Medical Follow-up (medical + follow-up)

Distribution by Scientific Domains


Selected Abstracts


Outcome of craniopharyngioma in children: long-term complications and quality of life

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 4 2004
Andrea Poretti MB BS
Childhood craniopharyngiomas are histologically benign tumours arising from remnants of Rathke's pouch in the hypothalamic,pituitary region. The two common treatment approaches are primary total resection or limited resection followed by radiotherapy. To study the outcome after a primary surgical approach, we followed 25 consecutive patients (10 females, 15 males) under 16 years of age who were treated in a single institution with a management policy of radical tumour excision (mean age at diagnosis 9 years 2 months, SD 4 years 3 months; range 2 years 9 months to 15 years 11 months). Mean follow-up after primary surgery was 11 years 3 months (SD 7 years 7 months). Tumour control, and neurological, endocrine, and hypothalamic complications and their impact on health-related quality of life were assessed (medical follow-up, semi-structured interview, and questionnaires). Results of tumour control were generally good, however, local failure was observed in 6 of 25 patients, and severe late-treatment complications decreased quality of life for many long-time survivors. Endocrine deficiency occurred in 24/25, visual complications in 16/24, neurological complications in 8/24, obesity in 14/23, increased daytime sleepiness in 6/21, and significant school problems in 10/20. Patients with craniopharyngioma rated their health-related quality of life as considerably lower than healthy controls; the domains of social and emotional functioning were particularly affected. Parents'ratings were considerably lower than those of the patients. Poor functional outcome was associated with large tumours infiltrating or displacing the hypothalamus, the occurrence of hydrocephalus, and young age at diagnosis, but also with multiple operations due to tumour recurrence. Alternative treatment strategies should be considered, especially in very young patients with large tumours. [source]


Prevalence of penetrating disease and extraintestinal manifestations of Crohn's disease detected with CT enterography

INFLAMMATORY BOWEL DISEASES, Issue 12 2008
David H. Bruining MD
Abstract Background: This study was conducted to determine the prevalence of penetrating disease and extraintestinal manifestations of Crohn's disease (CD) identified by computed tomography enterography (CTE). We also sought to examine the percentage of clinically significant new noninflammatory bowel disease (IBD) related findings in these patients. Methods: We analyzed the records of 357 consecutive patients with previously diagnosed CD evaluated at our institution who underwent a CTE between August 2004 and October 2005. Radiology reports were reviewed for the presence of penetrating disease (abscess, fistula, or phlegmon) or extraintestinal IBD manifestations (nephrolithiasis, cholelithiasis, sacroiliitis, avascular necrosis, deep vein thrombosis, or primary sclerosing cholangitis). Additional non-IBD-related abnormalities were also recorded, including any mass or cystic lesion. Urgent findings were defined as those that were deemed by the radiologist or ordering physician to require medical follow-up within 3 months. Results: Of 357 patients identified (51% female) the median age was 41.6 years and median disease duration was 9.9 years. Of this cohort, 20.7% had penetrating disease (new finding in 58.1%) and 18.8% had extraintestinal IBD manifestations (new finding in 67.2%). Six patients had primary sclerosing cholangitis and portal/mesenteric vein thrombosis, respectively. In addition, 45.1% had non-IBD findings including 2 unsuspected malignancies. Most of these extraenteric non-IBD abnormalities were benign, with only 13.0% requiring urgent follow-up. Conclusions: CT enterography is a valuable diagnostic modality for detecting both penetrating disease and extraintestinal IBD manifestations. These data add to a growing body of evidence that supports the use of CTE in CD diagnostic and management algorithms. (Inflamm Bowel Dis 2008) [source]


Renal transplantation in children: Psychological and donation-related aspects from the parental perspective

PEDIATRIC TRANSPLANTATION, Issue 4 2000
Helena M. E. Kärrfelt
Abstract: Parent(s) accompanying their 18 children to the annual medical follow-up after renal transplantation were interviewed by a child psychiatric social worker. Thirteen of the children had received their grafts from one of their parents, two from other relatives, and three from cadaveric donors. The aims of this interview were to study the decision-making process regarding donation, and the consequences, reflections, and psychological reactions from the parental perspective. Although most parents reported improved psychosocial functioning of the family, many parents also reported significant psychological distress, in many cases complicated by unemployment related to the care of the child. Most parent donors reported that the relationship with their child had improved. For most parents, the decision about the donation seemed to have been a matter of course. However, the process may have induced suffering in those parents who had felt obliged to donate. Thus, questions regarding donation must be approached in a professional and non-judgmental manner when parents are informed about the preconditions of transplantation. The present results indicate a need of psychosocial support for all families during the transplantation process. Therefore, a psychologist and a social worker have been included in the pediatric nephrology team at our unit. The donors also require further information concerning the operative details as well as in regard to the post-operative pain. [source]


Tracking Diabetes: New York City's A1C Registry

THE MILBANK QUARTERLY, Issue 3 2009
SHADI CHAMANY
Context: In December 2005, in characterizing diabetes as an epidemic, the New York City Board of Health mandated the laboratory reporting of hemoglobin A1C laboratory test results. This mandate established the United States' first population-based registry to track the level of blood sugar control in people with diabetes. But mandatory A1C reporting has provoked debate regarding the role of public health agencies in the control of noncommunicable diseases and, more specifically, both privacy and the doctor-patient relationship. Methods: This article reviews the rationale for adopting the rule requiring the reporting of A1C test results, experience with its implementation, and criticisms raised in the context of the history of public health practice. Findings: For many decades, public health agencies have used identifiable information collected through mandatory laboratory reporting to monitor the population's health and develop programs for the control of communicable and noncommunicable diseases. The registry program sends quarterly patient rosters stratified by A1C level to more than one thousand medical providers, and it also sends letters, on the provider's letterhead whenever possible, to patients at risk of diabetes complications (A1C level >9 percent), advising medical follow-up. The activities of the registry program are similar to those of programs for other reportable conditions and constitute a joint effort between a governmental public health agency and medical providers to improve patients' health outcomes. Conclusions: Mandatory reporting has proven successful in helping combat other major epidemics. New York City's A1C Registry activities combine both traditional and novel public health approaches to reduce the burden of an epidemic chronic disease, diabetes. Despite criticism that mandatory reporting compromises individuals' right to privacy without clear benefit, the early feedback has been positive and suggests that the benefits will outweigh the potential harms. Further evaluation will provide additional information that other local health jurisdictions may use in designing their strategies to address chronic disease. [source]


Limiting Financial Disincentives in Live Organ Donation: A Rational Solution to the Kidney Shortage

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2006
R. S. Gaston
Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of ,valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes. [source]