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Long-term Follow-up (long-term + follow-up)
Kinds of Long-term Follow-up Terms modified by Long-term Follow-up Selected AbstractsSmall and Medium-Sized Congenital Nevi in Children: A Comparison of the Costs of Excision and Long-Term Follow-UpDERMATOLOGIC SURGERY, Issue 12 2009FERNANDO ALFAGEME ROLDÁN MD BACKGROUND Clinical decisions on whether to follow up or remove small and medium congenital melanocytic nevi (SMCMN) in children have cost implications that have not been studied. OBJECTIVES To compare the costs of excision of SMCMN in children with lifelong follow-up in a tertiary center. METHODS AND MATERIALS We elaborated models for the evaluation of the costs of excision and long-term follow-up. We retrospectively collected data on 113 consecutive excised SMCMN (105 single-step interventions and 8 multiple-step interventions) from the medical records of our pediatric dermatology unit from 2001 to 2007 and calculated and compared the costs (direct and indirect) of surgery and follow-up. RESULTS The mean ± standard deviation and total cohort costs for single-step interventions were ,1,504.73 ± 198.33 and 157,996.20, respectively. Median and cohort lifelong follow-up costs were similar if performed every 4 years (1,482.66 ± 34.98 and 156,679.63). For multiple-step interventions (3 or 4 steps), surgery costs were similar to those of annual lifelong follow-up. In the case of two-step surgery, costs were similar to lifelong follow-up every 2 years. CONCLUSIONS An analysis of the costs of surgery and long-term follow-up in children with SMCMN is possible. Although the clinical judgment of the dermatologist and parental opinion are the main determinants in the management of SMCMN, costs should also be taken into account. [source] Long-Term Follow-Up of a Hemifacial Lentigo Maligna Treated Using 5% ImiquimodDERMATOLOGIC SURGERY, Issue 2 2009ANNE M. RAMSDELL MD First page of article [source] Long-Term Follow-Up After Autologous Fat Grafting: Analysis of Results from 116 Patients Followed at Least 12 Months After Receiving the Last of a Minimum of Two TreatmentsDERMATOLOGIC SURGERY, Issue 12 2000Sorin Eremia MD Background. The effectiveness of long-term results for correction of facial rhytides with single or multiple autologous fat transplants remains controversial. Objective. This study is a retrospective review of short- and long-term results for 116 patients who underwent multiple autologous fat grafting sessions into the nasolabial and melolabial (lateral oral commissure) fold, and in some cases additional sites such as lips and glabella. Methods. Criteria for inclusion into the study included at least two treatment sessions and at least a 12-month follow-up evaluation after the last treatment received. A 14-gauge needle cannula was used to aspirate the donor fat and to inject the fat grafts. Results. For the nasolabial and melolabial folds, short-term results at 3,4 months were uniformly excellent. Gradual correction loss was noted between 5 and 8 months, with 25% of patients still rated as excellent and 40% as good. Most patients continued to show correction loss between 9 and 14 months. Only 3,4% of the patients truly maintained long-term correction for more than 14 months. Multiple re-treatments did not significantly increase the percent of patients showing long-term results. For the glabella, the results were very disappointing, with most patients showing complete loss of correction after 3,4 months. For lip augmentation, correction loss was slower than in the glabella, but most patients showed complete loss of correction by 5,8 months. Complications were minimal. Conclusion. Autologous fat grafting is most effective for relatively short-term improvement of facial aging changes in the nasolabial and oral commissures areas. It is less effective for lip augmentation and completely ineffective for the glabella area. [source] Long-Term Follow-Up After Radiofrequency Catheter Ablation of Ventricular Tachycardia: A Successful Approach?JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2002ALIDA E. BORGER VAN DER BURG M.D. RF Catheter Ablation of VT.Introduction: Radiofrequency ablation (RFCA) of ventricular tachycardia (VT) is a potential curative treatment modality. We evaluated the results of RFCA in patients with VT. Methods and Results: One hundred fifty-one consecutive patients (122 men and 29 women; age 57 ± 16 years) with drug-refractory VT were treated. Underlying heart disease was ischemic heart disease in 89 (59%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 32 (21%), and idiopathic VT in 30 (20%; left ventricle in 9 [30%]; right ventricle in 21 [70%]). Ablation was performed using standard ablation techniques. Three hundred six different VTs were treated (cycle length 334 ± 87 msec, 2.0 ± 1.4 VTs per patient). Procedural success (noninducibility of VT after RFCA) was achieved in 126 (83%) patients (70 ischemic heart disease [79%]; 28 ARVC [88%]; 27 idiopathic VT [93%]). Procedure-related complications (< 48 hours) occurred in 11 (7%) patients: death 3 (2.0%), cerebrovascular accident 2 (1.3%), complete heart block 4 (2.6%), and pericardial effusion 3 (2.0%). Thirty-three (22%) patients received an implantable cardioverter defibrillator (because of hemodynamic unstable VT, failure of the procedure, or aborted sudden death). During follow-up (34 ± 11 months), VT recurrences occurred in 38 (26%) patients (recurrence rate: 19% in successfully ablated patients and 64% in nonsuccessfully ablated patients; P < 0.001). During follow-up, 12 (8%) patients died (heart failure 8, unknown cause 1, noncardiac cause 3). Conclusion: RFCA of VT can be performed with a high degree of success (83%). The long-term outcome of successfully ablated patients is promising, with a 75% relative risk reduction compared with nonsuccessfully ablated patients. During follow-up, only one patient died suddenly, supporting a selective ICD placement approach in patients with hemodynamically stable VT. [source] Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long-Term Follow-UpPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2009OFER MERIN M.D. Background: Conduction disturbances requiring permanent pacemaker implantation after heart surgery occur in about 1.5% of patients. Early pacemaker implantation may reduce morbidity and postoperative hospital stay. We reviewed our experience with patients undergoing surgery to try and identify predictors for pacemaker requirements and patients who will remain pacemaker dependent. Methods: We performed a retrospective review of 4,999 patients undergoing surgery between the years 1993 and 2005. Patient age was 64 ± 12 years, and 71% were males. Coronary bypass was performed in 4,071 (81%), aortic valve replacement in 675 (14%), and mitral valve replacement in 968 (18%) patients. Results: Seventy-two patients (1.4%) required implantation of a permanent pacemaker after surgery. Indications for pacemaker implantation included complete atrioventricular block in 59, symptomatic bradycardia/slow atrial fibrillation in nine, second-degree atrioventricular block in two, and other conduction disturbances in two patients. Predictors for pacemaker requirement by multivariate analysis were left bundle branch block and aortic valve replacement (P < 0.001). Late follow-up was available in 58 patients, at 72 ± 32 months. Thirty-seven (63%) were pacemaker dependent. Predictors for late pacemaker dependency were third-degree atrioventricular block after surgery and preoperative left bundle branch block (P < 0.001). Conclusions: Patients at high risk for pacemaker implantation after heart surgery include those with preexisting conduction disturbances, and those undergoing aortic valve replacement. Of those receiving a pacemaker, about one-third will recover at late follow-up. For patients in the high-risk group who are pacemaker dependent after surgery, we recommend implanting a permanent pacemaker at 5 days after surgery, thus enabling early mobilization and early discharge. [source] Long-Term Follow-Up Results of Selective Laryngeal Adductor Denervation-Reinnervation Surgery for Adductor Spasmodic DysphoniaTHE LARYNGOSCOPE, Issue 4 2006Dinesh K. Chhetri MD Abstract Selective laryngeal adductor denervation-reinnervation surgery for the treatment of adductor spasmodic dysphonia was reported in 1999 in 21 patients with encouraging results. Here, we report long-term results of this procedure. Surgical outcome was evaluated using patient surveys and perceptual voice assessment. Measured outcomes included Voice Handicap Index (VHI)-10 scores, patient questionnaire, and perceptual evaluation for voice breaks and breathiness. Patient survey was obtained from 83 patients, and perceptual voice evaluation was performed in voice samples from 46 patients. Average follow-up interval was 49 months. Mean VHI-10 scores improved from a mean of 35.6 to 12.7. Eighty-three percent showed significantly improved VHI-10 scores, representing improved physical, social, and emotional well-being. There was a high degree of patient satisfaction, with 91% agreeing that their voice is more fluent after the surgery. Perceptual evaluation of postoperative voice samples revealed voice breaks in 26% (15% mild, 4% moderate, 7% severe) and breathiness in 30% (11% mild, 13% moderate, 6% severe). A majority of patients had stable, long-lasting resolution of spasmodic voice breaks. [source] Liver Transplantation Using Donation After Cardiac Death Donors: Long-Term Follow-Up from a Single CenterAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2009M. E. De Vera There is a lack of universally accepted clinical parameters to guide the utilization of donation after cardiac death (DCD) donor livers and it is unclear as to which patients would benefit most from these organs. We reviewed our experience in 141 patients who underwent liver transplantation using DCD allografts from 1993 to 2007. Patient outcomes were analyzed in comparison to a matched cohort of 282 patients who received livers from donation after brain death (DBD) donors. Patient survival was similar, but 1-, 5- and 10-year graft survival was significantly lower in DCD (69%, 56%, 44%) versus DBD (82%, 73%, 63%) subjects (p < 0.0001). Primary nonfunction and biliary complications were more common in DCD patients, accounting for 67% of early graft failures. A donor warm ischemia time >20 min, cold ischemia time >8 h and donor age >60 were associated with poorer DCD outcomes. There was a lack of survival benefit in DCD livers utilized in patients with model for end-stage liver disease (MELD) ,30 or those not on organ-perfusion support, as graft survival was significantly lower compared to DBD patients. However, DCD and DBD subjects transplanted with MELD >30 or on organ-perfusion support had similar graft survival, suggesting a potentially greater benefit of DCD livers in critically ill patients. [source] Long-Term Follow-Up of Patients with Syncope Evaluated by Head-Up Tilt TestANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2010Giulia Domenichini M.D. Background: Clinicians may be tempted to consider a positive head-up tilt test (HUTT) an unfavorable prognostic indicator. We investigated whether results of routine HUTT predict long-term recurrence of syncope. Methods: We analyzed syncope recurrence at long-term among 107 patients (mean age 51 ± 20 years) receiving HUTT for diagnostic evaluation of unexplained/suspected neurocardiogenic syncope in our Institute. Results: HUTT was positive in 76 patients (vasodepressive response, n = 58; cardioinhibitory, n = 5; mixed, n = 13). During a median follow-up of 113 months (range, 7,161), 34 (32%) patients experienced recurrence (24 [32%] with positive HUTT during 110 months (7,159); 10 [32%] with negative HUTT during 120 [22,161] months). Actuarial freedom from recurrence at 10 years did not significantly differ for patients with positive/negative test results (after passive/active phases) or with different positive response patterns (vasodepressive, cardioinhibitory, mixed). By contrast, history of >4 syncopes in the 12 months preceding HUTT stratified risk of recurrence, irrespective of HUTT positivity/negativity. At Cox proportional hazards analysis, history of >4 syncopes in the 12 months preceding HUTT was the single independent risk factor for recurrence both in the overall study population (HR, 1.7; 95% CI, 1.07,2.69) and within the subset of patients who tested positive (HR, 1.83; 95% CI, 1.07,3.17). Conclusions: This long-term follow-up study reinforces the concept that a positive HUTT should not be considered an unfavorable prognostic indicator; frequency of recent occurrences may be a more valid predictor. Ann Noninvasive Electrocardiol 2010;15(2):101,106 [source] Marginal Bone Loss at Implants: A Retrospective, Long-Term Follow-Up of Turned Brånemark System® ImplantsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 1 2009Odont Lic, Solweig Sundén Pikner DDS ABSTRACT Background: Lately, presence of progressive bone loss around oral implants has been discussed. Purpose: The aim of this study was to report in a large patient group with different prosthetic restorations marginal bone level and its change as measured in radiographs obtained from prosthesis insertion up to a maximum 20 years in service. Further, it also aimed to study the impact of gender, age, jaw, prosthetic restoration, and calendar year of surgery. Materials and Methods: Out of 1,716 patients recorded for clinical examination during 1999, 1,346 patients (78.4%) could be identified. A total of 640 patients (3,462 originally installed Brånemark System® implants, Nobel Biocare, Göteborg, Sweden) with a follow-up of ,5 years were included in the study, while patients with continuous overdentures and augmentation procedures were not. Distance between the fixture/abutment junction (FAJ) and the marginal bone level was recorded. Results: The number of implants with a mean bone level of ,3 mm below FAJ increased from 2.8% at prosthesis insertion to 5.6% at year 1, and 10.8% after 5 years. Corresponding values after 10, 15, and 20 years were 15.2, 17.2, and 23.5%, respectively. Implant-based bone loss was as a mean 0.8 mm (SD 0.8) after 5 years, followed by only minor average changes. Mean bone loss on patient level followed a similar pattern. Disregarding follow-up time, altogether 183 implants (107 patients) showed a bone loss ,3 mm from prosthesis insertion to last examination. Significantly larger bone loss was found the older the patient was at surgery and for lower jaw implants. Conclusions: Marginal bone support at Brånemark implants was with few exceptions stable over years. [source] Palmar Hyperhidrosis: Long-term Follow-up of Nine Children and Adolescents Treated with Botulinum Toxin Type APEDIATRIC DERMATOLOGY, Issue 4 2009Lúcia H. Coutinho dos Santos M.D., Ph.D. Nine patients with palmar hyperhidrosis underwent treatment with botulinum A. Before the session, and in the 1-, 3-, 6-, 9-, and 12-month post-session follow-ups, the patients were administered the Minor test, gravimetry, the Scales of Frequency and Severity, and the Questionnaire of Quality of Life. The mean age was 11 years, with seven girls and two boys. Each patient was administered at least one treatment of botulinum toxin in the palm of the hands (75,150 U for palm), with the mean number of sessions 2.2 (range: 1,4). All sessions in the patients resulted in drying of the hands, with a mean duration of effect of 7 months. Botulinum toxin A controls excessive sweat in the palms of children and adolescents who have primary palmar hyperhidrosis, with an improvement in the quality of life. The therapy is safe and effective in this pediatric group and can be considered before surgical interventions. [source] Palmoplantar Keratoderma and Skin Grafting: Postsurgical Long-term Follow-up of Two Cases with Olmsted SyndromePEDIATRIC DERMATOLOGY, Issue 2 2008Marie-Sophie Bédard M.D. Treatment options include topical keratolytics, systemic retinoids, and debulking procedures. Full-thickness excision of hyperkeratotic plaques followed by skin grafting has been reported in the medical literature, although long-term results have not been evaluated. We present two cases of Olmsted syndrome with severe palmoplantar keratoderma treated with excision and skin grafting, along with long-term clinical results 11 years (patient 1) and 6 years (patient 2) following the initial surgery. [source] Occult Metastases in Axillary Lymph Nodes as a Predictor of Survival in Node-Negative Breast Carcinoma with Long-term Follow-upTHE BREAST JOURNAL, Issue 3 2004Wenche Reed MD Abstract: Increased detection rate in the lymph nodes is seen with serial sectioning or immunohistochemistry (IHC), but the importance of occult metastases is not resolved. IHC is still not recommended in routine examination of lymph nodes. Axillary lymph nodes from 385 node-negative breast cancer patients with a median follow-up of 25 years were examined with IHC for cytokeratins, applied on routine sections. The association between classic histopathologic prognostic factors and the presence of occult metastases was evaluated. Metastases were found in 45 of 385 cases (12%), 21 metastases (47%) measured ,0.2 mm, 8 (18%) were larger than 2 mm; 14 metastases were located in the subcapsular sinus, 22 in the parenchyma of the lymph node; and 51% (23/45) of the metastases were recognized on hematoxylin-eosin staining on "second look." The detection of metastases was significantly associated with the number of sectioned lymph nodes (6% metastases for one to five lymph nodes examined versus 17% for more than five lymph nodes) and with histologic subtype (metastases in 11% of the ductal versus 33% of the lobular carcinomas). No significant association was found between occult metastases and age, tumor size, histologic grade, estrogen or progesterone receptor status, p53, or c- erbB-2. Metastases larger than 2 mm predicted a poorer recurrence-free survival rate for the whole series. A subcapsular location of the metastases was a strong predictor of overall survival. Whether or not the metastases could be identified on hematoxylin-eosin sections did not have any prognostic significance. In the multivariate analysis, histologic grade, tumor size of the primary tumor, progesterone receptor status, and the presence of occult metastasis in the lymph nodes had a prognostic impact on survival with a 25-year follow-up. [source] Long-term Follow-up of Severely Atrophic Edentulous Mandibles Reconstructed with Short Branemark ImplantsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 4 2000Bertil Friberg DDS ABSTRACT Background: Oral implant treatment (Brånemark System) of edentulous mandibles has been presented in numerous studies. However, with regard to the severely atrophic lower jaw, no long-term follow-up studies with solely short implants are available. Purpose: The purpose of the present investigation was to retrospectively follow the long-term treatment outcome of patients with severely resorbed edentulous mandibles being subjected to oral implant placement with short (6,7 mm) Brånemark implants. Materials and Methods: A total of 247 standard (7 mm long, 3.75 mm) and 13 wide (6 mm long, 5 mm) implants were inserted in 49 patients, all of whom exhibited severe resorption of edentate mandibles. Fixed implant-supported prostheses were manufactured for 45 patients, whereas 4 patients received overdentures. The patients were followed for a mean period of 8 years (range, 1,14 yr). Results: Seventeen implants failed during the study period (cumulative implant survival rate 95.5% at 5-yr and 92.3% at 10-yr follow-up). Implant-supported constructions were worn continuously throughout the investigation by all study subjects. Marginal bone loss, measured after 1, 5, and 10 years of function, concurred with studies of Brånemark implants placed in more voluminous mandibles. No major clinical or construction complications occurred in the followed patients. Conclusions: The outcome of the present study showed that placement of short Brånemark implants without the use of bone grafting procedures for reconstruction of severely atrophic edentulous mandibles is a highly predictable treatment procedure. [source] Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization TherapyCONGESTIVE HEART FAILURE, Issue 2 2009David Tepper MD Background., A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. Methods., The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest x-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results., Significant LV reverse remodeling (reduction in LV end-systolic volume from 189±83 mL to 134±71 mL, P<.001) was noted in the group of patients with a concordant LV lead position (n=153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32±16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, P=.004). Conclusions., Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up. [source] Long-term follow-up of patients following negative colposcopy: a new gold standard and its implications for cervical screeningCYTOPATHOLOGY, Issue 5 2003P. D. Da Forno From 1189 colposcopy referrals in 1997 at a single cervical screening centre, 88 women who had no biopsy taken at colposcopy (negative colposcopy) were identified. We followed up these women for a maximum of 4 years and calculated the positive predictive value (PPV) of a single smear before and after follow-up. Using slide review we attempted to correlate the grade of smear leading to colposcopy referral with final outcome. Our results showed that long-term follow-up alters the PPV of cervical cytology. Analysis showed a strong correlation between the review grade of the referring smear and the final outcome after follow-up. From these results we suggest an evidence-based protocol for cervical screening follow-up after negative colposcopy. [source] Combined Ultrapulse CO2 Laser and Q-Switched Alexandrite Laser Compared with Q-Switched Alexandrite Laser Alone for Refractory Melasma: Split-Face DesignDERMATOLOGIC SURGERY, Issue 1 2003Suhattaya Angsuwarangsee MD Background. Melasma is common and can cause major psychological impact. To date, the mainstay of treatment, including various hypopigmenting agents and chemical peels, is ineffective and can cause adverse effects. Laser is a new approach and is yet to be explored for its efficacy and safety. Objective. To compare combined Ultrapulse CO2 laser and Q-switched alexandrite laser (QSAL) with QSAL alone in the treatment of refractory melasma. Methods. Six Thai females were treated with combined Ultrapulse CO2 laser and QSAL on one side of the face and QSAL alone on the other side. The outcome was evaluated periodically for up to 6 months using the modified Melasma Area and Severity Index score and the modified Melasma Area and Melanin Index score. Results. The side with combination treatment had a statistically significant reduction of both scores. On the QSAL side, the score reduction was not significant. Two cases developed severe postinflammatory hyperpigmentation and were effectively treated with bleaching agents. Transient hypopigmentation and contact dermatitis were observed with the combination treatment side. Conclusions. Combined Ultrapulse CO2 laser and QSAL showed a better result than QSAL alone but was associated with more frequent adverse effects. Long-term follow-up and a larger number of cases are required to determine its efficacy and safety for refractory melasma. [source] Long-term follow-up of children with obstetric brachial plexus palsy I: functional aspectsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2007Christina Strömbeck MD The aims of this study were to describe the development of sequelae in obstetric brachial plexus palsy (OBPP) and to identify possible differences in functional outcome from 5 years of age to follow-up, 2 to 15 years later. A cohort of 70 participants (35 males, 35 females; age range 7-20y, mean 13y 6mo [SD 4y 3mo], median 13y) with OBPP of varying degrees of severity were monitored. Differences in status between 5 years of age and follow-up were studied. Active joint motion in the shoulder and hand function, especially grip strength, generally remained unchanged or improved, whereas a slight but significant deterioration occurred in elbow function. Shoulder surgery resulted in considerable improvement of shoulder function. Participants with nerve reconstruction had a similar profile of change as the non-operated group. It was concluded that ongoing follow-up of children with OBPP, beyond the preschool years, is required due to decreases in elbow function, a commonly occurring restriction in external rotation of the shoulder, together with individual variations in long-term outcomes. In a related article (part II: neurophysiological aspects) long-term neurophysiological and sensory aspects of OBPP are reported. [source] Long-term follow-up of children with obstetric brachial plexus palsy II: neurophysiological aspectsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 3 2007Christina Strömbeck MD The aim of this study was to examine long-term neurophysiological outcomes and sensory function in patients with obstetric brachial plexus palsy (OBPP). The same 70 children/adolescents examined in part I: functional aspects (35 males, 35 females; age range 7-20y, mean 13y 6mo [SD 4y 3mo], median 13y) were examined with neurophysiological methods at 3 to 7 months and at 7 to 20 years of age. Thirteen of the 70 participants underwent nerve reconstruction before 1 year of age. Electromyography (EMG) was performed on deltoid and first interossei muscles; Quantitative Sensory Test was used for C6 and C8 dermatomes. Tests for functional sensibility and 2-point discrimination for C6 and C8 were performed. This study shows that considerable EMG changes can be observed in OBBP, even in those fully recovered. EMG changes in the deltoid were shown to deteriorate over time, and sensibility is considerably less affected than motor function. [source] Long-term follow-up of achalasic patients treated with botulinum toxinDISEASES OF THE ESOPHAGUS, Issue 2 2000D'Onofrio Botulinum toxin A (BoTx), a potent inhibitor of acetylcholine release from nerve endings both within the myenteric plexus and at the nerve,muscle junction, has been shown to decrease the lower esophageal sphincter (LES) pressure in patients with achalasia. Because of this property, the esophageal injection of BoTx has been suggested as an alternative treatment in achalasia. The objective of this study was to determine the long-term efficacy and safety of intrasphincteric injection of BoTx in a group of achalasic patients. Nineteen patients (mean age 56.1 ± 19.2 years) were enrolled in the study. All of them were injected endoscopically with 100 U of BoTx by sclerotherapy needle at different sites of the LES. Symptom score (dysphagia, regurgitation and chest pain, each on a 0,3 scale), esophageal manometer and esophageal radionuclide emptying were assessed before the treatment and at 4 weeks, 3 months and 1 year after BoTx injection. In case of failure or relapse (symptom score >2), the treatment was repeated. All but five patients (74%) were in clinical remission at 1 month. Mean symptom score after 1 month of BoTx decreased from 7.1 ± 0.9 to 2.2 ± 2.5 (p < 0.05). LES pressure decreased from 38.4 ± 13.7 to 27.4 ± 13.5 mmHg (p < 0.05) and 10-min radionuclide retention decreased from 70.9 ± 20.7% to 33.8 ± 27.0% (p < 0.05). Side-effects (transient chest pain) were mild and infrequent. At 12 months, the clinical score was 0.9 ± 0.5 (p < 0.05 vs. basal); mean LES pressure was 22.0 ± 7.1 (p < 0.05 vs. basal) and 10-min radionuclide retention was 15.8 ± 6.0% (p < 0.05 vs. basal). The efficacy of the first injection of BoTx lasted for a mean period of 9 months (range 2,14 months). At the time of writing (follow-up period mean 17.6 months, range 2,31), 14 patients (10 with one injection) were still in remission (74%). Our results showed that one or two intrasphincteric injections of BoTx resulted in clinical and objective improvement in about 74% of achalasic patients and are not associated with serious adverse effects; the efficacy of BoTx treatment was long lasting; this procedure could be considered an attractive treatment, especially in elderly patients who are poor candidates for more invasive procedures. [source] Invited comment: ,Long-term follow-up of achalasia patients'DISEASES OF THE ESOPHAGUS, Issue 2 2000Pellegrini No abstract is available for this article. [source] Community-based, Prospective, Controlled Study of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with EpilepsyEPILEPSIA, Issue 1 2006Katriina Viinikainen Summary:,Purpose: This study evaluated obstetric and neonatal outcome in a community-based cohort of women with active epilepsy (WWAE) compared with the general pregnant population receiving modern obstetric care. Methods: We reviewed the total population who gave birth between January 1989 and October 2000 at Kuopio University Hospital. Obstetric, demographic, and epilepsy data were collected prospectively from 179 singleton pregnancies of women with epilepsy and from 24,778 singleton pregnancies of unaffected controls. The obstetric data from the pregnancy register was supplemented with detailed neurologic data retrieved from the medical records. The data retrieved were comprehensive because of a follow-up strategy according to a predecided protocol. Results: During pregnancy, the seizure frequency was unchanged, or the change was for the better in the majority (83%) of the patients. We found no significant differences between WWAE and controls in the incidence of preeclampsia, preterm labor, or in the rates of caesarean sections, perinatal mortality, or low birth weight. However, the rate of small-for-gestational-age infants was significantly higher, and the head circumference was significantly smaller in WWAE. Apgar score at 1 min was lower in children of WWAE, and the need for care in the neonatal ward and neonatal intensive care were increased as compared with controls. The frequency of major malformations was 4.8% (,0.6,10.2%; 95% confidence interval) in the 127 children of WWAE. Conclusions: Pregnancy course is uncomplicated and neonatal outcome is good in the majority of cases when a predecided protocol is used for the follow-up of WWAE in antenatal and neurologic care. Long-term follow-up of the neurologic and cognitive development of the children of WWAE is still needed. [source] Arthroscopic laser extirpation of metacarpophalangeal synovial pad proliferation in eleven horsesEQUINE VETERINARY JOURNAL, Issue 3 2001D. J. MURPHY Summary A new surgical technique for treatment of chronic metacarpophalangeal synovial pad proliferation in the horse and the findings and long-term follow-up from 11 clinical cases are described. The medical records of all equine lameness cases attributed to metacarpophalangeal synovial pad proliferation admitted to the College of Veterinary Medicine at Cornell University (1991,1996) were reviewed and all those treated surgically by laser extirpation were included in this study. Retrieved data included subject details, preoperative lameness, ultrasonography, radiography and synovial fluid evaluations and lesion histopathology. Lesions were ablated using a CO2 or a Nd:YAG laser intra-articularly with arthroscopic guidance. Long-term follow-up was provided by telephone conversation with owners or trainers. All horses had fetlock joint effusion and were lame at presentation. Mean synovial pad thickness measured ultrasonographically was 9.0 mm (range 6,15 mm). Seven horses (64%) had radiographic evidence of remodelling of the dorsal cortex of distal McIII and 3 horses (27%) had concurrent dorsal proximal P1 fractures. No postoperative complications were noted. All 11 horses returned to training within 90 days of surgery without recurrence of the lesion(s). Laser extirpation of metacarpophalangeal synovial pad proliferation using arthroscopic guidance provided a rapid, safe and efficient method for surgical removal of such lesions without complications or recurrence. This surgical technique provides a suitable alternative to more conventional treatments for chronic metacarpophalangeal synovial pad proliferation in horses, particularly for removal of very large, fibrotic masses. [source] Long-term follow-up of adolescent onset anorexia nervosa in northern SwedenEUROPEAN EATING DISORDERS REVIEW, Issue 2 2005Karin Nilsson Abstract Objective This study examines the long-term outcome of adolescent onset anorexia nervosa, 8 and 16 years after first admission to child and adolescent psychiatric (CAP) treatment in northern Sweden. Method Two follow-ups (1991 and 1999) were made of 68 women who were first admitted to CAP between 1980 and 1985. The follow-ups included interviews and self-report inventories. Eating disorders and GAF were evaluated according to DSM-III-R. Results Recovery increased from 46 (68%) to 58 (85%). EDNOS (eating disorder not otherwise specified) decreased from 16 (24%) to seven (10%). The numbers for anorexia nervosa (AN) were the same, two (3%) in both follow-ups. Bulimia nervosa (BN) decreased from four (6%) in the first follow-up to one (1.5%) in the second follow-up. The mortality rate was one (1%). Self-evaluation of mental health indicated that 15% had problems with depression, anxiety or compulsive symptoms. Somatic problems and paediatric inpatient care during the first treatment period could predict long-term outcome. Most former patients had a satisfactory family and work situation. Conclusion Recovery from eating disorders continued during the follow-ups. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Long-term follow-up of patients with asymptomatic occlusion of the internal carotid artery with good and impaired cerebral vasomotor reactivityEUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2010I. Kimiagar Background:, Cerebral hemodynamic status might be prognostic for either the symptomatic or asymptomatic course of carotid occlusive disease. It is determined by evaluating cerebral vasomotor reactivity (VMR). We assessed VMR in asymptomatic patients with total occlusion of the internal carotid artery (ICA) and followed them to evaluate the role of impaired VMR in predicting ischaemic stroke (IS). Methods:, Thirty-five patients (21 men, mean age ± SD 68 ± 7.5 years) with unilateral asymptomatic ICA occlusion were studied by transcranial Doppler and the Diamox test (intravenous 1.0 g acetazolamide) and followed for 48 months or until reaching the end-points of IS, transient ischaemic attack, or vascular death. VMR% was evaluated by recording the percent differences in peak systolic blood flow velocities in each middle cerebral artery at baseline and after Diamox administration. Results:, Based on VMR% calculations, 14 (40%) patients had good VMRs and 21 (60%) had impaired VMRs. The global annual risk of ipsilateral ischaemic events was 5.7%. The annual ipsilateral ischaemic event risk was 1.8% in patients with good VMRs, whilst it was 7.1% in patients with impaired VMRs. An impaired VMR was significantly correlated with ipsilateral IS (Kaplan,Meier log rank statistic, P = 0.04). Conclusions:, Our results support the value of VMR assessment for identifying asymptomatic patients with carotid occlusion who belong to a high-risk subgroup for IS. New trials using extracranial-to-intracranial bypass surgery in patients with asymptomatic ICA occlusion and impaired VMRs are warranted. [source] Long-term follow-up on Viscum album (mistletoe) extract use by cervical cancer patientsFOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2007Article first published online: 14 JUN 2010 [source] Concurrent chemoradiotherapy with weekly paclitaxel and carboplatin for locally advanced head and neck cancer: Long-term follow-up of a Brown University Oncology Group Phase II Study (HN-53)HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2008Prakash B. Chougule MD Abstract Background. A phase II study was conducted using concurrent paclitaxel, carboplatin, and external beam radiotherapy (RT) in patients with advanced head and neck cancer. Methods. Forty-three patients (stage III, n = 12; stage IV, n = 31) were treated with 8 cycles of weekly paclitaxel (60 mg/m2), carboplatin (area under the curve [AUC] = 1), and RT (1.8 Gy daily; total dose, 66,72 Gy). Patients with initially palpable lymph nodes underwent neck dissection. Results. The overall clinical response rate was 91% (65% complete, 26% partial). Severe mucositis occurred in 37 (90%) patients, necessitating hospitalization in 13 (31%) patients. With a median follow-up of 49 months, the locoregional and distant failure rates were 26% and 21%, respectively. Conclusions. Concurrent paclitaxel, carboplatin, and RT for advanced head and neck cancer results in high complete response rates. Long-term follow-up has revealed the curative potential of this regimen, though the doses used resulted in unacceptable toxicity. © 2007 Wiley Periodicals, Inc. Head Neck 2008 [source] Malignant peripheral nerve sheath tumors of the head and neck: Management of 10 cases and literature review,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2007Amir Minovi MD Abstract Background. This study analyzes the management and outcomes of a series of 10 malignant peripheral nerve sheath tumors (MPNST) of the head and neck. Methods. From 1984 to 2004, 10 patients underwent surgical treatment of a MPNST. We retrospectively reviewed presenting symptoms, radiological findings, surgical management, and follow-up status and performed a literature review. Results. Eight tumors were located at the lateral skull base; 2 involved the vagus nerve in isolation. Two lesions were growing within the sinonasal tract. The most common presenting symptom was a rapidly enlarging cervical mass. Seventy percent of the tumors could be resected completely. Long-term follow-up showed a 2-year disease-specific survival rate of 50% and 5-year survival rate of 20%. Negative prognostic indicators were advanced tumor stage, early recurrence, and presumably also the presence of von Recklinghausen's disease. Postoperative adjuvant radiotherapy was found to make no difference in outcome. Conclusions. Although rare, MPNST is one of the most aggressive tumors in the head and neck area. Complete tumor removal is the mainstay of treatment and most important prognostic factor of MPNST. Adjuvant radiotherapy should be used to assist surgical excision in local control. The role of adjuvant chemotherapy remains controversial. © 2006 Wiley Periodicals, Inc. Head Neck, 2007. [source] Total upper lip reconstruction with a free temporal scalp flap: Long-term follow-up ,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2003Kao-Ping Chang MD Abstract Background. In men, reconstruction of large full-thickness defects of the upper lip requires both an inner layer to replace the mucosal lining and an outer hair-bearing layer. Methods. When locating the superficial temporal vessels, the design of the temporal flap is marked following the hairline needed. After meticulously dissecting the flap, it is inset and microanastomosed with the facial blood vessels. The internal mucosal layer of the flap is grafted on. During the follow-up period, the sensory recovery and motor functions are examined and recorded. Results. The postoperative courses were uneventful, and patients were satisfied with the results. One patient has a long follow-up period of 18 years. Conclusions. The free temporal scalp hair-bearing flap offers a reasonable alternative to conventional techniques in the reconstruction of large defects of the male upper lip or even a total upper lip. It is a single-staged, relatively simple method of providing hair-bearing skin to the upper lip. © 2003 Wiley Periodicals, Inc. Head Neck 25: 602,605, 2003 [source] Benefits and risks of interferon therapy for hepatitis B,HEPATOLOGY, Issue S5 2009Robert Perrillo Alpha interferon is the only licensed drug for hepatitis B with immunomodulatory as well as viral inhibitory properties. Potential advantages of interferon compared to nucleoside analogs include a lack of drug resistance, a finite and defined treatment course, and a higher likelihood for hepatitis B surface antigen (HBsAg) clearance. Approximately 30% of hepatitis B e antigen (HBeAg)-positive and 40% of HBeAg-negative cases have a sustained virological response (when defined as HBeAg seroconversion and/or hepatitis B virus (HBV) DNA levels below 20,000 copies/mL, respectively) 6 months after completion of a 48-week course of peginterferon alfa-2a These responses remain durable in 80% and 50% of cases, respectively, when evaluated several years later. Recent studies have shown that changes in HBsAg and HBeAg concentration during treatment predict sustained virological response and serial monitoring of HBsAg is helpful in predicting HBsAg clearance. HBeAg-positive patients with genotype A have higher rates of HBeAg and HBsAg clearance, whereas HBeAg-negative patients with genotype D have the lowest rate of response to interferon therapy. Long-term follow-up of virological responders to either standard alpha interferon or peginterferon has demonstrated a progressive increase in the rate of HBsAg clearance, particularly in patients who were initially HBeAg-positive. Future studies need to address if specific virological benchmarks during therapy can be used to tailor treatment duration. Conclusion: Peginterferon alfa has a place as first-line therapy of hepatitis B in patients who are carefully selected on the basis of pretreatment serum HBV DNA and aminotransferase levels, safety considerations, and viral genotype. (HEPATOLOGY 2009;49:S103,S111.) [source] Fractures and avascular necrosis before and after orthotopic liver transplantation: Long-term follow-up and predictive factors,HEPATOLOGY, Issue 4 2007Maureen M. J. Guichelaar With early posttransplant bone loss, orthotopic liver transplantation (OLT) recipients experience a high rate of fracturing and some avascular necrosis (AVN), but little is known about the incidence of and predictive factors for these skeletal complications. We studied 360 consecutive patients who underwent transplantation for primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) and assessed both vertebral and nonvertebral (rib, pelvic, and femur) fractures in a protocolized fashion. Before OLT, 20% of the patients had experienced fracturing, and 1.4% of the patients had experienced AVN. Following OLT, there was a sharp increase in fracturing, with a 30% cumulative incidence of fractures at 1 year and 46% at 8 years after transplantation. In contrast to previous studies, there was a similar incidence of posttransplant vertebral and nonvertebral fractures. The greatest risk factors for posttransplant fracturing were pretransplant fracturing and the severity of osteopenia and posttransplant glucocorticoids. Nine percent of the liver recipients experienced AVN after OLT, and this correlated with pretransplant and posttransplant lipid metabolism, bone disease (bone mineral density and fracturing), and posttransplant glucocorticoids. A novel association between cholestasis and AVN was also identified, the mechanism for which is not known. Conclusion: Fortunately, recent years have seen an increase in the bone mass of liver recipients and, along with this, less fracturing and less AVN. Nonetheless, 25% of patients undergoing OLT for chronic cholestatic liver disease still develop de novo fractures after OLT; this situation demands an ongoing search for effective therapeutic agents for these patients. (HEPATOLOGY 2007.) [source] | ||||||||||||||||||||||||||||||||||||||||||||||