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Long-term Results (long-term + result)
Selected AbstractsLong-Term Result of the New Endoscopic Vocal Fold Medialization Surgical Technique for Laryngeal Palsy,THE LARYNGOSCOPE, Issue 2 2006Koichiro Nishiyama MD Abstract Objective: The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap. Study Design and Methods: In the present study, we modified the method of medialization using the ATFV technique to obtain effective closure of a large glottal gap. To overcome this difficulty, an attempt was made to extend the site of transplantation more posteriorly so as to adduct the vocal process of the arytenoid cartilage in the body of the vocal fold. Results: This new technique was applied to eight cases of patients with unilateral laryngeal paralysis with severe dysphonia. None of the patients showed any evidence of falling off of the graft. Elongation of the maximum phonation time and a decrease in airflow rate during phonation were obtained with improvement in voice quality in all patients 1 year after the surgery. Conclusions: This method, with its less invasive approach, proved to be useful for the treatment of large glottal gap due to unilateral laryngeal nerve paralysis. [source] Autologous Transplantation of Fascia into the Vocal Fold: Long-Term Result of Type-1 Transplantation and the Future,THE LARYNGOSCOPE, Issue S108 2005Koichi Tsunoda MD Abstract Objectives: Since 1997, we have performed the autologous transplantation of fascia into the vocal fold (ATFV) procedure on cases of sulcus vocalis. In what follows, we report the long-term results of our new surgical approach and discuss the role of these transplantations. We also review and report some complications that can be caused by ATFV. Finally, we discuss the ATFV technique as a contribution to the phonosurgery of the future. Study Design: Prospective study. Methods: We were able to obtain long-term results from 10 volunteer cases (2 female and 8 male, age: 15,71, mean 46.5 years old) who could be followed up for at least 3 years after transplantation. All were cases of pathologic sulcus vocalis. We measured maximum phonation time (MPT) and carried out pre- and postsurgical clinical observation and laryngeal stroboscopy in all cases. These measurements and observations were made before the ATFV and at 6 months, 1 year, 2 years, and 3 years after surgery. Results: In stroboscopic observation 1 year after the ATFV, satisfactory glottal closure and excellent mucosal wave were observed for all cases, and there was no case with hyperadduction of the false vocal folds. MPT measures remained at an improved level 2 years and 3 years after the transplantations. Paired-sample t tests showed that the improvement relative to preATFV levels was significant for all postsurgical measurements up to 3 years. Conclusions: We conclude that ATFV is a successful surgical procedure for sulcus vocalis and scarred vocal folds. Other phonosurgical clinical applications may also be envisioned. [source] Laser Hair Removal: Long-Term Results with a 755 nm Alexandrite LaserDERMATOLOGIC SURGERY, Issue 11 2001Sorin Eremia MD Background. Hypertrichosis is a common problem for which laser hair removal is becoming the treatment of choice. Optimal wavelength, pulse duration, spot size, fluence, and skin cooling parameters for various skin types have not yet been firmly established. Objective. To evaluate the long-term efficacy and safety of a 3-msec 755 nm alexandrite laser equipped with a cryogen cooling device for patients with Fitzpatrick skin types I,V. Methods. Eighty-nine untanned patients with skin types I,V underwent a total of 492 treatments of laser hair removal over a 15-month period. Each patient in the study underwent a minimum of three treatment sessions spaced 4,6 weeks apart (mean treatments 5.6). Retrospective chart review and patient interviews were used to establish hair reduction results. Treatment sites included the axillae, bikini, extremities, face, and trunk. A 3-msec pulse width, 755 nm alexandrite laser equipped with a cryogen spray cooling device was used in this study. Spot sizes of 10,15 mm were used. A spot size of 10 mm was used for fluences greater than 40 J/cm2, a spot size of 12 mm was used for fluences of 35,40 J/cm2, and spot sizes of 12 and 15 mm were used for fluences less than 30 J/cm2. Fluences ranging from 20 to 50 J/cm2 (mean fluence 36 J/cm2) were used. Results. The patients had a mean 74% hair reduction. Skin type I patients had an average of 78.5% hair reduction using a mean fluence of 40 J/cm2 (35,50 J/cm2) and a 10,12 mm spot size (12 mm in more than 95% of treatments). Skin type II patients had a mean 74.3% hair reduction using a mean fluence of 38 J/cm2 (30,40 J/cm2) and a 12,15 mm spot size. Skin type III patients had a mean 73.4% hair reduction using a mean fluence of 37 J/cm2 (25,40 J/cm2) and a 12,15 mm spot size. Skin type IV patients had a mean 71.0% hair reduction using a mean fluence of 31 J/cm2 (25,35 J/cm2) and a 12,15 mm spot size. A patient with skin type V had a 60% hair reduction using a mean fluence of 23 J/cm2 (20,25 J/cm2) and a 12,15 mm spot size. The efficiency of hair removal directly correlates significantly with the fluence used. Rare side effects included transient postinflammatory hyperpigmentation (n = 9; 10%), burn with blisters (n = 1; 1%), and postinflammatory hypopigmentation (n = 2; 2%). All complications resolved without permanent scarring. Conclusion. The 3-msec cryogen cooling-equipped alexandrite laser can safely and effectively achieve long-term hair removal in patients with skin types I,V. The best results are achieved in untanned patients with skin types I,IV. [source] Surgical treatment options for hidradenitis suppurativa and critical review of own experienceEXPERIMENTAL DERMATOLOGY, Issue 6 2006Wolfgang Christian Marsch HS (acne inversa) is a chronic, progressive, initially inflammatory, ultimately a fistulating and scarring disease affecting apocrine gland-bearing skin areas. Late phases afford a broad surgical removal of affected skin areas including subcutaneous fatty tissue, with secondary mesh grafting after a period of granulation tissue formation. Fifty-three patients have been treated surgically at our Dermatology Department. Long-term results are excellent concerning satisfaction of the patients and functional objectives. Local recurrences or development of new lesions in formerly unaffected areas were noticed only in some patients who did not stop smoking. Patient details were as follows: gender distribution: male (M) 20 (38%), female (F) 33 (62%), age: M 19,62 (average 40.7), F 15,56 (average 35.4), onset: M 16,57 (32.2), F 8,50 (25.5), duration: 3 months to 37 years (8.0), F 6 months to 37 years (9.9). Sites mainly affected: axillary and perigenital. Specific regions for men: perineum and rima ani, for women: inguinal, submammary and abdominal. Multiple anatomical regions involved: men 40%, women 91%. Familiarity 0.4%. Associated acne papulo-pustulosa or nodulo-cystica (=conglobata): 19%. Cigarette smokers: men 100%, women 67%. Excised material from each operation was carefully examined histologically. The results endorse the concept of ,acne inversa' by recognizing a perifollicular accumulation of lymphocytes simultaneously at different infrainfundibula of terminal hair follicles. However, a follicular hyperkeratosis seems secondary to this, follicular perforation, and a combination of sinus, abscess and scar formation are most obviously tertiary events. Therefore, HS seems to be an inflammatory, probably an immunological disease with an initially strictly dermal target, even followed by an intradermal horizontal propagation. Laser flux imaging could visualize the subclinical peripheral extension of the basically dermal perifollicular inflammation. Biologics may have a beneficial effect on these early or perpetuating inflammatory events; however, thus far surgery remains the first-line therapy in late phases of the disease. [source] Optimization of treatment parameters for Foscan®-PDT of basal cell carcinomasLASERS IN SURGERY AND MEDICINE, Issue 5 2008Christian S. Betz MD Abstract Background and Objective Basal cell carcinomas (BCCs) are the most common form of skin cancers with high and increasing incidence rates. Photodynamic therapy (PDT) with mTHPC (Foscan®) has shown to be a promising treatment alternative with good cosmetic results. The current study was aimed to determine optimal treatment parameters for this indication. Study Design/Materials and Methods mTHPC-PDT was performed in 117 patients with a total of 460 BCCs with diagnosis confirmed by scratch cytology. Treatment parameters were altered as follows: Foscan® dose 0.03,0.15 mg/kg, drug-light interval (DLI) 1,96 hours, total energy density 20,120 J/cm2. Outcomes were assessed 8 weeks post-PDT following WHO guidelines. Results The overall rate of complete remissions (CR) was 96.7% and the cosmetic outcome was very good. In the largest subgroup (n,=,80) where low-dose Foscan® was applied (0.05 mg/kg mTHPC; 48 hours DLI; 50 J/cm2 total energy density), a CR rate of 100% with a high and narrow 95% Confidence Interval of 0.955,1.000 was achieved. Smaller variations of the treatment parameters (i.e., reducing the photosensitizer dose to 0.04 mg/kg or shortening the DLI to 24 hours) yielded similarly good results. Side effects were encountered in 52 out of 133 PDT sessions. They were more common in patients who had received high drug doses (0.06,0.15 mg/kg) and comprised mostly pain and phototoxic reactions. Three patients developed severe sunburns with subsequent scarring at the injection site following bright sunlight exposure 15,19 days after photosensitizer administration. Conclusions The presented data suggest that mTHPC-PDT with the treatment parameters mentioned above seems to be an effective treatment option for BCCs. If sensibly applied, it is well tolerated and provides mostly excellent cosmetic results. Long-term results are yet to be evaluated. Lesers Surg. Med. 40:300,311, 2008. © 2008 Wiley-Liss, Inc. [source] Percutaneous radiofrequency ablation of liver cancer in the hepatic dome using the intrapleural fluid infusion techniqueBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2008Y. Kondo Background: Intrapleural fluid infusion improves ultrasonographic visualization of tumours in the hepatic dome. The aim of this study was to assess the safety and long-term efficacy of ultrasonographically guided percutaneous radiofrequency ablation for tumours in the hepatic dome with intrapleural infusion. Methods: Of 2575 patients with hepatocellular carcinoma or hepatic metastases treated with radiofrequency ablation, intrapleural fluid infusion was performed in 587 patients for tumours in the hepatic dome. After the tip of a 14-G metallic needle was positioned in the pleural cavity under ultrasonographic guidance, 500,1000 ml of 5 per cent glucose solution was infused in 5,15 min. Radiofrequency ablation was performed using an internally cooled electrode. Long-term results were evaluated in 347 patients with a single hepatocellular carcinoma who were naive to any treatment. Results: Intrapleural fluid infusion was successfully performed in all 587 patients. The major complication rate on a per tumour basis was similar for patients treated with and without intrapleural infusion (1·6 versus 1·6 per cent; P = 0·924). The overall and recurrence-free survival were both similar for naive patients with a single hepatocellular carcinoma treated with and without intrapleural infusion (P = 0·429 and P = 0·109 respectively). Intrapleural infusion was not associated with lower overall survival in multivariable analysis. Conclusion: With intrapleural fluid infusion, radiofrequency ablation for tumours in the hepatic dome was safe and effective, resulting in satisfactory overall and recurrence-free survival. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Size of the pancreatic head as a prognostic factor for the outcome of Beger's procedure for painful chronic pancreatitisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2003E. Keus Background: Duodenum-preserving resection of the head of the pancreas (DPRHP) according to Beger has been developed as an alternative to pylorus-preserving resection of the pancreatic head for painful chronic pancreatitis. Methods: Between 1988 and 2000, 36 consecutive DPRHPs were performed. The group was divided into patients with (group 1; n = 23) and without (group 2; n = 13) significant enlargement of the pancreatic head. Pain was the indication for surgery in all patients. Results: Complications occurred in 12 patients, necessitating reoperation in 11. Initial overall results were favourable; significant improvement or complete relief of pain was reported in 27 of 35 patients. Long-term results were obtained in 27 of 30 patients; the overall success rate was 16 of 27, 13 of 16 patients with distinct enlargement of the pancreatic head and 3 of the 11 with minimal or no enlargement (P = 0·018). Conclusion: DPRHP can be performed with good early results. This effect is sustained in patients with distinct localized disease of the pancreatic head. In those without, the long-term results are disappointing. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Audiometric evaluation of an attempt to optimize the fixation of the transducer of a middle-ear implant to the ossicular chain with bone cementCLINICAL OTOLARYNGOLOGY, Issue 1 2004A. Snik Audiometric evaluation of an attempt to optimize the fixation of the transducer of a middle-ear implant to the ossicular chain with bone cement Typically, an implantable hearing device consists of a transducer that is coupled to the ossicular chain and electronics. The coupling is of major importance. The Vibrant Soundbridge (VSB) is such an implantable device; normally, the VSB transducer is fixed to the ossicular chain by means of a special clip that is crimped around the long process of the incus. In addition to crimping, bone cement was used to optimize the fixation in six patients. Long-term results were compared to those of five controls with crimp fixation alone. To assess the effect of bone cement (SerenoCem®, Corinthian Medical Ltd, Nottingham, UK) on hearing thresholds, long-term post-surgery thresholds were compared to pre-surgery thresholds. Bone cement did not have any negative effect. Next, to test the hypothesis that aided thresholds might be better with the use of bone cement, aided thresholds were studied. After correction for the severity of hearing loss, only a small difference was found between the two groups at one frequency, viz. 2 kHz. It was concluded that there was no negative effect of using bone cement; however, there is also no reason to use bone cement in VSB users on a regular basis. [source] Long-term results of mycophenolate mofetil as part of immunosuppressive induction therapy after liver transplantationCLINICAL TRANSPLANTATION, Issue 3 2006Jan M. Langrehr Abstract:, Background:, The addition of mycophenolate mofetil (MMF) to the induction protocol resulted in a lower incidence of rejection episodes. However, the question whether MMF should be administered in combination with tacrolimus or cyclosporine has not been answered yet. In our study, we report on the long-term results of triple induction therapy after orthotopic liver transplantation (OLT), consisting of MMF and low-dose corticosteroids, in combination with either tacrolimus or cyclosporine. Methods:, Between March 1996 and April 1997, 120 consecutive patients, who underwent OLT at our institution, were enrolled in this study. Of these patients, 80 received triple induction therapy consisting of cyclosporine and MMF (40) or tacrolimus and MMF (40), in combination with low-dose corticosteroids, whereas the remaining 40 patients served as ,MMF-free' control group receiving dual induction therapy with tacrolimus and corticosteroids. Besides the eight-yr follow-up of patient and graft survival, clinical data were also reviewed for episodes of rejection and infection. Additionally, the early post-operative pharmacokinetics of mycophenolic acid (MPA, immunological active metabolite of MMF) were evaluated. Results:, Long-term results provided higher patient and graft survival after tacrolimus/MMF-based induction therapy than after cyclosporine/MMF-based induction therapy. However, the tacrolimus-based control protocol yielded similar results and, therefore, no significantly superior effect was observed when MMF was added. The same observation was made for incidence of rejection and infection episodes. AUC and Cmax of MPA increased in combination with tacrolimus compared with cyclosporine. Conclusions:, Although pharmacological synergy between tacrolimus and MMF was observed, MMF showed no significant beneficial effects in the immunosuppressive induction protocol, neither in combination with tacrolimus nor with cyclosporine. [source] A New Technique for the Old Arterial Graft: Internal Thoracic ArteryJOURNAL OF CARDIAC SURGERY, Issue 2 2008Ufuk Tutun M.D. It stays patent well in the long-term period, and this evidence is directly related to the superior later outcome in terms of longevity. Coronary artery bypass grafting with multiarterial grafts can be performed safely, and better long-term result can be expected with the use of arterial conduits, especially ITA. We describe a simple and practical technique for the left ITA grafting by dividing the ITA graft and using its proximal and distal parts in situ for the distal left anterior descending (LAD) artery and the obtuse marginal artery grafting. [source] An Overview of Complete Artificial Fixed Dentition Supported by Endosseous ImplantsARTIFICIAL ORGANS, Issue 1 2005Dennis Flanagan Abstract:, The construction of a complete restoration of the dentition by the surgical placement of endosseous titanium implants that support a fixed prosthesis in each jaw is possible. The positionings of the implants and teeth in the prostheses are important factors for a successful long-term result. Distribution of the occlusal biting forces over as many implants as possible is important. Off-axial occlusal biting forces should be diverted to the anterior jaws where the forces are not as great. The posterior teeth should be designed with flat occlusal surfaces that separate during excursionary mandibular chewing movements. Medial mandibular flexure caused by the contraction of the medial pterygoid muscle can be addressed by constructing the prosthesis in segments, so as not to have a rigid entity encased in flexing bone that may induce stress in the bone, potentially leading to loss of implant integration and failure. Segmenting also ensures an appropriate fit of the prosthesis with respect to casting and porcelain firing distortion. Lip support by means of a flange in the prosthesis may be necessary when there has been a large amount of bone loss from edentulous resorption. Cleaning and routine maintenance of the prostheses every 3,6 months is essential. [source] Ileostomy revision using noncutting linear staplerCOLORECTAL DISEASE, Issue 8 2008M.-L. Skćrlund Abstract Objective, The study aimed to evaluate the outcome of ileostomy revision for retraction and prolapse using noncutting linear stapler. Method, Forty five patients undergoing a total of 94 stapled revisions between 1.1.1995 and 31.12.2005 were identified by the unique code for stomal revision. Medical records for all patients were examined. Results, Thirty-five (77.8%) of the 45 patients were women. In 43 (95.6%), the indication was stomal retraction. Median follow-up was 28 months (2,122). One or more stapling procedures resulted in a normal stoma at follow-up in 18 (41.9%) of 43 patients treated for stomal retraction. When other types of repair were included, a normal stoma was achieved in 30 (69.8%) of 43 patients. Patients with a low BMI had the lowest success rate (44%), but none of the possible factors analysed for influence on success had a statistically significant impact. Two patients were treated for prolapse, and both needed other types of revision. Conclusions, Stapled ileostomy revision is easy to perform and has a low morbidity. Less than half the patients achieve a satisfactory long-term result after one or more stapling procedures. Many patients still benefit from other types of revision when stapling has failed. [source] ENDOSCOPIC MANAGEMENT OF BILIARY and PANCREATIC DUCTS STRICTURESDIGESTIVE ENDOSCOPY, Issue 2004Hiroyuki Maguchi ABSTRACT Endoscopic treatment is applied to a relatively large number of biliary and pancreatic duct strictures, and is a practical matter. It is essential to select the most appropriate treatment for each lesion. For instance, when treating malignant biliary stricture, accurate diagnosis of whether surgical treatment is required or not is vital; and in choosing a stent for an inoperable case, location of the stricture, with or without anticancer treatment, prognosis, and management of possible post-stenting re-stricture must be taken into consideration. For benign strictures, not only short-term results in mobility and motality, but also decades of long-term results must be cautiously questioned. Bearing these in mind, we need to accumulate the worldwide data of the treatments and establish a proper treatment guideline. [source] Cardiac regeneration by progenitor cells , bedside before bench?EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 7 2005J. Bauersachs Abstract Recent experimental and clinical trials give rise to the hope that progenitor cells could replace scar tissue after myocardial infarction with healthy functional myocardium. However, while a significant increase in left ventricular ejection fraction has been described after progenitor cell transplantation in several clinical trials, long-term results are lacking, and the mechanisms underlying the improvement of ejection fraction are unclear. Therefore, the efficacy of progenitor cell transplantation after myocardial infarction has not been established, and potential problems may have been underestimated. In-depth laboratory and animal studies are needed to determine the best cell type, optimal amount of cells, and time point for transplantation. Treatment of patients with progenitor cells outside well controlled prospective trials should be avoided. [source] The Effect of Managerial Ownership on the Short- and Long-run Response to Cash DistributionsFINANCIAL REVIEW, Issue 2 2003Keith M. Howe G32/G35 Abstract We examine both the short-run and long-run responses to the following corporate cash flow transactions: dividend increases and decreases, dividend initiations, and tender offer repurchases. Our focus is the short-run and long-run effects of managerial ownership. We hypothesize that ownership plays an important role in explaining the announcement effects for these events, owing to signaling effects and the reduction of agency problems. Our short-run results accord well with the earlier work on announcement effects for these events and show that firms with high insider ownership exhibit higher excess returns. Our long-term results indicate a drift over a three-year period following the announcement, with the excess returns for the high insider-ownership group becoming more pronounced. [source] Current concepts in hypospadias surgeryINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008Yutaro Hayashi Abstract: Anatomical anomalies in hypospadias are an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis and abnormal distribution of the foreskin around the glans with a ventrally deficient hooded foreskin. The techniques of hypospadias surgery continue to evolve. The current standard of care for hypospadias repair includes not only a functional penis adequate for sexual intercourse and urethral reconstruction offering the ability to stand to urinate, but also a satisfactory cosmetic result. Tubularized incised plate repair has been the mainstay for distal hypospadias. In cases of proximal hypospadias, one-stage repairs such as the Duckett repair or the Koyanagi repair have been well established, while two-stage repairs remain important alternatives. Whether dorsal plication or ventral lengthening should be used to correct penile curvature is still controversial, and long-term results are required. Efforts have been made in this decade to improve cosmetic appearance, constructing a slit-like meatus or performing foreskin reconstruction, and to prevent onerous complications. [source] Results of Treatment Methods in Cardiac Arrest Following Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 3 2009Mehmet R. Guney M.D. We evaluated the short- and long-term consequences of these two methods and discussed the indications for re-revascularization. Methods: Between 1998 and 2004, a total of 148 CABG patients, who were complicated with cardiac arrest, were treated with emergency re-revascularization (n = 36, group R) and ICU procedures (n = 112, group ICU). Re-revascularizations are mostly blind operations depending on clinical/hemodynamic criteria. These are: no response to resuscitation, recurrent tachycardia/fibrillation, and severe hemodynamic instability after resuscitation. Re-angiography could only be performed in 3.3% of the patients. Event-free survival of the groups was calculated by the Kaplan-Meier method. Events are: death, recurrent angina, myocardial infarction, functional capacity, and reintervention. Results: Seventy percent of patients, who were complicated with cardiac arrest, had perioperative myocardial infarction (PMI). This rate was significantly higher in group R (p = 0.013). The major finding in group R was graft occlusion (91.6%). During in-hospital period, no difference was observed in mortality rates between the two groups. However, hemodynamic stabilization time (p = 0.012), duration of hospitalization (p = 0.00006), and mechanical support use (p = 0.003) significantly decreased by re-revascularization. During the mean 37.1 ± 25.1 months of follow-up period, long-term mortality (p = 0.03) and event-free survival (p = 0.029) rates were significantly in favor of group R. Conclusion: Better short- and long-term results were observed in the re-revascularization group. [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] Successful Long-Term Outcomes Using Pediatric En Bloc Kidneys for TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2002Jade S. Hiramoto Goal: The objective of our study was to determine whether acceptable long-term graft survival and function can be achieved using pediatric en bloc renal transplants by employing specific immunologic and selection strategies. Materials and Methods: A retrospective analysis of pediatric en bloc kidney transplants at a single institution was performed. A Kaplan-Meier analysis was used to evaluate graft survival. Findings: Fifty-seven adult recipients with at least a 1-year follow-up period were successfully transplanted using pediatric en bloc kidneys between 1993 and 1998. Complete data regarding immunosuppression were available for 53 patients. All patients had a cyclosporine (CsA)- or tacrolimus (TAC)-based regimen with either azathioprine (Aza) or mycophenolate mofetil (MMF) and corticosteroids. All but two received induction with OKT3. One-, 3-, 4-, 5- and 7-year graft survival was calculated to be 88%, 86%, 83%, 68% and 68%, respectively. The mean serum creatinine value at 3 years was 1.0 ± 0.4 mg/dL. Thirteen patients (23%) had biopsy-proven rejection. Ten of 19 (53%) patients treated with CsA/Aza had rejection, whereas 2/15 (13%) on CsA/MMF and 1/19 (5%) of patients on TAC/MMF had rejection. Nine patients (16%) had surgical complications. Conclusion: Excellent long-term results can be achieved in pediatric en bloc kidney transplantation using OKT3, TAC and MMF in carefully selected adult recipients. [source] Clinical outcome of microsurgical subinguinal varicocelectomy in infertile menANDROLOGIA, Issue 2 2001A. Jungwirth The present study assesses the clinical outcome of microsurgical subinguinal varicocelectomy in infertile men, especially with regard to sperm count, motility and fertility. Between June 1990 and October 1998, 272 patients had subinguinal microsurgical varicocelectomy operations for clinical varicoceles, and their long-term results were assessed. In nearly all the patients there was a significant improvement in sperm count and sperm motility after 3 and 6 months. Very few complications arose from this procedure. We concluded that microsurgical subinguinal varicocelectomy is an effective treatment for clinical varicoceles in infertile men. The significant improvement in the quality of spermatozoa, the low complication rates and the remarkably high pregnancy rates make this a valuable alternative to in vitro reproduction techniques. [source] Challenges to achieving sustainable community health development within a donor aid business modelAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Helen Ashwell Abstract Objective: This paper explores the paradox of donor aid being delivered through a business model through a case study in Papua New Guinea. Methods: A retrospective review of project implementation and an outcome evaluation provided an opportunity to examine the long-term results and sustainability of a large project. Analysis was informed by data collected from 175 interviews (national, provincial, district and village), 93 community discussions and observations across 10 provinces. Results: Problems with the business model of delivering aid were evident from implementation data and in an evaluation conducted two years after project completion (2006). Compounding the business model effect were challenges of over-ambitious project goals with limited flexibility to adapt to changing circumstances, a donor payment system requiring short-term productivity and excessive reporting requirements. Conclusion: An overly ambitious project design, donor dominance within the business model and limited local counterpart capacity created problems in the community initiatives component of the project. Contractual pressures can negatively influence long-term outcomes that require development of local leadership and capacity. Future planning for donor project designs needs to be flexible, smaller in scope and have a longer timeframe of seven to 10 years. Implications: Donor-funded projects need to be sufficiently flexible to apply proven principles of community development, build local ownership and allow adequate time to build counterpart knowledge and skills. [source] Doxazosin for treating lower urinary tract symptoms compatible with benign prostatic obstruction: a systematic review of efficacy and adverse effectsBJU INTERNATIONAL, Issue 9 2004Roderick MacDonald The first paper in this section is a systematic review of the efficacy and adverse effects of doxazosin for treating LUTS compatible with benign prostatic obstruction. The criteria for inclusion were met by 13 studies involving 6033 men. The authors found evidence that doxazosin was effective and well tolerated in patients with LUTS. Combined therapy was superior to doxazosin alone in reducing the risk of clinical progression and other long-term complications of this condition. Authors from the UK reviewed the long-term results they achieved with an endourethral stent for treating BPH; quite a large proportion of patients had either died from unrelated causes or had had the stent removed. They stressed the necessity for careful case selection, but showed that it was a safe treatment for BPH in poor-risk patients. OBJECTIVE To evaluate the efficacy and adverse effects of doxazosin for treating lower urinary tract symptoms (LUTS) compatible with benign prostatic obstruction (BPO). METHODS Randomized controlled trials were included in the meta-analysis if: the study duration was ,,1 month; the study involved men with symptomatic BPO; and doxazosin was compared with placebo or active controls. Study and patient characteristics and outcome data were extracted in duplicate onto standardized forms using a prospectively developed protocol. RESULTS Thirteen studies involving 6033 men with (mean age 64 years) met the inclusion criteria; 10 were placebo-controlled, including two with combined doxazosin/finasteride therapy and finasteride monotherapy arms. Three trials were a comparison with other ,-blockers. The study duration was 1,54 months. The mean baseline symptom scores and peak urinary flow (PUF) rates were indicative of moderate BPO. Doxazosin gave significant improvements in LUTS, assessed by symptom scores, vs placebo and finasteride in the short- to long-term. Two long-term studies (1 and 4 years) reported mean changes from baseline for the International Prostate Symptom Score of ,,8.3 and ,,6.6 points (,49% and ,,39%) for doxazosin and ,,5.7 and ,,4.9 points (,33% and ,,29%) for placebo, respectively. Doxazosin significantly increased PUF rates vs placebo. In pooled results from three studies, the weighted mean difference in the mean change from baseline vs placebo was 1.6 mL/s (95% confidence interval 1.2,2.1). Efficacy was comparable with other ,1,blockers. In the long-term (>4 years) doxazosin was no better then finasteride in improving PUF. Combined doxazosin and finasteride significantly reduced the risk of overall clinical progression of BPO vs each drug separately in men followed for >4 years. Absolute risk reductions vs placebo were 11.3%, 6.9% and 6.4% for combined therapy, doxazosin and finasteride, respectively (P < 0.001). Improvements in symptom scores and PUF were also significantly greater with combined than monotherapy, and the former reduced the need for invasive treatment for BPO and the risk of long-term urinary retention, although the absolute reductions in risk vs placebo were small (<4%). Dizziness and fatigue were significantly more common with doxazosin than placebo (11% vs 7%, and 6% vs 3%, respectively). Adverse events reported for combined therapy were similar to those with each monotherapy. CONCLUSION The evidence indicates that doxazosin is effective and generally well tolerated for improving LUTS and PUF in men with symptomatic BPO. Combined therapy was better than doxazosin alone in reducing the risk of clinical progression of BPO and other long-term complications related to BPO. [source] Long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo: effect of disease activityBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2009A. Fongers Summary Background, Punch grafting is a simple and frequently used technique for the treatment of stable vitiligo, resistant to medical therapy. However, studies reporting long-term results are exceptional. Objectives, To evaluate the long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo. Methods, We studied a prospective cohort study involving 61 patients (25 male, 36 female) with vitiligo vulgaris and nine patients (all male) with segmental vitiligo who underwent 2-mm punch grafting more than 3 years ago. The main outcome measure was the degree of repigmentation of a single transplanted lesion as measured with a digital image analysis system with a mean follow-up of 5·2 years. Results, In patients with vitiligo vulgaris, 17 lesions (28%) showed excellent, 14 lesions (23%) showed good, 14 lesions (23%) showed fair and 16 lesions (26%) showed poor repigmentation. In patients with segmental vitiligo, seven of nine lesions (78%) showed excellent repigmentation. A cobblestone-like effect was observed in 19 of 70 patients (27%). Disease activity after punch grafting was reported in 94% of patients with poor repigmentation but in only 18% of patients with excellent repigmentation (,2 test, P < 0·0005). Patients who reported disease activity after transplantation had a lower mean repigmentation than those who did not report disease activity (77% vs. 39%, P < 0·05). Conclusions, Two-millimetre punch grafting in vitiligo is an effective surgical procedure with long-lasting effect. To prevent a cobblestone-like effect, we advise the use of smaller grafts (1,1·2 mm). Disease activity after grafting, localization and type of vitiligo, prior ultraviolet B treatment and a Koebnerized donor site influence the long-term outcome of punch grafting and should be taken into account in the selection of patients eligible for this treatment. [source] Size of the pancreatic head as a prognostic factor for the outcome of Beger's procedure for painful chronic pancreatitisBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2003E. Keus Background: Duodenum-preserving resection of the head of the pancreas (DPRHP) according to Beger has been developed as an alternative to pylorus-preserving resection of the pancreatic head for painful chronic pancreatitis. Methods: Between 1988 and 2000, 36 consecutive DPRHPs were performed. The group was divided into patients with (group 1; n = 23) and without (group 2; n = 13) significant enlargement of the pancreatic head. Pain was the indication for surgery in all patients. Results: Complications occurred in 12 patients, necessitating reoperation in 11. Initial overall results were favourable; significant improvement or complete relief of pain was reported in 27 of 35 patients. Long-term results were obtained in 27 of 30 patients; the overall success rate was 16 of 27, 13 of 16 patients with distinct enlargement of the pancreatic head and 3 of the 11 with minimal or no enlargement (P = 0·018). Conclusion: DPRHP can be performed with good early results. This effect is sustained in patients with distinct localized disease of the pancreatic head. In those without, the long-term results are disappointing. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Sequential vs. kissing balloon angioplasty for stenting of bifurcation coronary lesionsCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2002Martin Brueck Abstract Coronary angioplasty of bifurcation lesions remains a technical challenge and is believed to result in low procedural success associated with the risk of side-branch occlusion. Furthermore, long-term results are associated with a high rate of reintervention. The aim of the study was to evaluate the immediate and long-term clinical and angiographic results of sequential vs. simultaneous balloon angioplasty (kissing balloon technique) for stenting of bifurcation coronary lesions. Between December 1999 and January 2001, 59 patients underwent coronary angioplasty because of symptomatic bifurcation lesions type III (i.e., side branch originates from within the target lesion of the main vessel, and both main and side branch are angiographically narrowed more than 50%). Twenty-six patients were treated with simultaneous and 33 patients with sequential balloon angioplasty. Main-vessel stent placement was mandatory; side-branch stenting and platelet IIb/IIIa antagonists were allowed at the discretion of the operator. Kissing balloon technique offered no advantage in terms of procedural success or need for repeat target vessel revascularization due to restenosis at 6-month follow-up. Using sequential balloon angioplasty, permanent or transient side-branch compromise rate (TIMI flow < 3) was significantly higher than after kissing balloon technique (33% vs. 0%, respectively; P = 0.003). Major clinical events in-hospital or at 6-month follow-up, however, showed no significant differences. Kissing balloon angioplasty reduces the rate of transient side-branch occlusion compared to sequential PTCA but does not improve immediate or long-term outcome compared to sequential PTCA for stenting of bifurcation lesions. Cathet Cardiovasc Intervent 2002;55:461,466. © 2002 Wiley-Liss, Inc. [source] | ||||||||||||||||||||||||||||