of the lung for carbon monoxide: + 10.6 ± 20.6%) were observed at 2 years. An exponential model fit to FEV₁ data at 6, 12, 18, and 24 months predicted improvements from a baseline of > 5% out to 4.1 years, similar to what has been reported following surgery. This report confirms long-term safety and efficacy following ELS therapy in advanced emphysema. Studies in a larger cohort are needed to define the role of ELS therapy in the treatment algorithm of patients with this condition.

  7. Follow-up of patients with functional bowel symptoms treated with a low FODMAP diet

    PubMed Central

    Maagaard, Louise; Ankersen, Dorit V; Végh, Zsuzsanna; Burisch, Johan; Jensen, Lisbeth; Pedersen, Natalia; Munkholm, Pia

    2016-01-01

    AIM: To investigate patient-reported outcomes from, and adherence to, a low FODMAP diet among patients suffering from irritable bowel syndrome and inflammatory bowel disease. METHODS: Consecutive patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) and co-existing IBS fulfilling the ROME III criteria, who previously attended an outpatient clinic for low FODMAP diet (LFD) dietary management and assessment by a gastroenterologist, were invited to participate in a retrospective questionnaire analysis. The questionnaires were sent and returned by regular mail and gathered information on recall of dietary treatment, efficacy, symptoms, adherence, satisfaction, change in disease course and stool type, and quality of life. Before study enrolment all patients had to sign an informed written consent. RESULTS: One hundred and eighty patients were included, 131 (73%) IBS and 49 (27%) IBD patients. Median age was 43 years (range: 18-85) and 147 (82%) were females. Median follow-up time was 16 mo (range: 2-80). Eighty-six percent reported either partial (54%) or full (32%) efficacy with greatest improvement of bloating (82%) and abdominal pain (71%). The proportion of patients with full efficacy tended to be greater in the IBD group than in the IBS group (42% vs 29%, P = 0.08). There was a significant reduction in patients with a chronic continuous disease course in both the IBS group (25%, P < 0.001) and IBD group (23%, P = 0.002) along with a significant increase in patients with a mild indolent disease course of 37% (P < 0.001) and 23% (P = 0.002), respectively. The proportion of patients having normal stools increased with 41% in the IBS group (P < 0.001) and 66% in the IBD group (P < 0.001). One-third of patients adhered to the diet and high adherence was associated with longer duration of dietary course (P < 0.001). Satisfaction with dietary management was seen in 83 (70%) IBS patients and 24 (55%) IBD patients. Eighty-four percent of patients

  8. Non-systemic vasculitic neuropathy: single-center follow-up of 60 patients.

    PubMed

    Üçeyler, Nurcan; Geng, Anna; Reiners, Karlheinz; Toyka, Klaus V; Sommer, Claudia

    2015-09-01

    The objective of this study is to report the clinical presentation and long-term outcome of patients with non-systemic vasculitic neuropathy (NSVN) seen at our neuromuscular center. In this retrospective analysis, we assessed medical records of 60 patients with biopsy-proven NSVN (39 men, 21 women; median age: 64 years, 24-80), who were seen at our department between 1999 and 2008 and were followed up until 2014. The initial neurological findings, laboratory and neurophysiological data, treatment regimens, and outcome were analyzed in all patients. NSVN was mostly asymmetric (48/60, 80%), sensorimotor (45/60, 75%), and painful (38/60, 63%), with walking impairment as one major sign (51/60, 85%). No compound action potentials could be recorded in 29/60 (48%) sural nerves (later biopsied side) and in 6/60 (10%) tibial (motor) nerves. Pathology of sural nerve was informative in all cases irrespective of neurophysiological findings and prior immunosuppression. After initial treatment with i.v. methylprednisolone, all patients reported overall improvement. Of the 46 patients who were followed for >1 year, those with mild to moderate affliction were stable with azathioprine (19/46, 41%), while 18/46 (39%) patients were treated with cyclophosphamide and other immunosuppressants due to progression or relapse. At 4 years, 24/46 (52%) patients had either discontinued (n = 21) or had primarily refused immunosuppressive treatment (n = 3) without relapse. Age younger than the group median of 64 years was associated with better outcome. No patient evolved to systemic vasculitis. NSVN is a potentially treatable disorder of the peripheral nervous system.

  9. Follow-up study and response to treatment in 23 patients with Lewis-Sumner syndrome.

    PubMed

    Viala, K; Renié, L; Maisonobe, T; Béhin, A; Neil, J; Léger, J M; Bouche, P

    2004-09-01

    Lewis-Sumner syndrome (LSS) is a dysimmune peripheral nerve disorder, characterized by a predominantly distal, asymmetric weakness mostly affecting the upper limbs with sensory impairment, and by the presence of multifocal persistent conduction blocks. The nosological position of this neuropathy in relation to multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is still debated. We report the clinical, biological and electrophysiological features, the course and the response to treatment in 23 LSS patients. The initial symptoms started in the distal part of an upper limb in 70% of patients. They were sensorimotor in 65% and purely sensory in 35% of patients. A cranial nerve involvement was observed in 26% of patients and a distal limb amyotrophy in 52%. The CSF protein level was normal in 67% of patients and mildly elevated in the remainder. None had serum anti-GM1 antibodies. There were multiple motor conduction blocks (average of 2.87/patient), predominantly located in the forearm, whereas demyelinating features outside the blocked nerves were rare. Abnormal distal sensory potentials were found in 87% of patients. The electrophysiological pattern suggests a very focal motor fibre demyelination sparing the nerve endings, whereas sensory fibre involvement was widespread. The course was chronic progressive in 71% of patients and relapsing-remitting in the others. During the follow-up study (median duration of 4 years), half of the patients progressed with a multifocal pattern and the distribution of the motor deficit remained similar to the initial presentation. The other patients showed a progression to the other limbs, suggesting a more diffuse process. Fifty-four percent of the patients treated with intravenous immunoglobulin showed an improvement, compared with 33% of the patients treated with oral steroids. Overall, 73% of patients had a positive response to immune-mediated therapy. LSS may be distinguished

  10. [Protocol for the diagnosis and follow up of patients with cystic fibrosis].

    PubMed

    Barrio Gómez de Agüero, M I; García Hernández, G; Gartner, S

    2009-09-01

    Cystic fibrosis (CF) is the most common severe recessive genetic disease in Caucasians. During the last years, new therapies and aggressive management of the lung disease have contributed significantly to the increased life expectancy in CF patients. A review and update of CF diagnosis and management of lung disease are included. The sweat chloride test (SCT) remains the gold standard for CF diagnosis and should be performed properly. However, in a few patients SCT results may not be conclusive to clarify the CF diagnosis. Patients with CF should be followed up in specialist Units by an expert multidisciplinary expert applying standard clinical protocols and using lung function tests, and microbiological and imaging studies. An overview with the recommendations for treatment of early onset and chronic infections due to Pseudomonas aeruginosa, Staphylococcus aureus and other uncommon pathogens is included. Furthermore, the management of other aspects of CF lung disease and complications is provided, as well as the indications for lung transplantation. This document has been prepared by the members of the CF working group of the Spanish Paediatrics Pulmonary Society to provide an update to the earlier documents published in this Journal in 1999.

  11. Laboratory guidelines for the diagnosis and follow-up of patients with monoclonal gammopathies.

    PubMed

    Bravo García-Morato, M; Padilla-Merlano, B; Nozal, P; Espiño, M; Juárez, C; Villar, L M; López-Trascasa, M

    2016-04-01

    We present guidelines from the Immunochemistry group of the Spanish Society for Immunology that are designed to provide a practical tool for the diagnosis and follow-up of monoclonal gammopathies. We review the clinical and analytical features of various monoclonal gammopathies, international consensus guidelines and techniques used to detect and follow-up monoclonal components.

  12. Use of nurse-led telephone follow-up as a sole method of assessing patients after nasal surgery

    PubMed Central

    Sooby, Paul; Kirkland, Paul

    2015-01-01

    Patients undergoing nasal surgery have historically been routinely followed up in consultant led clinics some months after surgery. It has been noted that a significant proportion of these patients either did not attend these appointments or did not require them, impacting on the efficiency of ENT outpatient clinics. A quality improvement project was undertaken to assess this problem and to propose a new patient pathway whereby patients are contacted by ENT nursing staff by telephone three months following surgery. During these telephone conversations only 9.5% of patients requested outpatient follow-up and all of these patients were discharged upon their follow-up. The project demonstrates that nurse-led follow up is an efficient, effective and safe way of managing patient care post-nasal surgery. PMID:26734352

  13. Patients' experiences of an open access follow up arrangement in managing inflammatory bowel disease

    PubMed Central

    Rogers, A; Kennedy, A; Nelson, E; Robinson, A

    2004-01-01

    Background: Improving access is a key policy issue in improving quality of care and extending patient choice and participation. People's experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored. Objectives: To examine patients' views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease (IBD). Design: Embedded qualitative study undertaken alongside a randomised controlled trial. Semi-structured interviews were undertaken to obtain an in depth understanding of patients' experience of the change in access arrangements. Participants: A purposive sample (n = 30) was drawn from the intervention group (n = 700) according to a range of responses to the trial baseline and follow up quantitative measures. Results: 28 interviews were included in the analysis. Compared with the previous system of fixed appointments, preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication. Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help. Conclusions: Open access may fit better with patients' self-management of their condition and everyday routines, roles and responsibilities. Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement. Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected. PMID:15465941

  14. Effectiveness of Cognitive-Behavioral Treatment for Panic Disorder Versus Treatment as Usual in a Managed Care Setting: 2-Year Follow-Up

    ERIC Educational Resources Information Center

    Addis, Michael E.; Hatgis, Christina; Cardemil, Esteban; Jacob, Karen; Krasnow, Aaron D.; Mansfield, Abigail

    2006-01-01

    Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral…

  15. Accelerated Corneal Collagen Cross-Linking in Pediatric Patients: Two-Year Follow-Up Results

    PubMed Central

    Shetty, Rohit; Nagaraja, Harsha; Jayadev, Chaitra; Pahuja, Natasha Kishore; Kurian Kummelil, Mathew; Nuijts, Rudy M. M. A.

    2014-01-01

    Purpose. To evaluate the effectiveness and safety of accelerated corneal collagen cross-linking (ACXL) in patients below 14 years of age with progressive keratoconus. Materials and Methods. Thirty eyes of 18 patients with established progressive keratoconus underwent preoperative and postoperative visual acuity assessment, topography, and specular microscopy prior to ACXL and were followed up for 24 months. Results. Mean age of the patients was 12.7 years with ten males and eight females. There was an improvement in the mean postoperative uncorrected distant visual acuity (from 0.76 ± 0.26 to 0.61 ± 0.25; P = 0.005), mean corrected distant visual acuity (from 0.24 ± 0.19 to 0.12 ± 0.12; P < 0.001), mean spherical refraction (from −3.04 DS ± 3.60 to −2.38 DS ± 3.37; P = 0.28), mean cylinder (from −3.63 DC ± 1.82 to −2.80 DC ± 1.48; P = 0.008), and spherical equivalent (from −4.70 D ± 3.86 to −3.75 D ± 3.49; P = 0.15). Three eyes of two patients with vernal keratoconjunctivitis (VKC) showed progression. There were no intra- or postoperative complications. Conclusion. In pediatric patients ACXL is an effective and safe procedure for the management of keratoconus. Optimal management of VKC is important to arrest the progression of keratoconus. PMID:25295278

  16. Regular aquatic exercise for chronic kidney disease patients: a 10-year follow-up study.

    PubMed

    Pechter, Ülle; Raag, Mait; Ots-Rosenberg, Mai

    2014-09-01

    Chronic kidney disease (CKD) patients not yet in dialysis can benefit from increased physical activity; however, the safety and outcomes of aquatic exercise have not been investigated in observational studies. The aim of this study was to analyze association of 10 years of regularly performed aquatic exercise with the study endpoint--that is, all-cause death or start of dialysis. Consecutive CKD patients were included in the study in January 2002. The exercise group (n=7) exercised regularly under the supervision of physiotherapist for 10 years; the control group (n=9), matched in terms of age and clinical parameters, remained sedentary. Low-intensity aerobic aquatic exercise was performed regularly twice a week; 32 weeks or more of exercise therapy sessions were conducted annually. None of the members of the aquatic exercise group reached dialysis or died in 10 years. In the sedentary control group, 55% reached the study endpoint--renal replacement therapy (n=2) or all-cause death (n=3). Occurrence of the study endpoint, compared using the exact multinomial test with unconditional margins, was statistically significantly different (P-value: 0.037) between the study groups. Regular supervised aquatic exercise arrested CKD progression. There was a statistically significant difference between the sedentary group and the exercise group in reaching renal replacement therapy or all-cause death in a follow-up time of 10 years.

  17. Stainless steel wire mesh cranioplasty: ten years' experience with 183 patients (100 followed up).

    PubMed

    Datti, R; Cavagnaro, G; Camici, S

    1985-01-01

    We have executed 183 cranioplasties in order to repair cranial defects using stainless steel wire mesh over a period of a decade, using Gardner's technique with minor modifications. The follow-up was possible in 100 patients and it ranged from 4 to 134 months, with an average of 64.1 months (5.3 years). Among these, 8 patients developed postoperative complications (8%): 7 needed cranioplasty remotion (7%) and 1 needed cranioplasty revision without remotion (1%). The causes of morbidity were due to: infection (3%), CSF leak (1%), haematoma (1%), skin local soaking (1%), posttraumatic plastic dislodgement (2%). Our total morbidity rate (8%) may compare with that resulting from the use of different materials such as alloplastics (6-12%), osteoplastics (until 40%) and miscellaneous (5.5%). The group in which cranioplasty was done within six months following the first operation had our highest complication rate (18.2%). In our experience the stainless steel wire mesh was shown to be an effective material to repair cranial defects.

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

    PubMed

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

    2009-09-15

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

  19. An implantable neuroprosthesis for standing and walking in paraplegia: 5-year patient follow-up

    NASA Astrophysics Data System (ADS)

    Guiraud, David; Stieglitz, Thomas; Koch, Klaus Peter; Divoux, Jean-Louis; Rabischong, Pierre

    2006-12-01

    We present the results of a 5-year patient follow-up after implantation of an original neuroprosthesis. The system is able to stimulate both epimysial and neural electrodes in such a way that the complete flexor-extensor chain of the lower limb can be activated without using the withdrawal reflex. We demonstrate that standing and assisted walking are possible, and the results have remained stable for 5 years. Nevertheless, some problems were noted, particularly regarding the muscle response on the epimysial channels. Analysis of the electrical behaviour and thresholds indicated that the surgical phase is crucial because of the sensitivity of the functional responses to electrode placement. Neural stimulation proved to be more efficient and more stable over time. This mode requires less energy and provides more selective stimulation. This FES system can be improved to enable balanced standing and less fatiguing gait, but this will require feedback on event detection to trigger transitions between stimulation sequences, as well as feedback to the patient about the state of his lower limbs.

  20. 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.

  1. Prosthetic Rehabilitation of a Patient With Gastroesophageal Reflux Disease: Five-Year Follow-up.

    PubMed

    Moretto, G; Pupo, Y M; Bueno, A L N; Araujo, F O

    2016-01-01

    Tooth wear is a multifactorial process that is a growing concern in dentistry. This phenomenon can be caused by mechanical (attrition, abrasion, or abfraction) or chemical (erosion) processes. Etiologic factors in dental erosion can be due to changes in behavior, an unbalanced diet, or gastrointestinal disorders such as acid regurgitation, which may influence the salivary flow rate and buffering capacity of saliva. This case report describes an esthetic rehabilitation of a patient with gastroesophageal reflux and dental erosion, with a treatment rationale that includes the use of a diagnostic template and five-year follow-up. This technique, presented here in a clinical case with moderate enamel loss, integrates an additive wax-up and a direct intraoral bis-acryl resin mock-up. Lithium disilicate glass-ceramic (IPS e.max Press, Ivoclar Vivadent) laminate veneers were fabricated with the heatpress technique. They were veneered with a layering ceramic (IPS e.max Ceram, Ivoclar Vivadent) to improve the appearance of the incisal edge. The case demonstrated the success of veneers as an effective, conservative, and esthetic treatment for patients with this pathology.

  2. 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

  3. Clinical and radiological evaluation of Trabecular Metal and the Smith-Robinson technique in anterior cervical fusion for degenerative disease: a prospective, randomized, controlled study with 2-year follow-up.

    PubMed

    Löfgren, Håkan; Engquist, M; Hoffmann, P; Sigstedt, B; Vavruch, L

    2010-03-01

    A prospective, randomized, controlled study was carried out to compare the radiological and clinical outcomes after anterior cervical decompression and fusion (ACDF) with Trabecular Metal (TM) to the traditional Smith-Robinson (SR) procedure with autograft. The clinical results of cervical fusion with autograft from the iliac crest are typically satisfactory, but implications from the donor site are frequently reported. Alternative materials for cervical body interfusion have shown lower fusion rates. Trabecular Metal is a porous tantalum biomaterial with structure and mechanical properties similar to that of trabecular bone and with proven osteoconductivity. As much as 80 consecutive patients planned for ACDF were randomized for fusion with either TM or tricortical autograft from the iliac crest (SR) after discectomy and decompression. Digitized plain radiographic images of 78 (98%) patients were obtained preoperatively and at 2-year follow-up and were subsequently evaluated by two senior radiologists. Fusion/non-fusion was classified by visual evaluation of the A-P and lateral views in forced flexion/extension of the cervical spine and by measuring the mobility between the fused vertebrae. MRI of 20 TM cases at 2 years was successfully used to assess the decompression of the neural structures, but was not helpful in determining fusion/non-fusion. Pain intensity in the neck, arms and pelvis/hip were rated by patients on a visual analog scale (VAS) and neck function was rated using the Neck Disability Index (NDI) the day before surgery and 4, 12 and 24 months postoperatively. Follow-ups at 12 and 24 months were performed by an unbiased observer, when patients also assessed their global outcome. Fusion rate in the SR group was 92%, and in the TM group 69% (P < 0.05). The accuracy of the measurements was calculated to be 2.4 degrees . Operating time was shorter for fusion with TM compared with autograft; mean times were 100 min (SD 18) and 123 min (SD 23

  4. Follow up of patients who start treatment with antidepressants: treatment satisfaction, treatment compliance, efficacy and safety

    PubMed Central

    2013-01-01

    Background Measuring satisfaction with treatment has proved useful to ascertain the treatment features that are most important to the patients, and to explain increased treatment compliance. However, there are few studies that relate satisfaction to other clinical or self-perceived health status indicators. Recent studies have shown the close relationship between satisfaction with treatment, treatment compliance, and effectiveness. This study attempts to design and validate a scale to evaluate satisfaction with antidepressant drug therapy, assess treatment compliance (self-reported, validated questionnaire, drug accountability and electronic monitorization system), assess efficacy in reducing depressive symptoms and safety in patients who initiate antidepressant drug therapy, as well as to establish predictors of satisfaction, compliance and effectiveness with these drugs. Methods/design This is an observational longitudinal study with a cohort of adults initiating treatment with antidepressant drugs. A multi-centre study will be performed in which 20 Primary Care practices from Castilla-La Mancha are expected to participate. An initial interview and follow-up visits at 15 days, 1, 3, 6, 9 and 12 months will be conducted with all study participants. 706 subjects will be studied (95% confidence interval, precision ± 3%, expected rate of non-compliance 50%, expected non-responders and lost to follow up rate 15%). The following measurements will be performed: development and validation of a scale of satisfaction with antidepressant therapy, participant and antidepressant characteristics, treatment compliance evaluation (Haynes-Sackett Test, Morisky-Green Test, drug accountability and Medication Event Monitoring System), depression symptom reduction (Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale), observation of adverse effects, and beliefs about treatment (The Beliefs about Medicines Questionnaire). Discussion Antidepressant drugs are

  5. Multi-observation PET image analysis for patient follow-up quantitation and therapy assessment.

    PubMed

    David, S; Visvikis, D; Roux, C; Hatt, M

    2011-09-21

    In positron emission tomography (PET) imaging, an early therapeutic response is usually characterized by variations of semi-quantitative parameters restricted to maximum SUV measured in PET scans during the treatment. Such measurements do not reflect overall tumor volume and radiotracer uptake variations. The proposed approach is based on multi-observation image analysis for merging several PET acquisitions to assess tumor metabolic volume and uptake variations. The fusion algorithm is based on iterative estimation using a stochastic expectation maximization (SEM) algorithm. The proposed method was applied to simulated and clinical follow-up PET images. We compared the multi-observation fusion performance to threshold-based methods, proposed for the assessment of the therapeutic response based on functional volumes. On simulated datasets the adaptive threshold applied independently on both images led to higher errors than the ASEM fusion and on clinical datasets it failed to provide coherent measurements for four patients out of seven due to aberrant delineations. The ASEM method demonstrated improved and more robust estimation of the evaluation leading to more pertinent measurements. Future work will consist in extending the methodology and applying it to clinical multi-tracer datasets in order to evaluate its potential impact on the biological tumor volume definition for radiotherapy applications.

  6. Multi-observation PET image analysis for patient follow-up quantitation and therapy assessment

    PubMed Central

    David, Simon; Visvikis, Dimitris; Roux, Christian; Hatt, Mathieu

    2011-01-01

    In Positron Emission Tomography (PET) imaging, an early therapeutic response is usually characterized by variations of semi-quantitative parameters restricted to maximum SUV measured in PET scans during the treatment. Such measurements do not reflect overall tumour volume and radiotracer uptake variations. The proposed approach is based on multi-observation image analysis for merging several PET acquisitions to assess tumour metabolic volume and uptake variations. The fusion algorithm is based on iterative estimation using stochastic expectation maximization (SEM) algorithm. The proposed method was applied to simulated and clinical follow-up PET images. We compared the multi-observation fusion performance to threshold-based methods, proposed for the assessment of the therapeutic response based on functional volumes. On simulated datasets, the adaptive threshold applied independently on both images led to higher errors than the ASEM fusion and on the clinical datasets, it failed to provide coherent measurements for four patients out of seven due to aberrant delineations. The ASEM method demonstrated improved and more robust estimation of the evaluation leading to more pertinent measurements. Future work will consist in extending the methodology and applying it to clinical multi-tracers datasets in order to evaluate its potential impact on the biological tumour volume definition for radiotherapy applications. PMID:21846937

  7. MRI as outcome measure in facioscapulohumeral muscular dystrophy: 1-year follow-up of 45 patients.

    PubMed

    Andersen, Grete; Dahlqvist, Julia R; Vissing, Christoffer R; Heje, Karen; Thomsen, Carsten; Vissing, John

    2017-03-01

    There is no effective treatment available for facioscapulohumeral muscular dystrophy type 1 (FSHD1), but emerging therapies are under way that call for a better understanding of natural history in this condition. In this prospective, longitudinal study, we used quantitative MRI to assess yearly disease progression in patients with FSHD1. Ambulatory patients with confirmed diagnosis of FSHD1 (25/20 men/women, age 20-75 years, FSHD score: 0-12) were tested with 359-560-day interval between tests. Using the MRI Dixon technique, muscle fat replacement was evaluated in paraspinal, thigh, and calf muscles. Changes were compared with those in FSHD score, muscle strength (hand-held dynamometry), 6-minute-walk-distance, 14-step-stair-test, and 5-time-sit-to-stand-test. Composite absolute fat fraction of all assessed muscles increased by 0.036 (CI 0.026-0.046, P < 0.001), with increases in all measured muscle groups. The clinical severity FSHD score worsened (10%, P < 0.05), muscle strength decreased over the hip (8%), neck (8%), and back (17%) (P < 0.05), but other strength measures, 6-minute-walk-distance, 5-times-sit-to-stand-test, and 14-step-stair-test were unchanged. Changes in muscle strength, FSHD score, and fat fraction did not correlate. This first study to systemically monitor quantitative fat replacement longitudinally in FSHD1 shows that MRI provides an objective measure of disease progression, often before changes can be appreciated in strength and functional tests. The study indicates that quantitative MRI can be a helpful end-point in follow-up and therapeutic trials of patients with FSHD1.

  8. Use of an extended INR follow-up interval for Veteran patients in an anticoagulation clinic.

    PubMed

    Porter, Andrea L; Margolis, Amanda R; Schoen, Rebecca R; Staresinic, Carla E; Ray, Cheryl A; Fletcher, Christopher D

    2017-04-01

    A prospective, single-arm study of 50 participants evaluated an extended INR follow-up interval to determine the implementation feasibility and safety of an extended interval in Veterans on a stable dose of warfarin. A protocol was designed to allow for a rigorous, yet pragmatic evaluation of a 12-week INR follow-up interval. Feasibility was determined by study enrollment, retention, and participant achievement rates for the extended INR interval. Safety was determined by bleeding and thromboembolism rates. Participants were monitored for 6 months. Despite the long-term stability of participants prior to enrollment, only 56% achieved a 12-week follow-up interval and only 34% of enrolled participants maintained a 12-week interval. Sixteen percent of participants were never eligible for an extension of their INR follow-up interval despite meeting initial enrollment criteria. There were two major bleeding events and one participant who experienced a thromboembolic event. Implementation of an extended interval of INR follow-up appears feasible as participant enrollment goals were met and pharmacists were able to follow the study protocol. However, a lower than expected proportion of participants were able to achieve and maintain an extended INR follow-up interval. Future evaluations are needed to confirm the safety of an extended INR interval.

  9. Cost-utility analysis modeling at 2-year follow-up for cervical disc arthroplasty versus anterior cervical discectomy and fusion: A single-center contribution to the randomized controlled trial

    PubMed Central

    Warren, Daniel; Andres, Tate; Hoelscher, Christian; Ricart-Hoffiz, Pedro; Bendo, John; Goldstein, Jeffrey

    2013-01-01

    Background Patients with cervical disc herniations resulting in radiculopathy or myelopathy from single level disease have traditionally been treated with Anterior Cervical Discectomy and Fusion (ACDF), yet Cervical Disc Arthroplasty (CDA) is a new alternative. Expert suggestion of reduced adjacent segment degeneration is a promising future result of CDA. A cost-utility analysis of these procedures with long-term follow-up has not been previously reported. Methods We reviewed single institution prospective data from a randomized trial comparing single-level ACDF and CDA in cervical disc disease. Both Medicare reimbursement schedules and actual hospital cost data for peri-operative care were separately reviewed and analyzed to estimate the cost of treatment of each patient. QALYs were calculated at 1 and 2 years based on NDI and SF-36 outcome scores, and incremental cost effectiveness ratio (ICER) analysis was performed to determine relative cost-effectiveness. Results Patients of both groups showed improvement in NDI and SF-36 outcome scores. Medicare reimbursement rates to the hospital were $11,747 and $10,015 for ACDF and CDA, respectively; these figures rose to $16,162 and $13,171 when including physician and anesthesiologist reimbursement. The estimated actual cost to the hospital of ACDF averaged $16,108, while CDA averaged $16,004 (p = 0.97); when including estimated physicians fees, total hospital costs came to $19,811 and $18,440, respectively. The cost/QALY analyses therefore varied widely with these discrepancies in cost values. The ICERs of ACDF vs CDA with Medicare reimbursements were $18,593 (NDI) and $19,940 (SF-36), while ICERs based on actual total hospital cost were $13,710 (NDI) and $9,140 (SF-36). Conclusions We confirm the efficacy of ACDF and CDA in the treatment of cervical disc disease, as our results suggest similar clinical outcomes at one and two year follow-up. The ICER suggests that the non-significant added benefit via ACDF comes at a

  10. Nelfinavir in HIV-HCV coinfected patients: a 24-month follow-up in a cohort of 82 patients.

    PubMed

    Poizot-Martin, I; Marimoutou, C; Drogoul-Vey, M P; Vion-Dury, F; Frixon-Marin, V; Benhaim, S; Poggi, P; Gastaut, J A

    2005-10-01

    This retrospective and longitudinal study evaluated the long-term hepatic tolerance of a nelfinavir (NFV)-antiretroviral combined regimen in 82 patients of the HCV-HIV Cohort of CISIH-Sud of Marseilles. Follow-up data (liver enzyme levels, CD4 cell count, HIV viral load, and metabolic parameters) of patients treated with NFV on inclusion or during the follow-up of the cohort were analyzed under treatment over 24 months. Comparisons were performed with X2 or Kruskal-Wallis tests. At baseline (n = 82), the median exposure to NFV was 4.1 months; 58 patients received NFV combined with NRTI and 24 with NNRTI. The median CD4 cell count was 337/mm3 [interquartile range (IR): 216-480) and 39.7% had an undetectable HIV RNA level. Qualitative HCV PCR was positive in 91% of the patients and 19/51 patients with liver biopsy were F3-F4. Median alanine and aspartate aminotransferase (ALAT, ASAT), gamma-glutamyltransferase (GT), and alkaline phosphatase (ALP) were 46 UI/liter (IR: 36-76), 55 UI/liter (IR: 32-97), 97 UI/liter (IR: 50-194), and 88 UI/liter (IR: 72-104), respectively, with 76% of the patients with ALAT/ASAT grade <2. Median follow-up was 23 months (IR: 13.8-37). No significant difference was observed in the distribution of ALAT, ASAT, GT, and ALP as well as of ALAT/ASAT grades over the 24-month study period. Patients treated with NFV + NNRTI had significantly higher GT and ALP levels at baseline with no significant increase during follow-up. Cholesterol, triglyceride, and glycemia distributions remained stable over time. In conclusion, this study showed a good hepatic and metabolic tolerance of a long-term NFV-combined regimen in HIV-HCV coinfected patients.

  11. Associations Among Symptoms of Autism, Symptoms of Depression and Executive Functions in Children with High-Functioning Autism: A 2 Year Follow-Up Study.

    PubMed

    Andersen, Per Normann; Skogli, Erik Winther; Hovik, Kjell Tore; Egeland, Jens; Øie, Merete

    2015-08-01

    This study investigated the course of and association among changes in autism symptoms, depression symptoms and executive functions (EF) in children with high-functioning autism (HFA). Thirty-four children with HFA and 45 typically developing children (age 9-16) were assessed at baseline and after 2 years. Children with HFA had impaired scores on all measures at both time points. According to parent reports, depressive symptoms decreased over time, while EF improved and autism symptoms were stable. Children's reports did not reveal less depressive symptoms over time. A positive association was found only between changes in autism symptoms and changes in symptoms of depression. A possible implication is that interventions aimed at either autism symptoms or symptoms of depression may improve the other.

  12. [The fate of very early premature babies. Mortality, morbidity and 2-year follow-up in a population of 96 very early premature babies].

    PubMed

    Lenclen, R; Paupe, A; Carbajal, R; Blanc, P; Hoenn, E; Olivier-Martin, M

    1992-11-01

    The neonatal fate, and outcome at 2 years in a population of 96 premature babies born after no more than 28 weeks of amenorrhea is described. Mortality was directly influenced by the gestational age (< 26 WA = 52% vs. > or = 26 WA = 21.1%, p < 0.01) and the birth weight (< 1,000 g = 41.5% vs. > 1,000 g = 20%, p < 0.05). Two other factors with a harmful impact were identified: retarded growth (neonatal mortality doubled) and fetal multiplicity (increased fourfold). Investigation of the neonatal morbidity highlights the importance of respiratory, neurological and digestive problems. Assessment of the longer-term outcome has shown an 11.3 p. cent incidence of handicap. An estimation of the prognosis on the basis of gestational age is proposed.

  13. The MCT-ketogenic diet as a treatment option in refractory childhood epilepsy: A prospective study with 2-year follow-up.

    PubMed

    Lambrechts, Danielle A J E; de Kinderen, Reina J A; Vles, Hans S H; de Louw, Anton J; Aldenkamp, Albert P; Majoie, Marian J M

    2015-10-01

    The present study assessed the long-term (i.e., 24months) efficacy of the ketogenic diet (KD) as an add-on therapy in children with refractory epilepsy, with focus on seizure frequency, seizure severity, and tolerability. Most patients were treated with the MCT-diet. At one and two years, 33% and 23%, respectively, of the 48 included patients were still on the KD. After three months, one year, and two years of treatment, 16.7% of the patients were responders. The highest responder rate (i.e., 22.9%) was seen at six and nine months of treatment. Of the fifteen patients with seizure clusters during baseline, 60% were responders after three months when looking at cluster reduction and most of them were not responders for the total seizure frequency. From three months of treatment onwards, most of the patients had a relevant decrease in seizure severity which was mainly related to the most severe seizure type. Gastrointestinal dysfunction was often reported, especially in the first six weeks of treatment. Growth deceleration was present in 30% of the patients, and weight reduction in 15%. Improved arousal was mentioned in 30% of patients. No patients developed ECG abnormalities or kidney stones. Increase in lipid profile was rare. The KD is an effective therapy for children with therapy-resistant epilepsy. Effectiveness is reflected in the reduction of seizure frequency as well as in the reduction of seizure severity. After 6months of treatment, it is obvious which patients are responders and tolerate the treatment well. Most of these patients will continue to benefit from the KD for a longer time. Long-term use of the diet was well tolerated.

  14. Motor recovery of stroke patients after rehabilitation: one-year follow-up study.

    PubMed

    Kuptniratsaikul, Vilai; Kovindha, Apichana; Suethanapornkul, Sumalee; Massakulpan, Pornpimon; Permsirivanich, Wutichai; Kuptniratsaikul, Patcharawimol Srisa-An

    2017-01-01

    Purpose To investigate motor recovery of stroke patients 1 year after rehabilitation. Materials and Methods A cross-sectional study of 192 stroke patients discharged from rehabilitation wards in nine tertiary hospitals was conducted. Motor recovery was assessed using the Brunnstrom motor recovery stages (BMRS), at 6 and 12 months after discharge. Factors related to the BMRS of the hand, arm and leg were analyzed. Results The mean age of patients was 62.2 years (57.3% male). Significantly more patients presented improvement of at least one BMRS of the hand, arm and leg compared with those with decreasing BMRS (p < 0.001). The percentage of patients with BMRS III- VI at 6 months was greater than that at discharge, but the recovery at 12 months was slightly higher than that at 6 months. It seems that motor recovery from stroke was near maximal at six months. Regarding the factors related to motor recovery, only lengths of stay (LOS) <30 d during the first admission and Barthel index at discharge ≥10 were related to the improvement of BMRS of the hand, arm and leg on multivariate analysis. Additionally, no complication at discharge was associated with the improvement of BMRS of the leg. Conclusions Approximately half of our stroke patients had motor improvement of at least one stage of BMRS at one year. Motor recovery after stroke at the end of the first year was associated with shorter LOS during the first admission, higher discharge Barthel index score and absence of complications at discharge.

  15. [Results of follow-up of operations in pediatric patients with indirect inguinal hernia].

    PubMed

    Hecker, W C; Ring-Mrozik, E

    1987-01-01

    This paper present the results of follow-up examinations of 2801 operated inguinal hernias. In comparison with the high excision of the hernial sac plus "crude suture", the standard Bassini technique produces poorer results as regards recurrence, testicular atrophy and secondary maldescent. The mortality of elective herniotomy was 0.016% in this series.

  16. The Sexual Adjustment of Coronary Bypass Surgery Patients: A 4-Year Follow-Up.

    ERIC Educational Resources Information Center

    Thurer, Shari; Thurer, Robert L.

    1983-01-01

    Measured the sexual adjustment of 14 individuals before coronary bypass surgery and both four months and four years afterwards. Results showed that sexual adjustment worsened with the onset of symptomatic coronary artery disease and did not improve at either follow-up interval. (LLL)

  17. Follow-up of Disabled Patients Discharged from a Rehabilitation Center

    ERIC Educational Resources Information Center

    Brodwin, Martin G.

    1976-01-01

    This article reports on a follow-up survey of disabled individuals discharged from an aftercare hospital residence program, who had begun a program for independent living to support their vocational development. Measures of independent behavior were related to client independence after discharge from the rehabilitation setting. (Author)

  18. Risk Factors of Loss to Follow up Among HIV Positive Pediatric Patients in Dar es Salaam, Tanzania

    PubMed Central

    MCCORMICK, Nora M.; LI, Nan; SANDO, David; MUYA, Aisa; MANJI, Karim P.; KISENGE, Rodrick; DUGGAN, Christopher; CHALAMILLA, Guerino; FAWZI, Wafaie W.; SPIEGELMAN, Donna

    2015-01-01

    Objective To identify risk factors for loss to follow up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania between 2004 and 2011. Design Longitudinal analysis of 6236 HIV-infected children. Methods We conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to risk of LTFU was examined using a Cox proportional hazards model. Results 2130 children (34%) were LTFU over a median follow up of 16.7 months (IQR, 3.4–36.9). Factors independently associated with a higher risk of LTFU were age 2 years (RR=1.59, 95% CI 1.40–1.80), diarrhea at enrollment (RR=1.20, 95% CI 1.03–1.41), a low mid-upper arm circumference for age (RR=1.20, CI 1.05–1.37), eating protein 3 times a week (RR=1.39, 95% CI 1.05–1.90), taking cotrimoxazole (RR=1.39, 95% CI 1.06–1.81), initiating onto antiretrovirals (RR=1.37, 95% CI 1.17–1.61), receiving treatment at a hospital instead of a local facility (RR=1.39, 95% CI 1.06–1.41), and starting treatment in 2006 or later (RR=1.10, 95% CI 1.04–1.16). Conclusions Health workers should be aware of pediatric patients who are at greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals. PMID:26247894

  19. Application of Regent mechanical valve in patients with small aortic annulus: 3-year follow-up

    PubMed Central

    2012-01-01

    Background Aortic valve replacement (AVR) with a small aortic annulus is always challenging for the cardiac surgeon. In this study, we sought to evaluate the midterm performance of implantation with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve in retrospective consecutive cohort of patients with small aortic annulus (diameter ≤ 19 mm). Methods From January 2008 to April 2011, 40 patients (31 female, mean age = 47.2 ± 5.8 years) with small aortic annulus (≤19 mm in diameter) underwent aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve. Preoperative mean body surface area, New York Heart Association class, and mean aortic annulus were 1.61 ± 0.26 m2, 3.2 ± 0.4, and 18 ± 1.4 mm respectively. Patients were divided into two groups, according to the implantation of 17 mm SJM Regent mechanical valve (group 1, n = 18) or 19 mm SJM Regent valve (group 2, n = 22). All patients underwent echocardiography examination preoperatively and at one year post-operation. Results There were no early deaths in either group. Follow-up time averaged 36 ± 17.6 months. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p < 0.001). By echocardiography, in group 1, the left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), and the indexed effective orifice area (EOAI) increased from 43.7% ± 11.6%, 27.3% ± 7.6%, and 0.70 ± 0.06 cm2/m2 to 69.8 ± 9.3%, 41.4 ± 8.3%, and 0.92 ± 0.10 cm2/m2 respectively (P < 0.05), while the left ventricular mass index (LVMI), and the aortic transvalvular pressure gradient decreased from 116.4 ± 25.4 g/m2, 46.1 ± 8.5 mmHg to 86.7 ± 18.2 g/m2 , 13.7 ± 5.2 mmHg respectively. In group 2, the LVEF, LVFS and EOAI increased from 45.9% ± 9.7%, 30.7% ± 8.0%, and 0.81 ± 0.09 cm2/m2 to 77.4%

  20. Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya.

    PubMed

    House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E

    2015-01-01

    Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

  1. Bilateral Leg Replantation in a 3-Month-Old Baby After a Knee Level Crush Amputation-A 2-Year Follow-up.

    PubMed

    Bulic, Kresimir; Antabak, Anko; Dujmovic, Anto; Kisic, Hrvoje; Lorencin, Mia

    2017-03-01

    We present a case of a successful bilateral leg replantation in a 3-month-old baby after a knee-level crush amputation with the loss of both knee joints. The legs were replanted after 4 hours of warm and an additional 2.5 and 3.5 hours of cold ischemia time. Both legs show motor and sensory reinnervation, without additional procedures performed on the right leg, and after a nerve reconstruction with cadaveric allografts on the left leg. Both replanted legs exhibit excellent bony and soft tissue growth. Two years after the injury, the patient is progressing well with rehabilitation, with favourable odds of having knee reconstructions performed at a later age. This is the youngest patient reported to have had successful replantation of both legs.

  2. Physical activity on prescription (PAP): self-reported physical activity and quality of life in a Swedish primary care population, 2-year follow-up

    PubMed Central

    Rödjer, Lars; H. Jonsdottir, Ingibjörg; Börjesson, Mats

    2016-01-01

    Objective To study the self-reported level of physical activity (PA) and quality of life (QOL) in patients receiving physical activity on prescription (PAP) for up to 24 months. Design Observational study conducted in a regular healthcare setting. Setting A primary care population in Sweden receiving physical activity on prescription as part of regular care was studied alongside a reference group. Subjects The group comprised 146 patients receiving PAP at two different primary care locations (n = 96 and 50, respectively). The reference group comprised 58 patients recruited from two different primary care centres in the same region. Main outcome measurements We used two self-report questionnaires – the four-level Saltin-Grimby Physical Activity Level Scale (SGPALS) to assess physical activity, and SF-36 to assess QOL. Results A significant increase in the PA level was found at six and 12 months following PAP, with an ongoing non-significant trend at 24 months (p = .09). A clear improvement in QOL was seen during the period. At 24 months, significant and clinically relevant improvements in QOL persisted in four out of eight sub-scale scores (Physical Role Limitation, Bodily Pain, General Health,Vitality) and in one out of two summary scores (Physical Component Summary). Conclusion Patients receiving PAP showed an increased level of self-reported PA at six and 12 months and improved QOL for up to 24 months in several domains. The Swedish PAP method seems to be a feasible method for bringing about changes in physical activity in different patient populations in regular primary healthcare. While increased physical activity (PA) is shown to improve health, the implementation of methods designed to increase activity is still being developed. Key points The present study confirms that the Swedish physical activity on prescription (PAP) method increases the self-reported level of PA in the primary care setting at six and 12 months. Furthermore, this study shows

  3. Overgeneral autobiographical memory at baseline predicts depressive symptoms at follow-up in patients with first-episode depression.

    PubMed

    Liu, Yansong; Zhang, Fuquan; Wang, Zhiqiang; Cao, Leiming; Wang, Jun; Na, Aiguo; Sun, Yujun; Zhao, Xudong

    2016-09-30

    Previous studies have shown that overgeneral autobiographical memory (OGM) is a characteristic of depression. However, there are no studies to explore the association between baseline OGM and depressive symptoms at follow-up in patients with first-episode depression (FE). This study investigated whether baseline OGM predicts depressive symptoms at follow-up in patients with FE. We recruited 125 patients with FE. The participants were divided into remitted group and non-remitted group according to the severity of their depression at 12 months follow-up. The measures consisted of the 17-item Hamilton Depression Rating Scale, Ruminative Response Scale, and Autobiographical Memory Test. Hierarchical linear regression analyses and bootstrap mediation analyses were conducted. The results showed that non-remitted patients had more OGM at baseline. Baseline OGM predicted depressive symptoms at follow-up in patients with FE. Rumination mediated the relationship between baseline OGM and depressive symptoms at follow-up. Our findings highlight OGM as a vulnerability factor involved in the maintenance of depression in patients with FE.

  4. Three-year follow-up of lanthanum carbonate therapy in hemodialysis patients.

    PubMed

    Takeuchi, Kazuhisa; Matsuda, Etsuko; Sekino, Makoto; Hasegawa, Yukiko; Kamo, Yoshie; Kikuchi, Natsue; Sekino, Hiroshi

    2013-04-01

    For 3 years following the start of lanthanum carbonate therapy, effects on other pharmaceutical treatment with sevelamer hydrochloride (SH), calcium carbonate (CC), and vitamin D, and those on clinical condition were examined. Dialysis patients with hyperphosphatemia (89 cases; average age 55.2 years; dialysis history of 10 years; 50 male and 39 female), who agreed to start lanthanum carbonate (LC) administration, were observed for a mean period of 32.6 ± 6.2 months. Mean daily dosages of CC and SH before starting LC were 2.68 g and 0.73 g; mean daily dosage amounts of LC, CC, and SH at the time of final evaluation were 0.87 g, 2.30 g, and 0.99 g, respectively. After the application of LC, serum phosphate as well as serum calcium controls were significantly improved, and the amounts of active vitamin D agents applied was significantly increased. In conclusion, LC is useful in managing serum phosphorus levels (P levels), and little incidence of hypercalcemia suggests favorable concomitant use with active vitamin D agents in LC therapy.

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

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

  6. Radiofrequency ablation of numerous premature ventricular contractions in a cardiac resynchronisation therapy patient: a long-term follow-up.

    PubMed

    Farkowski, Michał Mirosław; Chwyczko, Tomasz; Sterliński, Maciej; Syska, Paweł; Szwed, Hanna; Pytkowski, Mariusz

    2013-01-01

    We present a case study of a patient with dilated cardiomyopathy and a cardiac resynchronisation therapy (CRT) device who was repeatedly hospitalised due to heart failure (HF) exacerbations. A successful radiofrequency ablation of numerous premature ventricular contractions enabled the proper action of CRT and stabilised the patient's condition in NYHA II without HF subsequent hospitalisations during a 30 month follow-up.

  7. 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

  8. The use of long leg calipers for paraplegic patients: a follow-up study of patients discharged 1973-82.

    PubMed

    Hawran, S; Biering-Sørensen, F

    1996-11-01

    We reviewed the medical records of 45 paraplegic patients discharged with long leg calipers, during the 10 year period 1973-82, from the Rehabilitation Hospital in Hornbaek, Denmark. A follow-up interview was carried out during 1993-94 for all 40 patients who were still alive. Thirty had complete paraplegia (seven women) and 10 had incomplete paraplegia (two women). At the follow-up interview only three were still using their calipers. The main reasons for giving up the use of calipers was, in 38%, that it was too time consuming to put them on and take them off. For 22% the main reason was a fear of falling, while 19% reported that the calipers were impractical, as their hands had to be occupied in keeping balance and therefore could not be used for other purposes, including carrying items. The three paraplegic patients who did not totally give up the use of long leg calipers used them very little, at a maximum once a week. In contrast all 10 paraplegic patients who had been provided with a standing frame made use of this at least once a month. The majority of the remaining subjects were interested in having a standing frame. We therefore believe that a standing frame could be a good alternative to long leg calipers to facilitate standing for spinal cord injured patients.

  9. Pretreatment sputum smear grade and smear positivity during follow-up of TB patients in Ahmedabad, India.

    PubMed

    Patel, J; Dave, P; Satyanarayana, S; Kumar, A M V; Shah, A; Ananthakrishnan, R; Ratnu, A

    2013-12-21

    In Ahmedabad, India, a retrospective record review was undertaken among 2842 sputum smear-positive tuberculosis patients registered for treatment from April to September 2011 to assess the association of pretreatment sputum smear grade with sputum positivity and the additional yield of a second sputum sample during each follow-up examination. Respectively 39%, 26%, 28% and 7% of patients had pretreatment sputum grade 3+, 2+, 1+ and scanty. The higher the pretreatment sputum grade, the higher the proportion found positive during various follow-up periods. Overall, the additional yield of the second sputum sample was <2%; it did not vary with pretreatment smear grading.

  10. General practice vs surgical-based follow-up for patients with colon cancer: randomised controlled trial

    PubMed Central

    Wattchow, D A; Weller, D P; Esterman, A; Pilotto, L S; McGorm, K; Hammett, Z; Platell, C; Silagy, C

    2006-01-01

    This trial examined the optimal setting for follow-up of patients after treatment for colon cancer by either general practitioners or surgeons. In all, 203 consenting patients who had undergone potentially curative treatment for colon cancer were randomised to follow-up by general practitioners or surgeons. Follow-up guidance recommended three monthly clinical review and annual faecal occult blood tests (FOBT) and were identical in both study arms. Primary outcome measures (measured at baseline, 12 and 24 months were (1) quality of life, SF-12; physical and mental component scores, (2) anxiety and depression: Hospital Anxiety and Depression Scale and (3) patient satisfaction: Patient Visit-Specific Questionnaire. Secondary outcomes (at 24 months) were: investigations, number and timing of recurrences and deaths. In all, 170 patients were available for follow-up at 12 months and 157 at 24 months. At 12 and 24 months there were no differences in scores for quality of life (physical component score, P=0.88 at 12 months; P=0.28 at 24 months: mental component score, P=0.51, P=0.47; adjusted), anxiety (P=0.72; P=0.11) depression (P=0.28; P=0.80) or patient satisfaction (P=0.06, 24 months). General practitioners ordered more FOBTs than surgeons (rate ratio 2.4, 95% CI 1.4–4.4), whereas more colonoscopies (rate ratio 0.7, 95% CI 0.5–1.0), and ultrasounds (rate ratio 0.5, 95% CI 0.3–1.0) were undertaken in the surgeon-led group. Results suggest similar recurrence, time to detection and death rates in each group. Colon cancer patients with follow-up led by surgeons or general practitioners experience similar outcomes, although patterns of investigation vary. PMID:16622437

  11. Discharge huddle outfitted with mobile technology improves efficiency of transitioning stroke patients into follow-up care.

    PubMed

    Tielbur, Brittany R; Rice Cella, Donna E; Currie, Amanda; Roach, Jonathan D; Mattingly, Bryan; Boone, Jack; Watwood, Christina; McGauran, Ann; Kirshner, Howard S; Charles, P David

    2015-01-01

    Disjointed patient care is a well-documented problem in health care systems, often stemming from poor communication between providers, services, and follow-up care resources. A multidisciplinary discharge huddle, augmented with cellular and tablet technology, was implemented on the Neurology Stroke Service to facilitate multidisciplinary communication, improve transition of patients, and increase referrals into affiliated follow-up care. After initiating the huddle, patient length of stay decreased by 1.4 days (25%), patient flow into continuum partners increased by 10%, and the number of patients going without services after their hospital stay decreased by more than 12%. Huddle members reported that the technology was helpful, heavily utilized, and made their work more efficient. This pilot suggests that utilizing modern mobile technologies can help improve efficiency and referrals within the health care system and reduce patient length of stay.

  12. Proposal for management and dermoscopy follow-up of nevi in patients affected by oculocutaneous albinism type Ia

    PubMed Central

    Peralta, Rosario; Sabban, Emilia Cohen; Friedman, Paula; Marcucci, Carolina; Bollea Garlatti, Luis A.; Galimberti, Gastón; Cabo, Horacio

    2017-01-01

    Albino patients are at great risk for developing cutaneous neoplasms, including melanomas. In this paper we describe the dermatoscopic findings of nevi in two patients with oculocutaneous albinism type Ia (OCA-Ia) highlighting that they manifest a vascular pattern similar to that described for amelanotic melanoma. We propose managing these patients with dermoscopy, using the comparative approach, digital follow up (DFU), and reflectance confocal microscopy as a complementary tool for difficult cases. PMID:28243493

  13. Systemic and pulmonary screening of patients with Behçet's disease during periodic follow-up.

    PubMed

    Bilgin, Gulden; Sungur, Gulten; Kucukterzi, Vildan

    2013-03-01

    Behçet's disease (BD) is a multisystemic disease that may involve all systems, the most common symptoms being oral and genital ulcerations and ocular involvement. Pulmonary involvement is not usually investigated in BD unless there is a specific complaint. In this study, pulmonary parameters and findings were investigated in BD patients at periodic follow-ups. A total of 112 subjects with a definitive diagnosis of BD from the Ocular Diseases Polyclinic, Behçet Disease Center, Ankara Training and Research Hospital and who had been referred to the Thoracic Diseases Polyclinic between January-October 2010 were evaluated. In the patients, the absence of active smoking, pregnancy, lactation and systemic steroid use were especially considered. A total of 112 patients between 14 and 61 years-old (53 male, 59 female) were enrolled in the study. The duration of follow-up varied between 1 and 22 years. The most commonly encountered symptom was hemoptysis observed in 18 subjects. 43 patients had mild obstruction, 9 patients had moderate obstruction, 4 patients had advanced obstruction and 4 patients showed restrictive alterations. Thoracic CT was normal for 83 subjects. Pulmonary involvement was observed as a pulmonary artery aneurysm in 4 patients and was treated. In BD, although anyone of PFT and CT values is normal, others may show pathological values. We believe that it would be useful in the follow-up to keep a regular record of the patient data and to perform PFT and, if possible, CT periodically.

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

    PubMed

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

    2013-12-01

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

  15. Surgical Correction in Patients with Lumbar Degenerative Kyphosis Who Had Low Bone Mineral Density: An Analysis of 40 Patients with a Minimum Follow-Up of Two Years

    PubMed Central

    Kim, Ki Tack; Lee, Sang Hun; Huh, Dae Seok; Son, Eun Seok

    2015-01-01

    Study Design Retrospective study. Purpose To investigate influence of bone mineral density (BMD) on the surgical correction of lumbar degenerative kyphosis (LDK). Overview of Literature No studies so far have reported the influence of BMD on the surgical correction of LDK. Methods Forty LDK patients with more than 2 years follow-up were studied. Pelvic incidence (PI), pelvic tilt, sacral slope, sagittal vertical axis (SVA), lumbar lordosis (LL), and thoracic kyphosis were measured preoperatively, immediate postoperatively and at final follow-up. Adverse outcomes: proximal adjacent fractures, sagittal decompensation, pseudoarthrosis, and cage subsidence were documented. Results There were 37 females and 3 males. Average age was 65.1±4.5 years and mean follow-up was 34.2±16.7 months. 42.5% were Takemitsu type 3 curves, 27.5% type 2, 20.0% type 4 and 10.0% type 1. 37.5% had osteopenia, 40.0% osteoporosis and 22.5% had severe osteoporosis. SVA improved from 237.0±96.7 mm preoperatively to 45.3±41.8 mm postoperatively (p=0.000). LL improved from 10.5°±14.7° to -40.6°±10.9° postoperatively (p=0.000). At final follow-up SVA deteriorated to 89.8±72.2 mm and LL to 34.7°±15.8° (p=0.000). The association between late sagittal decompensation, pseudoarthrosis, or proximal adjacent fractures and osteoporosis was insignificant. The difference between immediate postoperative LL and PI (PIDiff) had a significant association with sagittal decompensation and pseudoarthrosis. Conclusions Osteoporosis did not influence the degree of correction, late sagittal decompensation, proximal adjacent fractures, and pseudoarthrosis in LDK. PIDiff had a significant association with sagittal decompensation and pseudoarthrosis. PMID:25705337

  16. Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services

    PubMed Central

    Tang, Shangfeng; Bishwajit, Ghose; Ji, Lu; Feng, Da; Fang, Haiqing; Fu, Hang; Shao, Tian; Shao, Piaopiao; Liu, Chunyan; Feng, Zhanchun; Luba, Tegene R.

    2016-01-01

    Abstract Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS. A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg) Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56–3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively. Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients. PMID:27057859

  17. Mobile phone-based telemedicine system for the home follow-up of patients undergoing ambulatory surgery.

    PubMed

    Martínez-Ramos, Carlos; Cerdán, María Teresa; López, Rodrigo S

    2009-01-01

    A pilot study was done to address the efficacy of a General Packet Radio Service mobile phone-based telemedicine system used to improve follow-up after ambulatory surgery. The method involves sending images of surgical wounds or other areas from the patient's home, to assess local complications and avoid unnecessary hospital visits. Ninety-six (N = 96) patients were enrolled in the study. The phone used was a Nokia 6600, which provides images in Joint Photographic Experts Group format. These images were sent via e-mail and visualized on a standard 17-inch screen of a personal computer. After the follow-up period, self-reported patient satisfaction was assessed by analyzing the replies to a 9-item questionnaire. Thirty of the 96 patients (31.3%) reported local problems including: hematoma in 20 (66.7%) patients, surgical bandage blood-stained in 7 (23.3%), exudates in 1 (3.3%), allergic skin reactions in 1 (3.3%), and bandage too tight in 1 (3.3%). In total, 225 photographs were evaluated by 3 physicians. In all cases, it was possible to identify and assess the postoperative problem with consensus among the 3 physicians. Images served to resolve patients' concerns in 20 individuals (66.7%). In 10 patients (33.3%), concerns were satisfied but it was suggested that follow-up images be sent in the following days. Only 1 patient (3.3%) was asked to visit the hospital. The telemedicine system proposed increases the efficiency of home follow-up to ambulatory surgery, avoids unnecessary hospital visits, and clearly improves patient satisfaction.

  18. Family Physician Involvement in Cancer Care Follow-up: The Experience of a Cohort of Patients With Lung Cancer

    PubMed Central

    Aubin, Michèle; Vézina, Lucie; Verreault, René; Fillion, Lise; Hudon, Éveline; Lehmann, François; Leduc, Yvan; Bergeron, Rénald; Reinharz, Daniel; Morin, Diane

    2010-01-01

    PURPOSE There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician’s involvement in their follow-up at the different phases of cancer. METHODS In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician’s involvement in cancer care. RESULTS Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care. CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up. PMID:21060123

  19. Predictors of loss to follow-up in antiretroviral treatment for adult patients in the Oromia region, Ethiopia

    PubMed Central

    Megerso, Abebe; Garoma, Sileshi; Eticha, Tolosa; Workineh, Tilaye; Daba, Shallo; Tarekegn, Mihretu; Habtamu, Zelalem

    2016-01-01

    Purpose It is known that antiretroviral treatment (ART) reduces mortality from acquired immunodeficiency syndrome related causes. Patient’s lost to follow-up (LTFU) in this treatment poses a paramount problem to the public and health care services. Information on predictors of loss to follow-up is scarce in this study area and similar settings. Therefore, this study aimed at identifying correlates of loss to follow-up in ART among adult patients in the Oromia region of Ethiopia. Methods A case–control study was conducted between February 2015 and April 2015 using medical records. The stratified sampling technique was used to select health facilities. The number of patient records to be included in the study was proportionally allocated to each stratum based on their patient proportion in the regional data. Specific health facilities from which to include the records were randomly selected from a list of the health facilities per stratum. All adult patient records registered as LTFU (416) in the selected health facilities during the 12-month period prior to the data collection date, and 832 patients with good adherence to ART were included. Data were double-entered into Epi Info 7 and analyzed using SPSS 20. Descriptive statistics and binary logistic regression were used to report the results. Qualitative data were thematically analyzed using open code computer software. Results Age 15–24 years (adjusted odds ratio [AOR], 19.82 95% CI: 6.80, 57.73); day laborers (AOR, 5.36; 95% confidence interval [CI]: 3.23, 8.89), rural residents (AOR, 2.35; 95% CI: 1.45, 3.89), World Health Organization clinical stage IV (AOR, 2.29; 95% CI: 1.45, 3.62), baseline CD4 <350 cells/mL (AOR, 2.06; 95% CI: 1.36, 3.13), suboptimal adherence to ART (AOR, 7.42; 95% CI: 1.87, 29.41), were factors which increased the risk of loss to follow-up in ART. Conclusion Multiple risk factors, both socioeconomic and clinical, were associated with loss to follow-up. Attention is required to

  20. What Women Want: Patient Recommendations for Improving Access to Breast and Cervical Cancer Screening and Follow-up

    PubMed Central

    Ragas, Daiva M.; Nonzee, Narissa J.; Tom, Laura S.; Phisuthikul, Ava M.; Luu, Thanh Ha; Dong, XinQi

    2016-01-01

    BACKGROUND The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net. METHODS Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers (FQHCs), free clinics, or an academic cancer center in the Chicago metropolitan area. FINDINGS Of the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient-provider and patient-clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines. CONCLUSIONS This exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change. PMID:25213744

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

    PubMed

    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.

  2. 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.

  3. Multiple copies of RUNX1: description of 14 new patients, follow-up, and a review of the literature.

    PubMed

    Pérez-Vera, Patricia; Montero-Ruíz, Oreth; Frías, Sara; Rivera-Luna, Roberto; Valladares, Adán; Arenas, Diego; Paredes-Aguilera, Rogelio; Carnevale, Alessandra

    2008-01-15

    RUNX1 over-representation is present in children with acute lymphoblastic leukemia. Although these cases have been related with poor outcome, not all reports describe patient follow-up. To understand its associated clinical features and prognosis, we report on 14 children with ALL and RUNX1 over-representation with laboratory data and outcomes compared to previous reports. Eighty-six children with RUNX1 over-representation have been described, including the 14 patients of this study. Most of them are between 6 and 15 years of age, have low leukocyte counts, pre-B immunophenotype, and three to eight RUNX1 copies. Of the 69 patients with follow-up data, 21 of them relapsed or died, suggesting that RUNX1 over-representation is associated to a poor outcome.

  4. Extracranial Carotid Artery Stenting in Surgically High-Risk Patients Using the Carotid Wallstent Endoprosthesis:Midterm Clinical and Ultrasound Follow-Up Results

    SciTech Connect

    Maleux, Geert Bernaerts, Pauwel; Thijs, Vincent; Daenens, Kim; Vaninbroukx, Johan; Fourneau, Inge; Nevelsteen, Andre

    2003-08-15

    The purpose of this study was to evaluate the feasibility, safety and midterm outcome of elective implantation of the Carotid Wallstent (registered) in patients considered to be at high surgical risk. In a prospective study, 54 carotid artery stenoses in 51 patients were stented over a 24-month period. Three patients underwent bilateral carotid artery stenting. Institutional inclusion criteria for invasive treatment of carotid occlusive disease (carotid endarterectomy or carotid artery stenting) are patients presenting with a 70% or more symptomatic stenosis and those with an 80% or more asymptomatic stenosis having a life-expectancy of more than 1 year. All patients treated by carotid artery stenting were considered at high risk for carotid endarterectomy because of a hostile neck (17 patients-31.5%) or because of severe comorbidities (37 patients-68.5%). No cerebral protection device was used. Of the 54 lesions, 33 (61.1%) were symptomatic and 21 (38.8%) were asymptomatic. Follow-up was performed by physical examination and by duplex ultrasonography at 1 month, 6 months, 1 year and 2 years after the procedure. All 54 lesions could be stented successfully without periprocedural stroke. Advert events during follow-up (mean 13.9 {+-} 5.7 months) were non-stroke-related death in 6 patients (11.1%), minor stroke in 4 stented hemispheres(7.4%), transient ipsilateral facial pain in 1 patient (1.8%),infection of the stented surgical patch in 1 patient (1.8%) and asymptomatic in stent restenosis in 4 patients (7.4%). The percutaneous implantation of the Carotid Wallstent (registered) , even without cerebral protection device, appears to be a safe procedure with acceptable clinical and ultrasonographic follow-up results in patients at high surgical risk. But some late adverse events such as ipsilateral recurrence of non-disabling (minor) stroke or in stent restenosis still remain real challenging problems.

  5. Acute fatty liver of pregnancy: Over six months follow-up study of twenty-five patients

    PubMed Central

    Xiong, Hao-Feng; Liu, Jing-Yuan; Guo, Li-Min; Li, Xing-Wang

    2015-01-01

    AIM: To evaluate the prognosis of patients with acute fatty liver of pregnancy (AFLP) 6 mo or longer after discharge. METHODS: The records of pregnant patients diagnosed with AFLP at Beijing Ditan Hospital over a 16-year period were reviewed in November 2012. Patients were monitored using abdominal ultrasound, liver and kidney functions, and routine blood examination. RESULTS: A total of 42 patients were diagnosed with AFLP during the study period, and 25 were followed. The mean follow-up duration was 54.5 mo (range: 6.5-181 mo). All patients were in good physical condition, but one patient had gestational diabetes. The renal and liver functions normalized in all patients after recovery, including in those with pre-existing liver or kidney failure. The ultrasound findings were normal in 12 patients, an increasingly coarsened echo-pattern and increased echogenicity of the liver in 10 patients, and mild to moderate fatty liver infiltration in 3 patients. Cirrhosis or liver nodules were not observed in any patient. CONCLUSION: Acute liver failure and acute renal failure in AFLP patients is reversible. Patients do not require any specific long-term follow-up after recovery from AFLP if their liver function tests have normalized and they remain well. PMID:25684961

  6. Correlation of baseline hormonal disorders with immunological failure and mortality in male HIV patients during follow-up

    PubMed Central

    Wen, Ying; Ding, Hai bo; Chen, Wei; Zhou, Ying; Wang, Wen; Wang, Yu; Lu, Xu; Liu, Jing; Kang, Jing; Geng, Wenqing; Shang, Hong; Liu, Pei

    2016-01-01

    Abstract To assess the effect that hormonal disturbances have on HIV prognosis in male patients. A prospective follow-up study was conducted among male HIV patients who started antiretroviral therapy (ART) between July 1, 2011 and June 30, 2014. The final follow-up session occurred before December 31, 2014. We examined the correlation between pre-ART hormone levels and disease prognosis. The Kaplan–Meier method and the multivariate Cox proportional hazard model were used to identify hormone-related predictors of immunological failure and mortality. During the follow-up of 163 male HIV patients, mortality rate occurred at a rate of 16.0% (26/163). Of these deaths, 84.6% (22/26) were acquired immunodeficiency syndrome–related. Furthermore, 53 patients were found to have suffered from immunological failure. Both pre-ART CD4+ T cell counts and the clinical stage assigned to the patients correlated strongly with dehydroepiandrosterone sulfate levels. Hyponatremia, high cortisol levels, tuberculosis, and being at World Health Organization (WHO)-defined clinical stage 4 were characteristics that associated significantly with mortality. Being at WHO clinical stage 4 was, itself, a factor that significantly associated with immunological failure. High cortisol levels were found to be an important hormonal disorder that associated with mortality. None of the hormones examined in this study had a strong correlation with immunological failure. PMID:28033281

  7. Patient Satisfaction and Surgeon Experience: A Follow-Up to the Reduction Mammaplasty Learning Curve Study

    PubMed Central

    Carty, Matthew J.; Duclos, Antoine; Gu, Xiangmei; Elele, Nkemdiche; Orgill, Dennis

    2012-01-01

    Background: While it is known that increasing surgeon experience is correlated with improved efficiency and safety in the reduction mammaplasty procedure, it is unclear whether these improvements lead to an erosion in patient satisfaction. Methods: The authors distributed the Breast-Q questionnaire to all patients who underwent bilateral reduction mammaplasty at their institution between 1995 and 2007. Univariate and multivariate analyses were performed to assess the relationship between postoperative patient satisfaction scores and surgeon experience, as well as to characterize those patients with particularly high or low satisfaction scores, in general. Results: A total of 279 (26.1%) completed surveys were analyzed. No statistically significant erosion in either Satisfaction with Breasts (SWB) or Satisfaction with Outcomes (SWO) scores were witnessed with increasing surgeon experience or efficiency. Patients older than 40 years demonstrated significantly higher SWB scores than younger patients (P = .004), while patients who suffered postoperative soft tissue necrosis demonstrated significantly lower SWB (P = .003) and SWO (P = .010) scores. Conclusions: Gains in operative efficiency with increasing surgeon experience do not appear to come at the expense of patient satisfaction in the reduction mammaplasty procedure. Younger patients and those who experience postoperative soft tissue necrosis appear to be at higher risk for reporting lower postoperative patient satisfaction scores. PMID:22582119

  8. [Rehabilitation standards for follow-up treatment and rehabilitation of patients with ventricular assist device (VAD)].

    PubMed

    Willemsen, Detlev; Cordes, C; Bjarnason-Wehrens, B; Knoglinger, E; Langheim, E; Marx, R; Reiss, N; Schmidt, T; Workowski, A; Bartsch, P; Baumbach, C; Bongarth, C; Phillips, H; Radke, R; Riedel, M; Schmidt, S; Skobel, E; Toussaint, C; Glatz, J

    2016-03-01

    The increasing use of ventricular assist devices (VADs) in terminal heart failure patients provides new challenges to cardiac rehabilitation physicians. Structured cardiac rehabilitation strategies are still poorly implemented for this special patient group. Clear guidance and more evidence for optimal modalities are needed. Thereby, attention has to be paid to specific aspects, such as psychological and social support and education (e.g., device management, INR self-management, drive-line care, and medication).In Germany, the post-implant treatment and rehabilitation of VAD Patients working group was founded in 2012. This working group has developed clear recommendations for the rehabilitation of VAD patients according to the available literature. All facets of VAD patients' rehabilitation are covered. The present paper is unique in Europe and represents a milestone to overcome the heterogeneity of VAD patient rehabilitation.

  9. Follow-up and diagnostic reappraisal of 75 patients with Leber's congenital amaurosis.

    PubMed

    Lambert, S R; Kriss, A; Taylor, D; Coffey, R; Pembrey, M

    1989-06-15

    We reexamined 75 children in whom Leber's congenital amaurosis had been previously diagnosed. On review, 30 of these patients had an ocular or systemic disorder other than Leber's congenital amaurosis. The most common of these revised diagnoses were congenital stationary night blindness, achromatopsia, infantile-onset retinitis pigmentosa, Joubert's syndrome, Zellweger syndrome, and infantile Refsum's disease. Of the 45 patients with Leber's congenital amaurosis, mental retardation occurred in six patients, and visual deterioration in six patients. Leber's congenital amaurosis should only be diagnosed if other known ocular and systemic disorders have been carefully excluded.

  10. [Quality assurance with administrative data (QSR): follow-up in quality measurement - an analysis of patient records].

    PubMed

    Jeschke, Elke; Günster, Christian; Klauber, Jürgen

    2015-01-01

    The present study analyses the information gain obtained by evaluating adverse events during follow-up compared to the sole analysis of events during the initial hospital stay for quality measurement purposes. The analysis is based on AOK administrative data from the years 2010 to 2012. The analyses were carried out for 10 quality indicators from the 4 QSR sectors knee replacement for osteoarthritis, appendectomy, prostate surgery for benign prostatic syndrome (BPS) and therapeutic cardiac catheterization (PCI) in patients with myocardial infarction. A total of 409,774 AOK cases were included. For almost all indicators considered, a relevant share of complications can be found to have occurred only after discharge from the initial hospitalization (7.7 %-92.6 %). Furthermore, there is only a weak connection between the findings from the first hospitalization and those from the follow-up period (0.0449 < r < 0.1935). 26-66 % of the hospitals will be classified differently based on Standardized Mortality/Morbidity Ratio (SMR) quartiles if follow-up events are included in the quality assessment (with the exception of "Other Complications after PCI" of 14 %). In summary, quality assessment is improved considerably by evaluating the follow-up period for almost all indicators considered. A quality measurement based solely on events in the initial hospital stay obscures relevant adverse events that have an impact on a comparative hospital quality assessment for these indicators.

  11. Illness perception of dropout patients followed up at bipolar outpatient clinic, Turkey.

    PubMed

    Oflaz, Serap; Guveli, Hulya; Kalelioglu, Tevfik; Akyazı, Senem; Yıldızhan, Eren; Kılıc, Kasım Candas; Basyigit, Sehnaz; Ozdemiroglu, Filiz; Akyuz, Fatma; Gokce, Esra; Bag, Sevda; Kurt, Erhan; Oral, Esat Timucin

    2015-06-01

    Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance.

  12. Management of Sjogren's Syndrome Patient: A Case Report of Prosthetic Rehabilitation with 6-Year Follow-Up

    PubMed Central

    de Mendonça Invernici, Marcos; Vale Nicolau, Gastão; Naval Machado, Maria Ângela; Soares de Lima, Antônio Adilson

    2014-01-01

    Completely and partially edentulous patients with Sjogren's syndrome (SS) experience severe hyposalivation, xerostomia, and considerable difficulty in using tissue-supported prosthesis. This clinical paper describes the management, treatment, and 6-year follow-up of a patient diagnosed with SS type II, who uses corticosteroids and antihyperglycemic drugs. The patient received restorative, periodontal, and surgical treatments followed by implant-supported fixed prosthesis. Radiographic evaluation and probing depth showed gingival health and no bone loss after 6 years. Treatment with implant-retained dental prosthesis greatly increased comfort and function, offering an alternative to patients with SS. PMID:25478245

  13. [Update on the morbidity of psychiatric disorders in patients with AIDS: results of a clinical follow-up].

    PubMed

    Crespo, M D; Ochoa, E; Vicente, N; Pérez de los Cobos, J; Morales, P

    1990-01-01

    A follow-up study after one or two years of treatment was carried out on 107 AIDS patients who were seen by the Consultation-Liaison Psychiatry Unit of the Ramon y Cajal Hospital. The sample was reduced to 52 patients (49%) mainly due to the lack of check-ups in 43% and to the death of 8% of the cases. 36% of patients suffered from Delirium or Dementia and these had the greater mortality rate. Grade IV patients and those with a diagnosis of Adjustment Disorders came to the check-ups most frequently.

  14. Surgical treatment of inflammatory abdominal aortic aneurysms: a long-term follow-up of 19 patients.

    PubMed

    Railo, Mikael; Isoluoma, Martti; Keto, Pekka; Salo, Jarmo A

    2005-05-01

    The prevalence of inflammatory abdominal aortic aneurysms (IAAA) in autopsy material ranges between 2.5 and 10% of all aneurysms. Clinical findings, the distinction between inflammatory and degenerative aneurysms, and epidemiological data are uncertain, and only a few long-term follow-up studies of patients after surgical treatment of IAAAs exist. In this study, 19 patients underwent either emergency or elective surgery for IAAA during the 10-year period between 1983 and 1993 at Helsinki University Central Hospital. Demographics, symptoms, and operative and follow-up data were collected retrospectively with emphasis on the long-term outcome of IAAA. Causes of late death were available from hospital records and the central statistical office of Finland. For survival analysis we compared ruptured versus nonruptured and emergency versus elective cases of IAAAs. Mean follow-up for the 18 surviving patients (1 hospital death) was 7.4 years. One patient (5%) died of a long-term complication of the aneurysmal disease. There was no statistically significant difference in survival rates for emergency versus elective surgery cases or ruptured versus nonruptured aneurysms. The most common cause of late death was myocardial infarction. The hospital stay mortality (5%) and morbidity (31%), and the survival rate of 26% at 5 years for ruptured and 65% and 43% for nonruptured IAAAs at 5 years and 10 years, respectively, are comparable to normal AAA survival rates. These findings show that surgery is recommended, especially as ruptures also occur in this subgroup of aneurysms.

  15. The evaluation of QT intervals during diagnosis and after follow-up in acromegaly patients.

    PubMed

    Baser, Husniye; Akar Bayram, Nihal; Polat, Burcak; Evranos, Berna; Ersoy, Reyhan; Bozkurt, Engin; Cakir, Bekir

    2014-01-01

    Introdução: O estudo teve como objectivo a determinação do intervalo QT em doentes com acromegália e a análise da correlação entre o intervalo QT e a concentração de hormona do crescimento e de IGF-1 (insulin-like growth factor-1). Material e Métodos: O estudo englobou 41 doentes com acromegália. O grupo de controlo englobou 41 indivíduos com características semelhantes no que se refere a comorbilidades, idade e género. A electrocardiografia de doentes com acromegália foi obtida no início do estudo e após o follow-up. Foi apenas obtido um electrocardiograma no grupo de controlo. Foram calculados o QT máximo, QT mínimo, dispersão do intervalo QT, QT máximo corrigido, QT mínimo corrigido e dispersão do intervalo QT corrigido. Resultados: Os valores do QT máximo basal, dispersão do intervalo QT, QT máximo corrigido e dispersão do QT corrigido foram significativamente mais prolongados no grupo de doentes com acromegália do que nos controlos. O QT máximo corrigido e a dispersão do QT corrigido foram significativamente mais curtos durante o seguimento clínico, quando comparados com os valores basais dos doentes. O QT máximo, dispersão do QT, QT máximo corrigido e dispersão do QT corrigido durante o seguimento clínico não foram estatisticamente diferentes dos valores obtidos nos controlos. Com excepção de uma correlação negativa entre os valores da hormona do crescimento e a dispersão do QT corrigido em doentes durante o seguimento clínico, nenhuma outra correlação foi assinalada entre os valores do intervalo QT e as concentrações de hormona do crescimento e de IGF-1. Concluiu-se que a dispersão do intervalo QT está correlacionada com a duração da doença nos doentes com acromegália. Discussão: Em doentes com acromegália, é importante a detecção de preditores clínicos de arritmia cardíaca. A dispersão do intervalo QT é considerada um preditor relevante de arritmias ventriculares. Os doentes com acromeg

  16. Adrenal Function Status in Patients with Paracoccidioidomycosis after Prolonged Post-Therapy Follow-Up

    PubMed Central

    Tobón, Angela M.; Agudelo, Carlos A.; Restrepo, Carlos A.; Villa, Carlos A.; Quiceno, William; Estrada, Santiago; Restrepo, Angela

    2010-01-01

    This study assessed adrenal function in patients with paracoccididioidomycosis who had been treated to determine a possible connection between high antibody titers and adrenal dysfunction attributable to persistence of the fungus in adrenal gland. Adrenal gland function was studied in 28 previously treated patients, 2 (7.1%) of whom were shown to have adrenal insufficiency and 7 (259%) who showed a below normal response to stimuli by adrenocorticotropic hormone. Paracoccidioides brasiliensis was detected in the adrenal gland from one of the patients with adrenal insufficiency. Although the study failed to demonstrate a significant difference between high antibody titers and low cortisol levels, the proportion of adrenal insufficiency detected and the subnormal response to adrenocorticotropic hormone confirmed that adrenal damage is an important sequela of paracoccidioidomycosis. Studies with a larger number of patients should be conducted to confirm the hypothesis of persistence of P. brasiliensis in adrenal gland after therapy. PMID:20595488

  17. Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain.

    PubMed

    Hidalgo, M; Álvarez, R; Gallego, J; Guillén-Ponce, C; Laquente, B; Macarulla, T; Muñoz, A; Salgado, M; Vera, R; Adeva, J; Alés, I; Arévalo, S; Blázquez, J; Calsina, A; Carmona, A; de Madaria, E; Díaz, R; Díez, L; Fernández, T; de Paredes, B G; Gallardo, M E; González, I; Hernando, O; Jiménez, P; López, A; López, C; López-Ríos, F; Martín, E; Martínez, J; Martínez, A; Montans, J; Pazo, R; Plaza, J C; Peiró, I; Reina, J J; Sanjuanbenito, A; Yaya, R; Carrato, Alfredo

    2016-12-19

    The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

  18. Long Term Follow up and Patient Satisfaction after Reduction Mammoplasty: Superomedial versus Inferior Pedicle

    PubMed Central

    Makboul, Mohamed; Abdelhamid, Mahmoud; Al-Attar, Ghada

    2017-01-01

    BACKGROUND Surgery for hypertrophied breast represents a challenge for plastic surgeons. The search for a good cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, with round shape, good projection, small cicatrices that are not very perceptible, and a lasting result. METHODS This study was carried out on 60 cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and asked for late post-operative results and overall patients’ satisfaction. RESULTS Long term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistical significant difference. No statistical significant difference was observed between patients undergone either types of operations concerning breast symmetry, nipple symmetry and sensation. The mean score of satisfaction was higher among patients undergone superomedial pedicle than inferior pedicle. CONCLUSION The superomedial pedicle shows better long term cosmetic result in reduction mammoplasty. PMID:28289618

  19. Short-term follow-up of chagasic patients after benznidazole treatment using multiple serological markers

    PubMed Central

    2011-01-01

    Background Conventional serological tests, using total soluble proteins or a cocktail of recombinant proteins from T. cruzi as antigens, are highly sensitive for Chagas disease diagnosis. This type of tests, however, does not seem to be reliable tools for short- and medium-term monitoring of the evolution of patients after antiparasitic treatment. The aim of the present study was to search for immunological markers that could be altered in the sera from Chagas disease patients after benznidazole treatment, and therefore have a potential predictive diagnostic value. Methods We analyzed the reactivity of sera from chagasic patients during different clinical phases of the disease against a series of immunodominant antigens, known as KMP11, PFR2, HSP70 and Tgp63. The reactivity of the sera from 46 adult Chronic Chagas disease patients living in a non-endemic country without vector transmission of T. cruzi (15 patients in the indeterminate stage, 16 in the cardiomiopathy stage and 16 in the digestive stage) and 22 control sera from non-infected subjects was analyzed. We also analyzed the response dynamics of sera from those patients who had been treated with benznidazole. Results Regardless of the stage of the sickness, the sera from chagasic patients reacted against KMP11, HSP70, PFR2 and Tgp63 recombinant proteins with statistical significance relative to the reactivity against the same antigens by the sera from healthy donors, patients with autoimmune diseases or patients suffering from tuberculosis, leprosy or malaria. Shortly after benznidazole treatment, a statistically significant decrease in reactivity against KMP11, HSP70 and PFR2 was observed (six or nine month). It was also observed that, following benznidazole treatment, the differential reactivity against these antigens co-relates with the clinical status of the patients. Conclusions The recombinant antigens KMP11, PFR2, Tgp63 and HSP70 are recognized by Chagas disease patients' sera at any clinical stage

  20. Long-term follow-up and patient satisfaction after reduction mammoplasty: Superomedial versus inferior pedicle

    PubMed Central

    Makboul, Mohamed; Abdelhamid, Mahmoud S.; Al-Attar, Ghada S.

    2016-01-01

    Background: Surgery for hypertrophied breasts represents a challenge for plastic surgeons. The search for a good post-surgical cosmetic breast has led to the development of many techniques. Objectives for reduction mammoplasty are to achieve elevated, symmetrical breasts, a round shape, good projection, small cicatrices that are not very perceptible, and a lasting result. Patients and Methods: This study was carried out on sixty cases who had done reduction mammoplasty from January 2009 to December 2014. All patients were examined and were asked for late post-operative results and overall patients' satisfaction. Results: Long-term projection and contour of the breast were more satisfactory among patients who had superomedial pedicle with a statistically significant difference. No statistically significant difference was observed between patients underwent either superomedial or inferior pedicle reduction mammoplasty with regard to breast shape symmetry, nipple symmetry and sensation. The mean score for satisfaction was higher among patients who underwent superomedial pedicle rather than the inferior pedicle method. Conclusion: The superomedial pedicle shows better long-term cosmetic results. PMID:27833284

  1. Intermediate-term follow-up of chronically ill patients with digital ischemia treated with peripheral digital sympathectomy.

    PubMed

    Soberón, José R; Greengrass, Roy A; Davis, William E; Murray, Peter M; Feinglass, Neil

    2016-02-01

    Digital ischemia is commonly found in patients with scleroderma and has been shown to respond to peripheral digital sympathectomy. While favorable long- and intermediate-term results have been documented in the literature, minimal objective data are available and the mechanism of surgical sympathectomy has not been entirely elucidated. Patients with digital ischemia secondary to Raynaud's phenomenon that had undergone peripheral sympathectomy surgery between 2001 and 2009 were identified and contacted for participation. Radial artery Doppler ultrasound studies were performed and compared to those done at the time of their sympathectomy. Of 11 patients treated over a 9-year period, only two patients were available for detailed follow-up analysis. Four patients were deceased, and two were lost to follow-up. Four of the five remaining patients reported excellent use of the hand and no significant episodes of digital ischemia. Of the two patients studied, functional results were favorable and pain was markedly improved despite worsening of the digital flow resistance over time. We conclude that peripheral digital sympathectomy may provide favorable long-term results in patients with digital ischemia from autoimmune causes, although this intervention should be considered in the early stages once ischemic symptoms manifest. Interestingly, Doppler data did not appear to correlate with functional status and symptom severity in these two patients. Further research, particularly prospective studies, is warranted to guide clinical decisions in this patient population.

  2. Follow-up examinations: are multidrug-resistant tuberculosis patients in Uttar Pradesh, India, on track?

    PubMed

    Tripathi, U C; Nagaraja, S B; Tripathy, J P; Sahu, S K; Parmar, M; Rade, K; Bhatnagar, S; Ranjan, A; Sachdeva, K S

    2015-03-21

    Contexte : Tous les patients atteints de tuberculose multirésistante (TB-MDR) qui avaient achevé 6 mois de traitement dans le cadre du Programme National Révisé de Lutte contre la Tuberculose (RNTCP) dans l’Uttar Pradesh, le plus grand état dans le nord de l’Inde.Objectif : Déterminer la proportion de patients TB-MDR bénéficiant d’examens de suivi régulier et la vision des prestataires et des patients sur ces services de suivi.Méthodes : Une étude rétrospective de cohorte a été réalisée grâce à la revue des dossiers de 64 patients TB-MDR éligibles enregistrés entre avril et juin 2013 dans 11 districts de l’état. Les patients et le personnel du RNTCP des districts sélectionnés ont également été interviewés grâce à un questionnaire semi-structuré.Résultats : Au total, 34 (53,1%) patients ont bénéficié d’examens de culture de crachats au 3(e) mois, 43 (67,2%) au 4(e) mois, 36 (56,3%) au 5(e) mois et 37 (57,8%) au 6(e) mois. Les principaux facteurs associés à un suivi irrégulier émanant des entretiens étaient le nombre élevé de consultations, la distance à parcourir, les ruptures de stock dans les structures et le manque de connaissances des patients vis-à-vis du programme de suivi.Conclusion : La majorité des patients TB-MDR ont eu un suivi irrégulier. Les facteurs liés aux prestataires dépassent ceux liés aux patients en matière d’examens de suivi médiocres. Le RNTCP devrait se concentrer sur la décentralisation des services de suivi, assurer la logistique et le conseil centré sur le patient afin d’accroitre la régularité du suivi.

  3. Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up.

    PubMed

    Chang, Dong-Gune; Yang, Jae Hyuk; Lee, Jung-Hee; Kim, Jin-Hyok; Suh, Seung-Woo; Ha, Kee-Yong; Suk, Se-Il

    2016-08-01

    OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4-18.0 years), and the mean length of follow-up was 12.8 years (range 10.1-18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

  4. Vitamin D Status Does Not Affect Disability Progression of Patients with Multiple Sclerosis over Three Year Follow-Up

    PubMed Central

    Smolders, Joost; Rolf, Linda; Klinkenberg, Lieke J. J.; van der Linden, Noreen; Meex, Steven; Damoiseaux, Jan; Hupperts, Raymond

    2016-01-01

    Background and Objective The risk of developing multiple sclerosis (MS) as well as MS disease activity is associated with vitamin D (25(OH)D) status. The relationship between the main functional disability hallmark of MS, disability progression, and 25(OH)D status is less well established though, especially not in MS patients with progressive disease. Methods This retrospective follow-up study included 554 MS patients with a serum baseline 25(OH)D level and Expanded Disability Status Scale (EDSS) with a minimum follow-up of three years. Logistic regressions were performed to assess the effect of baseline 25(OH)D status on relapse rate. Repeated measures linear regression analyses were performed to assess the effect on disability and disability progression. Results Baseline deseasonalized 25(OH)D status was associated with subsequent relapse risk (yes/no), but only in the younger MS patients (≤ 37.5 years; OR = 0.872, per 10 nmol/L 25(OH)D, p = 0.041). Baseline 25(OH)D status was not significantly associated with either disability or disability progression, irrespective of MS phenotype. Conclusion Within the physiological range, 25(OH)D status is just significantly associated with the occurrence of relapses in younger MS patients, but is not associated with disability or disability progression over three years follow-up. Whether high dose supplementation to supra physiological 25(OH)D levels prevents disability progression in MS should become clear from long term follow-up of supplementation studies. PMID:27276080

  5. Three-year follow-up of protease inhibitor-based regimen simplification in HIV-infected patients.

    PubMed

    Martínez, Esteban; Arnaiz, Juan A; Podzamczer, Daniel; Dalmau, David; Ribera, Esteban; Domingo, Pere; Knobel, Hernando; Leyes, Maria; Pedrol, Enric; Force, Luís; de Lazzari, Elisa; Gatell, José M

    2007-01-30

    Patients with sustained virological suppression on protease inhibitor (PI)-based therapy were randomly assigned to switch the PI to nevirapine (n = 155), efavirenz (n = 156), or abacavir (n = 149) and were followed for at least 3 years regardless of the discontinuation of assigned therapy. There was a higher probability of maintaining virological suppression after 3 years of follow-up with nevirapine or efavirenz than with abacavir. In contrast, abacavir showed a lower incidence of adverse effects leading to drug discontinuation.

  6. The clinical profile of patients with anorexia nervosa in Singapore: a follow-up descriptive study

    PubMed Central

    Kuek, Angeline; Utpala, Ranjani; Lee, Huei Yen

    2015-01-01

    INTRODUCTION The prevalence rate of anorexia nervosa is lower in Asia than in the West, although studies have found that it is on the rise in Asia. This study aims to present the clinical profile of patients presenting with anorexia nervosa in Singapore. METHODS The present study used archival data from the Eating Disorder Programme registry of the Department of Psychiatry, Singapore General Hospital, Singapore. Patient records from 2003 to 2010 were collected and analysed. Presenting characteristics of the patients were also compared with those of another local study conducted eight years earlier. RESULTS From 2003 to 2010, a total of 271 patients were diagnosed with anorexia nervosa by a psychiatrist in our hospital. Of these, 251 (92.6%) were female and 238 (87.8%) were Chinese. Our patients had a lower mean weight (36.83 kg, p < 0.001) and a lower mean body mass index (BMI) (14.43 kg/m2, p < 0.001) than patients from the previous local study. Almost half of all our patients (n = 135, 49.8%) were diagnosed with at least one psychiatric comorbidity and 50 (18.5%) had a history of self-harm. CONCLUSION The presenting characteristics of our study cohort were similar to those of the Western population. However, the lower presenting weight and BMI in our cohort indicates that cases seen today are more severe than those seen eight years ago. Therefore, it is important to put in place prevention programmes to help adolescents cultivate a healthy body image as well as early intervention programmes to improve detection rates and treatment outcomes. PMID:26106239

  7. [Circulating biomarkers association in the follow-up of patients with oral cancer].

    PubMed

    Colella, G; Cozzolino, A; Santagata, M; Vicidomini, A; Itro, A

    2001-05-01

    The goal of this study is to analyze the importance of circulating biomarkers association in the management of patients affected by oral cancer. In this study a survey is made of the international experience from 1980 to 1990 based on the presence of CEA, LASA, SCC Ag, TPA, ferritina, CA-50 and others in patients affected by oral cancer and the sensitivity and specificity of these circulating biomarkers association are assessed. In patients with active disease, the results obtained at the time of diagnosis of oral cancer are not satisfactory due to poor specificity of these circulating biomarkers association. The conclusions is drawn that the circulating biomarkers association (especially CEA, SCC Ag, LASA, ferritin, TPA and CA-50) appears to be useful in the prognosis and staging of oral cancer, while their presence is not significative for the diagnosis.

  8. Risk Assessment of BRONJ in Oncologic Patients Treated with Bisphosphonates: Follow-Up to 18 Months

    PubMed Central

    Vitali, Lucia; Nori, Alessandra; Berlin, Ricarda Sara; Mazur, Marta; Orsini, Giovanna; Putignano, Angelo

    2014-01-01

    Objectives. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a pathological condition characterized by bone exposure or latent infection in patients treated with the drug. The aim of the study is to monitor the BRONJ level of risk health in patients with cancer, according to a preventive clinical protocol, which is firstly aimed at reducing risk factors such as the periodontal infections. Materials and Methods. 10 patients participated in the protocol and were evaluated at baseline and after 3 and 18 months of treatment with bisphosphonates, through full mouth plaque and bleeding scores (FMPS and FMBS), clinical attachment level (CAL) measurement, and the occurrence of osteonecrosis. Results. The mean plaque and bleeding were reduced and the CAL has not shown significant changes and in no cases was there manifestation of BRONJ. Conclusion. The protocol proved crucial for the maintenance of good oral health conditions by eliminating the risk of BRONJ during the observation period. PMID:25258628

  9. [Follow-up of the cancer patient, maintaining self-identity].

    PubMed

    Krenz, S; Rousselle, I; Guex, P; Stiefel, F

    2009-02-11

    The individual facing the diagnosis of cancer is subjected to abrupt changes with regard to his inner world, his life, habits and social relationships. The patient's capacity to cope, to integrate changes in the way of living and to face the future is determined by his personal resources. However, psychological support may also be an important mean to search for and find sense to the singular experience of the illness. The narrative reconstruction within a supportive setting provides the patient a possibility to recognise his pain as an integral part of himself. A life narrative, which integrates the illness, allows the patient to re-appropriate his history again. Such a therapeutic project necessitates from the therapist a psychological and temporal availability and a capacity to create links all along the different stages of the disease.

  10. Hearing and Patient Satisfaction Among 19 Patients Who Received Implants Intended for Hybrid Hearing: A Two-Year Follow-Up

    PubMed Central

    Rask-Andersen, Helge

    2015-01-01

    Objectives: To measure patient satisfaction and correlate to hearing results in partially deaf patients, after hearing preservation cochlear implant surgery with hybrid hearing strategy, and to evaluate the stability of residual low-frequency hearing (LFH) over time. Design: A patient satisfaction survey and a retrospective, 2-year follow-up journal study. Nineteen partially deaf patients intended for hybrid hearing responded to a questionnaire when they had used their cochlear implants for at least a year. The questionnaire consisted of the International Outcome Inventory for Hearing Aids, EuroQol Group visual analogue scale and nine questions about hybrid hearing. Pure-tone audiometry, monosyllables, and hearing in noise test results from the patients’ medical records were evaluated and compared with the results from the patient satisfaction survey. Results: All of the patients were satisfied with their CIs. The mean International Outcome Inventory for Hearing Aids score was 29. The CIs provided a major contribution to the speech comprehension of these partially deaf patients. Two years after surgery, the patients’ mean binaural score on tests of monosyllables was 58%, and the mean signal to noise ratio was 4.6 dB. We observed ongoing deteriorations in the residual hearing of the operated ears that surpassed the deteriorations observed in the contralateral ears. One month after surgery, the LFH loss (125–500 Hz) was 17 dB, and after 2 years, this loss was 24 dB compared with 5 dB in the nonoperated ear. There were no significant correlations between preserved LFH and patient satisfaction or speech perception results. Conclusions: Electric stimulation provided a major contribution to speech comprehension of partially deaf patients. The gain reached in speech understanding widely exceeded the downside in losing some residual hearing. All the patients showed a high degree of satisfaction with their CIs regardless of varying hearing preservation. PMID:25932703

  11. The Impact for Patient Outcomes of Failure to Follow Up on Test Results. How Can We Do Better?

    PubMed Central

    Georgiou, Andrew; Li, Julie; Westbrook, Johanna I

    2015-01-01

    Background The World Health Organization–World Alliance for Patient Safety has identified test result management as a priority area. Poor test result follow-up can have major consequences for the quality of care, including missed diagnoses and suboptimal patient outcomes. Over the last three decades there has been considerable growth in the number of requests for pathology and radiology services which has added to the complexity of how patient care is delivered and test results are managed. This can contribute to a lack of clarity about where and with whom responsibility for test follow-up should reside: a problem that is compounded by a lack of clear definitions about what are critical, unexpected or significantly abnormal results. Aim of this paper This paper will present a narrative review highlighting key issues related to the problem of failure to follow up laboratory test results, and outline potential solutions. Conclusions Information technology (IT) has the potential to enhance the performance and safety of test result management processes. Effective solutions must engage all stakeholders, including consumers, in arriving at decisions about who needs to receive results, how and when they are communicated, and how they are acknowledged and acted upon and the documentation of these actions. PMID:27683480

  12. Clinical Findings, Follow-up and Treatment Results in Patients with Ocular Rosacea

    PubMed Central

    Kılıç Müftüoğlu, İlkay; Aydın Akova, Yonca

    2016-01-01

    Objectives: To report the clinical features, treatment options and complications in patients with ocular rosacea. Materials and Methods: The records of 48 eyes of 24 patients with ocular rosacea were retrospectively reviewed. Patients’ ocular signs and symptoms were scored between 1 and 4 points according to disease severity; tear film break-up time (BUT) and Schirmer’s test results were recorded before and after the treatment. Preservative-free artificial tears, topical antibiotic eye drops/ointments, short-term topical corticosteroids, topical 0.05% cyclosporine and oral doxycycline treatment were applied as a standard therapy to all patients. Additional treatments were given as needed. Complications were recorded. Results: Twenty-four patients with a mean age of 48.5±35.4 (32-54) years were followed for a mean 15±9.4 (8-36) months. Ocular findings included meibomitis in 100% of cases, anterior blepharitis in 83% (40 eyes), punctate keratopathy in 67% (32 eyes), chalazia in 50% (24 eyes), corneal neovascularization in 50% (24 eyes) and subepithelial infiltrates in 16.6% (8 eyes). Significant improvement of symptoms and clinical findings were achieved in all patients with treatment. The increases in Schirmer’s test and BUT were 3.3±1.5 and 4.5±2.8, respectively (p<0.05). Descemetocele and small corneal perforation occurred in 2 eyes; re-epithelialization was achieved in both eyes with tissue adhesive application (1 eye) and additional amniotic membrane transplantation (1 eye). Four eyes of three patients showed significant regression of corneal neovascularization with topical bevacizumab therapy. Conclusion: Ocular rosacea may present with a variety of ophthalmic signs. It is possible to control the ophthalmic disease with appropriate therapeutic modalities including topical corticosteroids, topical cyclosporine and systemic doxycycline. PMID:27800249

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

    PubMed

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

    1983-10-03

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

  14. Discharged Elderly Nursing Home Care Unit Patients: A Follow-Up Study.

    ERIC Educational Resources Information Center

    Barnes, Lori; And Others

    The success of rehabilitative nursing homes has been measured by their ability to return patients to their homes. The rates of reinstitutionalization after discharge are less studied but are basic to the role of alternative levels of care. This research examines the relationship of predischarge factors with long term outcomes of patients…

  15. Physical outcomes of patients with burn injuries--a 12 month follow-up.

    PubMed

    Jarrett, Mark; McMahon, Margaret; Stiller, Kathy

    2008-01-01

    There is only limited research documenting functional ability, physical fitness, and health related quality of life after burn injury. The objective of this study was to measure a comprehensive range of physiotherapy-related outcomes over a 12-month period for patients with significant burn injuries. A prospective study was performed on consecutive patients admitted to the Royal Adelaide Hospital over a 12-month period. Outcomes were measured at admission and discharge from hospital and at 1, 3, 6, and 12 months, and comprised the: Medical Outcomes Study 36-Item Short Form Health Survey, Quick Disabilities of the Arm, Shoulder and Hand questionnaire, Lower Extremity Functional Scale questionnaire, shuttle walk test, grip strength and scar appearance using the Matching Assessment with Photographs of Scars. A total of 86 patients (74 male, mean age 38 years) participated. There was a significant deterioration in all outcomes in the first few months after burn injury, with most outcomes improving towards baseline levels by 6 months. However, lower limb function (Lower Extremity Functional Scale) remained significantly reduced at 12 months and functional exercise capacity (shuttle walk test) was still markedly reduced at 6 months compared with predicted normal values. The total burn surface area significantly affected many of the outcomes. In conclusion, for this sample of patients after burn injury, there was an acceptable rate of recovery for physiotherapy-related outcomes, in that most measures had returned to near baseline levels by 6 months postinjury, with the exception of lower limb function and functional exercise capacity.

  16. Follow-up of 53 Alzheimer patients with the MODA (Milan Overall Dementia Assessment).

    PubMed

    Capitani, E; Manzoni, L; Spinnler, H

    1997-01-01

    Fifty-three patients affected by Alzheimer's disease entered a longitudinal survey aimed at studying which factors influence the rate of progression, assessed by means of the Milan Overall Dementia Assessment (MODA). The second examination was carried out, on average, after 16 months from the first assessment. Only age proved to influence the decline rate, which was faster in elders.

  17. Dynamics of Fukuoka Criteria and Patient Management in Pancreatic Intraductal Papillary Mucinous Neoplasms (IPMNs) During Follow-Up

    PubMed Central

    Schellhaas, Barbara; Vitali, Francesco; Wildner, Dane; Görtz, Rüdiger S.; Pfeifer, Lukas; Konturek, Peter C.; Neurath, Markus F.; Strobel, Deike

    2017-01-01

    Background Pancreatic intraductal papillary mucinous neoplasms (IPMNs) present a clinical challenge. Evidence-based guidelines are lacking. The so-called “Fukuoka criteria” were developed to assess the risk of malignancy in IPMNs upon imaging. However, little is known about their diagnostic value and the natural course of IPMNs. Thus, the aim of this study was the assessment of Fukuoka criteria and patient management in pancreatic IPMNs during follow-up. Material/Methods IPMNs were identified via retrospective survey of endoscopic ultrasound (EUS) examinations. Fukuoka criteria were assessed on EUS findings and additional imaging (CT, MRI, ultrasound). Patients’ symptoms and comorbidities were recorded. Dynamics of Fukuoka criteria and patient management were compared at first presentation and during follow-up. Results We screened 1324 EUS examinations. Sixty-five patients (male/female, 14/37; mean age, 68.8 years; range, 48–85 years) with IPMNs were identified (57 branch duct (BD-)IPMNs, 3 main duct (MD-) IPMNs, 5 mixed-type (MT)-IPMNs). Seven patients received surgical resection (4 BD-IPMNs, 2 MD-IPMNs, 1 MT-IPMN). Nine BD-IPMNs had neither surgery nor follow-up. Fifty-one patients (44 BD-IPMNs, 2 MD-IPMNs, 5 MT-IPMNs) underwent follow-up (mean duration, 18.7 months; range, 3–139 months). There were 15/51 patients who were initially Fukuoka-positive. One MD-IPMN, 4/5 MT-IPMNs, and 13/44 BD-IPMNs showed progressive changes but were not resected due to patients’ refusal or comorbidities. Four BD-IPMNs converted to Fukuoka-positive. Conclusions Evidence-based guidelines for non-invasive dignity assessment of IPMNs are lacking. In our study, MD-IPMNs displayed greater dynamics than BD-IPMNs and MT-IPMNs concerning Fukuoka criteria. Prospective long-term studies are needed to clarify prognostic significance of the single Fukuoka criteria and sensible duration of follow-up. PMID:28348359

  18. Orthodontic treatment for a patient with advanced periodontal disease: 11-year follow-up.

    PubMed

    Tavares, Carlos Alberto Estevanell; Allgayer, Susiane; Calvete, Ernani da Silva; Polido, Waldemar Daudt

    2013-09-01

    This case report demonstrates the interdisciplinary treatment of an adult patient with a Class II malocclusion, convex profile, incompetent lips, gummy smile, and advanced periodontal loss. Initial periodontal-endodontic treatment was followed by orthodontic and orthognathic surgical therapies. An esthetic facial profile, a pleasing smile, an appropriate occlusion, and overall good treatment outcomes, including the periodontal condition, remained stable 11 years after active orthodontic treatment.

  19. One - staged reconstruction of bladder exstrophy in male patients: long - term follow-up outcomes

    PubMed Central

    Giron, Amilcar Martins; Mello, Marcos Figueiredo; Carvalho, Paulo Afonso; Moscardi, Paulo Renato Marcelo; Lopes, Roberto Iglesias; Srougi, Miguel

    2017-01-01

    ABSTRACT Introduction The surgical correction of bladder exstrophy remains challenging. In our institution, the repair has evolved from a staged repair to one-stage reconstruction. The one-stage reconstruction includes; bladder closure, Cantwell-Ransley neourethroplasty and abdominoplasty using groin flaps, without the need of pelvic ostheotomies. Repair of urinary continence (UC) and vesicoureteral reflux (VUR) is done after development of the infant. Objective To present our experience of our modified one-stage reconstruction of bladder exstrophy in male patients. Materials and Methods Medical records of male patients submitted to one-stage reconstruction of bladder exstrophy were analyzed retrospectively. Fifteen exstrophy bladder patients with mean age 4.2±7 years were treated at our institution between 1999-2013. Results 2 5 Conclusions One-stage reconstruction minimizes the number of surgical procedures required to achieve UC and potentiates bladder-neck function. The advantages of using groin flaps over current techniques for complete repair are the small risk for penile tissue loss and the avoidance of ostheotomies. PMID:28124539

  20. Effects of Frequency of Follow-Up on Quality of Life of Type 2 Diabetes Patients on Oral Hypoglycemics

    PubMed Central

    Hu, Ming; Zhou, Zhiguang; Zeng, Fang

    2012-01-01

    Abstract Background Poor quality of life (QoL) in diabetes patients is reportedly associated with adverse outcomes. In the present study, we assessed the effects of frequency of follow-up on clinical indicators as well as QoL of type 2 diabetes patients taking hypoglycemic agents. Subjects and Methods In total, 155 type 2 diabetes patients were randomly assigned to two groups, which only differed in the frequency of follow-up visits. In both therapy groups, the patients were taking oral hypoglycemic agents. QoL was measured with a QoL Scale for Diabetes Mellitus (DMQLS) at study entry and months 3, 6, 9, and 12. Based on the drugs used, the patients were divided in three medication groups: glimepiride group, metformin group, and glimepiride+metformin group. Results Repeated-measures analysis of variance revealed that compared with the conventional therapy group, the intensive therapy group showed significant improvement in the Disease, Psychology, and Satisfaction domain scores of the DMQLS, the overall DMQLS score, and clinical indicator values (fasting blood glucose, 2-h postprandial blood glucose, and glycosylated hemoglobin). Correlation analyses showed that the changes in Disease, Physiology, Psychology, and Satisfaction domain scores of the DMQLS and in the overall DMQLS score were negatively correlated with changes in clinical indicator values. Conclusions Intensive frequency of follow-up is associated with improved QOL and clinical indicators and thus may be a preferred approach for type 2 diabetes patients on oral hypoglycemic agents. As QoL is negatively correlated with clinical indicators, it could be used as a comprehensive indicator of therapeutic effects on type 2 diabetes patients. PMID:22731794

  1. Association between ambient temperature and blood pressure and blood pressure regulators: 1831 hypertensive patients followed up for three years.

    PubMed

    Chen, Qing; Wang, Jinwei; Tian, Jun; Tang, Xun; Yu, Canqing; Marshall, Roger J; Chen, Dafang; Cao, Weihua; Zhan, Siyan; Lv, Jun; Lee, Liming; Hu, Yonghua

    2013-01-01

    Several studies have suggested an association between ambient air temperature and blood pressure. However, this has not been reliably confirmed by longitudinal studies. Also, whether the reaction to temperature stimulation is modified by other factors such as antihypertensive medication is rarely investigated. The present study explores the relationship between ambient temperature and blood pressure, without and with antihypertensive medication, in a study of 1,831 hypertensive patients followed up for three years, in two or four weekly check ups, accumulating 62,452 follow-up records. Both baseline and follow-up blood pressure showed an inverse association with ambient temperature, which explained 32.4% and 65.6% of variation of systolic blood pressure and diastolic blood pressure (P<0.05) respectively. The amplitude of individual blood pressure fluctuation with temperature throughout a year (a 29 degrees centigrade range) was 9.4/7.3 mmHg. Medication with angiotensin converting enzyme inhibitor benazepril attenuated the blood pressure fluctuation by 2.4/1.3 mmHg each year, though the inverse association of temperature and blood pressure remained. Gender, drinking behavior and body mass index were also found to modify the association between temperature and diastolic blood pressure. The results indicate that ambient temperature may negatively regulate blood pressure. Hypertensive patients should monitor and treat blood pressure more carefully in cold days, and it could be especially important for the males, thinner people and drinkers.

  2. Optimisation of breast cancer patients' follow-up - potential way to improve cancer care in transitional countries.

    PubMed

    Bošković, L; Gašparić, M; Petrić Miše, B; Petković, M; Gugić, D; Ban, M; Jazvić, M; Dabelić, N; Belac Lovasić, I; Vrdoljak, E

    2016-05-05

    The aim of this analysis was to evaluate adherence of Croatian oncologists to follow-up criteria as suggested by the current national and international guidelines for women with breast cancer receiving adjuvant endocrine therapy. The use of clinical and diagnostic methods was documented in this prospective, non-interventional, multicenter study. A total of 438 post-menopausal patients receiving adjuvant endocrine treatment with non-steroidal aromatase inhibitors were included. Average annual frequency for each clinical and diagnostic method was calculated. Median adjuvant endocrine treatment duration before study recruitment was 10.5 months (interquartile 4.7-26.6). Patients were followed up for an average 23.5 ± 4.9 months. Average number of oncological visits was 5.3. Mammograms were performed at mean annual frequency of 0.7, chest radiographs at 0.5, abdominal ultrasounds at 0.9, breast ultrasounds at 1.2, complete blood counts and chemistry panels at 1.7, carcinoembryonic antigen at 0.8, cancer antigen 15-3 at 1.6, gynaecological examination at 0.3, and densitometry at mean annual frequency of 0.3. In conclusion, among post-menopausal women with breast cancer receiving adjuvant endocrine therapy in this study, more unnecessary and unproven follow-up procedures were done compared to the guidelines' recommendations.

  3. [Treatment of acute porphyrias. The importance of follow-up of patients and carriers].

    PubMed

    Tasnádi, Gyöngyi; Bor, Márta; Pusztai, Agnes

    2003-05-11

    Acute porphyrias are caused by the inherited decreased activity of the enzymes of the heme biosynthesis pathway. Depending on the affected enzyme there are 4 types of them: acute intermittent porphyria, porphyria variegata, coproporphyria and delta-aminolevulinic acid dehydratase deficient porphyria, listed in order of their frequency. Basically the clinical picture is the same in the four types of acute porphyria. The most frequent complaints and symptoms are: cramping abdominal pain, nausea, vomiting, muscle weakness of the limbs then, in the advanced phase, there is a red-colored urine, hyponatremia, subileus, acute psychosis and Landry-type paralysis. Without proper treatment death is caused by respiratory paralysis or serious arrhythmia. In case of suspicion of acute porphyria it is mandatory to identify the type of the acute porphyria and the actual status of the patient. The later indicates what kind of treatment should be used. In the acute phase the early therapy with heme arginate is the treatment of choice. Since the clinical symptoms are precipitated by endogenous or exogenous inducing factors--most often by drugs-, the drugs negatively affecting the heme biosynthesis should be omitted at once even in the suspicion of acute porphyria. The role of the inducing factors in the manifestation of the clinical symptoms makes possible the prevention. It is possible to avoid the inducing factors and this way to prevent the acute attack if the acute porphyrias are recognized in time and the patients and the carriers are under regular control. The patients receive special identification card and the up-to-date list of safe drugs. They can use only these drugs in any kind of illness. Other drugs should be considered as porphyrinogenic since it is impossible to predict based on their chemical structure if they negatively affect the heme biosynthesis.

  4. Our patients followed up with a diagnosis of neurogenic pulmonary edema

    PubMed Central

    Sarı, Mehmet Yusuf; Yıldızdaş, Rıza Dinçer; Yükselmiş, Ufuk; Horoz, Özden Ögür

    2015-01-01

    Neurogenic pulmonary edema is a clinical situation which developes as a result of central nervous system injury. It is rare in the childhood. Neurogenic pulmonary edema is a clinical diagnosis. Although the pathogenesis is not elucidated well, there is increase in pulmonary interstitial and alveolar fluid. The main principle in treatment of neurogenic pulmonary edema is supportive treatment and decreasing intracranial pressure as in acute respiratory distress syndrome. In this article, clinical properties of our two patients diagnosed with neurogenic pulmonary edema developed as a result of central nervous system injury are presented. PMID:26884694

  5. An atypical neuropsychological profile of a Korsakoff syndrome patient throughout the follow-up.

    PubMed

    Noël, X; Schmidt, N; Van der Linden, M; Sferrazza, R; Hanak, C; De Mol, J; Kornreich, C; Pelc, I; Verbanck, P

    2001-01-01

    The basis of amnesia in alcoholic Wernicke-Korsakoff syndrome (WKS) has been generally associated with diencephalic lesions and more specifically with lesions of the anterior thalamic nuclei. These brain structures are considered to be involved in encoding/consolidation processes of episodic memory. However, frontal lobe damage responsible for executive function deficits has also been documented. The present report details the nature and extent of amnesia in an alcoholic patients with WKS and which appears to be mainly due to frontal lobe (executive) deficits.

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

    PubMed Central

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

    1999-01-01

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

 PMID:10373127

  7. Lessons Learned for Follow-up Phone Booster Counseling Calls with Substance Abusing Emergency Department Patients

    PubMed Central

    Donovan, Dennis M.; Hatch-Maillette, Mary A.; Phares, Melissa M.; McGarry, Ernest; Peavy, K. Michelle; Taborsky, Julie

    2014-01-01

    Background Post-visit “booster” sessions have been recommended to augment the impact of brief interventions delivered in the Emergency Department (ED). This paper, which focuses on implementation issues, presents descriptive information and interventionists’ qualitative perspectives on providing brief interventions over the phone, challenges, “lessons learned”, and recommendations for others attempting to implement adjunctive booster calls. Method Attempts were made to complete two 20-minute telephone “booster” calls within a week following a patient’s ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine. Results Over half (56.2%) of participants completed the initial call; 66.9% of those who received the initial call also completed the second call. Median number of attempts to successfully contact participants for the first and second calls was 4 and 3, respectively. Each completed call lasted an average of about 22 minutes. Common challenges/barriers identified by booster callers included unstable housing, limited phone access, unavailability due to additional treatment, lack of compensation for booster calls, and booster calls coming from an area code different than the participants’ locale and from someone other than ED staff. Conclusions Specific recommendations are presented with respect to implementing a successful centralized adjunctive booster call system. Future use of booster calls might be informed by research on contingency management (e.g., incentivizing call completions), smoking cessation quitlines, and phone-based continuing care for substance abuse patients. Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the ED setting. PMID:25534151

  8. Repeated infusions of infliximab, a chimeric anti-TNFα monoclonal antibody, in patients with active spondyloarthropathy: one year follow up

    PubMed Central

    Kruithof, E; Van den Bosch, F; Baeten, D; Herssens, A; De Keyser, F; Mielants, H; Veys, E

    2002-01-01

    Background: In a pilot study, the anti-tumour necrosis factor α monoclonal antibody, infliximab, induced a rapid and significant improvement in global, peripheral, and axial disease manifestations of patients with active spondyloarthropathy. Objective: To determine whether repeated infusions of infliximab would effectively and safely maintain the observed effect. Methods: Safety and efficacy of a maintenance regimen (5 mg/kg infliximab every 14 weeks) was evaluated using the measurements reported in the pilot study. Of the 21 patients, 19 completed the one year follow up for efficacy; two patients changed to another dosing regimen after week 12 owing to partial lack of efficacy. However, they are still being followed up for safety analysis. Results: After each re-treatment a sustained significant decrease of all disease manifestations was observed. Before re-treatment, symptoms recurred in 3/19 (16%) at week 20, in 13/19 (68%) at week 34, and in 15/19 (79%) at week 48. No withdrawals due to adverse events occurred. Twelve minor infectious episodes were observed. Twelve patients (57%) developed antinuclear antibodies; in four of them (19%) anti-dsDNA antibodies were detected. However, no lupus-like symptoms occurred. Conclusion: In this open study of infliximab in patients with active spondyloarthropathy, the significant improvement of all disease manifestations was maintained over a one year follow up period without major adverse events. Although recurrence of symptoms was noted in a rising number of patients before each re-treatment, no loss of efficacy was observed after re-treatment. PMID:11830424

  9. Do patients with bipolar disorder and subsyndromal symptoms benefit from functional remediation? A 12-month follow-up study.

    PubMed

    Sanchez-Moreno, Jose; Bonnín, Caterina; González-Pinto, Ana; Amann, Benedikt L; Solé, Brisa; Balanzá-Martínez, Vicent; Arango, Celso; Jimenez, Esther; Tabarés-Seisdedos, Rafael; Garcia-Portilla, M Paz; Ibáñez, Angela; Crespo, Jose Manuel; Ayuso-Mateos, Jose Luis; Vieta, Eduard; Martinez-Aran, Anabel; Torrent, Carla

    2017-01-23

    We analyzed the efficacy of functional remediation, in a sample of patients with bipolar disorder who presented with subsyndromal symptoms. From a total sample of 239 patients with bipolar I and II disorder, according to DSM-IV-TR diagnostic criteria, entering a randomized clinical trial, those patients who presented with subsyndromal symptoms were selected based on a method already described by Berk and colleagues was applied. It consists of using the Clinical Global Impression-Bipolar version (CGI-BP) to establish the scores of the Hamilton Depression Rating Scale (HAM-D) and of the Young Mania Rating Scale (YMRS) that correspond with 1 in the CGI-BP. Functional outcome and mood symptoms were assessed at 6 and at 12-month follow-up. A total of 99 patients were selected for this post-hoc analysis, allocated as follows: functional remediation (n=33); psychoeducation (n=37) and treatment as usual (TAU,n=29). The repeated-measures analyses at 12-month follow-up revealed a significant group x time interaction in favour of the patients who received functional remediation when compared to psychoeducation and TAU (F=2.93; p=0.02) at improving psychosocial functioning. Finally, mood symptoms did not significantly change in any of the three groups at any time of follow-up, as shown by the non-significant group x time interaction effect in HAM-D scores (F=1.57; p=0.18) and YMRS scores (F=1.51; p=0.20). Bipolar patients with subsyndromal symptoms improve their functional outcome when exposed to functional remediation regardless of the persistence of mood symptomatology.

  10. [Development of HIV 1 antigenemia during treatment with azidothymidine (AZT): follow-up of 90 patients for a year].

    PubMed

    Berlie, H C; Berlioux, J; Daguet, G L

    1989-06-01

    VIH 1 antigenaemia has a significant value in the follow-up of patients treated with AZT. This study of 90 patients (55 ARC - 35 AIDS), each receiving AZT for more than a year, 200 mg every 4 hours, demonstrates the prognosis value of antigenaemia at Day 0, as well as its therapeutic indication value. However, at term and under this treatment, the significance of this virological data has to be reconsidered. Various kinetic patterns are described according to the clinical status and the CD4+ cells count.

  11. Follow-up in patients with congenital cardiac disease more complex than haemodynamic assessment.

    PubMed

    Fredriksen, Per Morten; Mengshoel, Anne Marit; Frydenlund, Aina; Sørbye, Øystein; Thaulow, Erik

    2004-08-01

    The objective of the study was to assess behavioural and emotional problems, as well as physical capacity, in children and adolescents with congenital cardiac disease. From the database of Paediatric Heart Section, Children's Clinic, Rikshospitalet University Hospital, Oslo, Norway, we identified 430 patients whose parents received questionnaires using the Child Behaviour Check-List. The response rate was 75.8%. In addition, the parents received a questionnaire focusing on special issues with regard to physical activity. Parents of children and adolescents with congenital cardiac diseases reported significantly more behavioural problems than did a reference population and boys were scored higher compared to girls. Analysis showed a significant impact of physical capacity on the score representing total problems, as well as scores for externalising and internalising behaviour. Compared to a reference population, parents of children and adolescents with congenital cardiac disease score their children higher on most scales when rated using the Child Behaviour Check-List. The type of diagnosis did not affect the scores reflecting the total problem. The main factor of impact on behavioural problems was, as evaluated by the parents, the physical capacity of the children.

  12. The role of depressive symptoms, family invalidation and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury in Chinese adolescents: a 2-year follow-up study.

    PubMed

    You, Jianing; Leung, Freedom

    2012-04-01

    This study used zero-inflated poisson regression analysis to examine the role of depressive symptoms, family invalidation, and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury among Chinese community adolescents over a 2-year period. Participants, 4782 high school students, were assessed twice during the follow-up period. Results indicate that while Year 1 depressive symptoms and family invalidation were significantly associated with the occurrence of Year 2 NSSI, Year 1 behavioral impulsivity contributed to both the occurrence and repetition of Year 2 NSSI. Findings of this study suggest that adolescents who display multiple impulsive behaviors may be at particular risk for engaging in repetitive NSSI. Clinical implications of these findings and future research directions were discussed.

  13. Different outcomes of never-treated and treated patients with schizophrenia: 14-year follow-up study in rural China

    PubMed Central

    Ran, Mao-Sheng; Weng, Xue; Chan, Cecilia Lai-Wan; Chen, Eric Yu-Hai; Tang, Cui-Ping; Lin, Fu-Rong; Mao, Wen-Jun; Hu, Shi-Hui; Huang, Yue-Qin; Xiang, Meng-Ze

    2015-01-01

    Background The long-term outcome of never-treated patients with schizophrenia is unclear. Aims To compare the 14-year outcomes of never-treated and treated patients with schizophrenia and to establish predictors for never being treated. Method All participants with schizophrenia (n = 510) in Xinjin, Chengdu, China were identified in an epidemiological investigation of 123 572 people and followed up from 1994 to 2008. Results The results showed that there were 30.6%, 25.0% and 20.4% of patients who received no antipsychotic medication in 1994, 2004 and 2008 respectively. Compared with treated patients, those who were never treated in 2008 were significantly older, had significantly fewer family members, had higher rates of homelessness, death from other causes, being unmarried, living alone, being without a caregiver and poor family attitudes. Partial and complete remission in treated patients (57.3%) was significantly higher than that in the never-treated group (29.8%). Predictors of being in the never-treated group in 2008 encompassed baseline never-treated status, being without a caregiver and poor mental health status in 1994. Conclusions Many patients with schizophrenia still do not receive antipsychotic medication in rural areas of China. The 14-year follow-up showed that outcomes for the untreated group were worse. Community-based mental healthcare, health insurance and family intervention are crucial for earlier diagnosis, treatment and rehabilitation in the community. PMID:26382951

  14. Effective radiation exposure evaluation during a one year follow-up of urolithiasis patients after extracorporeal shock wave lithotripsy

    PubMed Central

    Tekinarslan, Erdem; Keskin, Suat; Buldu, İbrahim; Sönmez, Mehmet Giray; Karatag, Tuna; Istanbulluoglu, Mustafa Okan

    2015-01-01

    Introduction To determine and evaluate the effective radiation exposure during a one year follow-up of urolithiasis patients following the SWL (extracorporeal shock wave lithotripsy) treatment. Material and methods Total Effective Radiation Exposure (ERE) doses for each of the 129 patients: 44 kidney stone patients, 41 ureter stone patients, and 44 multiple stone location patients were calculated by adding up the radiation doses of each ionizing radiation session including images (IVU, KUB, CT) throughout a one year follow-up period following the SWL. Results Total mean ERE values for the kidney stone group was calculated as 15, 91 mSv (5.10-27.60), for the ureter group as 13.32 mSv (5.10-24.70), and in the multiple stone location group as 27.02 mSv (9.41-54.85). There was no statistically significant differences between the kidney and ureter groups in terms of the ERE dose values (p = 0.221) (p >0.05). In the comparison of the kidney and ureter stone groups with the multiple stone location group; however, there was a statistically significant difference (p = 0.000) (p <0.05). Conclusions ERE doses should be a factor to be considered right at the initiation of any diagnostic and/or therapeutic procedure. Especially in the case of multiple stone locations, due to the high exposure to ionized radiation, different imaging modalities with low dose and/or totally without a dose should be employed in the diagnosis, treatment, and follow-up bearing the aim to optimize diagnosis while minimizing the radiation dose as much as possible. PMID:26568880

  15. The siblings of childhood cancer patients need early support: a follow up study over the first year

    PubMed Central

    Lahteenmaki, P; Sjoblom, J; Korhonen, T; Salmi, T

    2004-01-01

    Background and methods: In a 1 year follow up study, we assessed the life situation of 33 siblings of childhood cancer patients and 357 healthy controls. The hypothesis was that siblings have more behavioural and health related problems just after the cancer diagnosis. Validated assessment methods were used. Results: Siblings below school age tended to have conduct problems, psychosomatic problems, and a mixed group of other behavioural problems, when assessed 3 months after the cancer diagnosis. These symptoms became less evident during follow up. Among the school aged siblings, however, conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive symptoms, and other behavioural symptoms remained unchanged during follow up. In their self assessments, the school aged siblings showed both state and trait anxiety more often than controls at the first assessment, but later these symptoms settled to the same level as the controls. The overall Children's Depression Inventory (CDI) depression scores did not show differences between the study groups. Conclusions: The ratings of the parents were in keeping with the self assessment of the school aged siblings only in a few aspects; the emphasis of findings can be changed when proxies are used. The siblings have symptoms and adverse feelings which probably could be relieved by targeted, early information about the illness, and possibly by group discussions or activities, soon after the cancer diagnosis. In order to obtain necessary support for the siblings with educational problems, school personnel need to be informed about the sibling distress. PMID:15499052

  16. Long term follow up of prosthetic valve endocarditis: what characteristics identify patients who were treated successfully with antibiotics alone?

    PubMed Central

    Truninger, K; Jost, C; Seifert, B; Vogt, P; Follath, F; Schaffner, A; Jenni, R

    1999-01-01

    OBJECTIVE—To identify predictors for the safe use of antibiotic treatment without reoperation in patients with prosthetic valve endocarditis.
SETTING—Retrospective study in a tertiary care centre.
SUBJECTS AND DESIGN—All 49 episodes of definite prosthetic valve endocarditis (Duke criteria) diagnosed at one institution between 1980 to 1997 were analysed. Ten episodes (20%) were treated with antibiotics only (antibiotic group) and 39 episodes (80%) with combined antibiotic and surgical treatment (surgery group). The analysis included detailed study of hospital records and data on long term follow up which were obtained in all patients by a questionnaire or telephone contact with physician or patient. The length of follow up (mean (SD)) was 41 (32) months in the antibiotic group and 45 (24) months in the surgery group (NS). Long term survival was estimated by the Kaplan-Meier method and compared by the log-rank test.
RESULTS—There was no significant difference in age, history of previous endocarditis, number of previous heart operations, vegetations, emboli, type of prosthesis, or percentage of early prosthetic valve endocarditis and positive blood cultures between the two groups. In the antibiotic group, there were more enterococcal (50%; p = 0.005) and in the surgery group more staphylococcal infections (55%; p = 0.048). Annular abscesses (p < 0.0001) and aortoventricular dehiscence (p = 0.02) were more common in the surgery group. No patient in the antibiotic group had heart failure. Long term follow up showed no significant difference between the surgery and antibiotic groups regarding late mortality (14% v 18%) and five year rates of recurrent endocarditis (14% v 16%), event related mortality (14% v 3%, log-rank test), and the need for reoperation (14% v 19%; log-rank test). The only patient with conservatively treated staphylococcal prosthetic valve endocarditis died after reoperation for recurrence

  17. [Follow-up of patients treated by VKA: Interest of a pharmaceutical link between the hospital and the retail pharmacies].

    PubMed

    Bidon, D; Lecoeur, A; Segui, E; Seguette, N; Le Mercier, F; Bauler, S

    2017-01-01

    Vitamin K antagonists (VKA) are used by 1,7% of the French population. Patient education and monitoring can decrease the number of iatrogenic hospitalizations due to VKA. We assessed the impact of a communication between hospital and retail pharmacists about patient's knowledge on VKA. The aim of our study has been to evaluate the value added by the link between the hospital pharmacist and the community pharmacist on the follow-up of patients treated by vitamin K antagonist. Patient information about VKA treatment is offered to inpatients in our hospital. An information form is filled for each patient treated by VKA. Patient's knowledge is assessed on the document (Name of VKA, cause of treatment, monitoring, risks of overdose, compliance…). This form is sent to the community pharmacist after the training when the patient leaves the hospital (by fax or by email). The form is sent back by the community pharmacist after the second training. Sixty-eight patients received the training, 48 forms have been sent to the retail pharmacists and 43 forms have been sent back to the hospital. Seven retail pharmacists replied spontaneously. Twenty-eight patients increased their knowledge (in average+21%) and 12 patients stabilized their knowledge. The best-known concepts were the INR target, the time of drug intake, the risks of overdose and the information of the family. The improvement of knowledge is significant for the name of VKA, the cause of treatment, efficacy assessment and signs of overdose. The implementation of a communication between the hospital and the retail pharmacies is time-consuming but the follow-up of those patients seems essential to keep a good knowledge.

  18. Outcome of oral dysplasia: a retrospective hospital-based study of 207 patients with a long follow-up.

    PubMed

    Arduino, Paolo G; Surace, Antonio; Carbone, Mario; Elia, Alessandra; Massolini, Gianluca; Gandolfo, Sergio; Broccoletti, Roberto

    2009-07-01

    The aim of this retrospective hospital-based study was to review and evaluate the long-term outcome of patients with oral epithelial dysplasia (OED), with or without surgical intervention, to identify factors affecting clinical course and malignant evolution. Patients with a follow-up of at least 12 months were included. Data collected were statistically analyzed. The mean age was 63.58 years for women (n = 100) and 64.17 years for men (n = 107). One hundred and thirty-five of the patients had lesions with histopathological features of mild OED, 50 had moderate OED and 22 had severe OED. Gender and risk factors seemed not to be related with the development of OED. One hundred and thirty-three patients underwent active treatment. During the period considered, 39.4% of the 207 lesions disappeared; 19.66% remained stable and 33.7% of the total cases showed a new dysplastic event after treatment. Fifteen (7.24%) out of 207 developed a squamous cell carcinoma during follow-up. Our data showed that speckled lesions are more often associated with high histological grade. The risk of malignant development does not seem to be predictable. Surrounded by the limitations of the retrospective designs, we have showed that there is no eminent benefit of surgical intervention of OED in preventing recurrences and malignant development.

  19. Changes in Disease Failure Risk of Nasopharyngeal Carcinoma over Time: Analysis of 749 Patients with Long-Term Follow-Up

    PubMed Central

    Liu, Xu; Tang, Ling-Long; Du, Xiao-Jing; Li, Wen-Fei; Chen, Lei; Zhou, Guan-Qun; Guo, Rui; Liu, Qing; Sun, Ying; Ma, Jun

    2017-01-01

    Background: The changes in the risk of disease failure over time in nasopharyngeal carcinoma (NPC) remains unknown. Methods: We analyzed 749 patients treated with intensity-modulated radiotherapy in a single center. The annual hazard rates of disease failure (recurrence or death from any cause) were estimated using the life-table method. Results: In total, 41 (5.5%), 22 (2.9%) and 129 (17.2%) patients developed local, regional and distant recurrences, respectively; 149 (19.9%) patients died. Of the 600 patients who were alive at the last follow-up, 496 (82.7%) had follow-up times longer than 6 years. The 6-year failure-free survival rate was 74.8%. Older age (> 50 years) and advanced stage (Ⅲ-ⅣB) were independent risk factors for disease failure in multivariate analysis. The hazard curve for failure risk in the whole cohort showed a sharp peak at 2 years, changed to a gradually decreasing plateau between years 3 and 5 and then declined sharply. Subgroup analyses revealed similar hazard curves in both sexes. However, the patterns of hazard curve significantly differed between high-risk (> 50 years or stage Ⅲ-ⅣB) and low-risk (≤ 50 years or stage Ⅰ-Ⅱ) patients. Interpretation: The failure hazard rate in NPC didn't decline in a linear manner, but displayed a sharp peak at 2 years. The patterns of hazard function significantly differed between patients with different age and stage. Further studies are warranted to confirm our results. PMID:28261347

  20. Dysphagia and health-related quality of life in patients with eosinophilic esophagitis: a long-term follow-up.

    PubMed

    Larsson, Helen; Bergman, Karin; Finizia, Caterina; Johansson, Leif; Bove, Mogens; Bergquist, Henrik

    2015-12-01

    Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disease, with dysphagia as the main symptom. The aim of this study was to survey symptoms and health-related quality of life in adult patients with EoE at least 1 year after diagnosis and a 2-month course of topical corticosteroids. Forty-seven consecutive patients [79 % males, mean age 49 years (range 18-90 years)] were evaluated using three different questionnaires at three different occasions: the Watson Dysphagia Scale (WDS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Oesophageal Module 18 (EORTC QLQ-OES18) and the Short Form-36 (SF-36). The median time from diagnosis to the long-term follow-up was 23 months (range 12-34 months). The WDS scores and the EORTC QLQ-OES18 Dysphagia and Eating scale scores were improved after 2 months of treatment (p = 0.00007, p = 0.01, p = 0.004, respectively), as were the long-term follow-up scores (p = 0.01, p = 0.03, p = 0.005, respectively), relative to the scores at diagnosis. In addition, the EORTC QLQ-OES18 Choking scores were improved after the steroid course (p = 0.003) but not after the long-term follow-up. No significant differences were detected with respect to the SF-36 scores. In summary, EoE seems to be associated with a substantial burden of symptoms that improve significantly after treatment. A partial remission persists more than 1 year after diagnosis and the discontinuation of medication. The WDS and the EORTC QLQ-OES18 appear to be sensitive instruments appropriate for surveillance in these patients.

  1. Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients.

    PubMed

    Rosen, P P; Kimmel, M

    1990-05-01

    Breast carcinoma presenting with axillary metastases and no clinically apparent primary tumor in the breast is an uncommon form of stage II disease. Published studies have been characterized by small numbers and/or limited follow-up information. Although these patients are often looked on individually as having advanced disease, several published reports suggest that their prognosis is not exceptionally grave. The present study evaluated the largest series thus far described, consisting of 48 patients with a median follow-up of 5 years. Each presented with an axillary mass which proved to be metastatic adenocarcinoma, consistent with mammary origin when examined histologically. No patient had a palpable breast tumor. Mammography was negative in 28 patients (76%), and suspicious or positive in nine (24%). Nine (35%) of 26 metastases were positive for estrogen (ER) and progesterone (PR) receptors, 10 (38%) were negative for both receptors, and seven (27%) were ER positive/PR negative. Primary treatment was mastectomy and axillary dissection in 38 cases, 21 with adjuvant chemotherapy. A primary tumor was found pathologically in the breast in 36 cases (75%). Among 34 reviewed primary lesions, 27 (79%) were invasive and seven (21%) were histologically "noninvasive." Measured size was 0.1 to 6.5 cm (median, 1.5 cm). The number of involved lymph nodes was one to 65 with 20 cases having one to three positive and 20 having four or more positive. Follow-up ranged from 5 to 267 months (median, 60 months). Overall, 29 patients (60%) remained alive and disease free; two (4%) were disease free, but died of other causes; and the status of two (4%) was not known. Fifteen patients developed recurrent carcinoma, including 12 (25%) who died of disease. When compared with a matched series of stage II patients with equivalent extent of disease who presented with palpable breast tumors, patients with occult lesions had a more favorable prognosis overall, as well as when stratified by

  2. 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.

  3. Skeletal alkaline phosphatase as a serum marker of bone metastases in the follow-up of patients with breast cancer.

    PubMed

    Reale, M G; Santini, D; Marchei, G G; Manna, A; Del Nero, A; Bianco, V; Marchei, P; Frati, L

    1995-01-01

    Immunoradiometric determination of the bone isoenzyme of alkaline phosphatase with a method provided by Hybritech Inc., San Diego CA (USA) was carried out in 145 female patients, 97 of whom with radically operated breast cancer and 48 with benign mammary cysts, in order to evaluate the correlation of serum levels with the metabolic process of bone rearrangement in patients with bone metastases. This study shows that skeletal ALP, having high specificity (86.48%) and sensitivity (78.6%) for early progression (the average anticipation time compared to scintigraphic detection was 101 days) could represent a valid marker for bone metastases in association with mucinous markers in the follow-up of patients operated for breast cancer. In addition, dynamic serum determination of skeletal ALP could be a valid help in monitoring the efficacy of therapy in patients with bone progression.

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

    PubMed

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

    2011-11-01

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

  5. Joint preservation after hip arthroscopy in patients with FAI. Prospective analysis with a minimum follow-up of seven years

    PubMed Central

    Comba, Fernando; Yacuzzi, Carlos; Ali, Pablo J.; Zanotti, Gerardo; Buttaro, Martin; Piccaluga, Francisco

    2016-01-01

    Summary Background The purpose of this study is to evaluate the clinical outcomes, radiological degenerative progression and the joint preservation rate in a series of patients with Femoroacetabular Impingement (FAI) treated with hip arthroscopy at a minimum follow-up of 7 years. The predictive factors for total hip arthroplasty (THA) requirement were analyzed. Materials and methods Between February 2008 and February 2009, 42 consecutive patients treated with hip arthroscopy due to FAI syndrome were included. There were 15 women and 27 men with an average age of 38 years (range 23 to 56 years). The surgery involved joint damage stabilization (labral tears and/or chondrolabral injuries) and correction of associated bony deformities (cam and/or pincer lesions). A prospective clinical follow-up was made with no patient lost. We specifically addressed the need for THA. Predictive factors for THA were also analyzed. Results At final follow up, joint preservation rate was 83.33% (CI 95% 68,64%–93,03%). Probability of evolving to a THA in patients with radiographic preoperative Tonnis grades 0 and I was of 0% (CI 95%: 0–12.77). Probability of evolving to a THA in patients with preoperative Tonnis grades II and III was 46,67% (CI 95%21.27%–73,41%). A statistically significant difference was present between both groups (p= 0.002). Patients older than 45 years at the time of hip arthroscopy were at significant risk of evolving to a THA (p=0.0012). Excluding those patients who undergone a THA: modified HHS was 88.25 points (80–96) and radiographic analysis addressed a 14,29% (IC95% 4,81%–30,26%) of progressive degenerative changes without affecting clinical results. Conclusions Hip arthroscopy for the treatment of patients with FAI syndrome showed favorable results regarding joint preservation. Patients with preoperative radiographic evidence of advanced-stage osteoarthritis and those older than 45 years at the time of surgery have higher risk of requiring THA

  6. [The echographic and clinical follow-up of patients operated on for subcutaneous rupture of the Achilles tendon].

    PubMed

    Cinotti, A; Massari, L; Traina, G C; Mannella, P

    1996-01-01

    Thanks to its good long-term results, surgery is the method of choice to treat subcutaneous ruptures of the Achilles tendon. Reconstructed tendons present typical morphological and functional US patterns which depend partly on the kind of surgical reconstruction and partly on the time passed since surgery. The authors report the results of the clinical and US follow-up of a series of 62 surgical patients treated in 7 years for the subcutaneous rupture of the Achilles tendon. The patients were 55 men and 7 women, whose mean age was 36 years (range: 25-65 years). The left-hand side was affected in 38 patients and the right-hand side in 24 patients. All patients were operated on using an end-to-end suture and reinforcement plastic surgery pulling down a gastrocnemius tendon flap. To homogenize the results, all the US exams were performed by the same operator, in the presence of the orthopedic specialist and under the same conditions: both the involved and the contralateral Achilles tendons were studied, longitudinal and transverse scans were performed with the foot in max. plantar and dorsal flexion and, whenever possible, dynamic scans were also performed making the sural triceps contract against resistance. The following parameters were studied clinically: pain (which was absent in 39 patients, occasional in 11, after stress in 9 and on walking in 3 patients), skin scar trophism (which was eutrophic in 53.23% of patients, keloid in 27.42% and hypertrophic in 19.35% of patients), ankle joint excursion (plantar flexion was impaired in 32.3% and dorsal flexion in 36% of patients), walking on tiptoe (in all, 22.6% of patients complained of difficulties walking on tiptoe) and, finally, work activity resumption (which all patients achieved). US depicted the surgical tendons as much bigger than the contralateral ones (3-4 times on the average), which increase in volume lasted throughout the follow-up. In 75% of patients the echo structure of the surgical tendons was

  7. Extreme lateral interbody fusion (XLIF): A single-center clinical and radiological follow-up study of 20 patients.

    PubMed

    Tessitore, Enrico; Molliqaj, Granit; Schaller, Karl; Gautschi, Oliver Pascal

    2017-02-01

    Extreme lateral interbody fusion (XLIF) is an alternative to standard posterior approaches for achieving fusion in the lumbar spine. It allows exposure of the lateral aspect of the lumbar disc through a lateral approach with the possibility to insert a wide footprint interbody cage as a stand-alone procedure or associated with a uni- or bilateral percutaneous fixation. This is a retrospective series of 20 consecutive patients operated with a XLIF procedure from 2014 to 2015. N=10 women and N=10 men with a mean age of 67.5years (range 37.9-81.2) were included in the study. N=18 patients have been operated at one level, while N=2 patients underwent a double-level XLIF. The index levels were: L2-L3 in 2, L3-L4 in 7, L4-L5 in 9 and L3-L5 in 2 patients, respectively. The mean clinico-radiological follow-up was 9.8months (range 2.5-16.6). The clinical outcome was assessed with the Oswestry Disability Index (ODI), Euro-Qol (EQ)-5D, visual analogue scale (VAS) and EQ-5D index scores. Preoperative, postoperative and follow-up sagittal balance was assessed by EOS full spine X-ray. Furthermore, presence or absence of fusion was assessed by thin cuts CT scan at the end of the follow-up. The analysis highlighted a clear clinical improvement for the study collective. The mean ODI improved from 41.6 preoperatively to 23.5 at the last follow-up (p<0.0036). EQ-5D VAS and EQ-5D index improved from 45.5 to 71.8 (p<0.0001) and from 0.454 to 0.693 (p<0.0002), respectively. Analysis of the sagittal balance revealed an increase of the total lumbar lordosis, however not in a statistically significant manner (p=0.164). Furthermore, an increase of 55.7% in mean disc height (from 7.0mm to 10.9mm) has been observed (p<0.0001). Surprisingly, the right foramen height was increased in a statistically significant manner compared to the left one, but both of them increased in absolute values. However, foraminal area on both sides did not significantly increase. The mean canal area was 115.7mm(2

  8. Outcome of hybrid stem fixation in osteoporotic female patients. A minimum five-year follow-up study

    PubMed Central

    Tassinari, Enrico; Pilla, Federico; De Fine, Marcello; Biondi, Federico; Cristofolini, Luca; Toni, Aldo

    2008-01-01

    In osteoporotic patients cemented stems are usually used to achieve a good primary stability. However, when patients are obese or active the long-term survival of cemented prostheses is questioned. In these patients, a partially-cemented stem with a hybrid fixation could be advantageous. A hybrid stem was retrospectively evaluated at a minimum follow-up of 60 months (mean, 75 months) in 58 osteoporotic women: seventeen with a body mass index (BMI) >30 (obese), 41 with a BMI between 25 and 29.9 (overweight), and an UCLA score for activity level >6. At the latest follow up, the Harris hip score improved from 33.5 points preoperatively to 81.6 points, and the WOMAC score improved significantly. Three stems (4.9%) had an asymptomatic subsidence of less than 2.5 mm; no stem was revised. These results support the use of partially-cemented stems in heavy or active osteoporotic women. PMID:18712386

  9. Gender differences and determinants of health related quality of life in coronary patients: a follow-up study

    PubMed Central

    2011-01-01

    Background The role of gender differences in Health Related Quality Life (HRQL) in coronary patients is controversial, so understanding the specific determinants of HRQL in men and women might be of clinical importance. The aim of this study was to know the gender differences in the evolution of HRQL at 3 and 6 months after a coronary event, and to identify the key clinical, demographic and psychological characteristics of each gender associated with these changes. Methods A follow-up study was carried out, and 175 patients (112 men and 63 women) with acute myocardial infarction (AMI) or unstable angina were studied. The SF-36v1 health questionnaire was used to assess HRQL, and the GHQ-28 (General Health Questionnaire) to measure mental health during follow-up. To study the variables related to changes in HRQL, generalized estimating equation (GEE) models were performed. Results Follow-up data were available for 55 men and 25 women at 3 months, and for 35 men and 12 women at 6 months. Observations included: a) Revascularization was performed later in women. b) The frequency of rehospitalization between months 3 and 6 of follow-up was higher in women c) Women had lower baseline scores in the SF-36. d) Men had progressed favourably in most of the physical dimensions of the SF-36 at 6 months, while at the same time women's scores had only improved for Physical Component Summary, Role Physical and Social Functioning; e) the variables determining the decrease in HRQL in men were: worse mental health and angina frequency; and in women: worse mental health, history of the disease, revascularization, and angina frequency. Conclusions There are differences in the evolution of HRQL, between men and women after a coronary attack. Mental health is the determinant most frequently associated with HRQL in both genders. However, other clinical determinants of HRQL differed with gender, emphasizing the importance of individualizing the intervention and the content of rehabilitation

  10. Sentinel lymph node dissection in stage I/II melanoma patients: surgical management and clinical follow-up study.

    PubMed

    Macripò, Giuseppe; Quaglino, Pietro; Caliendo, Virginia; Ronco, Anna Maria; Soltani, Shoreh; Giacone, Elena; Pau, Stefano; Fierro, Maria Teresa; Bernengo, Maria Grazia

    2004-04-01

    Selective sentinel lymph node (SLN) dissection is widely used in the management of cutaneous melanoma patients without clinical evidence of nodal metastases. A series of 274 consecutive melanoma patients who underwent melanoma primary excision and SLN mapping at our institutions since 1998, and were thereafter followed up and eventually treated, is reported in this prospective study. The aim was to analyse the parameters associated with a higher risk of occult nodal metastases, to evaluate the clinical outcome of melanoma patients who underwent SLN procedure, and to identify by means of multivariate analysis the prognostic parameters with independent predictive value on disease-free survival (DFS) in node-positive and negative patients. The SLN was tumour-negative in 228 patients (83.2%). A disease progression occurred in 25 (10.9%); among them, 10 patients in whom the initially identified SLN had been negative, developed a clinically and histologically evident positive lymph node in the same basin during follow-up. Five-year DFS and overall survival were 75% and 82%, respectively. In 46 patients (16.8%), the SLN proved to be tumour positive. The percentage of SLN-positive patients varied according to the primary thickness, from 11.8% in patients with Breslow of 2 mm or lower, to 34.7% in patients with Breslow from 2 to 4 mm, up to 55.9% in patients with Breslow greater than 4 mm (P<0.001). Only two patients with Breslow thickness lower than 1 mm had positive SLN biopsy. Five-year DFS and overall survival (OS) were 42 and 69%, respectively, significantly lower than those of negative SLN-patients (P<0.001). Multivariate analyses showed that the parameters with prognostic independent value on DFS were SLN status (micrometastases or macrometastases; P=0.0001), and to a lesser extent, Breslow thickness (P=0.04). In conclusion, our data support the clinical usefulness of SLN dissection as a reliable and accurate staging method in patients with cutaneous melanoma. SLN

  11. Eight-year follow-up of airway hyperresponsiveness in patients with primary Sjögren’s syndrome

    PubMed Central

    Ludviksdottir, Dora; Valtysdottir, Sigridur Th.; Hedenström, Hans; Hällgren, Roger; Gudbjörnsson, Björn

    2017-01-01

    Objective To evaluate in a longitudinal study the influence of airway hyperresponsiveness (AHR) on lung function in patients with primary Sjögren’s syndrome (pSS). Methods Lung function was studied over an eight-year period in 15 patients who fulfilled the Copenhagen criteria for primary Sjögren’s syndrome and who were covered in our earlier published study on AHR in patients with Sjögren’s syndrome. Standard spirometry and measurements of lung volumes, diffusing capacity (DLCO), and AHR to methacholine were performed. Results A significant decline over time was found in total lung capacity (TLC), vital capacity (VC), forced vital capacity (FVC), functional residual capacity (FRC), and expiratory midflows (FEF50). A sign of small airway obstruction (decrease in FEF50) at entry correlated with VC at follow-up (r = .8, P < .003), and the individual change in FEF50 during the observation period correlated with the individual change in VC (r = .6, P < .05). Six patients had increased AHR, and three of them had decreased DLCO. Six of the patients progressively reduced DLCO over time, and five of them had spirometric signs of increased small airway obstruction. Conclusions During this eight-year follow-up we observed that one-third of the patients with pSS developed a significant reduction in lung function. Our findings suggest that small airways obstruction and AHR are associated with reduction of VC and development of impaired DLCO as a sign of interstitial lung disease in this group of patients. PMID:27849141

  12. Talectomy in patients with recurrent deformity in club foot. A long-term follow-up study.

    PubMed

    Legaspi, J; Li, Y H; Chow, W; Leong, J C

    2001-04-01

    We reviewed 24 feet in 15 patients who had undergone talectomy for recurrent equinovarus deformity; 21 were associated with arthrogryposis multiplex congenita, two with myelomeningocele and one with idiopathic congenital talipes equinovarus. The mean follow-up was 20 years. Good results were achieved in eight feet (33%) in which further surgery was not needed and walking was painless; a fair result was obtained in ten feet (42%) in which further surgery for recurrence of a hindfoot deformity had been necessary but walking was painless; the remaining six feet (25%) were poor, with pain on walking. All patients wore normal shoes and could walk independently, except one who was wheelchair-bound because of other joint problems. Recurrent deformity, the development of tibiocalcaneal arthritis and spontaneous fusion of the tibia to the calcaneum were all seen in these patients.

  13. Venous thromboembolic disease in uncemented total hip replacement surgery--a one-year follow-up of 490 patients.

    PubMed Central

    Wittmann, P H; Wittmann, F W; Ring, P A

    1991-01-01

    A retrospective study of the morbidity and mortality from deep vein thrombosis (DVT) and pulmonary embolus (PE) in 490 consecutive patients undergoing uncemented total hip replacement was carried out in a district general hospital. Special diagnostic tests for DVT and PE were not available. Patients were followed up for one year. There were three deaths in hospital and eight further deaths during the first year, all unrelated to DVT and PE. The clinical incidence of venous thromboembolism was 2.04%. While clinical diagnosis of venous thromboembolic disease probably underestimates its incidence, the figures for mortality are accurate. With every patient accounted for one year after operation, there were no deaths attributable to PE in this series. PMID:1941855

  14. Clinical Features, Prothrombotic Risk Factors, and Long-Term Follow-Up of Eight Pediatric Moyamoya Patients

    PubMed Central

    Tatlı, Burak; Sencer, Altay; Sencer, Serra; Aydın, Kubilay; Aydınlı, Nur; Çalışkan, Mine; Özmen, Meral; Kırış, Talat

    2012-01-01

    Background and Purpose The aim of this study was to elucidate the clinical features, prothrombotic risk factors, and outcome of pediatric Moyamoya patients. Methods Patients diagnosed with Moyamoya disease at a tertiary center between January 2000 and December 2006 were enrolled in this study. The clinical presentations, underlying diseases, prothrombotic risk factors, family history of thrombosis, radiological findings, treatment, and outcome of the patients were reviewed retrospectively. Results Eight patients with angiographically proven Moyamoya disease were identified, one of whom had neurofibromatosis type I and one had Down syndrome. The age at diagnosis varied between 19 months and 11 years (73.4±41.8 months, mean±SD). The follow-up period after diagnosis was 52.5±14.8 months. In six patients, the initial clinical presentation was hemiparesis. None of the patients had any identifiable prothrombotic factors. Despite medical and surgical treatment, three patients had recurrences and one died. Only two patients recovered without sequelae. Conclusions The value of prothrombotic risk factor evaluation appears to be limited in Moyamoya patients; the outcome for pediatric patients remains dismal. PMID:22787492

  15. [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.

  16. Long-term follow-up of cortisol awakening response in patients treated for stress-related exhaustion

    PubMed Central

    Ljung, Thomas; Jonsdottir, Ingibjörg H

    2012-01-01

    Objectives Studies on hypothalamus–pituitary–adrenal (HPA) axis activity in stress-related exhaustion and burnout have revealed incongruent results, and few longitudinal studies on clinical populations have been performed. This study was designed to investigate differences in HPA axis activity between patients with stress-related exhaustion and healthy controls and to investigate longitudinal changes in HPA axis activity in the patient group as they entered a multimodal treatment programme. Design HPA axis activity was assessed through the cortisol awakening response (CAR). Salivary cortisol was sampled at awakening and after 15 min. Follow-up measurements were performed in the patient group after 3, 6, 12 and 18 months. Setting An outpatient clinic specialising in stress-related illness. Participants Patients with clinically diagnosed stress-related exhaustion (n=162) and healthy controls (n=79). Primary and secondary outcome measures The primary measure was CAR measured as the difference between the two salivary cortisol samples. Changes in CAR during follow-up were related to changes in symptoms of burnout, depression and anxiety. Results Patients showed similar CAR as the controls and their CAR did not change significantly during treatment. No association was found between CAR and symptom development during treatment. Conclusions The authors conclude that CAR does not seem to discriminate clinically defined patients with exhaustion from healthy controls and it appears not to change during treatment. CAR, measured as salivary cortisol, at awakening and after 15 min, is thus not a valid marker for stress-related exhaustion. PMID:22786949

  17. Echoguided pair technique in diagnosis and treat-ment of abdominal hydatid cystic disease in Egyptian patients: clnical and ultrasonographic follow up.

    PubMed

    El Kady, Nabeel; Ramzy, Iman; Hanan, Hasan A El-Garem; Haleem, Abdel; El-Bahnasawy, Mamdouh M

    2011-12-01

    The introduction of the percutaneous puncture, aspiration, injection of scolecidal agent and reaspiration (PAIR) technique is gaining an increasing acceptance in diagnosis and treatment of abdominal cystic hydatid disease (CHD). Thirty-three patients (12 male & 21 female with age between 15 and 70 years) had 46 cysts in liver, spleen and kidneys (75.7%, 18.2% & 6.1% respectively). Puncture, aspiration, injection of 95% sterile alcohol for 20 minutes and reaspiration (PAIR) was used for treatment of hydatid cysts of different types and sizes. Follow up both clinically and ultrasonographically was done over a period of 2 years. The commonest ultrasound picture was type la (overall echofree) in 80.4%, commonly in the liver (75.7%) mainly in the right lobe (88%). Improvement of symptoms had occurred its 85% within 3 weeks. As regards ultrasound follow up of 41 non-complicated cysts within the 1st six months, was disappearance of 5 cysts, 34 reduced in size and 36 showed different grades of solidification. After 1.5 year 10 more cysts disappeared while the pseudotumour appearance was shown in remaining 26 cysts. Ultrasound follow up of the 5 infected cysts revealed complete cure within a period of 8-16 weeks in 4 of them. The last patient discontinued drainage therapy and was referred to surgery. This makes ultrasound cure reaching 97%. Minor complications were skin reaction only in 2 patients (6%). No fatal anaphylaxis cyst recurrence or rupture into the peritoneal cavity or bleeding from renal or splenic puncturing. PAIR technique under ultrasonographic guidance is the first choice method for treatment of abdominal CHD especially in the developing countries and inoperable hydatid cysts.

  18. Radiation-induced brachial plexopathy: Neurological follow-up in 161 recurrence-free breast cancer patients

    SciTech Connect

    Olsen, N.K.; Pfeiffer, P.; Johannsen, L.; Schroder, H.; Rose, C. )

    1993-04-30

    The purpose was to assess the incidence and clinical manifestations of radiation-induced brachial plexopathy in breast cancer patients, treated according to the Danish Breast Cancer Cooperative Group protocols. One hundred and sixty-one recurrence-free breast cancer patients were examined for radiation-induced brachial plexopathy after a median follow-up period of 50 months (13-99 months). After total mastectomy and axillary node sampling, high-risk patients were randomized to adjuvant therapy. One hundred twenty-eight patients were treated with postoperative radiotherapy with 50 Gy in 25 daily fractions over 5 weeks. In addition, 82 of these patients received cytotoxic therapy (cyclophosphamide, methotrexate, and 5-fluorouracil) and 46 received tamoxifen. Five percent and 9% of the patients receiving radiotherapy had disabling and mild radiation-induced brachial plexopathy, respectively. Radiation-induced brachial plexopathy was more frequent in patients receiving cytotoxic therapy (p = 0.04) and in younger patients (p = 0.04). The clinical manifestations were paraesthesia (100%), hypaesthesia (74%), weakness (58%), decreased muscle stretch reflexes (47%), and pain (47%). The brachial plexus is more vulnerable to large fraction size. Fractions of 2 Gy or less are advisable. Cytotoxic therapy adds to the damaging effect of radiotherapy. Peripheral nerves in younger patients seems more vulnerable. Radiation-induced brachial plexopathy occurs mainly as diffuse damage to the brachial plexus. 24 refs., 9 tabs.

  19. Long-term Follow-up of Therapeutic ERCP in 78 Patients Aged 90 Years or Older

    PubMed Central

    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

  20. Charnley low-frictional torque arthroplasty in patients under the age of 51 years. Follow-up to 33 years.

    PubMed

    Wroblewski, B M; Siney, P D; Fleming, P A

    2002-05-01

    Between November 1962 and December 1990 a group of 1092 patients, 668 women and 424 men, under the age of 51 years at the time of surgery, underwent 1434 primary Charnley low-frictional torque arthroplasties and are being followed up indefinitely. Their mean age at operation was 41 years (12 to 51). At the latest review in June 2001 the mean follow-up had been for 15 years 1 month. Of the 1092 patients 54 (66 hips) could not be traced, 124 (169 hips) were known to have died and 220 (248 hips) had had a revision procedure. At a mean follow-up of 17 years and 5 months, 759 patients (951 hips) are still attending. In this group satisfaction with the outcome is 96.2%. The incidence of deep infection for the whole group was 1.67%. It was more common in patients who had had previous surgery (hemi- and total hip arthroplasties excluded), 2.2% compared with 1.5% in those who had not had previous surgery, but this difference was not statistically significant (p = 0.4). There were fewer cases of deep infection if gentamicin-containing cement was used, 0.9% compared with 1.9% in those with plain acrylic cement, but this was not also statistically significant (p = 0.4). There was a significantly higher rate of revision in patients who had had previous hip surgery, 24.8% compared with 14.1% in those who had not had previous surgery (p < 0.001). At the latest review, 1.95% are known to have had at least one dislocation and 0.4% have had a revision for dislocation. The indication for revision was aseptic loosening of the cup (11.7%), aseptic loosening of the stem (4.9%), a fractured stem (1.7%), deep infection (1.5%) and dislocation (0.4%). With revision for any indication as the endpoint the survivorship was 93.7% (92.3 to 95.0) at ten years, 84.7% (82.4 to 87.1) at 15 years, 74.3% (70.5 to 78.0) at 20 years and 55.3% (45.5 to 65.0) at 27 years, when 55 hips remained 'at risk'.

  1. Self-perceived effects of occlusal appliance therapy on TMD patients: an eight-year follow-up.

    PubMed

    Erixon, Caroline Linné; Ekberg, EwaCarin

    2013-01-01

    There are few long-term follow-up studies of treatment of temporomandibular disorders (TMD).The aim of this questionnaire study was to evaluate eight-year outcomes of appliance therapy in patients suffering from arthralgia/osteoarthritis and/or myofascial pain. The subjects comprised 120 patients, originally randomly assigned to treatment with an occlusal or a control (palatal) appliance. Eight years later, a questionnaire was sent to 118 eligible patients: 90 (76%) responded. The outcome measures were intensity and frequency of pain, physical and emotional functioning, and overall improvement of pain and headache. Maximum pain intensity had decreased by > 30% in 54 patients (60%); frequency of pain had also decreased significantly. A majority, 57/90, reported improved physical function. Fifty-nine patients reported moderate to severe depression and 61 reported non-specific physical symptoms. Sixty-eight patients reported an overall improvement in TMD pain and 61 perceived overall improvement in severity of headaches. In the intervening years, 57 patients had undergone further treatment, most frequently in the form of another occlusal appliance. The majority of respondents reported improvement in TMD pain and headache. However, it is difficult to evaluate the long-term outcome of appliance therapy as more than 60% of the patients had additional treatments during the eight years.

  2. Cementless acetabular fixation in patients 50 years and younger at 10 to 18 years of follow-up.

    PubMed

    Teusink, Matthew J; Callaghan, John J; Warth, Lucian C; Goetz, Devon D; Pedersen, Douglas R; Johnston, Richard C

    2012-08-01

    The purpose of the study was to evaluate the 10- to 18-year follow-up of cementless acetabular fixation in patients 50 years and younger. We retrospectively reviewed a consecutive group of 118 patients (144 hips) in whom primary total hip arthroplasty had been performed by 2 surgeons using a cementless acetabular component. Two (1.4%) cementless acetabular components were revised because of aseptic loosening. Twenty-four hips (16.7%) were revised for any mechanical failure of the acetabular component mostly related to acetabular liner wear and osteolysis. The average linear wear rate was 0.19 mm per year, which was higher than our previous reports with cemented acetabular fixation. The fiber mesh ingrowth surface of the cementless acetabular component in this study was superior to cemented acetabular components in terms of fixation. However, the high rates of wear and osteolysis have led to poor overall acetabular component construct survivorship.

  3. Skin cancer in patients with psoriasis treated with coal tar. A 25-year follow-up study

    SciTech Connect

    Pittelkow, M.R.; Perry, H.O.; Muller, S.A.; Maughan, W.Z.; O'Brien, P.C.

    1981-08-01

    For many years, crude coal tar has been used for the treatment of psoriasis. The possible carcinogenic effect of crude coal tar and ultraviolet (UV) radiation (Goeckerman regimen), considered individually or in combination, has been of some concern to physicians. A 25-year follow-up study was completed on 280 patients with psoriasis who were hospitalized and treated with crude coal tar and UV radiation at the Mayo Clinic, Rochester, Minn, during the years 1950 through 1954. The results of this study suggest that the incidence of skin cancer is not appreciably increased above the expected incidence for the general population when patients are treated with coal tar ointments. It seems that the Goeckerman regimen (topical crude coal tar combined with UV radiation) can be used with minimal risk for skin cancer in the treatment of psoriasis.

  4. Cilazapril Treatment in a Cohort of Seven Patients with Congestive Heart Failure: A Seven-Year Follow-Up Study

    PubMed Central

    Demirel, Şeref; Erk, Osman; Ünal, Mehmet; Vatansever, Sezai; Oflaz, Hüseyin; Yücesir, İlker; Florinalı, Nursal; Adalet, Kamil

    2003-01-01

    Background: Although angiotensin-converting enzyme inhibitors (ACEIs) have been shown to prolong life in patients with congestive heart failure (CHF), the prognosis of these patients remains poor. Objective: The purpose of the study was to reevaluate a cohort of patients with CHF after 7 years of follow-up with cilazapril therapy to assess the renin-angiotensin system (RAS), anatomic and functional capacity of the heart, and aldosterone escape. Methods: Surviving patients from a cohort hospitalized for CHF between January 1994 and December 1994 who were treated with cilazapril in our center were included in this study. Exercise testing was carried out using the Kattus protocol, and breath-by-breath oxygen analysis, echocardiography, and hormonal analysis were done. Results: Seven patients (5 men, 2 women; mean [SD] age, 70.6 [4.4]) were included in the study. Compared with the early effects (at 15 days) of cilazapril therapy, only mean (SD) peak exercise time decreased significantly at the 7-year follow-up (8.9 [2.4] minutes vs 5.1 [1.9] minutes; P = 0.02). Mean (SD) anaerobic threshold (AT) oxygen consumption and AT ratio increased slightly from 15 days, although these changes were not statistically significant (12.86 [3.5] mL/kg·min vs 13.57 [2.6] mL/kg·min; 70.3% [7.7%] vs 78.9% [9.8%], respectively). Compared with the early effect of therapy, patients had slightly lower mean (SD) ejection fractions (EFs), but the decrease did not reach statistical significance (52% [4%] vs 48% [4%]). Aldosterone levels were within normal limits in all patients, and 2 patients had increased RAS activity. Conclusions: In this study, the observed lack of aldosterone escape, as well as patient survival during ACEI therapy, may be due to selection bias of the surviving patients, who had better EFs and lack of aldosterone escape. Therefore, the remaining issue seems to be the selection of patients who will not show aldosterone escape during chronic ACEI treatment. PMID:24944363

  5. Functional evaluation of patients treated with osteochondral allograft transplantation for post-traumatic ankle arthritis: one year follow-up.

    PubMed

    Berti, L; Vannini, F; Lullini, G; Caravaggi, P; Leardini, A; Giannini, S

    2013-09-01

    Severe post-traumatic ankle arthritis poses a reconstructive challenge in active patients. Whereas traditional surgical treatments, i.e. arthrodesis and arthroplasty, provide good pain relief, arthrodesis is associated to functional and psychological limitations, and arthroplasty is prone to failure in the active patient. More recently the use of bipolar fresh osteochondral allografts transplantation has been proposed as a promising alternative to the traditional treatments. Preliminary short- and long-term clinical outcomes for this procedure have been reported, but no functional evaluations have been performed to date. The clinical and functional outcomes of a series of 10 patients who underwent allograft transplantation at a mean follow-up of 14 months are reported. Clinical evaluation was performed with the AOFAS score, functional assessment by state-of-the-art gait analysis. The clinical score significantly improved from a median of 54 (range 12-65) pre-op to 76.5 (range 61-86) post-op (p=0.002). No significant changes were observed for the spatial-temporal parameters, but motion at the hip and knee joints during early stance, and the range of motion of the ankle joint in the frontal plane (control: 13.8°±2.9°; pre-op: 10.4°±3.1°, post-op: 12.9°±4.2°; p=0.02) showed significant improvements. EMG signals revealed a good recovery in activation of the biceps femoris. This study showed that osteochondral allograft transplantation improves gait patterns. Although re-evaluation at longer follow-ups is required, this technique may represent the right choice for patients who want to delay the need for more invasive joint reconstruction procedures.

  6. Long-term outcomes of epilepsy surgery in 85 pediatric patients followed up for over 10 years: a retrospective survey.

    PubMed

    Hosoyama, Hiroshi; Matsuda, Kazumi; Mihara, Tadahiro; Usui, Naotaka; Baba, Koichi; Inoue, Yushi; Tottori, Takayasu; Otsubo, Toshiaki; Kashida, Yumi; Iida, Koji; Hirano, Hirofumi; Hanaya, Ryosuke; Arita, Kazunori

    2017-03-03

    OBJECTIVE The aim of this study was to investigate the treatment outcomes and social engagement of patients who had undergone pediatric epilepsy surgery more than 10 years earlier. METHODS Between 1983 and 2005, 110 patients younger than 16 years underwent epilepsy surgery at the National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders. The authors sent a questionnaire to 103 patients who had undergone follow-up for more than 10 years after surgery; 85 patients (82.5%) responded. The survey contained 4 categories: seizure outcome, use of antiepileptic drugs, social participation, and general satisfaction with the surgical treatment (resection of the epileptic focus, including 4 hemispherectomies). The mean patient age at the time of surgery was 9.8 ± 4.2 (SD) years, and the mean duration of postoperative follow-up was 15.4 ± 5.0 years. Of the 85 patients, 79 (92.9%) presented with a lesional pathology, such as medial temporal sclerosis, developmental/neoplastic lesions, focal cortical dysplasia, and gliosis in a single lobe. RESULTS For 65 of the 85 responders (76.5%), the outcome was recorded as Engel Class I (including 15 [93.8%] of 16 patients with medial temporal sclerosis, 20 [80.0%] of 25 with developmental/neoplastic lesions, and 27 [73.0%] of 37 with focal cortical dysplasia). Of these, 29 (44.6%) were not taking antiepileptic drugs at the time of our survey, 29 (44.6%) held full-time jobs, and 33 of 59 patients (55.9%) eligible to drive had a driver's license. Among 73 patients who reported their degree of satisfaction, 58 (79.5%) were very satisfied with the treatment outcome. CONCLUSIONS The seizure outcome in patients who underwent resective surgery in childhood and underwent followup for more than 10 years was good. Of 85 respondents, 65 (76.5%) were classified in Engel Class I. The degree of social engagement was relatively high, and the satisfaction level with the treatment outcome was also high. From the perspective of

  7. Breast and ovarian cancer screening of non-carriers from BRCA1/2 mutation-positive families: 2-year follow-up of cohorts from France and Quebec

    PubMed Central

    Dorval, Michel; Noguès, Catherine; Berthet, Pascaline; Chiquette, Jocelyne; Gauthier-Villars, Marion; Lasset, Christine; Picard, Claude; Plante, Marie; Simard, Jacques; Julian-Reynier, Claire

    2011-01-01

    We described and compared breast and ovarian screening practices in the 2-year period following test result disclosure in female non-carriers from BRCA1/2 mutation-positive families living in two countries, France and Quebec, Canada, which provide universal health care. Four hundred and two (France n=293; Quebec n=109) unaffected female non-carriers from BRCA-proven mutation families provided information about the uptake of mammography, clinical breast examination, breast self-examination, and ovarian ultrasounds using self-administered questionnaires. The frequency of screening practices between study cohorts were compared using logistic regression. Annual mammography was conducted in 23 and 43% of French and Quebecer women participants <50 years of age, respectively (adjusted odds ratio (aOR)=2.72; 95% confidence interval (CI), 1.08–6.81). In women ≥50 years of age, mammography was conducted in 49 and 65% of French and Quebecer participants (aOR=1.77; 95% CI, 0.07–4.51). Overall, 33% of French women and 39% of Quebecer women underwent at least one ovarian ultrasound during the 2-year period following BRCA1/2 test result with no significant difference between cohorts of women <50 years of age. Among older women, Quebecers reported more frequently than French women that they had undergone ultrasound once (aOR=3.00; 95% CI, 1.02–8.83). The frequency of cancer screening practices for female non-carriers from BRCA1/2 mutation-positive families in both France and Quebec exceeded those recommended for similarly aged women in the general population. Our findings highlight the need for clearcut recommendations on the follow-up of women from BRCA1/2 families who are not themselves carriers of a BRCA1/2 mutation. PMID:21248744

  8. Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation

    PubMed Central

    Ates, Bülent; Akalin, Serdar; Citak, Mehmet; Kaya, Alper; Alanay, Ahmet

    2006-01-01

    Last two decades witnessed great advances in the surgical treatment of idiopathic scoliosis. However, the number of studies evaluating the long-term results of these treatment methods is relatively low. During recent years, besides radiological and clinical studies, questionnaires like SRS-22 assessing subjective functional and mental status and life-quality of patients have gained importance for the evaluation of these results. In this study, surgical outcome and Turkish SRS-22 questionnaire results of 109 late-onset adolescent idiopathic scoliosis patients surgically treated with third-generation instrumentation [Texas Scottish Rite Hospital (TSRH) System] and followed for a minimum of 10 years were evaluated. The balance was analyzed clinically and radiologically by the measurement of the lateral trunk shift (LT), shift of head (SH), and shift of stable vertebra (SS). Mean age of the patients was 14.4±1.9 and mean follow-up period was 136.9±12.7 months. When all the patients were included, the preoperative mean Cobb angle of major curves in the frontal plane was 60.8°±17.5°. Major curves that were corrected by 38.7±22.1% in the bending radiograms, postoperatively achieved a correction of 64.0±15.8%. At the last follow-up visit, 10.3°±10.8° of correction loss was recorded in major curves in the frontal plane with 50.5±23.1% final correction rate. Also, the mean postoperative and final kyphosis angles and lumbar lordosis angles were 37.7°±7.4°, 37.0°±8.4°, 37.5°±8.7°, and 36.3°±8.5°, respectively. A statistically significant correction was obtained at the sagittal plane; mean postoperative changes compared to preoperative values were 7.9° and 12.9° for thoracic and lumbar regions, respectively. On the other hand, normal physiological thoracic and lumbar sagittal contours were achieved in 83.5% and 67.9% of the patients, respectively. Postoperatively, a statistically significant correction was obtained in LT, SH, and SS values (P<0

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

    PubMed

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

    2012-02-01

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

  10. Newly established stem cell transplant program: 100 days follow-up of patients and its comparison with published Indian literature

    PubMed Central

    Tiwari, Aseem Kumar; Arora, Dinesh; Dara, Ravi C.; Dorwal, Pranav; Sood, Nitin; Misra, Ruchira; Gupta, Sunil Kumar; Raina, Vimarsh; Vaid, Ashok Kumar

    2016-01-01

    Background: Hematopoietic progenitor stem cell transplantation (HPSCT) is used as a standard treatment option to improve outcome in hematological and nonhematological disorders. It is important for new HPSCT program to look at its patient outcome data and compare it with the published data to evaluate the efficacy of program. Aims: The aim was to compile and collate the patient outcome data of HPSCT and compare with published reports. Materials and Methods: Patient demographics, indications, stem cell harvest by apheresis, dose collected, infusion, engraftment, and follow-up data were collected from hospital information system from 2010 to 2013 in a tertiary care hospital. HPSCs were mobilized with granulocyte colony-stimulating factor, and harvests were done on the 5th day. Engraftment was decided for neutrophil when counts were 0.5 × 109/L and for platelets when counts were 20 × 109/L on two consecutive days without any transfusion support. Results: There were 133 harvests for 95 patients with various disorders; multiple myeloma was most common in autologous and acute lymphoblastic leukemia in allogeneic group. One hundred harvests were done for autologous and 33 for allogeneic HPSCT. In autologous group, of 66 patients, 60 (90.9%) received stem cell infusion at median dose of 4.63 × 106 CD34+ cells/kg. Similarly, in allogeneic group, of 29 patients, 27 (93.10%) received infusion at median dose of 5.8 × 106 CD34+ cells/kg. 58 (96.9%) patients and 25 (92.6%) engrafted in autologous and allogeneic group, respectively. The median time for neutrophils engraftment was 11 days in autologous group and 12 days in allogeneic group. The median time for platelet engraftment was 11.5 days in autologous group and 13 days in allogeneic group. The 100-day survival rate was 95% (n = 57) in autologous group and 77.8% (n = 21) in allogeneic group. Conclusion: This data analysis shows reasonably good results of HPSCTs with majority of patients surviving at 100-day follow-up

  11. Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial.

    PubMed Central

    Grunfeld, E; Fitzpatrick, R; Mant, D; Yudkin, P; Adewuyi-Dalton, R; Stewart, J; Cole, D; Vessey, M

    1999-01-01

    BACKGROUND: Routine follow-up of breast cancer patients in specialist clinics is standard practice in most countries. Follow-up involves regularly scheduled breast cancer check-ups during the disease-free period. The aims of follow-up are to detect breast cancer recurrence and to provide psychosocial support to the patient; however, little is known about patients' views on breast cancer follow-up. AIM: To assess the effect on patient satisfaction of transferring primary responsibility for follow-up of women with breast cancer in remission from hospital outpatient clinics to general practice. METHOD: Randomized controlled trial with 18 months' follow-up in which women received routine follow-up either in hospital outpatient clinics or from their own general practitioner. Two hundred and ninety-six women with breast cancer in remission receiving regular follow-up care at two district general hospitals in England were included in the study. Patient satisfaction was measured by means of a self-administered questionnaire supplied three times during the 18-month study period. RESULTS: The general practice group selected responses indicating greater satisfaction than did the hospital group on virtually every question. Furthermore, in the general practice group there was a significant increase in satisfaction over baseline; a similar significant increase in satisfaction over baseline was not found in the hospital group. CONCLUSION: Patients with breast cancer were more satisfied with follow-up in general practice than in hospital outpatient departments. When discussing follow-up with breast cancer patients, they should be provided with complete and accurate information about the goals, expectations, and limitations of the follow-up programme so that they can make an informed choice. PMID:10756611

  12. Evaluating outcomes of patients lost to follow-up in a large comprehensive care treatment program in western Kenya

    PubMed Central

    Rachlis, B; Ochieng, D; Geng, E; Rotich, E; Ochieng, V; Maritim, B; Ndege, S; Naanyu, V; Martin, J; Keter, A; Ayuo, P; Diero, L; Nyambura, M; Braitstein, P

    2014-01-01

    Background The Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients. Methods LTFU was defined as missing a scheduled visit by ≥ 3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status. Results Of 14,811 LTFU patients, 2,540 were randomly selected for tracing (2,179 adults, 1,071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died while 29% had disengaged from care for various reasons. The remaining patients had moved away (n=458, 25%) or were still receiving HIV care (n=443 total, 25%). Conclusions Our findings demonstrate the feasibility of a large scale sampling-based approach. A significant proportion of patients were found not to be LTFU and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences. PMID:25692336

  13. Clinical utility of serial serum c-erbB-2 determinations in the follow-up of breast cancer patients.

    PubMed

    Fehm, Tanja; Gebauer, Gerhard; Jäger, Wolfram

    2002-09-01

    To evaluate the ability of serum c-erbB-2 protein to (1) indicate occult and manifest metastases and (2) reflect response to first-line therapy, serial serum c-erbB-2 measurements were performed in a retrospective series of 52 primary breast cancer patients who had developed metastatic disease during follow-up. The results were compared with CA 15-3. Preoperatively, 31% (16/52) of the primary breast cancer patients had elevated c-erbB-2 concentrations. The CA 15-3 positivity rate was 13% (7/52). After surgery, 10 of the 52 patients showed either stable but highly elevated or rising c-erbB-2 serum levels indicating serum c-erbB-2 producing minimal residual disease. Increasing CA 15-3 concentrations were seen in only three patients. Elevated serum c-erbB-2 levels predicted manifest metastases in 27 and 50% of the patients at 6 and 3 months, respectively, prior to clinical diagnosis. CA 15-3 was less sensitive. Only 16 and 32% of the patients had increased CA 15-3 serum concentrations at 6 and 3 months, respectively, prior to clinical detection. The positivity rates of c-erbB-2 and CA 15-3 were similar when metastases were clinically diagnosed. Elevated c-erbB-2 concentrations were found in 62% (32/52). The sensitivity of CA 15-3 was 56% (29/52). The association between serum profiles and response to first-line therapy was evaluated in detail for 45 patients. Serial c-erbB-2 and CA 15-3 measurements reflected disease course in 24 and 27 patients, respectively. The serum profiles of c-erbB-2 and CA 15-3 were similar in 17 patients. In summary, our results suggest that serial determinations of serum c-erbB-2 are useful to monitor breast cancer patients.

  14. Changes in coronary heart disease risk profiles of HIV patients in Zimbabwe over 9 months: a follow-up study

    PubMed Central

    Zhou, Danai Tavonga; Oektedalen, Olav; Shawarira-Bote, Sandra; Stray-Pedersen, Babill

    2016-01-01

    Dyslipidemia, hypertension, inflammation, and coronary heart disease (CHD) are adverse events in human immunodeficiency virus (HIV)-infected patients even if they are receiving antiretroviral therapy (ART). Yet, data on CHD risk induced by HIV or ART in sub-Saharan Africa are limited. The aim of this longitudinal study was to describe changes in CHD risk profiles measured by lipids, inflammatory markers, and Framingham scores among HIV-positive patients previously reported from Harare, Zimbabwe. Patients were grouped into ART-experienced patients (n=147) and ART-naïve patients (n=23) and followed up for 9 months. Generalized least squares random-effects modeling was applied to explain changes in total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein, TC/HDL ratio, myeloperoxidase, highly sensitive C-reactive protein, and Framingham scores over the 9-month period. Independent variables included age, sex, monthly earning, body mass index, systolic blood pressure (SBP), diastolic blood pressure, duration of HIV diagnosis, duration of ART, viral load, and CD4 count. In ART-experienced patients, there was a substantial decrease in TC over time, ART-negative patients showed a significant increase in TC and HDL over time, and the increase in TC was associated with high viral load and low duration of HIV diagnosis, while increase in HDL was associated with young age, low body mass index, and low SBP. Framingham risk scores increased with time in ART-positive patients, and the change was positively correlated with age, sex, high SBP, and low HDL. There was no association between calculated CHD risk (TC/HDL ratio or Framingham score) and changes in levels of inflammatory markers (myeloperoxidase and highly sensitive C-reactive protein) in any of the patient groups. In conclusion, ART-experienced HIV-positive patients show changes in lipid values over time that makes it necessary to include lipid monitoring in order to reduce any risk of long

  15. Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care

    PubMed Central

    de Waal, Margot WM; Arnold, Ingrid A; Eekhof, Just AH; Assendelft, Willem JJ; van Hemert, Albert M

    2008-01-01

    Background Better management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively. Methods In eight family practices 1046 consulting patients (25–79 yrs) were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV) using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP). Results In the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7)). Anxiety disorders had no independent effect. Conclusion Health care planning should focus on the recognition and treatment of somatoform as well as affective disorders. PMID:18218070

  16. Non-Compliance and Related Factors in Patients With Bipolar I Disorder: A Six Month Follow-Up Study

    PubMed Central

    Azadforouz, Sanaz; Shabani, Amir; Nohesara, Shabnam; Ahmadzad-Asl, Masoud

    2016-01-01

    Background Medication treatment compliance among bipolar patients is quite widespread. Objectives Treatment compliance depends on multiple factors. The aim of this study was to evaluate the predicting factors of noncompliance in patients with bipolar I disorder admitted to an Iranian hospital during a six-month follow up period. Materials and Methods This cross-sectional study included 47 bipolar I disorder subjects who were admitted to the Iran psychiatric hospital and that were chosen using a non-randomized convenient sampling model. The patients were assessed at baseline, and at two and six months after admission. For evaluating the patients, we used the medication possession ratio (MPR), the drug attitude inventory (DIA-10), the young mania rating scale (Y-MRS) and the scale for the assessment of positive symptoms (SAPS). The data were analyzed using a general linear model by SPSS 16 software. Results The repeated measures analysis revealed that medication compliance increased successively (P = 0.045), and age, gender and symptom severity did not alter the pattern. Conclusions There is an increasing pattern in treatment compliance in bipolar I disorder patients, regardless of the known predicting factors for nonadherence. PMID:27803718

  17. Bortezomib, thalidomide and dexamethasone, with or without cyclophosphamide, for patients with previously untreated multiple myeloma: 5-year follow-up.

    PubMed

    Ludwig, Heinz; Greil, Richard; Masszi, Tamas; Spicka, Ivan; Shpilberg, Ofer; Hajek, Roman; Dmoszynska, Anna; Paiva, Bruno; Vidriales, María-Belén; Esteves, Graca; Stoppa, Anne Marie; Robinson, Don; Chaturvedi, Shalini; Ataman, Ozlem; Enny, Christopher; Feng, Huaibao; van de Velde, Helgi; Viterbo, Luisa

    2015-11-01

    This follow-up extension of a randomised phase II study assessed differences in long-term outcomes between bortezomib-thalidomide-dexamethasone (VTD) and VTD-cyclophosphamide (VTDC) induction therapy in multiple myeloma. Newly diagnosed patients (n = 98) were randomised 1:1 to intravenous bortezomib (1·3 mg/m(2); days 1, 4, 8, 11), thalidomide (100 mg; days 1-21), and dexamethasone (40 mg; days 1-4, 9-12), with/without cyclophosphamide (400 mg/m(2); days 1, 8), for four 21-day cycles before stem-cell mobilisation/transplantation. After a median follow-up of 64·8 months, median time-to-next therapy was 51·8 and 47·9 months with VTD and VTDC, respectively. Type of subsequent therapy was similar in both arms. After adjusting for asymmetric censoring, median time to progression was not significantly different between VTD and VTDC [35·7 vs. 34·5 months; Hazard ratio (HR) 1·26, 95% confidence interval: 0·76-2·09; P = 0·370]. Five-year survival was 69·1% and 65·3% with VTD and VTDC, respectively. When analysed by minimal residual disease (MRD) status, overall survival was longer in MRD-negative versus MRD-positive patients with bone marrow-confirmed complete response (HR 3·66, P = 0·0318). VTD induction followed by transplantation provides long-term disease control and, consistent with the primary analysis, there is no additional benefit from adding cyclophosphamide. This study was registered at ClinicalTrials.gov (NCT00531453).

  18. Comparative Efficacy and Durability of Continuation Phase Cognitive Therapy for Preventing Recurrent Depression: Design of a Double-Blinded, Fluoxetine- and Pill-Placebo–Controlled, Randomized Trial with 2-Year Follow-up

    PubMed Central

    Thase, Michael E.

    2010-01-01

    Background Major depressive disorder (MDD) is highly prevalent and associated with disability and chronicity. Although cognitive therapy (CT) is an effective short-term treatment for MDD, a significant proportion of responders subsequently suffer relapses or recurrences. Purpose This design prospectively evaluates: 1) a method to discriminate CT-treated responders at lower versus higher risk for relapse; and 2) the subsequent durability of 8-month continuation phase therapies in randomized higher risk responders followed for an additional 24-months. The primary prediction is: after protocol treatments are stopped, higher risk patients randomly assigned to continuation phase CT (C-CT) will have a lower risk of relapse/recurrence than those randomized to fluoxetine (FLX). Methods Outpatients, aged 18 to 70 years, with recurrent MDD received 12–14 weeks of CT provided by 15 experienced therapists from two sites. Responders (i.e., no MDD and 17-item Hamilton Rating Scale for Depression ≤ 12) were stratified into higher and lower risk groups based on stability of remission during the last 6 weeks of CT. The lower risk group entered follow-up for 32 months; the higher risk group was randomized to 8 months of continuation phase therapy with either C-CT or clinical management plus either double-blinded FLX or pill placebo. Following the continuation phase, higher risk patients were followed by blinded evaluators for 24 months. Results The trial began in 2000. Enrollment is complete (N=523). The follow-up continues. Conclusions The trial evaluates the preventive effects and durability of acute and continuation phase treatments in the largest known sample of CT responders collected worldwide. PMID:20451668

  19. Current imaging follow-up of non-Hodgkin lymphoma exposes patients to significant radiation but does not detect asymptomatic relapses.

    PubMed

    Riva, Eloisa; Oliver, Carolina; Pérez, Maria del Carmen; Telis, Osmar; Díaz, Lilian; Mikhael, Joseph R

    2016-01-01

    The standard approach to the follow-up of lymphoma includes computed tomography (CT) every 6-12 months for the first 2 years and, then, as clinically indicated. Recent evidence suggests that most relapses are detected clinically, outside scheduled CT which, on the other hand, increases risk of second malignancies and cost. In early-stage lymphomas, involved site CT instead of full body CT may be a reasonable alternative to reduce radiation dose. We analyzed whether regular CT surveillance detects asymptomatic relapses in a single-center Uruguayan early stage non-Hodgkin lymphoma (NHL) population. We evaluated utility of full body CT halfway and at the end-of-treatment evaluation and calculated the radiation exposure. In our study, CT surveillance added nothing to clinical follow-up. Moreover, 44% of our patients received a cumulative effective dose that doubles the risk of malignancies. Involved-site CT scan would be enough to monitor response during treatment in early stage NHL.

  20. A follow-up study of patients with Dhat syndrome: Treatment pattern, outcome, and reasons for dropout from treatment

    PubMed Central

    Grover, Sandeep; Gupta, Sunil; Avasthi, Ajit

    2016-01-01

    Aim: The aim of this study was to evaluate the treatment pattern and satisfaction with treatment provided to patients with Dhat syndrome. It was also aimed to study the follow-up rates and reasons for dropping out of treatment in patients with Dhat syndrome. Materials and Methods: Sixty-four subjects diagnosed with Dhat syndrome were prospectively contacted to evaluate treatment satisfaction and reason for dropout after 6 months of baseline evaluation. Sociodemographic, clinical details were recorded at initial intake and Sex Knowledge and Attitude Questionnaire was applied. After 6 months, information on treatment received, number of follow-up visits to the clinic and the outcome were extracted from the treatment records. Treatment satisfaction using Patient Satisfaction Questionnaire and reasons for dropping out from treatment were assessed by a telephonic interview. Results: Twenty-three patients were categorized as treatment completers, 14 as early drop-outs and 27 as late drop-out. The mean (standard deviation) number of visits over the period of 6 months was 3.81 (3.06). The outcome at 6 months was no change in 45.3%, improved in 32.8% and recovered in 21.9%. Higher proportion of treatment completers (52.2%) sought psychiatric help on their own compared to those who dropped out early from the treatment (7.1%). Treatment completers had better knowledge, and more positive attitude toward sex compared to late drop-out group. 34.4%of the subjects were fully satisfied with the various components of treatment. Level of satisfaction was highest for treatment completers. The most common reasons given by those who dropped out early were “not able to spare time for consultation” (21.4%) and “not prescribed medications” (21.4%). The most common reason given by those belonging to “late drop-out” group was ‘no improvement with treatment in symptoms of Dhat syndrome (40.7%). Conclusions: Patients with Dhat syndrome frequently drop-out of the treatment network

  1. An empirical approach to defining loss to follow-up among patients enrolled in antiretroviral treatment programs.

    PubMed

    Chi, Benjamin H; Cantrell, Ronald A; Mwango, Albert; Westfall, Andrew O; Mutale, Wilbroad; Limbada, Mohammed; Mulenga, Lloyd B; Vermund, Sten H; Stringer, Jeffrey S A

    2010-04-15

    In many programs providing antiretroviral therapy (ART), clinicians report substantial patient attrition; however, there are no consensus criteria for defining patient loss to follow-up (LTFU). Data on a multisite human immunodeficiency virus (HIV) treatment cohort in Lusaka, Zambia, were used to determine an empirical "days-late" definition of LTFU among patients on ART. Cohort members were classified as either "in care" or LTFU as of December 31, 2007, according to a range of days-late intervals. The authors then looked forward in the database to determine which patients actually returned to care at any point over the following year. The interval that best minimized LTFU misclassification was described as "best-performing." Overall, 33,704 HIV-infected adults on ART were included. Nearly one-third (n = 10,196) were at least 1 day late for an appointment. The best-performing LTFU definition was 56 days after a missed visit, which had a sensitivity of 84.1% (95% confidence interval (CI): 83.2, 85.0), specificity of 97.5% (95% CI: 97.3, 97.7), and misclassification of 5.1% (95% CI: 4.8, 5.3). The 60-day threshold performed similarly well, with only a marginal difference (<0.1%) in misclassification. This analysis suggests that > or =60 days since the last appointment is a reasonable definition of LTFU. Standardization to empirically derived definitions of LTFU will permit more reliable comparisons within and across programs.

  2. Noninvasive Transcutaneous Monitoring in Long-Term Follow-Up of Patients With Thromboangiitis Obliterans Treated With Intravenous Iloprost.

    PubMed

    Melillo, Elio; Grigoratos, Chrysanthos; Sanctis, Francesco De; Spontoni, Paolo; Nuti, Marco; Dell'Omodarme, Matteo; Ferrari, Mauro; Balbarini, Alberto

    2015-07-01

    We evaluated the effectiveness of intravenous iloprost (IVI) in outpatients with thromboangiitis obliterans (TAO) and lower limb noninvasive transcutaneous monitoring (TCM) at follow-up (FU). Ten consecutive patients with TAO underwent IVI therapy. Transcutaneous oxygen (TcPo 2) and carbon dioxide (TcPco 2) determination and laser Doppler flowmetry (LDF) were performed before and after IVI at 3, 6, and 12 months of FU. Clinical response was positive in 7 patients, whereas 3 nonresponders underwent a second IVI cycle with 1 showing a late positive clinical response. After 12 months of FU, all patients were alive without amputations. Supine and dependent TcP2 levels significantly improved (P < .005). Hallux LDF values showed significant change with the maximal hyperemic test at 44°C (P < .005). Forefoot maximal hyperemic test at 44°C LDF (P < .005) and improved venous arterial reflex (P < .05) showed statistically significant time evolution. We demonstrated some degree of IVI effectiveness and evaluated TCM in patients with TAO.

  3. [Follow-up of the patients in the program of self-management of OAT. Experience in a unit].

    PubMed

    Camino, Guiu Jesús; Cebollero, Mata Luisa; Borrel, Roncalés Mercedes

    2012-11-01

    Development in the implementation of the programme of the anticoagulated patient self-management concludes with the follow-up. Your objective is to guide, support, advise and provide the patient with the necessary support material and training and improve their autonomy and quality of life. Contacts are established through both scheduled and unscheduled visits and phone calls. The article describes this phase interspersed, so serve as a practical example, with the experience which has resulted in our unit. Relates the workloads of different professionals and the most the recurrent causes of consultation. Also lists the contents that must be observed in the contacts: practical problems in the puncture or tables of dosing, assessment of the implementation of the programme, dump the data registered in the coagulometer to the computer system, revision of the autoanalyzer, material supply and treatment settings. Reviews of records that help us detect and assess problems that are resolved by a continuous and permanent health education almost in its entirety should periodically conduct. Finally, we present a study on the incidence of adverse effects occurring in self-controlled patients that we are witnessing in our unit.

  4. [Follow-up of two patients with mesangial IgA glomerulonephritis exposed to cadmium and organic solvents].

    PubMed

    Fernández, J; Colomé, Jaime Fernández; Sanz-Gallén, P; Sanz-Gallén, Pere; Nogué, S; Xarau, Santiago Nogué

    2010-01-01

    For several years we carried out a follow-up of two patients with IgA mesangial glomerulonephritis with antecedents of exposure to toxic substances (cadmium and organic solvents). The first case involved a 47 year old male who was diagnosed with mesangial IgA glomerulonephritis eight years ago; he had been working for twelve years as a solderer. He had used metal bars containing 25% cadmium as part of the soldering material. Very high levels of cadmium were detected in his blood and urine. The second case involved a 50 year male who was exposed to a wide number of organic dissolvents for 23 years. Three years ago he was diagnosed with a proliferative diffuse mesangial glomerulonephritis with IgA deposits; in spite of that, the patient continued working until one year ago, when was found to have a chronic stage 3 renal disease secondary to IgA nephropathy. Patients diagnosed with mesangial IgA glomerulonephritis should be kept apart from exposure to nephrotoxic substances.

  5. Fish Oil Supplementation and Quality of Life in Stage II Colorectal Cancer Patients: A 24-Month Follow-Up Study.

    PubMed

    Lewis, Cari; Xun, Pengcheng; Fly, Alyce D; Luo, Juhua; He, Ka

    2015-01-01

    Research suggests that cancer survivors have an interest in lifestyle changes following a diagnosis. However, few studies have prospectively investigated whether these changes result in positive outcomes. The objective of this study was to examine the associations between fish oil supplementation and quality of life (QoL), cancer recurrence, and all-cause mortality in Stage 2 colorectal cancer (CRC) patients following diagnosis. Four hundred fifty-three patients were enrolled from the North Carolina Cancer Registry from 2009 to 2011. Data on demography, treatment, and health behaviors were collected at diagnosis, 12-, and 24 mo postdiagnosis. Generalized estimating equations were performed to examine fish oil supplementation in relation to QoL, recurrence, and all-cause mortality. An increase in fish oil supplementation over 24 mo postdiagnosis was associated with an increase in the physical component score of the 12-item Medical Outcomes Short Form (β = 2.43, 95% CI: 0.10-4.76). Supplementation showed no association with the Functional Assessment of Cancer-Colorectal, cancer recurrence or mortality across the 24-mo follow-up. This study suggests that fish oil supplementation may improve symptom-related QoL (i.e., physical functioning) in Stage 2 CRC patients following diagnosis. Future research should address the dose-dependent effects of this relationship.

  6. "When patients have cancer, they stop seeing me" – the role of the general practitioner in early follow-up of patients with cancer – a qualitative study

    PubMed Central

    Anvik, Tor; Holtedahl, Knut A; Mikalsen, Hege

    2006-01-01

    Background The role of the general practitioner (GP) in cancer follow-up is poorly defined. We wanted to describe and analyse the role of the GP during initial follow-up of patients with recently treated cancer, from the perspective of patients, their relatives and their GPs. Methods One focus group interview with six GPs from the city of Bodø and individual interviews with 17 GPs from the city of Tromsø in North Norway. Text analysis of the transcribed interviews and of free text comments in two questionnaires from 91 patients with cancer diagnosed between October 1999 and September 2000 and their relatives from Tromsø. Results The role of the GP in follow-up of patients with recently treated cancer is discussed under five main headings: patient involvement, treating the cancer and treating the patient, time and accessibility, limits to competence, and the GP and the hospital should work together. Conclusion The GP has a place in the follow-up of many patients with cancer, also in the initial phase after treatment. Patients trust their GP to provide competent care, especially when they have more complex health care needs on top of their cancer. GPs agree to take a more prominent role for cancer patients, provided there is good access to specialist advice. Plans for follow-up of individual patients could in many cases improve care and cooperation. Such plans could be made preferably before discharge from in-patient care by a team consisting of the patient, a carer, a hospital specialist and a general practitioner. Patients and GPs call on hospital doctors to initiate such collaboration. PMID:16549036

  7. Automated breast imaging-reporting and data system (BI-RADS) category 3 follow-up application: improving patient care and compliance

    NASA Astrophysics Data System (ADS)

    Kandula, Praveena; Cook, T. S.; Boonn, W. W.; Kim, W.

    2011-03-01

    With the current emphasis on healthcare reform and cost effectiveness, methods to increase healthcare efficiency while improving outcomes are paramount. With reference to breast cancer, delay in diagnosis can cause significant morbidity and mortality, as well as increased long term health care costs. Assessment with short interval mammographic follow-up of BI-RADS category 3 lesions has been shown to increase detection of a small number of breast cancers at an early stage. Because of the importance of timely follow-up for these patients, we propose a novel computer application that identifies patients due for short-term mammographic follow-up, thus reducing costly hours spent by personnel, reducing human error, and improving patient compliance. Our web-based application mines radiology reports and scheduling information to generate lists of patients due for short-term mammographic follow-up of BI-RADS category 3 results. The results can be placed in a worklist that can be used by a staff member to contact patients to schedule follow-up appointments. Additional analytic features of the application can identify referral characteristics that may serve as potential sources for improvement of patient follow-up. We believe that an automated system can be designed to improve patient care and compliance with follow-up of BI-RADS category 3 results.

  8. Impact of Physician-Coordinated Intensive Follow-Up on Long-Term Medical Costs in Patients with Unstable Angina Undergoing Percutaneous Coronary Intervention

    PubMed Central

    Jia, Jing-Jing; Dong, Ping-Shuan; Du, Lai-Jing; Li, Zhi-Guo; Lai, Li-Hong; Yang, Xu-Ming; Wang, Shao-Xin; Yang, Xi-Shan; Li, Zhi-Juan; Shang, Xi-Yan; Fan, Xi-Mei

    2017-01-01

    Background To investigate the impact of professional physician-coordinated intensive follow-up on long-term expenditures after percutaneous coronary intervention (PCI) in unstable angina (UA) patients. Methods In this study, there were 669 UA patients who underwent successful PCI and followed up for 3 years, then divided into the intensive follow-up group (N = 337), and the usual follow-up group (N = 332). Patients were provided with detailed discharge information and individualized follow-up schedules. The intensive group received the extra follow-up times and medical consultations, and all patients were followed up for approximately 3 years. Results At the 3-year mark after PCI, the cumulative major adverse cardiac events (MACE), recurrence of myocardial ischemia, cardiac death, all-cause death and revascularization in the intensive group were lower than in the usual group. Additionally, the proportion of good medication adherence was significantly higher than in the usual group (56.4% vs. 46.1%, p < 0.001). The hospitalization daytime, total hospitalization cost and total medical cost in the intensive group were lower. Multiple linear regression showed that diabetes, hypertension, intensive follow-up and good medication adherence were associated with emergency and regular clinical cost (p < 0.05), the re-hospitalization cost (p < 0.05) and the total medical cost (p < 0.05) of patient care. Intensive follow-up and good adherence were negatively correlated with the cost of re-hospitalization (standardized coefficients = -0.132, -0.128, p < 0.05) and total medical costs (standardized coefficients = -0.072, -0.086, p < 0.05). Conclusions Intensive follow-up can reduce MACE, improve medication adherence and save long-term total medical costs, just by increasing the emergency and regular clinical visits cost in UA patients after PCI. PMID:28344421

  9. Bone Mass Outcomes in Patients With Osteoporosis Treated With Risedronate After Alendronate Failure: a 12-Month Follow-Up Study.

    PubMed

    Mendonça, Leonardo Teixeira; Pinheiro, Marcelo Medeiros; Szejnfeld, Vera Lúcia; Castro, Charlles Heldan de Moura

    Oral bisphosphonates are the drugs most frequently used for the treatment of osteoporosis. Clinicians usually switch between these drugs in clinical practice based on differences in efficacy. We aim to investigate the reasons associated with switching between oral bisphosphonates and to evaluate bone mass response and the incidence of fractures 12 mo after the exchange in a cohort of patients with osteoporosis seen at a tertiary hospital. Patients with osteoporosis who switched between oral bisphosphonates between January 2007 and December 2014 were included. Bone mass measured by dual-energy X-ray absorptiometry and the incidence of fracture were evaluated. A total of 112 patients (73.1 yr old on average, 95.5% women, 98% postmenopausal) were included. All patients were taking alendronate at the time of the switch to risedronate. In 91 patients (81.3%), the following reasons for the exchange of medication were identified: bone loss (59.8%), adverse events (11.6%), and recent fragility fracture (10.7%). One year after the switch, bone densitometry revealed bone loss in 51 patients (45.5%), bone mass maintenance in 34 (30.4%), and bone mass gain in 27 (24.1%). No new vertebral fracture was detected and no nonvertebral fracture was reported in 12 mo of follow-up. Bone mass outcomes (gain, loss, or maintenance) were not associated with the reason for switching between oral bisphosphonates. Similarly, none of the parameters evaluated could predict good densitometric response (gain or maintenance) in this scenario. Our findings suggest that the use of risedronate should not be recommended in the scenario of treatment failure or adverse events following the use of alendronate.

  10. Natural history of the TT virus infection through follow-up of TTV DNA-positive multiple-transfused patients.

    PubMed

    Lefrère, J J; Roudot-Thoraval, F; Lefrère, F; Kanfer, A; Mariotti, M; Lerable, J; Thauvin, M; Lefèvre, G; Rouger, P; Girot, R

    2000-01-01

    Little is known about the natural history and the pathogenicity of the TT virus (TTV). We present our findings of a cross-sectional study based on the TTV DNA screening of 173 multiple-transfused patients and a longitudinal study based on the follow-up of TTV DNA-positive patients. Overall, 48 patients (27.7%) tested positive for TTV DNA. The influence of the number of blood donor exposures on the prevalence of blood-borne viral infection indicates that TTV, hepatitis C virus (HCV), and an RNA virus known as GB virus C/hepatitis G virus (GBV-C/HGV) share a parenteral transmission, but that TTV, in contrast to the 2 other viruses, is also transmitted by at least another efficient means. The patients having a well-defined date of TTV infection were positive for TTV DNA during a mean period of 3.1 years. A chronic infection was observed in 31 cases (86%). TTV carriage appeared clinically benign in all patients. No clinical evidence of a disease potentially linked to the TTV infection was observed in patients with TTV DNA carriage over several years. The majority of TTV carriers had no biochemical evidence of liver disease. The prevalence of elevated serum alanine aminotransferase (ALT) level was higher in the TTV DNA-positive group, even in the absence of HCV infection, but the observed peaks of ALT level were most often transient and very mild. The prevalence of TTV DNA observed in blood recipients is consistent with that of TTV infection observed in blood donors. TTV infection frequently tends to persist. (Blood. 2000;95:347-351)

  11. Evaluation and follow-up of cognitive functions in patients with minor stroke and transient ischemic attack

    PubMed Central

    Deniz, Çiğdem; Çelik, Yahya; Özdemir Gültekin, Tuğçe; Baran, Gozde Eryiğit; Deniz, Çağla; Asil, Talip

    2016-01-01

    Background and purpose We aimed to examine the incidence of cognitive impairment among patients with stroke, the associated risk factors, progression of the cognitive impairment, and the association between the localization of the lesion(s) as detected by magnetic resonance imaging and the affected areas of cognitive function. Methods A total of 40 patients over 18 years of age enduring a transient ischemic stroke or minor stroke within the past 3 months who had a minimum life expectancy of 1 year were included in this study. Same number, age-, and sex-matched individuals were included as controls. Patients were inquired on the presence of risk factors for stroke. A series of neuropsychological test batteries were administered in patient and control subjects for assessing cognitive functions. These tests were readministered at 6 and 12 months of follow-up to assess the progression of cognitive functions. Results In this study among the patients with stroke, a significant impairment was seen in multiple cognitive functional tests following ischemic stroke as compared to control groups. The most common risk factors for stroke included hypertension (72.5%), hyperlipidemia, and cigarette smoking. The number of cognitive domains with an impairment was highest (in four cognitive tests) among those with coronary artery disease and atrial fibrillation, followed by those who had a >50% stenosis in Doppler (three cognitive tests). These findings suggest that the frequency of risk factors associated with stroke does not correlate with the frequency of risk factors associated with cognitive dysfunction. The stroke localizations were classified among the patients with stroke and reviewed in accordance with cognitive impairment. Conclusion Neuropsychological tests, clinical findings, and imaging studies should be used to document the poststroke cognitive dysfunction. PMID:27578977

  12. Tuberculosis Treatment Non-Adherence and Lost to Follow Up among TB Patients with or without HIV in Developing Countries: A Systematic Review.

    PubMed

    Tola, Habteyes Hailu; Tol, Azar; Shojaeizadeh, Davoud; Garmaroudi, Gholamreza

    2015-01-01

    This systematic review intended to combine factors associated with tuberculosis treatment non-adherence and lost to follow up among TB patients with/without HIV in developing countries. Comprehensive remote electronic databases (MEDLINE, (PMC, Pub Med Central), Google scholar and Web of science) search was conducted using the following keywords: Tuberculosis, treatment, compliance, adherence, default, behavioural factors and socioeconomic factors. All types of studies intended to assess TB treatment non-adherence and lost to follow up in developing countries among adult TB patient from 2008 to data extraction date were included. Twenty-six original and one-reviewed articles, which meet inclusion criteria, were reviewed. TB treatment non-adherence and lost to follow up were continued across developing countries. The main factors associated with TB treatment non-adherence and lost to follow up were socioeconomic factors: lack of transportation cost, lack of social support, and patients-health care worker poor communication. Behavioural factors were Feeling better after few weeks of treatments, tobacco and alcohol use, knowledge deficit about duration of treatment and consequences of non-adherence and lost to follow up. TB treatment non-adherence and lost to follow up were continued across developing countries throughout the publication years of reviewed articles. Numerous, socioeconomic and behavioural factors were influencing TB treatment adherence and lost to follow up. Therefore, well understanding and minimizing of the effect of these associated factors is very important to enhance treatment adherence and follow up completion in developing countries.

  13. Cognitive Experiences Reported by Borderline Patients and Axis II Comparison Subjects: A 16-year Prospective Follow-up Study

    PubMed Central

    Zanarini, Mary C.; Frankenburg, Frances R.; Wedig, Michelle M.; Fitzmaurice, Garrett M.

    2013-01-01

    Objective This study assesses three main types of cognition: nonpsychotic thought (odd thinking, unusual perceptual experiences, and non-delusional paranoia), quasi-psychotic thought, and true-psychotic thought in borderline patients followed prospectively for 16 years. It also compares the rates of these disturbed cognitions to those reported by axis II comparison subjects. Method The cognitive experiences of 362 inpatients—290 borderline patients and 72 axis II comparison subjects—were assessed at study entry using the cognitive section of the Revised Diagnostic Interview for Borderlines. Their cognitive experiences were reassessed every two years using the same interview. Results Each of the five main types of thought studied was reported by a significantly higher percentage of borderline patients than axis II comparison subjects over time. Each of these types of thought, except true-psychotic thought, declined significantly over time for those in both groups. Eleven of the 17 more specific forms of thought studied were also reported by a significantly higher percentage of borderline patients over the years of follow-up: magical thinking, overvalued ideas, recurrent illusions, depersonalization, derealization, undue suspiciousness, ideas of reference, other paranoid ideation, quasi-psychotic delusions, quasi-psychotic hallucinations, and true-psychotic hallucinations. Fourteen specific forms of thought were found to decline significantly over time for those in both groups: all forms of thought mentioned above except true-psychotic hallucinations plus marked superstitiousness, sixth sense, telepathy, and clairvoyance. Conclusions Disturbed cognitions are common among borderline patients and distinguishing for the disorder. They also decline substantially over time but remain a problem, particularly those of a nonpsychotic nature. PMID:23558452

  14. Detection of multiple mutations in urinary exfoliated cells from male bladder cancer patients at diagnosis and during follow-up

    PubMed Central

    Critelli, Rossana; Fasanelli, Francesca; Oderda, Marco; Polidoro, Silvia; Assumma, Manuela Bianca; Viberti, Clara; Preto, Mirko; Gontero, Paolo; Cucchiarale, Giuseppina; Lurkin, Irene; Zwarthoff, Ellen C.; Vineis, Paolo; Sacerdote, Carlotta; Matullo, Giuseppe; Naccarati, Alessio

    2016-01-01

    Most bladder cancer (BC) patients need life-long, invasive and expensive monitoring and treatment, making it a serious burden on the health system. Thus, there is a pressing need for an accurate test to assist diagnosis and surveillance of BC as an alternative to cystoscopy. Mutations in human TERT, FGFR3, PIK3CA, and RAS genes have been proposed as potential molecular markers in bladder tumor. Their concomitant presence in urine samples has not been fully explored. We investigated a panel of mutations in DNA from exfoliated urinary cells of 255 BC patients at diagnosis. Forty-one mutations in TERT, FGFR3, PIK3CA, and RAS were analyzed by SNaPshot assay in relation to clinical outcome. In 81 of these patients under surveillance, the same set of mutations was screened in additional 324 samples prospectively collected. The most common mutations detected in urine at diagnosis were in the TERT promoter. In non-invasive BC, these mutations were related to high risk and grade (p<0.0001) as well as progression to muscle-invasive disease (p=0.01), whereas FGFR3 mutations were observed in low-grade BC (p=0.02) and patients with recurrences (p=0.05). Stronger associations were observed for combined TERT and FGFR3 mutations and number of recurrences (OR: 4.54 95% CI: 1.23-16.79, p=0.02). Analyses of the area under the curve for combinations of mutations detected at diagnosis and follow-up showed an accuracy of prediction of recurrence of 0.80 (95% CI: 0.71-0.89). Mutations in urine of BC patients may represent reliable biomarkers. In particular, TERT and FGFR3 mutations have a good accuracy of recurrence prediction. PMID:27611947

  15. 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

  16. Eighteen-year follow-up of a patient with partial hypoxanthine phosphoribosyltransferase deficiency and a new mutation.

    PubMed

    Gregoric, Alojz; Rabelink, Gwenda M; Kokalj Vokac, Nadja; Varda, Natasa Marcun; Zagradisnik, Boris

    2005-09-01

    Hypoxanthine phosphoribosyltransferase (HPRT) deficiency is an inherited disorder. Complete deficiency of HPRT activity is phenotypically expressed as the devastating Lesch-Nyhan syndrome. Partial HPRT deficiency usually causes hyperuricemia, precocious gout, and uric acid nephrolithiasis. We describe an 18-year follow-up of a 5-year old boy with partial HPRT deficiency and report a novel mutation in his HPRT gene. He presented with overproduction of uric acid and passage of uric acid renal stones, and without gout or neurological and behavioral abnormalities. Treatment with allopurinol, adequate hydration, urinary alkalization, and a low-purine diet was started. No subsequent nephrolithiasis has occurred. After 18-year of this therapy his physical and neuropsychological status were normal, merely his glomerular filtration rate (GFR, normal 97-137 mL min(-1)/1.73 m(2)) fell from normal to 65.1 mL min(-1). The most likely cause of initial renal impairment in our patient is uric and/or xanthine crystalluria. A missense and transition mutation 169A>G (57ATG>GTG, 57met>val) in exon 3 of the patient's HPRT gene was identified and the mother was the carrier of the mutation. As far as we are aware, the identified mutation has not previously been reported. We named the mutant HPRT Maribor.

  17. Conservative Approach to Unilateral Condylar Fracture in a Growing Patient: A 2.5-Year Follow Up

    PubMed Central

    Tuna, Elif Bahar; Dündar, Aysun; Çankaya, Abdülkadir Burak; Gençay, Koray

    2012-01-01

    Condylar fractures in children are especially important because of the risk of a mandibular growth-center being affected in the condylar head, which can lead to growth retardation and facial asymmetry. The purpose of this article is to follow up the two and half year clinical and radiological evaluation of the conservative treatment of a 10 year-old patient, who had a unilateral green-stick type fracture. The patient presented with painful facial swelling localized over the left condylar region, limited mouth-opening and mandibular deviation to the left. Panoramic radiography and computed tomography confirmed the diagnosis of incomplete fracture on the left condyle with one side of the bone fractured and the other bent. Closed reduction was chosen to allow for initial fibrous union of the fracture segments and remodeling with a normal functional stimulus. A non-rigid mandibular splint was applied in order to remove the direct pressure on the fracture side of the mandible. Clinical and radiologic examination after 30 months revealed uneventful healing with reduction of the condylar head and remodeling of the condylar process following conservative treatment. PMID:22276078

  18. Computed tomography and ultrasound in follow-up of patients after endovascular repair of abdominal aortic aneurysm.

    PubMed

    Elkouri, Stéphane; Panneton, Jean M; Andrews, James C; Lewis, Bradley D; McKusick, Michael A; Noel, Audra A; Rowland, Charles M; Bower, Thomas C; Cherry, Kenneth J; Gloviczki, Peter

    2004-05-01

    The purpose of this study was to compare our experience with duplex ultrasonography (US) and computed tomography (CT) for the routine follow-up of patients after endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). We reviewed the electronic charts and radiologic exams of the first 125 patients (113 males, 12 females, median age of 76 years, range 48-98 years) with AAA treated by EVAR from June 1996 to November 2001. Our follow-up protocol included serial CT and US at regular intervals after the procedure (before discharge, at 1 month, and then every 6 months). Adequacy of each exam, ability to detect endoleaks, measurements of AAA diameter, and ability to determine graft patency were compared. For endoleak detection, comparison between CT and US was done using CT as the gold standard. A total of 608 exams, 337 CTs and 271 US, were performed 1 day to 5 years after endovascular aneurysm repair; 98% of CT and 74% of US were technically adequate. Contrary to CT, the proportion of adequate US exam was significantly less in patients with higher body mass index (BMI > or = 30 = 54% vs. BMI < 30 = 81%, p < 0.001) and for pre-discharge US compared to the post-discharge US (54% vs. 88%, p = 0.0005). Concurrent scan pairs were obtained in 252 instances in 107 patients (1-8 pairs per patient). Excellent correlation between AAA diameter measured on CT and US was noted (correlation coefficient of 0.9, p < 0.0001). However, agreement was poor. CT anteroposterior (AP) and transverse measurements were on average 2.9 mm (95% limits of agreement = -7 to 13 mm) and 1.8 mm (95% limits of agreement = -9 to 12 mm) greater than US. For AAA diameter change, there was no case of increase AP diameter on CT. However, in 23% (29/128 pairs of sets) of US, an increase in AAA size that could have influenced patient management (> or = 4 mm) was reported despite no change demonstrated on CT. For endoleak detection, sensitivity and specificity of US compared to that of CT was 25% and 89

  19. Optimal Follow-up of Patients with Viral Hepatitis Improves the Detection of Early-stage Hepatocellular Carcinoma and the Prognosis of Survival

    PubMed Central

    Oeda, Satoshi; Iwane, Shinji; Takasaki, Mitsuhiro; Furukawa, Naoko E; Otsuka, Taiga; Eguchi, Yuichiro; Anzai, Keizo

    2016-01-01

    Objective To manage patients with viral hepatitis, it is important to screen for hepatitis, conduct a comprehensive examination if such screening is positive, administer antiviral treatment, and conduct surveillance for hepatocellular carcinoma (HCC). The proper execution of this strategy is expected to effectively reduce the number of deaths from viral hepatitis. Such an “optimal” follow-up for HCC surveillance is therefore important. This study aimed to determine the benefits of performing an optimal follow-up of patients with viral hepatitis. Methods The subjects were infected with the hepatitis virus and were initially diagnosed with or treated for HCC from 2004-2012. We retrospectively analyzed the history of a patient's current illness using the hospital discharge summary. To minimize any lead-time bias, we calculated the corrected survival for patients who received an optimal follow-up. Results Of 333 patients, 107 (32.1%) did not receive an optimal follow-up and thus had low cumulative survival rates in comparison to those who did. The median corrected survival was 51.5 months for patients with an optimal follow-up compared with 31.4 months for those without (p=0.011). A multivariate analysis revealed that AFP <35 [odds ratio (OR), 2.054], Child-Pugh A (OR, 2.488), and an optimal follow-up (OR, 4.539) were independent factors associated with the detection of early-stage HCC. Age (OR, 0.939), tumor stage I/II (OR, 6.918), and an optimal follow-up (OR, 3.213) were found to be independent factors associated with receiving curative treatment. Conclusion An optimal follow-up of patients with viral hepatitis independently increased the detection of early-stage HCC and the administration of curative treatment. Patients with an optimal follow-up survived longer than those without. PMID:27725532

  20. Smartphone Application WeChat for Clinical Follow-up of Discharged Patients with Head and Neck Tumors: A Randomized Controlled Trial

    PubMed Central

    Lyu, Ke-Xing; Zhao, Jing; Wang, Bin; Xiong, Guan-Xia; Yang, Wei-Qiang; Liu, Qi-Hong; Zhu, Xiao-Lin; Sun, Wei; Jiang, Ai-Yun; Wen, Wei-Ping; Lei, Wen-Bin

    2016-01-01

    Background: Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods: A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up (WFU) group or telephone follow-up (TFU) group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results: Time consumption in WFU group for each patient (23.36 ± 6.16 min) was significantly shorter than that in TFU group (42.89 ± 7.15 min) (P < 0.001); total economic cost in WFU group (RMB 90 Yuan) was much lower than that in TFU group (RMB 196 Yuan). Lost-to-follow-up rate in the WFU group was 7.02% (4/57) compared with TFU group, 9.80% (5/51), while no significance was observed (95% confidence interval [CI]: 0.176–2.740; P = 0.732). The overall satisfaction rate in WFU group was 94.34% (50/53) compared with 80.43% (37/46) in TFU group (95% CI: 0.057–0.067; P = 0.034). Conclusions: The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions. Trial Registration: Chinese Clinical Trial Registry, Chi

  1. Incidence and Effects of Polypharmacy on Clinical Outcome among Patients Aged 80+: A Five-Year Follow-Up Study

    PubMed Central

    Fan, Li; Gao, Dewei; Liang, Zhiru; He, Jing; Gong, Weiqin; Gao, Linggen

    2015-01-01

    Objectives Polypharmacy is a problem of growing interest in geriatrics with the increase in drug consumption in recent years, is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication”. We investigated the clinical characteristics of polypharmacy and identified the effects of polypharmacy on clinical outcome among patients aged 80+ admitted to Chinese PLA general hospital. Methods Older men aged ≥80 years (n = 1562) were included in this study. The included participants attended a structured clinical examination and an interview carried out by a geriatrician and trained nurses. A follow-up survey in 2014 was carried out on survivors in the same way as in 2009. The clinical outcome measured were adverse drug reactions, falls, frailty, disability, cognitive impairment, mortality. The association between polypharmacy and clinical outcome was assessed by logistic regression. Results The mean (range) age of the included participants was 85.2 (80–104) years. Medication exposure was reported by 100% of the population. Mean number of medications reported in this population was 9.56±5.68. The prevalence of polypharmacy (≥6 medications) in the present study was 70%. At the time of the follow-up survey, an increase in the number of taken medicines had occurred among half of the survivors. The risk of different outcomes in relation to number of medications rises significantly, the odds ratios were 1.21 (95% confidence interval [CI]1.17–1.28) for adverse drug reactions, 1.18 (95% CI 1.10–1.26) for falls, 1.16 (95% CI 1.09–1.24) for disability, and 1.19 (95% CI 1.12–1.23) for mortality. There was no association between increasing number of medications and cognitive impairment. Conclusions Our study demonstrates that polypharmacy is very common in the very old patients, and observed that number of medications was a factor associated with difference clinical outcome independently of the age, type of

  2. [Epidemiological and clinical characteristics of HIV/AIDS patients followed-up in Cappadocia region: 18 years experience].

    PubMed

    Alp, Emine; Bozkurt, Ilkay; Doğanay, Mehmet

    2011-01-01

    HIV/AIDS is still an important health problem worldwide and the number of people living with HIV worldwide continued to grow in the last years. The first HIV/AIDS cases had been reported in 1985 from Turkey and with an increasing trend during the following years, the number of cases reached to 3898 with 528 new cases in 2009. The aim of this retrospective study was to share the 18 years experience with the patients who were followed-up in Erciyes University Hospital Infectious Diseases Clinics in Cappadocia region. The records of 55 (81%) HIV/AIDS patients out of 68 who were admitted to our clinic between 1992- 2009 have been attained and the demographic and clinical characteristics, administered therapy regimens and adverse effects of antiretroviral therapy of those cases have been evaluated. Forty-three (78%) of the patients were male and 12 (22%) were female of which 11 (92%) of their spouses had HIV/AIDS. The median age of the patients was 45 and 20 (36%) of them were over 54 years old. Fifty (91%) of patients lived in Cappadocia region, and 24 (44%) had lived in foreign countries. Fifty (91%) patients had risky heterosexual contact as a risk factor. Of these patients, 47 (85%) were in full-blown AIDS stage at admission. Twenty-seven (49%) of the patients diagnosed occasionally during routine anti-HIV testing, did not have any symptoms. Fever, weakness and weight loss were the most frequently detected symptoms in the rest of the patients. Ten (18%) patients had underlying diseases such as hypertension, chronic hepatitis B or C, coronary artery disease, diabetes mellitus and chronic renal disfunction. Opportunistic infections were determined in 25 (45.5%) patients and 20 (40%) of these infections were determined at admission. The most frequent opportunistic infection was oral candidiasis, followed by Pneumocystis (carinii) jiroveci pneumonia and tuberculosis. Malignancy was diagnosed in three patients; two had Kaposi's sarcoma and one had multiorgan

  3. The FRAX ® as a predictor of mortality in Japanese incident hemodialysis patients: an observational, follow-up study.

    PubMed

    Hayashi, Toshihide; Joki, Nobuhiko; Tanaka, Yuri; Iwasaki, Masaki; Kubo, Shun; Asakawa, Takasuke; Matsukane, Ai; Takahashi, Yasunori; Imamura, Yoshihiko; Hirahata, Koichi; Hase, Hiroki

    2015-11-01

    The World Health Organization Fracture Risk Assessment Tool (FRAX(®)) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX(®) and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX(®) for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX(®) for major osteoporotic fracture was 6.9 (4.6-12.0) % in men and 19.0 (7.6-33.0) % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX(®) levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX(®) remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX(®) value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX(®) seems to be useful for predicting death, especially in men.

  4. Patient outcome after surgical management of the spinal accessory nerve injury: A long-term follow-up study

    PubMed Central

    Göransson, Harry; Leppänen, Olli V; Vastamäki, Martti

    2016-01-01

    Objectives: A lesion in the spinal accessory nerve is typically iatrogenic: related to lymph node biopsy or excision. This injury may cause paralysis of the trapezius muscle and thus result in a characteristic group of symptoms and signs, including depression and winging of the scapula, drooped shoulder, reduced shoulder abduction, and pain. The elements evaluated in this long-term follow-up study include range of shoulder motion, pain, patients’ satisfaction, delay of surgery, surgical procedure, occupational status, functional outcome, and other clinical findings. Methods: We reviewed the medical records of a consecutive 37 patients (11 men and 26 women) having surgery to correct spinal accessory nerve injury. Neurolysis was the procedure in 24 cases, direct nerve repair for 9 patients, and nerve grafting for 4. Time elapsed between the injury and the surgical operation ranged from 2 to 120 months. The patients were interviewed and clinically examined after an average of 10.2 years postoperatively. Results: The mean active range of movement of the shoulder improved at abduction 44° (43%) in neurolysis, 59° (71%) in direct nerve repair, and 30° (22%) in nerve-grafting patients. No or only slight atrophy of the trapezius muscle was observable in 75%, 44%, and 50%, and no or controllable pain was observable in 63%, 56%, and 50%. Restriction of shoulder abduction preceded deterioration of shoulder flexion. Patients’ overall dissatisfaction with the state of their upper extremity was associated with pain, lower strength in shoulder movements, and occupational problems. Conclusion: We recommend avoiding unnecessary delay in the exploration of the spinal accessory nerve, if a neural lesion is suspected. PMID:27152195

  5. Hemodynamic Follow-Up in Adult Patients with Pulmonary Hypertension Associated with Atrial Septal Defect after Partial Closure

    PubMed Central

    Song, Jinyoung; Lee, Sang-Yun; Kang, I-Seok; Lee, Chang Ha; Lee, Cheul; Yang, Ji-Hyuk; Jun, Tae-Gook

    2016-01-01

    Purpose We evaluated the hemodynamic statuses of patients after partial closure of atrial septal defects with fenestration due to pulmonary hypertension. Materials and Methods Seventeen adult patients underwent partial atrial septal defect closure and follow-up cardiac catheterization. We analyzed hemodynamic data and clinical parameters before and after closure. Results The median age at closure was 29 years old. The baseline Qp/Qs was 1.9±0.6. The median interval from the operation to the cardiac catheterization was 27 months. The CT ratio decreased from 0.55±0.07 to 0.48±0.06 (p<0.05). The mean pulmonary arterial pressure decreased from 50.0±11.5 mm Hg to 32.5±14.4 mm Hg (p<0.05), and the pulmonary resistance index decreased from 9.2±3.6 Wood units*m2 to 6.3±3.8 Wood units*m2 (p<0.05). Eleven patients (64.7%) continued to exhibit high pulmonary resistance (over 3.0 Wood units*m2) after closure. These patients had significantly higher pulmonary resistance indices and mean pulmonary arterial pressures based on oxygen testing before the partial closures (p<0.05). However, no significant predictors of post-closure pulmonary hypertension were identified. Conclusion Despite improvement in symptoms and hemodynamics after partial closure of an atrial septal defect, pulmonary hypertension should be monitored carefully. PMID:26847280

  6. Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients.

    PubMed

    Isaacs, Albert M; Bezchlibnyk, Yarema B; Yong, Heather; Koshy, Dilip; Urbaneja, Geberth; Hader, Walter J; Hamilton, Mark G

    2016-09-01

    OBJECTIVE The efficacy of endoscopic third ventriculostomy (ETV) for the treatment of pediatric hydrocephalus has been extensively reported in the literature. However, ETV-related long-term outcome data are lacking for the adult hydrocephalus population. The objective of the present study was to assess the role of ETV as a primary or secondary treatment for hydrocephalus in adults. METHODS The authors performed a retrospective chart review of all adult patients (age ≥ 18 years) with symptomatic hydrocephalus treated with ETV in Calgary, Canada, over a span of 20 years (1994-2014). Patients were dichotomized into a primary or secondary ETV cohort based on whether ETV was the initial treatment modality for the hydrocephalus or if other CSF diversion procedures had been previously attempted respectively. Primary outcomes were subjective patient-reported clinical improvement within 12 weeks of surgery and the need for any CSF diversion procedures after the initial ETV during the span of the study. Categorical and actuarial data analysis was done to compare the outcomes of the primary versus secondary ETV cohorts. RESULTS A total of 163 adult patients with symptomatic hydrocephalus treated with ETV were identified and followed over an average of 98.6 months (range 0.1-230.4 months). All patients presented with signs of intracranial hypertension or other neurological symptoms. The primary ETV group consisted of 112 patients, and the secondary ETV consisted of 51 patients who presented with failed ventriculoperitoneal (VP) shunts. After the initial ETV procedure, clinical improvement was reported more frequently by patients in the primary cohort (87%) relative to those in the secondary ETV cohort (65%, p = 0.001). Additionally, patients in the primary ETV group required fewer reoperations (p < 0.001), with cumulative ETV survival time favoring this primary ETV cohort over the course of the follow-up period (p < 0.001). Fifteen patients required repeat ETV, with all but

  7. Intensity-modulated radiotherapy versus radical prostatectomy in patients with localized prostate cancer: long-term follow-up

    PubMed Central

    2013-01-01

    Background The objective of this work was to assess the overall survival, cause-specific survival and biochemical failure-free survival of a contemporary cohort of patients with localized prostate cancer (PCa) treated with intensity-modulated radiation therapy (IMRT) or radical prostatectomy (RP). Methods We did a retrospective cohort study of our institution’s registry of patients undergoing either IMRT or RP between January 1999 and March 2010, and assessed Prostate Specific Antigen (PSA), age at diagnosis, Gleason score, and digital rectal examination. Two groups were separated according to RP or IMRT treatment and these groups were in turn divided into risk groups according to the D’Amico classification. Overall survival (OS), cause-specific survival (CSS), mortality from other causes (MOC), and biochemical disease-free survival (BDFS) were assessed. Results Twelve-hundred patients were included: 993 in the RP group and 207 in the IMRT group. The IMRT group had older age, PSA at diagnosis and a significantly higher percentage of cancer on the needle biopsy (p <0.001). Of the 207 patients who underwent IMRT, 54% presented comorbidities. Median follow-up was 91.7 months for the RP group and 76 months for the IMRT group. The OS at 5 and 7 was 96.2, and 93.7 for the RP group respectively and 88.4, and 83.1 for the IMRT group respectively (p <0.001). There were no significant differences in the CSS in relation to treatment received among the low- and high-risk groups, while in the intermediate-risk group, patients who underwent to RP had a higher CSS than patients who underwent IMRT (99.6% vs 94.1%, p = 0.003). The IMRT group had a significantly better BDFS than the RP group (86.4% vs. 74.3%, respectively, p = 0.016). Conclusions Patients treated with RP were significantly younger and had a better prognosis than patients treated using IMRT, and according to our results, RP had better outcomes in terms of OS while IMRT had greater MOC. Treatment

  8. Impact of tuberculosis treatment on health-related quality of life of pulmonary tuberculosis patients: a follow-up study

    PubMed Central

    2014-01-01

    Background At present, much of the attention within tuberculosis (TB) management is spent on microbiological cure, and its impact on health-related quality of life (HRQoL) is either undervalued or seldom considered. The aim of this study was to evaluate the impact of TB treatment on HRQoL of new smear positive pulmonary tuberculosis (PTB) patients. Moreover, we also aimed to determine whether the selected socio-demographic and clinical variables were predictive of variability in the HRQoL scores over time. Methods This was a prospective follow-up of new smear positive PTB patients who were diagnosed at the chest clinic of Penang General Hospital between March 2010 and February 2011. All eligible patients (i.e., a new case of smear positive PTB, literate and aged 18 years or above) were asked to self-complete the SF-36v2 questionnaire at the start of their treatment, and then subsequently after the intensive phase and at the end of the treatment. A score on a health domain or component summary measure that was less than 47 norm-based scoring (NBS) point was considered indicative of impaired function within that health domain or dimension. Likewise, an individual having mental component summary (MCS) score ≤ 42 NBS point was considered to be at the risk of depression. Repeated measures ANOVA test was performed to examine how the summary scores varied over time, and to determine whether independent variables were predictive of variability in the physical component summary (PCS) and MCS scores over time. Results A total of 216 patients completed the SF-36v2 questionnaire at the start of their treatment. Out of these, 177 and 153 completed the questionnaire at the second and third follow-ups, respectively. The mean PCS scores at the start of the treatment, after the intensive phase and at the end of treatment were 41.9 (SD 5.1), 45.8 (SD 4.8) and 46.0 (SD 6.9), respectively. Similarly, the mean MCS scores at the start of the treatment, after the intensive phase

  9. Long-Term Follow-up of Phase II Study of Chemotherapy Plus Dasatinib for the Initial Treatment of Patients with Philadelphia-Chromosome Positive Acute Lymphoblastic Leukemia

    PubMed Central

    Ravandi, Farhad; O'Brien, Susan; Cortes, Jorge; Thomas, Deborah; Garris, Rebecca; Faderl, Stefan; Burger, Jan; Rytting, Michael; Ferrajoli, Alessandra; Wierda, William; Verstovsek, Srdan; Champlin, Richard; Kebriaei, Partow; McCue, Deborah; Huang, Xuelin; Jabbour, Elias; Garcia-Manero, Guillermo; Estrov, Zeev; Kantarjian, Hagop

    2015-01-01

    Background The long-term efficacy of combination of chemotherapy with dasatinib in patients with Philadelphia-chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) is not well-established. Methods Patients received dasatinib with 8 cycles of alternating hyperCVAD and high dose cytarabine and methotrexate. Patients in complete remission (CR) continued maintenance dasatinib, vincristine and prednisone for 2 years followed by dasatinib indefinitely. Patients eligible for allogeneic stem cell transplant (SCT) received it in first CR. Results 72 patients with a median age of 55 years (range 21 – 80) were treated; 69 (96%) achieved CR. Among them, 57 (83%) achieved cytogenetic (CG) CR after 1 cycle and 64 (93%) achieved a major molecular response (MMR) at a median of 4 weeks (range, 2 – 38 weeks). Minimal residual disease by flow cytometry was negative in 65 (94 %) patients at a median of 3 weeks (range, 2–37). Dasatinib-related grade 3 and 4 adverse events included bleeding, pleural/pericardial effusions, and elevated transaminases. With a median follow-up of 67 months (range, 33–97), 33 patients (46%) are alive and 30 (43%) are in CR; 12 underwent an allogeneic SCT. Thirty nine patients have died (3 at induction, 19 after relapse, 7 post SCT performed in CR1, and 10 in CR). The median disease free and overall survival are 31 months (range, 0.3 to 97) and 47 months (range, 0.2 to 97). Seven relapsed patients had ABL mutations including 4 T315I. Conclusion Combination of chemotherapy with dasatinib is effective in achieving long-term remissions in patients with newly diagnosed Ph+ ALL. PMID:26308885

  10. Evaluation of myocardial deformation in patients with Kawasaki disease using speckle-tracking echocardiography during mid-term follow-up.

    PubMed

    Dedeoglu, Reyhan; Barut, Kenan; Oztunc, Funda; Atik, Sezen; Adrovic, Amra; Sahin, Sezgin; Cengiz, Dicle; Kasapcopur, Ozgur

    2017-04-05

    Speckle-tracking echocardiography is a recently developed technique for the evaluation of myocardial deformation or strain. Our objective was to examine strain through a mid-term follow-up of patients with Kawasaki disease.

  11. Role of follow-up imaging after resection of brain arteriovenous malformations in pediatric patients: a systematic review of the literature.

    PubMed

    Jimenez, Joaquin E; Gersey, Zachary C; Wagner, Jason; Snelling, Brian; Ambekar, Sudheer; Peterson, Eric C

    2017-02-01

    OBJECTIVE Pediatric patients are at risk for the recurrence of brain arteriovenous malformation (AVM) after resection. While there is general consensus on the importance of follow-up after surgical removal of an AVM, there is a lack of consistency in the duration of that follow-up. The object of this systematic review was to examine the role of follow-up imaging in detecting AVM recurrence early and preventing AVM rupture. METHODS This systematic review was performed using articles obtained through a search of the literature contained in the MeSH database, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Search results revealed 1052 articles, 13 of which described 31 cases of AVM recurrence meeting the criteria for inclusion in this study. Detection of AVM occurred significantly earlier (mean ± SD, 3.56 ± 3.67 years) in patients with follow-up imaging than in those without (mean 8.86 ± 5.61 years; p = 0.0169). While 13.34% of patients who underwent follow-up imaging presented with rupture of a recurrent AVM, 57.14% of those without follow-up imaging presented with a ruptured recurrence (p = 0.0377). CONCLUSIONS Follow-up imaging has an integral role after AVM resection and is sometimes not performed for a sufficient period, leading to delayed detection of recurrence and an increased likelihood of a ruptured recurrent AVM.

  12. A Regenerative Approach to the Successful Treatment of Peri-implantitis: A Consecutive Series of 170 Implants in 100 Patients with 2- to 10-Year Follow-up.

    PubMed

    Froum, Stuart J; Froum, Scott H; Rosen, Paul S

    2015-01-01

    This article presents the results of a consecutive case series of 170 treated peri-implantitis-affected implants in 100 patients with follow-up measurements from 2 to 10 years. A total of 51 implants in 38 patients previously reported on were followed for an additional 2.5 years, and 119 additional implants in 62 additional patients were treated with the same protocol and monitored for at least 2 years posttreatment. The treatment consisted of flap reflection, surface decontamination, use of enamel matrix derivative (EMD) or platelet-derived growth factor (PDGF), and guided bone regeneration with mineralized freezedried bone and/or anorganic bovine bone combined with PDGF or EMD and covered with an absorbable membrane and/or subepithelial connective tissue graft. Maintenance and monitoring followed every 2 to 3 months. Two implants were lost 6 months posttreatment, for a 98.8% survival rate. Bleeding on probing was eliminated in 91% of the treated implants. Probing depth reduction averaged 5.10 mm, bone level gain averaged 1.77 mm, and soft tissue marginal gain averaged 0.52 mm. These outcomes were obtained with one surgical procedure on 140 implants, with two procedures on 18 implants, and with three procedures on 10 implants. The results to date with this layered/combined regenerative approach for the treatment of peri-implantitis appear to be encouraging.

  13. [The follow up of patients with extracranial pathology of the carotid arteries and ischemic disorders of cerebral circulation].

    PubMed

    Dzhibladze, D N; Amintaeva, A G; Lagoda, O V; Ionova, V G

    2003-01-01

    According to the populational studies, about 50% of ischemic disorders of cerebral circulation, both persistent and transient, are induced by thrombotic or embolic complications of atherosclerotic plaques which produce an adverse effect on the large and small caliber arteries; about 20-25% is associated with lesion of the small diameter intracranial vessels, about 20% with embolism from the heart, and the remaining disorders fall within other rare causes. The prevalence of atherosclerotic lesions of the vessels feeding the brain, the severity of their clinical manifestations, insufficient efficacy of conservative therapy and the high risk of surgical treatment remain as before a matter of great medical and social concern. In connection with an appreciable progress of vascular surgery carotid endarterectoray (GEAE) as one of the radical approaches to correction of the pathology of the carotid artery segment is widespread at the large centers of vascular surgery of different countries. However, in spite of the fact that CEAE is an advanced and radical technique of preventive operation, it produces only a local effect on vascular diseases whereas the other, no less important pathogenetic mechanisms leading to disorders of cerebral circulation remain unchanged and demand drug correction to avoid repeated disorders of cerebral circulation. Analysis of the long-tern results evidences a stable and lasting effect of CEAE. The postoperative clinical manifestations can be used as the main criterion for the efficacy of CEAE, especially as compared to the purely conservative therepy. The results of the long-term follow up (over the period as long as 15 years) of a large group of operated patients demonstrate that the majority of them did not show the emergence of the new focal neurologic symptomatology in the ipsilateral hemisphere and only a small percentage of cases developed stroke. The major western statistics provide the analogous results.

  14. Racial and Ethnic Disparities in Functioning at Discharge and Follow-Up Among Patients With Motor Complete Spinal Cord Injury

    PubMed Central

    Fyffe, Denise C.; Deutsch, Anne; Botticello, Amanda L.; Kirshblum, Steven; Ottenbacher, Kenneth J.

    2015-01-01

    Objective To examine racial and ethnic differences in self-care and mobility outcomes for persons with a motor complete, traumatic spinal cord injury (SCI) at discharge and 1-year follow-up. Design Retrospective cohort study. Setting Sixteen rehabilitation centers contributing to the Spinal Cord Injury Model Systems (SCIMS) database. Participants Adults with traumatic, motor complete SCI (N=1766; American Spinal Injury Association Impairment Scale grade A or B) enrolled in the SCIMS between 2000 and 2011. Selected cases had complete self-reported data on race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic) and motor FIM scores assessed at inpatient rehabilitation admission, discharge, and 1-year follow-up. Interventions Not applicable. Main Outcome Measures Functional outcomes were measured by FIM self-care and mobility scores on a 1 to 7 FIM scale, at discharge and 1-year follow-up. Results Multiple regression models stratified by neurologic category and adjusted for sociodemographic and injury characteristics assessed racial and ethnic group differences in FIM self-care and mobility change scores at discharge and 1-year follow-up. At discharge, non-Hispanic black participants with tetraplegia and paraplegia had significantly poorer gains in FIM self-care and mobility scores relative to non-Hispanic white and Hispanic participants. At 1-year follow-up, similar FIM self-care and mobility change scores were found across racial and ethnic groups within each neurologic category. Conclusions Non-Hispanic white and Hispanic participants had comparatively more improvement in self-care and mobility during inpatient rehabilitation compared with non-Hispanic black participants. At 1-year follow-up, no differences in self-care and mobility outcomes were observed across racial and ethnic groups. Additional research is needed to identify potential modifiable factors that may contribute to racially and ethnically different patterns of functional outcomes

  15. Risk factors for mortality in end-stage kidney disease patients under online-hemodiafiltration: three-year follow-up study.

    PubMed

    Sousa-Martins, Pedro de; Moura, Alexandra; Madureira, José; Alija, Pablo; Oliveira, José Gerardo; Lopez, Martin; Filgueiras, Madalena; Amado, Leonilde; Sameiro-Faria, Maria; Miranda, Vasco; Mesquita, Edgar; Teixeira, Laetitia; Poveda, Verónica; Lobato, Luísa; Santos-Silva, Alice; Costa, Elísio

    2016-09-01

    The aim of this work was to evaluate the predictors of mortality in a group of end-stage kidney disease (ESRD) patients under dialysis, by performing a three-year follow-up study. From the 236 patients included in this study, 54 patients died during the three-year follow-up period. Our data showed that the risk of death was higher in patients presenting lower levels of mean cell hemoglobin concentration, transferrin, and albumin. Our study showed that poor nutritional status and an inflammatory-induced iron depleted erythropoiesis are important factors for mortality in these patients.

  16. Long-term follow-up of clinical symptoms in TMD patients who underwent occlusal reconstruction by orthodontic treatment.

    PubMed

    Imai, T; Okamoto, T; Kaneko, T; Umeda, K; Yamamoto, T; Nakamura, S

    2000-02-01

    Fifty-eight patients (mean age 18.4 years) who had received splint therapy for internal derangement of the temporomandibular joint (TMJ) were examined retrospectively to investigate the efficacy of occlusal reconstruction by orthodontic treatment. The subjects were divided into three groups: 18 patients (mean age 18.6 years) who underwent orthodontic treatment combined with the use of splints (ST group); 27 patients (mean age 18.2 years) who underwent orthodontic treatment without the use of splints (NST group); and 13 patients (mean age 17.9 years) who received only splint therapy for temporomandibular joint disorders (TMD; control group). TMJ sound, pain on movement and restriction of mandibular movement were examined at the initial examination (T1), at the end of the splint therapy for TMD or beginning of orthodontic treatment (T2), at the end of orthodontic treatment (T3), and at recall or 1 year after orthodontic treatment (T4). The following results were found. (1) The percentage of patients with no joint sound at T2 was 20-30 per cent. The percentage of such patients in both the ST and NST groups increased to over 50 per cent at T3, but slightly decreased to 39-50 per cent at T4. There were no significant inter-group differences at any time point. (2) The number of patients who had no pain on movement at T2 was 60-80 per cent. The percentage of such patients in both the ST and NST groups increased to over 90 per cent at T3, but then slightly decreased to 80 per cent at T4. There were no significant inter-group differences at any time point. (3) None of the patients showed restriction of movement of the TMJ at T2 or T4. One patient in the ST group was found to have restriction at T3. There were no significant inter-group differences at any time point. (4) The most frequent type of malocclusion in both ST and NST groups was anterior open bite. These results suggest that TMD symptoms that have been eliminated by splint therapy are not likely to recur due to

  17. Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis

    PubMed Central

    Pryor, Michael B; Carrion, Rafael; Wang, Run; Henry, Gerard

    2016-01-01

    A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements. This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1–2 h daily for 6–24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer (30.8%) or the same (46.2%) as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject (96.5%) was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant. PMID:26459782

  18. Subcutaneous Interferon β-1a May Protect against Cognitive Impairment in Patients with Relapsing–Remitting Multiple Sclerosis: 5-Year Follow-up of the COGIMUS Study

    PubMed Central

    Patti, Francesco; Morra, Vincenzo Brescia; Amato, Maria Pia; Trojano, Maria; Bastianello, Stefano; Tola, Maria Rosalia; Cottone, Salvatore; Plant, Andrea; Picconi, Orietta

    2013-01-01

    Objective To assess the effects of subcutaneous (sc) interferon (IFN) -1a on cognition over 5 years in mildly disabled patients with relapsing–remitting multiple sclerosis (RRMS). Methods Patients aged 18–50 years with RRMS (Expanded Disability Status Scale score ≤4.0) who had completed the 3-year COGIMUS study underwent standardized magnetic resonance imaging, neurological examination, and neuropsychological testing at years 4 and 5. Predictors of cognitive impairment at year 5 were identified using multivariate analysis. Results Of 331 patients who completed the 3-year COGIMUS study, 265 participated in the 2-year extension study, 201 of whom (75.8%; sc IFN β-1a three times weekly: 44 µg, n = 108; 22 µg, n = 93) completed 5 years' follow-up. The proportion of patients with cognitive impairment in the study population overall remained stable between baseline (18.0%) and year 5 (22.6%). The proportion of patients with cognitive impairment also remained stable in both treatment groups between baseline and year 5, and between year 3 and year 5. However, a significantly higher proportion of men than women had cognitive impairment at year 5 (26.5% vs 14.4%, p = 0.046). Treatment with the 22 versus 44 µg dose was predictive of cognitive impairment at year 5 (hazard ratio 0.68; 95% confidence interval 0.48–0.97). Conclusions This study suggests that sc IFN β-1a dose-dependently stabilizes or delays cognitive impairment over a 5-year period in most patients with mild RRMS. Women seem to be more protected against developing cognitive impairment, which may indicate greater response to therapy or the inherently better prognosis associated with female sex in MS. PMID:24137499

  19. Adherence to Hypertension Management Recommendations for Patient Follow-Up Care and Lifestyle Modifications Made by Military Healthcare Providers

    DTIC Science & Technology

    2000-05-01

    hypertension . The importance of monitoring high blood pressure (follow-up) and...research to provide contemporary approaches to hypertension control, and further classified a high normal blood pressure with hypertension in three stages...managing high blood pressure and its deleterious complications. The JNC VI (1997) recommendation (a) classified blood pressure ( hypertension ),

  20. Improving follow-up care for women with a history of gestational diabetes: perspectives of GPs and patients.

    PubMed

    Pennington, Andrew V R; O'Reilly, Sharleen L; Young, Doris; Dunbar, James A

    2016-07-25

    This paper investigates factors influencing women's engagement with diabetes preventative care after a pregnancy with gestational diabetes (GDM) from the perspectives of GPs and women and explores the role of the GP in that care. Qualitative research using semi-structured interviews with women who had experienced GDM (n=16) and GPs (n=18) were conducted and a thematic content analysis conducted. Women's interviews explored their experience of GDM, factors influencing, and engagement with, follow-up care for diabetes prevention and role of the GP in that care. GP interviews explored postnatal care provided to women with GDM, the role of the GP in that care and perceived factors influencing a mother's engagement in her self-care. Three themes were identified: (1) advice and testing; (2) role of the GP; and (3) barriers and enablers to care. Significant consensus about the role of the GP and barriers and enablers to care existed. Both groups believed post GDM follow-up is best done by GPs and suggested recall and reminders would improve care. GPs gave consistent exercise advice, but lacked consensus on follow-up testing, dietary and weight-loss advice. Women's health literacy influenced how they viewed their GPs role. Consensus guidelines on follow-up testing and diabetes prevention advice, tailored advice according to health literacy and addressing barriers to care would likely improve the capacity of GPs to prevent unnecessary conversion to type 2 diabetes in these at-risk women.

  1. [Long-term patient follow-up conducted during the supervised self-directed training in ambulatory primary care. One-semester assessment carried out in Angers, France].

    PubMed

    Plourdeau, Ludivine; Huez, Jean-François; Connan, Laurent

    2008-06-30

    To assess the taking charge of the patients requiring a follow-up with the long course by the trainees during the Saspas, to identify the obstacles to its setting up and to propose prospects of improvement are the main objectives of this work. The trainees of Angers carried out a collection concerning each patient seen three times or more during the semester of winter 2006-2007. At the end of semester, they answered a questionnaire and participated in a focus group. There were great inequalities between the trainees. They had seen between 13 and 51 patients three times or more (average=22). The proportion of chronic disease varied from 24 to 68%. Most frequently met were those of the 50 first results of consultation of the SFMG. Four of the 11 trainees made a follow-up of pregnancy, three a follow-up of infant. When the first consultation concerned a situation requiring a follow-up with the long course, the trainees had proposed a new appointment in 38.6% of the cases, 95% of the patient had it honoured. The obstacles identified were inherent in the organization of the training course, the secretariat, the Masters of training course, the trainees and the patients. These obstacles are perfectible by a work on the appointement management privileging the patients concerned with a follow-up to the long course, on the organization of the training courses, on the invesment of the trainees and the masters of training course.

  2. Importance of a Patient Dosimetry and Clinical Follow-up Program in the Detection of Radiodermatitis After Long Percutaneous Coronary Interventions

    SciTech Connect

    Vano, Eliseo; Escaned, Javier; Vano-Galvan, Sergio; Fernandez, Jose M.; Galvan, Carmen

    2013-04-15

    Complex percutaneous interventions often require high radiation doses likely to produce skin radiation injuries. We assessed the methodology used to select patients with potential skin injuries in cardiac procedures and in need of clinical follow-up. We evaluated peak skin dose and clinical follow-up in a case of radiodermatitis produced during a total occlusion recanalization. This prospective study followed CIRSE and ACC/AHA/SCAI recommendations for patient radiation dose management in interventional procedures carried out in a university hospital with a workload of 4200 interventional cardiac procedures per year. Patient dose reports were automatically transferred to a central database. Patients exceeding trigger levels for air kerma area product (500 Gy cm{sup 2}) and cumulative skin dose (5 Gy) were counseled and underwent follow-up for early detection of skin injuries, with dermatologic support. The Ethical Committee and the Quality Assurance and Radiation Safety Committee approved the program. During 2010, a total of 13 patients (3.0/1,000 that year) received dose values exceeding trigger levels in the cardiovascular institute. Only one patient, who had undergone two consecutive procedures resulting in 970 Gy cm{sup 2} and 13.0 Gy as cumulative skin dose, showed signs of serious radiodermatitis that resolved in 3.7 months. The remaining patients did not manifest skin lesions during follow-up, and whenever patient examination was not feasible as part of the follow-up, neither patients nor families reported any skin injuries. Peak skin dose calculation and close clinical follow-up were feasible and appropriate, with a moderate additional workload for the staff and satisfaction for the patient.

  3. A 7-year follow-up of multidisciplinary rehabilitation among chronic neck and back pain patients. Is sick leave outcome dependent on psychologically derived patient groups?

    PubMed

    Bergström, Gunnar; Bergström, Cecilia; Hagberg, Jan; Bodin, Lennart; Jensen, Irene

    2010-04-01

    A valid method for classifying chronic pain patients into more homogenous groups could be useful for treatment planning, that is, which treatment is effective for which patient, and as a marker when evaluating treatment outcome. One instrument that has been used to derive subgroups of patients is the Multidimensional Pain Inventory (MPI). The primary aim of this study was to evaluate a classification method based on the Swedish version of the MPI, the MPI-S, to predict sick leave among chronic neck and back pain patients for a period of 7 years after vocational rehabilitation. As hypothesized, dysfunctional patients (DYS), according to the MPI-S, showed a higher amount of sickness absence and disability pension expressed in days than adaptive copers (AC) during the 7-years follow-up period, even when adjusting for sickness absence prior to rehabilitation (355.8days, 95% confidence interval, 71.7; 639.9). Forty percent of DYS patients and 26.7% of AC patients received disability pension during the follow-up period. However, this difference was not statistically significant. Further analyses showed that the difference between patient groups was most pronounced among patients with more than 60days of sickness absence prior to rehabilitation. Cost-effectiveness calculations indicated that the DYS patients showed an increase in production loss compared to AC patients. The present study yields support for the prognostic value of this subgroup classification method concerning long-term outcome on sick leave following this type of vocational rehabilitation.

  4. Adherence to Hypertension Management Recommendations for Patient Follow-Up Care and Lifestyle Modifications Made By Military Healthcare Providers

    DTIC Science & Technology

    2000-05-01

    hypertension . The importance of monitoring high blood pressure (follow-up) and maintaining blood pressure control was examined...committee used evidence-based research to provide contemporary approaches to hypertension control, and further classified a high normal blood pressure ... Blood Pressure High Normal Hypertension 130-139 mm Hg 85-89 mm Hg Stage 1 140-159 mm Hg 90-99 mm Hg Stage 2 160-179 mm Hg 100-109 mm Hg Stage 3 ≥ 180

  5. Cost of using a patient tracer to reduce loss to follow-up and ascertain patient status in a large antiretroviral therapy program in Johannesburg, South Africa

    PubMed Central

    Rosen, Sydney; Ketlhapile, Mpefe

    2010-01-01

    Objective To evaluate a pilot intervention to engage a patient tracer to follow up lost patients at a large public clinic in South Africa. Methods A social worker spent 4 months contacting by telephone a random sample of patients who had initiated antiretroviral therapy (ART) at least 6 months earlier and were ≥1 month late for a scheduled visit. The tracer was authorized to assist patients to return to care if needed. Cost was calculated from the perspective of the clinic. Results The tracer was able to determine the final status of 260 of a sample of 493 lost patients. Of the 260, 55 (21%) had died, 56 (21%) were still on ART at the same site, 79 (30%) reported transferring to another site and 70 (27%) had discontinued treatment. Among those discontinuing, commonly cited reasons were relocation (n = 18, 26%), traditional medicine or religious beliefs (n = 11, 16%), fear of disclosure or other family barriers (n = 9, 13%), and employment obstacles (n = 7, 10%). Twenty patients returned to care at the original site as a result of the intervention, at an average cost of $432 per patient returned. Conclusions A patient tracer was an effective way to determine the final status of lost patients and succeeded in returning some to care, but the cost per patient returned was high. Better information systems allowing sites to track deaths and transfers would greatly improve the efficiency of loss to follow-up interventions. PMID:20586967

  6. Real life cancer comorbidity in Greek patients with diabetes mellitus followed up at a single diabetes center: an unappreciated new diabetes complication.

    PubMed

    Thanopoulou, Anastasia; Pectasides, Demetrios

    2014-01-01

    We determined cancer comorbidity in patients with diabetes followed up at a single Greek academic clinic and investigated the potential related factors. Cancer comorbidity was prospectively recorded for all patients with type 2 (T2DM, n = 759) or type 1 (T1DM, n = 134) diabetes of at least 10-year duration examined during one year. Patient characteristics, diabetes age of onset, duration, treatment, control, and complication rates were compared between subjects with and without cancer. Moreover, a retrospective collection of data from similar patients examined for the first time during the last 25 years, but lost to follow-up, after at least one-year's regular visits, was performed. In regularly followed-up T2DM patients cancer comorbidity was 12.6%. Patients with cancer were older and more frequently smokers. Prostate cancer was the most frequent (24.0%) type. In T1DM cancer comorbidity was 3.0%. Similar rates of comorbidity and types of cancer were observed in lost to follow-up patients. In conclusion, our patients with T2DM of at least 10-year' duration show high cancer comorbidity. No specific characteristics discriminate patients with cancer. Therefore presymptomatic cancer detection and prevention strategies may have to be incorporated into the annual systematic evaluation of our patients.

  7. Patient follow-up: the scope of the duty, the impact of tort law reform and practical suggestions to comply with legal requirements.

    PubMed

    Ellis, Matthew

    2007-12-01

    The exercise of reasonable care and skill by a medical practitioner may give rise to an obligation to follow up a patient after a consultation or procedure. That obligation cannot always be discharged by passing the burden onto the patient, for instance, by advising the patient to return for a further consultation. The few cases that have addressed the issue in Australia have clearly placed a heavier burden on the medical profession to implement effective follow-up procedures. This article addresses the scope of the duty and makes practical recommendations to assist the medical profession in addressing its legal responsibilities.

  8. The early detection of lung cancer during follow-up of patients undergoing endobronchial one-way valve treatment for emphysema.

    PubMed

    Fiorelli, Alfonso; Costanzo, Saveria; di Costanzo, Emilio; Santini, Mario

    2015-03-01

    We describe the early detection of lung cancer during the follow-up of two emphysematous patients undergoing endobronchial treatment with one-way valves for severe dyspnea. In both cases, the lung function improvement achieved after the valves placement allowed their surgical treatment. In additional to standard follow-up for evaluating the progression of emphysema, such patients should be enrolled in a screening program. It may allow the early detection of lung cancer with the possibility for surgery in accordance with respiratory function of patient.

  9. Short-term imaging follow-up of patients with concordant benign breast core needle biopsies: is it really worth it?

    PubMed Central

    Adams, Michelle C.; Falcon, Shannon; Mooney, Blaise P.; Laronga, Christine; Chau, Alec; Drukteinis, Jennifer S.

    2014-01-01

    PURPOSE Women with histologically proven concordant benign breast disease are often followed closely after biopsy for a period of two years, and they are considered to be at high-risk for cancer development. Our goal was to evaluate the utility of short-term (six-month) imaging follow-up and determine the incidence of breast cancer development in this population. METHODS Retrospective review of concordant benign breast pathology was performed in 558 patients who underwent multi-modality breast core biopsy. A total of 339 patients (60.7%) with 393 biopsies qualified for the study. The six-, 12-, and 24-month incidence rates of breast cancer development were estimated with 95% confidence intervals (CI), using the exact method binomial proportions. RESULTS No cancer was detected in 285 of 339 patients (84.1%) returning for the six-month follow-up. No cancer was detected in 271 of 339 patients (79.9%) returning for the 12-month follow-up. Among 207 follow-up exams (61.1%) performed at 24 months, three patients were detected to have cancer in the ipsilateral breast (1.45% [95% CI, 0.30%–4.18%]) and two patients were detected to have cancer in the contralateral breast (0.97% [95% CI, 0.12%–3.45%]). Subsequent patient biopsy rate was 30 of 339 (8.85%, [95% CI, 6.05%–12.39%]). Three ipsilateral biopsies occurred as a sole result of the six-month follow-up of 285 patients (1.05%, [95% CI, 0.22%–3.05%]). CONCLUSION Short-term imaging follow-up did not contribute to improved breast cancer detection, as all subsequent cancers were detected on annual mammography. Annual diagnostic mammography after benign breast biopsy may be sufficient. PMID:25205024

  10. Developing a useful, user-friendly website for cancer patient follow-up: users' perspectives on ease of access and usefulness.

    PubMed

    Bartlett, Y K; Selby, D L; Newsham, A; Keding, A; Forman, D; Brown, J; Velikova, G; Wright, P

    2012-11-01

    UK cancer survival has improved, leading to an increase in review patients and pressure on clinics. Use of the Internet for information exchange between patients and healthcare staff may provide a useful adjunct or alternative to traditional follow-up. This study aimed to develop and evaluate a website for use in follow-up cancer care in terms of usability, feasibility and acceptability. A website was developed and underwent iterative amendment following patient usability testing in focus groups. Patients on follow-up completed a Computer and Internet Usage Questionnaire. Internet users consented to a randomised crossover study to complete paper and online questionnaires, browse the website and participate in a website evaluation interview. Patient website use was tracked. Usability: Website changes were made following patient testing (n= 21). Patients would have liked a 'personalized' website with links to their clinical team, out with the scope of this study. Feasibility: The majority of participants (65%) had Internet access. Age remained a differentiating factor. Acceptability: Final evaluation (n= 103) was positive although many would like to maintain face-to-face hospital contact. User involvement in website design can ensure patient needs are met. A website model for follow-up will suit some patients but others will prefer clinical contact.

  11. Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up.

    PubMed

    Rostaminejad, Akbar; Behnammoghadam, Mohammad; Rostaminejad, Marzieh; Behnammoghadam, Zargham; Bashti, Somaye

    2017-04-07

    The aim of this study was to evaluate the efficacy of eye movement desensitization and reprocessing (EMDR) on the phantom limb pain (PLP) of patients with amputations within a 24-month follow-up. This study was a randomized-controlled trial. A total of 60 patients with amputations were selected by a purposive sampling and patients were divided randomly into two experimental and control groups. Samples were assigned through randomized allocation. EMDR therapy was administered individually to the experimental group participants in 12 one-hour sessions over a 1-month period, In each session, the patient completed the Subjective Units of Distress Scale and a pain-rating scale before and after the intervention. Follow-up measures were obtained 24 months later for the experimental group. The participants in the control group were measured on the two scales at an initial session and again after 1- and 24-month follow-up. The mean PLP decreased in the experimental group between the first and last sessions and remained so at a 24-month follow-up. No decrease occurred for the control group over the 1- and 24-month period. The differences were statistically significant (P<0.001) according to a repeated-measures analysis of variance. EMDR therapy proved to be a successful treatment for PLP. Because of its efficacy and the fact that the positive effects were maintained at the 24-month follow-up, this therapy is recommended for the treatment of PLP.

  12. Serious Infection and Mortality in Patients With Crohn's Disease: More Than 5 Years of Follow-Up in the TREAT™ Registry

    PubMed Central

    Lichtenstein, Gary R; Feagan, Brian G; Cohen, Russell D; Salzberg, Bruce A; Diamond, Robert H; Price, Samiyeh; Langholff, Wayne; Londhe, Anil; Sandborn, William J

    2012-01-01

    OBJECTIVES: The objective of this study was to contribute long-term safety data for infliximab and other therapies in Crohn's disease (CD). METHODS: We prospectively evaluated CD patients enrolled in the large, observational Crohn's Therapy, Resource, Evaluation, and Assessment Tool registry, established to compare infliximab safety with conventional nonbiological medications in CD. RESULTS: A total of 6,273 patients were enrolled and evaluated on or before 23 February 2010; 3,420 received infliximab (17,712 patient-years; 89.9% received ≥2 infusions) and 2,853 received other-treatments-only (13,251 patient-years). Mean length of patient follow-up was 5.2 years. More infliximab- than other-treatments-only-treated patients had moderate-to-severe (30.6% vs. 10.7%) or severe-to-fulminant (2.5% vs. 0.6%) disease severity (P<0.001). In the year before enrollment, more infliximab- than other-treatments-only-treated patients required surgical intervention (17.4% vs. 13.6%), medical hospitalization (14.2% vs. 8.8%), prednisone (47.8% vs. 31.4%), immunomodulators (52.0% vs. 32.1%), and narcotic analgesics (17.3% vs. 9.1%). Patient mortality was similar for infliximab- and other-treatments-only-treated patients (0.58 vs. 0.59/100 patient-years). In multivariate logistic regression analyses, treatment with prednisone (hazard ratio (HR)=2.14, 95% confidence interval (CI)=1.55, 2.95; P<0.001) or narcotic analgesics (HR=1.79, 95% CI=1.29, 2.48; P<0.001) and age (HR=1.08, 95% CI=1.07, 1.09; P<0.001) were associated with increased mortality risk. Neither infliximab nor immunomodulator treatment was associated with increased mortality risk. Factors independently associated with serious infections included moderate-to-severe disease activity (HR=2.24, 95% CI=1.57, 3.19; P<0.001), narcotic analgesic treatment (HR=1.98, 95% CI=1.44, 2.73; P<0.001), prednisone therapy (HR=1.57, 95% CI=1.17, 2.10; P=0.002), and infliximab treatment (HR=1.43, 95% CI=1.11, 1.84; P=0.006). CONCLUSIONS

  13. Verrucous carcinoma of the oral mucosa: An epidemiological and follow-up study of patients treated with surgery in 5 last years

    PubMed Central

    Dean-Ferrer, Alicia; Alamillos-Granados, Francisco J.; Heredero-Jung, Susana; García-García, Blas; Ruiz-Masera, Juan J.; Arévalo-Arévalo, Rafael; Zafra-Camacho, Francisco; Valenzuela-Salas, Borja

    2014-01-01

    Introduction: Oral Verrucous Carcinoma (OVC) is described apart of the Squamous Cell Carcinoma (SCC) due to its specific properties. The objective of our study is to show our series of cases of OVC and to compare with the SCC in terms of clinical manifestations, epidemiology, histopathology, treatment and follow-up. Material and Methods: This is a retrospective study of all the OVC treated in our department between January-2007 and December-2011. The analyzed variables were sex, age, localization in the oral cavity, histopathology, number of biopsies needed to diagnose OVC, TNM classification, treatment and recurrences during follow-up. Results: Our sample was composed by n=14 patients, 57% female, with a mean age of 69.14 years. The most common localization was buccal mucosa (n=5). Seven patients were diagnosed of OVC with the first biopsy. TNM classification was: pT1: 7 patients, pT2: 3 patients, pT3: 3 patients, pT4: 1 patient. No cervical metastases were observed either in cervical neck dissection or during the follow-up of the patients. The treatment was surgery with clinical resection margins up to 1 cm in all cases, followed by radiotherapy in selected cases. Only n=1 patient (7.69%) presented a recurrence after 34 months of follow-up. The overall survival rate was 92.85%. Conclusions: In our population, OVC represents the 6.16% of all oral cavity and oropharynx cancer, and is more frequent in female patients above 70 years old. It uses to rise over a previous lesion, and usually affects the buccal mucosa. In patients with high suspicious lesions, more than one biopsy may be needed to diagnose OVC. No patient showed cervical dissemination. In our experience, treatment based on local resection, without cervical neck dissection, could be a good option for these patients. Key words:Verrucous carcinoma, squamous cell carcinoma, oral cancer, oral cavity, epidemiology, follow-up. PMID:24880446

  14. Corpus Callosum Function in Verbal Dichotic Listening: Inferences from a Longitudinal Follow-Up of Relapsing-Remitting Multiple Sclerosis Patients

    ERIC Educational Resources Information Center

    Gadea, Marien; Marti-Bonmati, Luis; Arana, Estanislao; Espert, Raul; Salvador, Alicia; Casanova, Bonaventura

    2009-01-01

    This study conducted a follow-up of 13 early-onset slightly disabled Relapsing-Remitting Multiple Sclerosis (RRMS) patients within an year, evaluating both CC area measurements in a midsagittal Magnetic Resonance (MR) image, and Dichotic Listening (DL) testing with stop consonant vowel (C-V) syllables. Patients showed a significant progressive…

  15. Fragment reattachment of fractured anterior teeth in a young patient with a 1.5-year follow-up.

    PubMed

    Ninawe, Nupur; Doifode, Deoyani; Khandelwal, Vishal; Nayak, Prathibha Anand

    2013-04-22

    Crown fracture of maxillary anterior teeth is relatively common among children and teenagers. Aesthetic rehabilitation of crown fractures of the maxillary anterior is one of the greatest challenges to the dentist. Reattachment of a fractured fragment to the remaining tooth can provide better and long-lasting aesthetics, improved function, a positive psychological response and is a faster and less-complicated procedure. This article presents a case of reattachment of anterior tooth with a coronal fracture involving enamel, dentin and pulp with a 1.5-year follow-up.

  16. A nurse-driven outpatient clinic for thiopurine-treated inflammatory bowel disease patients reduces physician visits and increases follow-up efficiency.

    PubMed

    López, María; Dosal, Angelina; Villoria, Albert; Moreno, Laura; Calvet, Xavier

    2015-01-01

    Patients on thiopurine therapy need frequent monitoring to prevent drug adverse events. To describe the structure and main results of a nurse-driven outpatient clinic (NDOC) program for the follow-up of patients receiving treatment with thiopurine immunosuppressants, we retrospectively reviewed patients' clinical charts on thiopurine drugs, azathioprine (AZA), and 6-mercaptopurine. We evaluated the efficacy of the NDOC by comparing the number of physician visits and the adequacy of laboratory controls for each patient before and after inclusion in the program. From January 2006 to December 2008, 179 patients were included. Of these, 102 had received thiopurines for at least 1 year before the start of the NDOC. Mean age was 42 ± 15 years; 83 were female. In all, 137 of the 179 patients (76%) had Crohn disease. AZA was the most frequent drug used (97%). Mean time of follow-up was 2.03 ± 0.9 years. Implementation of this program decreased the number of physician visits per year-from 4.6 ± 1.9 to 2.4 ± 1.3 (p < .001)-and the number of periods longer than 4 months without laboratory control (from 68% to 45%; p = .01). Leucopenia episodes and complications did not differ significantly before and after the start of the NDOC. Nurse-driven follow-up of these patients reduces physician visits while improving tightness of the follow-up.

  17. 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

  18. The effects of anti-depressants on depression symptom scores at 12 months follow-up in patients with cardiometabolic disease: Results from a large primary care cohort

    PubMed Central

    Jani, Bhautesh Dinesh; Purves, David; Barry, Sarah J. E.; McCowan, Colin; Cavanagh, Jonathan; Mair, Frances S.

    2015-01-01

    Background: Evidence on the long-term usefulness of anti-depressants in managing depression in cardiometabolic disease is limited. Aim: We examined the effects of anti-depressant prescribing on depressive symptoms at 12 months follow-up in patients with cardiometabolic disease and a positive depression screening result at baseline. Design and Setting: We retrospectively reviewed routine UK primary care data for patients with coronary heart disease, diabetes and previous stroke for the year 2008–2009. 35,537 patients with one of the three above diseases underwent depression screening using the Hospital Anxiety and Depression Scale (HADS-D). Of 7080 patients with a positive screening result (HADS-D ≥ 8), 3933 (55.5%) patients had a repeat HADS-D recorded at 12 months follow-up. Methods: We compared the change in HADS-D at follow-up and remission rate in those who were prescribed anti-depressants (n = 223) against those who were not (n = 3710). Results: The mean change in HADS-D from baseline, for the nonprescribed group was similar to the reduction observed in patients who were continuously prescribed (n = 93) with anti-depressants during follow-up. Patients who were prescribed intermittently (n = 72) or only one (n = 58) prescription during follow-up had a lower reduction in HADS-D compared to the nonprescribed group. There was no difference in remission rates between continuously prescribed and the nonprescribed group, but remission was lower in patients prescribed intermittently and single prescription. Conclusion: Improvement in depressive symptoms in patients with cardiometabolic disease at 12 months was not any better in patients prescribed with anti-depressants compared to the nonprescribed group. The role of anti-depressants in the management of depression in cardiometabolic disease merits further investigation. PMID:26286616

  19. Benefits of new immunoglobulin-derived biomarkers for the diagnosis and follow-up of patients with dysglobulinemia.

    PubMed

    Ermak, Natalia; Nguyen-Khoa, Thao; Alyanakian, Marie-Alexandra

    2016-10-01

    The diagnostics and follow-up of monoclonal gammopathies such as multiple myeloma require precise analysis of the monoclonal component as well as the other immunoglobulins isotypes, which might be limited by the sensitivity of standard laboratory methods. New serum biomarkers were developed for routine practice in the last decades, such as the free light chain assays and more recently the heavy/light chain assays. Studies have shown that serum free light chain measurement was useful in the identification and follow-up of pauci or nonsecretory myeloma, free light-chain multiple myeloma and AL amyloidosis. It is also an important prognostic marker for monoclonal gammopathy of undetermined significance and AL amyloidosis progression. Hevylite method enables quantitative analysis of heavy/light chain pairs of IgG, IgA and IgM immunoglobulins. This technique has a promising potential to enrich the standard analytic tools as it enables to assess the concentration and ratio of the levels of both tumor and physiological immunoglobulins (heavy/light chain pair suppression), which is not possible with serum protein electrophoresis or global quantitative analysis of immunoglobulin isotypes. This review includes the latest International myeloma working group recommendations and key data presented at the Euromedlab convention in June 2015 Paris regarding serum free light chain and heavy/light chain assays in the biological monitoring of dysglobulinemia.

  20. 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.

  1. Outcomes and Short-Term Follow-Up in Complex Ross Operations in Pediatric Patients Undergoing Damus-Kaye-Stansel Takedown.

    PubMed

    Baird, Christopher W; Zurakowski, David; Bueno, Alejandra; Borisuk, Michele J; Raju, Vijayakumar; Mokashi, Suyog A; Emani, Sitaram; Marx, Gerald R; Del Nido, Pedro J

    2016-01-01

    Review echocardiography and outcomes before and after Ross procedures, including patients undergoing biventricular conversion with Damus-Kaye-Stansel (DKS) takedown. A retrospective review was performed on 62 patients undergoing simple (control group) and complex Ross procedures, including 12 patients who underwent biventricular conversion with Ross operation and DKS takedown (complex). Echocardiography was reviewed preoperatively and at discharge and late follow-up. Kaplan-Meier estimates of patient survival and freedom from reintervention were obtained. In all, 62 patients had a median age of 4.5 years (interquartile range [IQR]: 1-12.5), weight of 16.4kg (IQR: 8-41), and follow-up of 3.8 years (IQR: 1.3-6). The complex DKS takedown group had 2 deaths, no neoaortic valve or root reinterventions, and 3 right ventricular outflow tract (VOT) reinterventions. There were no differences from the control group in left VOT or right VOT reinterventions. Neither group showed differences between pre- and late follow-up aortic root and ascending aorta dimensions, and no correlations were found among preoperative pulmonary valve (PV) size, late aortic regurgitation (AR), aortic root, or ascending aortic Z-scores. Aortic valve size increased from discharge to late follow-up for both groups (P ≤ .05); 90% of patients at late follow-up had mild or less AR with similar distributions in severity between complex and control groups. Severity of late AR showed no correlation with preoperative PV size and is independent of it. The Ross procedure has good short-term results in simple and complex patients and should be considered in those undergoing Ross operation with biventricular conversion and DKS takedown. Moreover, native PV size should not be a contraindication for Ross procedure.

  2. Symptom load and general function among patients with erythema migrans: a prospective study with a 1-year follow-up after antibiotic treatment in Norwegian general practice

    PubMed Central

    Eliassen, Knut Eirik; Hjetland, Reidar; Reiso, Harald; Lindbæk, Morten; Tschudi-Madsen, Hedda

    2017-01-01

    Objective Promptly treated erythema migrans (EM) has good prognosis. However, some patients report persistent symptoms. Do patients with EM have more symptoms than the general population? We describe individual symptoms and general function in EM-patients at time of diagnosis and one year after treatment. Design Prospective study with 1-year follow up after treatment. Questionnaires included a modified version of the Subjective Health Complaints Inventory, comprising three additional Lyme borreliosis (LB) related symptoms. General function was assessed using a five-point scale modified from the COOP/WONCA charts. Setting Norwegian general practice. Subjects A total of 188 patients were included in a randomized controlled trial comparing three antibiotic regimens for EM, of whom 139 had complete data for this study. Main outcome measures Individual symptoms, symptom load and general function. Results Mild symptoms were common, reported by 84.9% at baseline and by 85.6% at follow-up. At baseline, patients reported a mean of 5.4 symptoms, compared with 6.2 after one year. Severely bothersome symptoms and severely impaired general function were rare. Tiredness was the most reported symptom both at baseline and at follow-up. Palsy (other than facial) was the least reported symptom, but the only one with a significant increase. However, this was not associated to the EM. Conclusion The symptom load was comparable to that reported in the general population. We found an increase in symptom load at follow-up that did not significantly affect general function. Implication: Monitoring patients’ symptom loads prior to treatment reduce the probability of attributing follow-up symptoms to LB. Key points Erythema migrans has a good prognosis.Patients treated for erythema migrans have a slight increase in symptom load one year after treatment. This increase does not affect general function. The levels of subjective health complaints in patients treated for erythema migrans are

  3. Age 2: Findings from the 2-Year-Old Follow-Up of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). E.D. TAB. NCES 2006-043

    ERIC Educational Resources Information Center

    Mulligan, Gail M.; Flanagan, Kristin Denton

    2006-01-01

    This E.D. TAB is the first report produced using data from the second round of data collection for the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), a study of a nationally representative sample of children born in the year 2001. The report provides descriptive information about these children when they were about 2 years old. It…

  4. The Role of Depressive Symptoms, Family Invalidation and Behavioral Impulsivity in the Occurrence and Repetition of Non-Suicidal Self-Injury in Chinese Adolescents: A 2-Year Follow-Up Study

    ERIC Educational Resources Information Center

    You, Jianing; Leung, Freedom

    2012-01-01

    This study used zero-inflated poisson regression analysis to examine the role of depressive symptoms, family invalidation, and behavioral impulsivity in the occurrence and repetition of non-suicidal self-injury among Chinese community adolescents over a 2-year period. Participants, 4782 high school students, were assessed twice during the…

  5. Limited clinical relevance of imaging techniques in the follow-up of patients with advanced chronic lymphocytic leukemia: results of a meta-analysis.

    PubMed

    Eichhorst, Barbara F; Fischer, Kirsten; Fink, Anna-Maria; Elter, Thomas; Wendtner, Clemens M; Goede, Valentin; Bergmann, Manuela; Stilgenbauer, Stephan; Hopfinger, Georg; Ritgen, Matthias; Bahlo, Jasmin; Busch, Raymonde; Hallek, Michael

    2011-02-10

    The clinical value of imaging is well established for the follow-up of many lymphoid malignancies but not for chronic lymphocytic leukemia (CLL). A meta-analysis was performed with the dataset of 3 German CLL Study Group phase 3 trials (CLL4, CLL5, and CLL8) that included 1372 patients receiving first-line therapy for CLL. Response as well as progression during follow-up was reassessed according to the National Cancer Institute Working Group1996 criteria. A total of 481 events were counted as progressive disease during treatment or follow-up. Of these, 372 progressions (77%) were detected by clinical symptoms or blood counts. Computed tomography (CT) scans or ultrasound were relevant in 44 and 29 cases (9% and 6%), respectively. The decision for relapse treatment was determined by CT scan or ultrasound results in only 2 of 176 patients (1%). CT scan results had an impact on the prognosis of patients in complete remission only after the administration of conventional chemotherapy but not after chemoimmunotherapy. In conclusion, physical examination and blood count remain the methods of choice for staging and clinical follow-up of patients with CLL as recommended by the International Workshop on Chronic Lymphocytic Leukemia 2008 guidelines. These trials are registered at http://www.isrctn.org as ISRCTN 75653261 and ISRCTN 36294212 and at http://www.clinicaltrials.gov as NCT00281918.

  6. 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…

  7. A Telemedicine system based on Internet and short message service as a new approach in the follow-up of patients with gestational diabetes.

    PubMed

    Pérez-Ferre, Natalia; Galindo, Mercedes; Fernández, M Dolores; Velasco, Victoria; de la Cruz, M José; Martín, Patricia; del Valle, Laura; Calle-Pascual, Alfonso L

    2010-02-01

    To evaluate the feasibility of a Telemedicine system based on Internet and short message service in the follow-up of patients with gestational diabetes. Compared to control group, Telemedicine group reduced 62% the number of unscheduled face-to-face visits, and 82.7% in the subgroup of insulin-treated patients, improving patient satisfaction, and achieving similar pregnancy and new born outcomes.

  8. Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy

    PubMed Central

    Louw, Adriaan; Diener, Ina; Landers, Merrill R.; Zimney, Kory

    2016-01-01

    Background Results from a previous multicenter randomized controlled trial (RCT) on preoperative pain neuroscience education (PNE) for lumbar radiculopathy found no significant difference in patient reported outcomes between groups. However, patients who received PNE viewed their surgical experience more favorably and utilized significantly less healthcare compared to those that did not. The purpose is to determine if the reduction in healthcare costs from 1-year would be continued at 3-year following surgery, and to explore differences (if any) in patient reported outcomes. Study design—analysis of 3-year follow-up data from RCT on preoperative PNE for lumbar radiculopathy. Methods Participating patients from the previous RCT were contacted for 3-year follow-up. Of the 67 patients who commenced in the study, there were 61 who completed 1-year follow-up. Data packets were sent to these 61 patients to examine post-operative utilization of healthcare (Utilization of Healthcare Questionnaire); LBP [numeric rating scale (NRS)]; leg pain (NRS); function (Oswestry disability index); and beliefs and experiences related to LS (10 item survey with Likert responses). Results At 3-year follow-up, 50 patients (29 females) responded, with 22 patients in the experimental group (EG) and 28 in the control group (CG). Cumulative medical expenses were 37% lower for the EG, with those patients spending less on X-rays and visits to their family physician, physical therapist, and massage therapist. There were no differences in patient reported outcomes between groups. Patients who received PNE continued to view their surgical experience more favorably compared to those that did not. Conclusions Adding a single PNE session prior to surgery for lumbar radiculopathy results in significant healthcare savings over 3 years. Educating such patients about normal responses to lumbar surgery (LS) in a neuroscience framework may result in lasting behavior changes following surgery. PMID

  9. Differences in diagnosis, follow-up and treatment of patients with dementia living in the peripheral areas compared with the central areas of Israel.

    PubMed

    Merims, D; Shemesh, D Golan; Nahari, H; Arharov, O; Ari, G Ben; Israel, J Ben

    2015-07-01

    We compared data regarding diagnosis, treatment and follow-up of patients with dementia in the central and the peripheral areas of Israel. Data were collected from the medical records of 164 patients with advanced dementia, all residents of dementia special care units - 97 patients from a central nursing home and 67 patients from the peripheral areas. The data collected related to the period prior to hospitalization and included: demographic data, imaging tests, follow-up by a memory clinic and drug treatment prior to admission. Mini Mental State Examination on admission was also recorded. Patients in the peripheral areas were hospitalized while having better cognitive function, as demonstrated by the Mini Mental State Examination (p < 0.05). More patients in the central areas versus the peripheral areas were aided by an in-house worker prior to admission (p < 0.001). More patients with dementia in the central areas were followed up by a memory clinic (p < 0.001) and underwent brain imaging (p < 0.01) compared with patients with dementia living in the peripheral areas. Although not significant, patients from the central areas were more commonly treated with atypical neuroleptics for behavioral problems (p = 0.05). On the basis of the current data, we suggest that there are differences in the diagnosis, follow-up and drug treatment among patients with dementia living in the central areas versus those living in the peripheral ones. Patients in the peripheral areas are hospitalized while their cognitive abilities are relatively better than those of the patients in central areas.

  10. Intervention Strategies for Improving Patient Adherence to Follow-Up in the Era of Mobile Information Technology: A Systematic Review and Meta-Analysis

    PubMed Central

    2014-01-01

    Background Patient adherence to follow-up plays a key role in the medical surveillance of chronic diseases and affects the implementation of clinical research by influencing cost and validity. We previously reported a randomized controlled trial (RCT) on short message service (SMS) reminders, which significantly improved follow-up adherence in pediatric cataract treatment. Methods RCTs published in English that reported the impact of SMS or telephone reminders on increasing or decreasing the follow-up rate (FUR) were selected from Medline, EMBASE, PubMed, and the Cochrane Library through February 2014. The impacts of SMS and telephone reminders on the FUR of patients were systematically evaluated by meta-analysis and bias was assessed. Results We identified 13 RCTs reporting on 3276 patients with and 3402 patients without SMS reminders and 8 RCTs reporting on 2666 patients with and 3439 patients without telephone reminders. For the SMS reminders, the majority of the studies (>50%) were at low risk of bias, considering adequate sequence generation, allocation concealment, blinding, evaluation of incomplete outcome data, and lack of selective reporting. For the studies on the telephone reminders, only the evaluation of incomplete outcome data accounted for more than 50% of studies being at low risk of bias. The pooled odds ratio (OR) for the improvement of follow-up adherence in the SMS group compared with the control group was 1.76 (95% CI [1.37, 2.26]; P<0.01), and the pooled OR for the improvement of follow-up adherence in the telephone group compared with the control group was 2.09 (95% CI [1.85, 2.36]; P<0.01); both sets showed no evidence of publication bias. Conclusions SMS and telephone reminders could both significantly improve the FUR. Telephone reminders were more effective but had a higher risk of bias than SMS reminders. PMID:25100267

  11. Coil therapy for patients with severe emphysema and bilateral incomplete fissures – effectiveness and complications after 1-year follow-up: a single-center experience

    PubMed Central

    Kontogianni, Konstantina; Gerovasili, Vasiliki; Gompelmann, Daniela; Schuhmann, Maren; Hoffmann, Hans; Heussel, Claus Peter; Herth, Felix JF; Eberhardt, Ralf

    2017-01-01

    Background Lung volume reduction coil (LVRC) treatment is established in daily endoscopic lung volume reduction routine. The aim of this study was to evaluate the safety and efficacy of LVRC treatment. Patients and methods This was a retrospective analysis of 86 patients (male/female: 40/46, mean age: 64±7 years) with severe COPD and bilateral incomplete fissures. A total of 10 coils were unilaterally implanted in a single lobe, and 28 out of 86 patients were treated bilaterally. At 90-, 180-, and 365-day follow-up, changes in pulmonary function test (PFT), 6-minute walk test (6MWT) and modified Medical Research Council (mMRC) dyspnea scale, as well as possible complications, were recorded. Results At 90 days, the forced expiratory volume in 1 second did improve (P<0.001), but the improvement was not sustained at the 180- and 365-day follow-up (baseline: 0.71±0.21 vs 0.77±0.23 vs 0.73±0.22 vs 0.70±0.18 L). Both vital capacity and residual volume improved significantly (P<0.001) at the 90- and 180-day follow-up, but the improvement was lost after 365 days. Total lung capacity decreased at the 90-day follow-up but returned to baseline values at the 180- and 365-day follow-up. 6MWT (P=0.01) and mMRC (P=0.007) also improved at 90 and 180 days (Δ6MWT of 31±54 and 20±60 m, respectively), but the improvement was also lost at the 365-day follow-up. No significant further improvement was evident at any point in the follow-up after the second procedure. A total of 4 out of 86 patients passed away due to complications. Significant complications in the first 3 months and then at 12 months included the following: severe hemoptysis in 4 (3.5%) and 4 (3.5%) patients, pneumonia requiring hospitalization in 32 (28.1%) and 9 (7.9%) patients and pneumothorax in 7 (6.1%) and 2 (1.7%) patients, respectively. Milder adverse events included self-limited hemoptysis, pneumonias, or COPD exacerbations treated orally. Conclusion LVRC improved PFT, 6MWT and mMRC initially, but the

  12. Manipulation Therapy Relieved Pain More Rapidly Than Acupuncture among Lateral Epicondylalgia (Tennis Elbow) Patients: A Randomized Controlled Trial with 8-Week Follow-Up

    PubMed Central

    Lee, Ko-Hung; Chang, Zi-Yu; Chen, Hsing-Yu

    2016-01-01

    Radial bone adjustment manipulation treatment may be effective to reduce pain rapidly in lateral epicondylalgia patients and the pathological tension in the biceps brachii muscle is highly concerned. To prove this hypothesis, we conducted a randomized controlled trial and included 35 patients with lateral epicondylalgia for more than 2 months. Either manipulation treatment (n = 16) or acupuncture (n = 19) was given to these patients for 2 weeks and all patients' symptoms were followed up for 8 weeks after treatment. Both groups demonstrated changes in pain VAS score, grip strength, and DASH questionnaire. Lateral epicondylalgia patients who received manipulation treatment felt pain relief sooner than those who had acupuncture treatments during the first few treatments. However, both acupuncture and manipulation are effective, while the difference has no significance at the 8-week follow-up. The trial was registered with Current Controlled Trials ISRCTN81308551 on 5 February 2016. PMID:27143983

  13. Advanced therapies in patients with congenital heart disease-related pulmonary arterial hypertension: results from a long-term, single center, real-world follow-up.

    PubMed

    Favilli, Silvia; Spaziani, Gaia; Ballo, Piercarlo; Fibbi, Veronica; Santoro, Gennaro; Chiappa, Enrico; Arcangeli, Chiara

    2015-06-01

    Pulmonary arterial hypertension (PAH) is a common finding in patients with congenital heart disease (CHD), and has relevant prognostic implications. The recent introduction of advanced therapies (AT) considerably improved the clinical outcome of these patients, but real-world data are still lacking. We aimed at reporting the results of a long-term follow-up of CHD patients with PAH undergoing AT, followed at a tertiary Center during the two last decades. The study population included a total of 34 patients with an established diagnosis of CHD-related PAH. In addition to conventional treatment, 97% of patients started AT during the follow-up. Over a median follow-up of 9 [3-31] years, 11 (32.4%) patients died: 7 of them were affected by Eisenmenger syndrome and the majority of patients were in NYHA class ≥3 at the time of death. Among the 23 patients who were alive at the last follow-up, the majority were in NYHA class I-II. Oxygen saturation and 6-min walking distance improved in all subjects within the first 6 months after starting of AT. One patient with ventricular septum defect and high pulmonary resistances was successfully treated with AT to lower resistances and underwent defect closure. A good clinical outcome was also observed in the subset (n = 8) with Down syndrome. The results of this real-world experience suggest that, despite a relatively high mortality rate mostly related to late commencement of AT, the clinical outcome of subjects with CHD-related PAH undergoing AT are characterized by a good quality of life and clinical improvement in most patients.

  14. Frequency of joint involvement in juvenile idiopathic arthritis during a 5-year follow-up of newly diagnosed patients: implications for MR imaging as outcome measure.

    PubMed

    Hemke, Robert; Nusman, Charlotte M; van der Heijde, Désirée M F M; Doria, Andrea S; Kuijpers, Taco W; Maas, Mario; van Rossum, Marion A J

    2015-02-01

    To assess the sequence and type of active joints in a cohort of newly diagnosed juvenile idiopathic arthritis (JIA) patients with full access to current treatment at first visit and during a follow-up period of 5-years, in order to identify an index joint/group of joints for magnetic resonance imaging in JIA. Patient charts of all consecutive newly diagnosed JIA patients with a follow-up duration of at least 5 years were analyzed. Patients were derived from two tertiary pediatric rheumatology centers. Patient characteristics and data concerning the presence of joints with arthritis and the use of medication were recorded. Findings from 95 JIA patients [39 (41 %) oligoarticular and 56 (59 %) polyarticular] were analyzed. At first visit, distribution of active joints among patients was as follows: knee (n = 70, 74 %), ankle (n = 55, 58 %), elbow (n = 23, 24 %), wrist (n = 23, 24 %), metacarpophalangeal (MCP) (n = 20, 21 %), proximal interphalangeal (PIP) (n = 13, 14 %), hip (n = 6, 6 %), shoulder (n = 5, 5 %), and distal interphalangeal (DIP) (n = 4, 4 %) joints. After a follow-up period of 5 years, the cumulative percentage of patients with specific joint involvement changed into: knee (n = 88, 93 %), ankle (n = 79, 83 %), elbow (n = 43, 45 %), wrist (n = 38, 40 %), MCP (n = 36, 38 %), PIP (n = 29, 31 %), shoulder (n = 20, 21 %), hip (n = 17, 19 %), and DIP (n = 9, 10 %) joints. Despite changes in treatment strategies over the years, the knee remains the most commonly involved joint at onset and during follow-up in JIA, followed by the ankle, elbow, and wrist. For the evaluation of outcome with MRI, the knee appears the most appropriate joint in JIA.

  15. [Psychosomatic rehabilitation of in-patients with somatoform disorders and of patients with social-medically relevant problems: results of a two-year follow-up].

    PubMed

    Hoffmann, C; Ruf-Ballauf, W

    2007-10-01

    The success of psychosomatic rehabilitation based on psychoanalytical therapy was analyzed within the framework of a two-year follow-up in patients with somatoform disorders and in patients with social-medically relevant problems, who had been on sick leave for more than six months. Both groups of patients are often considered to be difficult. They were compared with patients of other diagnostic categories and with patients with shorter periods of sick leave. All in all, the physical and mental state of health showed lasting improvement, and demands on the health service and frequency of days off sick decreased. Patients with somatoform disorders partly proved to be more seriously affected at the time of admission, treatment outcomes, however, were to a great extent comparable to patients of other diagnostic categories. Patients who had been on sick leave for more than six months were found to have been more seriously affected at the time of admission and also to have been unable to benefit from rehabilitation to the same degree as those with shorter periods of sick leave. The success of rehabilitation does not seem to depend so much on diagnostic categories but rather on the duration of disablement. In cases of inability to work a specific treatment that pays greater attention to the somatic concept of illness as well as the low level of motivation for psychotherapy in this patient group could lead to better treatment outcomes.

  16. Watchful waiting and active surveillance approach in patients with low risk localized prostatic cancer: an experience of out-patients clinic with 12-year follow-up.

    PubMed

    Kravchick, Sergey; Peled, Ronit; Cytron, Shmuel

    2011-12-01

    In this study we evaluated the safety of expectant approach in the patients with low risk prostate cancer in the reality of community based out-patients clinics. 48 men were enrolled into the study. The inclusion criteria were age ranged from 60 to 75 years and the Epstein criteria for low risk prostate cancer. Patients were managed expectantly while curative treatment was offered when indicated. Initial and final Charlson comorbidity index (CCI) and BMI were assessed for all men. Patients' median follow-up was 81.1 ± 29.1 years. During this study 41.7% of the patients chose active forms of treatment. Cancer was found in 20.8% (n-10) of our patients. Two first sessions of re-biopsy diagnosed 92% of T1c upgrading. Six men with CCI ≥2 died from concomitant disease and no one died from PCa. Significant correlation was found between BMI and final CCI ≥2 (p-0.001). Expectant approach can be considered as self alternative to active treatment model in selected group of patients with well differentiated PCa, however 20.8% of these patients are still at risk of having aggressive form of cancer. Expectant approach is particular beneficial for the patients with CCI 1-2 and high BMI.

  17. Bland Embolization in Patients with Unresectable Hepatocellular Carcinoma Using Precise, Tightly Size-Calibrated, Anti-Inflammatory Microparticles: First Clinical Experience and One-Year Follow-Up

    SciTech Connect

    Bonomo, Guido; Pedicini, Vittorio; Monfardini, Lorenzo; Della Vigna, Paolo; Poretti, Dario; Orgera, Gianluigi; Orsi, Franco

    2010-06-15

    The purpose of this study is to report on the feasibility, local response, and 1-year clinical outcome of bland transarterial embolization (TAE) with 40- and 100-{mu}m Embozene microspheres in patients affected by unresectable hepatocellular carcinoma (HCC). Up to January 2009, 53 patients underwent superselective TAE for a total of 74 lesions. Diagnosis of HCC was based on multidetector computed tomography (MDCT), {alpha}-fetoprotein, and biopsy. MDCT was performed 24 after treatment and repeated at 1 month, 3 months, and then every 6 months. Local efficacy was defined according to RECIST criteria. Technical success was always achieved. Local results at 1-month, 3- to 6-month, and 6- to 12-month follow-up were 62%, 37%, and 16%, respectively, for stable disease and 35%, 56%, and 51%, respectively, for partial response. Complete response (no evidence of lesion) has been observed only at late follow-up (three lesions; 7%). To date, 20 of 53 patients have had at least 1 year of follow-up, with an overall survival rate of 96%. Hepatic progressive disease (i.e., new nodules) was observed in 14 of 20 patients due to underlying liver disease. Minor complications were observed in four patients. A major complication occurred in one patient, who died unexpectedly 24 h after TAE due to pulmonary embolism of necrotic pathologic tissue and passage of particles through a disrupted hepatic vein. Local results as well as 1-year clinical outcome after TAE with Embozene microspheres are veryly encouraging, however, further studies, a larger patient population, and a longer follow-up are mandatory to assess the real clinical impact.

  18. Clinical manifestations and long-term follow-up in pediatric patients living at altitude with isolated pulmonary artery of ductal origin.

    PubMed

    Takatsuki, Shinichi; Darst, Jeffrey R; Das, Bibhuti B; Fagan, Thomas E; Wolfe, Robert; Ivy, David Dunbar

    2012-06-01

    This study's aim was to define the clinical manifestations and long-term outcome of pediatric patients living at altitude with isolated pulmonary artery (PA) of ductal origin (IPADO). This was a retrospective cohort study of 17 consecutive cases of IPADO at a single center. All patients lived at modest altitude (median 2050 m [range 1700 m to 3050 m]). Fifteen children (88%) were symptomatic at presentation. High-altitude pulmonary edema was present in 2 patients (12%) at diagnosis, and only 1 patient had episodes of hemoptysis during follow-up. Fourteen patients (82%) demonstrated evidence of pulmonary arterial hypertension (PAH). Among 14 patients with PAH, 11 patients had surgical interventions. PAH resolved in 5 of 11 patients (45%) undergoing surgical rehabilitation. One patient died during follow-up, and 7 patients are receiving oral vasodilator therapies due to residual PAH; 14 patients remained asymptomatic. Our study showed that early intervention in patients with IPADO at modest altitude can potentially rehabilitate the isolated PA and reverse PAH. Whether surgery is indicated for patients with this disorder in the absence of PAH is unknown.

  19. Ultrasound pleural effusion sign as a useful marker for identifying heart failure worsening in established heart failure patients during follow-up.

    PubMed

    Kataoka, Hajime

    2012-01-01

    Clinical significance of UltraSound Pleural Effusion (US-PLE) and test characteristics of this sign for identifying worsening heart failure (HF) during follow-up of HF patients are unclear. Clinical records of 83 established HF patients were examined. The diagnosis of worsening HF was classified as "highly certain,"probable,"uncertain," or "no" based on the combination of the changes in symptoms/signs and B-type natriuretic peptide (BNP). Routine test included searching for the US-PLE sign. During a follow-up of 652±456 days, 1826 visits were evaluated. Among the 83 study patients, 78 had at least one