What happens to Modic changes following lumbar discectomy? Analysis of a cohort of 41 patients with a 3- to 5-year follow-up period

2010 ◽  
Vol 13 (5) ◽  
pp. 562-567 ◽  
Author(s):  
Ralph Rahme ◽  
Ronald Moussa ◽  
Rabih Bou-Nassif ◽  
Joseph Maarrawi ◽  
Tony Rizk ◽  
...  
Keyword(s):  
Natural History ◽  
Modic Changes ◽  
Lumbar Discectomy ◽  
Develop Type ◽  
History Of ◽  
Study Population ◽  
The Impact

Object The natural history of Modic changes (MCs) in the lumbar spine is often marked by conversion from one type to another, but their course following lumbar discectomy remains unknown. The authors sought to study the impact of surgery on the natural history of these lesions. Methods Forty-one patients treated with lumbar microdiscectomy between 2004 and 2005 were enrolled in this study and underwent clinical evaluation and repeat MR imaging after a median follow-up of 41 months (range 32–59 months). Preoperative and follow-up MR images were reviewed and the type, location, and extent of MCs at the operated level were recorded and compared. Results The study population consisted of 27 men and 14 women with a mean age of 54 years (range 24–78 years). During the follow-up period, the prevalence of MCs increased from 46.3% to 78%, and 26 patients (63.4%) had Type 2 lesions at the operated level. Of the 22 patients without MCs, 4 (18.2%) converted to Type 1 and 9 (40.9%) to Type 2. Of the 5 Type 1 lesions, 3 (60%) converted to Type 2, and 2 (40%) remained Type 1 but increased in size. In contrast, none of the 14 Type 2 changes converted to another type, although 10 (71.4%) increased in extent. There were no reverse conversions to Type 0. Conclusions Following lumbar discectomy, most patients develop Type 2 changes at the operated level, possibly as a result of accelerated degeneration in the operated disc. Neither the preoperative presence of MCs nor their postoperative course appears to affect the clinical outcome.

A form of Autoimmune Diabetes in Adults Named LADA – An Update on Essential Features and Controversies

2019 ◽  
Vol 15 (3) ◽  
pp. 172-173 ◽  
Author(s):  
Valdemar Grill ◽  
Bjørn O. Åsvold
Keyword(s):  
Genetic Background ◽  
Clinical Utility ◽  
Autoimmune Diabetes ◽  
Classical Type ◽  
Phenotypic Characteristics ◽  
Latent Autoimmune Diabetes ◽  
The Impact

Latent Autoimmune Diabetes in the Adult, LADA has been investigated less than “classical” type 1 and type 2 diabetes and the criteria for and the relevance of a LADA diagnosis has been challenged. Despite the absence of a genetic background that is exclusive to LADA, this form of diabetes displays phenotypic characteristics that distinguish it from other forms of diabetes. LADA is heterogeneous in terms of the impact of autoimmunity and lifestyle factors, something that poses problems as to therapy and follow-up perhaps particularly in those with marginal positivity. Yet, there appears to be clear clinical utility in classifying individuals as LADA.

scholarly journals S19 The impact of clotting abnormalities on the natural history of idiopathic pulmonary fibrosis: an extended follow up of a population based cohort

Thorax ◽  
2016 ◽  
Vol 71 (Suppl 3) ◽  
pp. A13.1-A13
Author(s):  
V Navaratnam ◽  
AW Fogarty ◽  
T McKeever ◽  
N Thompson ◽  
G Jenkins ◽  
...  
Keyword(s):  
Natural History ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Population Based ◽  
History Of ◽  
The Impact

scholarly journals Different Contributions of Dyslipidemia and Obesity to the Natural History of Type 2 Diabetes: 3-Year Cohort Study in China

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Lu Liu ◽  
Xiaoling Guan ◽  
Zhongshang Yuan ◽  
Meng Zhao ◽  
Qiu Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Natural History ◽  
Glucose Tolerance ◽  
Serum Triglyceride ◽  
Glycemic Status ◽  
History Of

Aim. It is known that different stages of type 2 diabetes represent distinct pathophysiological changes, but how the spectrum of risk factors varies at different stages is not yet clarified. Hence, the aim of this study was to compare the effect of different metabolic variables on the natural history of type 2 diabetes. Methods. A total of 5,213 nondiabetic (normal glucose tolerance (NGT) and prediabetes) Chinese older than 40 years participated this prospective cohort study, and 4,577 completed the 3-year follow-up. Glycemic status was determined by standard oral glucose tolerance test both at enrollment and follow-up visit. Predictors for conversion in glycemic status were studied in a corresponding subcohort using the multiple logistic regression analysis. Results. The incidence of prediabetes and diabetes of the cohort was 93.6 and 42.2 per 1,000 person-years, respectively. After a 3-year follow-up, 33.1% of prediabetes patients regressed to NGT. The predictive weight of body mass index (BMI), serum triglyceride, total cholesterol, and systolic blood pressure in different paths of conversions among diabetes, prediabetes, and NGT differed. Specifically, BMI was the strongest predictor for regression from prediabetes to NGT, while triglyceride was most prominent for onset of diabetes. One SD increase in serum triglyceride was associated with a 1.29- (95% CI 1.10–1.52; P=0.002) or 1.12- (95% CI 1.01–1.27; P=0.039) fold higher risk of diabetes for individuals with NGT or prediabetes, respectively. Conclusion. Risk factors for different stages of diabetes differed, suggesting personalized preventive strategies for individuals with different basal glycemic statuses.

scholarly journals P286 Rate of colectomy in ulcerative colitis: Results from a Spanish cohort with 15 years of follow-up

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S295-S296
Author(s):  
C Rodriguez Gutiérrez ◽  
A Elosua Gonzalez ◽  
C Prieto Martínez ◽  
S Rubio Iturria ◽  
M A Vicuña ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Natural History ◽  
Therapeutic Strategies ◽  
Definitive Diagnosis ◽  
Biological Drugs ◽  
History Of ◽  
Incident Cohort ◽  
The Impact ◽  
Spanish Cohort

Abstract Background Knowing the natural history of ulcerative colitis (UC) is essential to understand the evolution of the disease, assess the impact of different therapeutic strategies, identify poor prognostic factors and provide patients with understandable information who help them in decision making. It has been suggested that biological drugs could modify natural history of UC and therefore decrease the rates of colectomy. In Spain, infliximab is approved for CU since 2005. Methods We performed a retrospective study that includes all patients with a definitive diagnosis (DD) of UC or Unclassifiable Colitis (UC) in the Navarra Incident Cohort (which includes all patients diagnosed between 2001 and 2003 in Navarra, Spain). Our objectives were to analyse the Colectomy Incidence Rate (CIR) from diagnosis to the end of follow-up (12-31-2017) and identify predictive factors of colectomy. Results We included 174 patients with DD of UC (42.5% E2 - 26.8% E3) and 5 of IC: 44.1 women, median age 39.2 years (7–88), median follow-up of 15.7 years. At the end of the follow-up, 8 patients underwent colectomy (CIR 3 surgeries per 100000patients-year). Timing of colectomy was: 3 at the initial diagnosis (<1 month), 2 in the first 2 years, 2 at 5 years and 1 at 12 years from diagnosis. All had previously received steroids, 5 immunomodulators and 2 biological agents. In 7 (87%) the surgery was urgent and the indication, megacolon in 3 (37.5%), severe outbreak in 3 (37.5%) and failure to medical treatment in 2 (25%). In 5 cases (62.5%), an ileoanal reservoir was made and in 3 definitive ileostomy. Conclusion In our cohort, global colectomy rates are lower than those reported in other series and occur mostly in the first 5 years of evolution.

P365Does papillary muscle ablation affect mitral valve function: a single centre experience

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
J Stassen ◽  
D Dilling ◽  
J Vijgen ◽  
J Schurmans ◽  
P Koopman
Keyword(s):  
Mitral Valve ◽  
Papillary Muscle ◽  
Delayed Enhancement ◽  
Papillary Muscles ◽  
Premature Ventricular Contractions ◽  
Valve Function ◽  
History Of ◽  
Study Population ◽  
The Impact

Abstract Introduction Ventricular arrhythmias from papillary muscles (PMs) often require extensive catheter ablation (CA). Not much is known about the mitral valve (MV) function after these extensive catheter ablations. Purpose The goal of this study was to determine the impact of papillary muscle CA on MV function.  Methods We retrospectively examined echocardiographic measurements in 21 patients with frequent premature ventricular contractions (PVCs) originating from the mitral PMs who underwent CA, dating from October 2012 till November 2018. We assessed MV function at baseline, 6 month and last follow-up. Degree of mitral regurgitation (MR) was graded as mild (ERO <0,2 cm2, regurgitation volume (RV) <30ml), moderate (ERO 0,2-0,4cm2, RV 30-59ml) or severe (ERO ≥0,4cm2, RV  ≥60ml). Significant MR was defined as a 2+ change. Results Mean age of the study population was 59,7 (27-80)years, 52,4% was female. 2 patients were known with ischemic heart disease. There was a family history of sudden cardiac death in 3 patients. Main symptoms at presentation were palpitations (66,7%), fatigue (33,3%), dyspnea (33,3%, all NYHA 2), dizziness (28,6%), angina pectoris (14,3%) and syncope (4,8%). Beta blocker (71,4%), flecaïnide (23,8%), amiodarone (9,5%), sotalol (4,8%) and propafenon (4,8%) were the most frequent medical therapies before CA. Mean burden of PVC before ablation was 15 574 (2000-39700)/24h. In 28,6% non sustained VT was documented, 1 patient suffered a sustained episode of VT.  After ablation, mean burden of PVC was reduced to 1331 (0-14200)/24h. Redo ablation was necessary in 28,6% of patients. PVCs orginated from the anterolateral PM in 33,3% and from the posteromedial PM in 66,7%. Mean troponin release was 9.4 ± 5.3 µg/l, mean troponin hs (since 2016) was 1591.0 ±658.6ng/ml. CMR was done in 14/21 (66,7%) patients before CA. In 5 out of 14 patients (35,7%), delayed enhancement at the papillary muscles was noticed. In 5 patients without delayed enhancement, CMR was repeated after CA. In all these 5 patients, delayed enhancement was noticed at the level of the papillary muscles.  At baseline, 15/21 had mild, 5/21 moderate and  1/21 severe MR. There was no significant chance in MR at 6m follow-up with 15/21 having mild and  6/21 moderate MR (p 0.58) with 1 patient having a significant MR 2+ change. At last follow-up (23.7 ± 22.6 months) there was also no significant chance in MR with 15/21 having mild and 6/21 moderate MR (p 0.58) without a significant MR 2+ change.  Complications occurred in 1 patient (transient AV blok). No patients died during follow up.  Conclusions Although PM ablation was associated with time extensive ablation, significant troponine release and documented delayed enhancement on post ablation MRI, there was no risk of additional valvular dysfunction after CA in this study. Larger studies will be necessary to confirm these findings.

scholarly journals The impact of parental risk factors on the risk of stroke in type 1 diabetes

2021 ◽  
Author(s):  
Anni Ylinen ◽  
◽  
Stefanie Hägg-Holmberg ◽  
Marika I. Eriksson ◽  
Carol Forsblom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Hemorrhagic Stroke ◽  
Cox Regression Analysis ◽  
Parental Risk Factors ◽  
Increased Risk ◽  
History Of ◽  
The Impact

Abstract Background Individuals with type 1 diabetes have a markedly increased risk of stroke. In the general population, genetic predisposition has been linked to increased risk of stroke, but this has not been assessed in type 1 diabetes. Our aim was, therefore, to study how parental risk factors affect the risk of stroke in individuals with type 1 diabetes. Methods This study represents an observational follow-up of 4011 individuals from the Finnish Diabetic Nephropathy Study, mean age at baseline 37.6 ± 11.9 years. All strokes during follow-up were verified from medical records or death certificates. The strokes were classified as either ischemic or hemorrhagic. All individuals filled out questionnaires concerning their parents’ medical history of hypertension, diabetes, stroke, and/or myocardial infarction. Results During a median follow-up of 12.4 (10.9–14.2) years, 188 individuals (4.6%) were diagnosed with their first ever stroke; 134 were ischemic and 54 hemorrhagic. In Cox regression analysis, a history of maternal stroke increased the risk of hemorrhagic stroke, hazard ratio 2.86 (95% confidence interval 1.27–6.44, p = 0.011) after adjustment for sex, age, BMI, retinal photocoagulation, and diabetic kidney disease. There was, however, no association between maternal stroke and ischemic stroke. No other associations between parental risk factors and ischemic or hemorrhagic stroke were observed. Conclusion A history of maternal stroke increases the risk of hemorrhagic stroke in individuals with type 1 diabetes. Other parental risk factors seem to have limited impact on the risk of stroke.

scholarly journals Effect of COVID-19 on the clinical course of diabetic ketoacidosis (DKA) in people with type 1 and type 2 diabetes

2021 ◽  
Vol 10 (4) ◽  
pp. 371-377
Author(s):  
Punith Kempegowda ◽  
Eka Melson ◽  
Agnes Johnson ◽  
Lucy Wallett ◽  
Lucretia Thomas ◽  
...  
Keyword(s):  
Natural History ◽  
Clinical Course ◽  
External Control ◽  
Multi Centre Study ◽  
Significant Difference ◽  
History Of ◽  
Using Data ◽  
Worse Prognosis

Objective COVID-19 in people with diabetes is associated with a disproportionately worse prognosis. DKA is an acute complication of diabetes with a mortality rate of approximately 0.67%. Little is known about the natural history of DKA in the presence of COVID-19. This study aimed to explore the effects of COVID-19 on presentation, clinical course and outcome in patients presenting with DKA. Design Retrospective cohort study. Methods All patients treated for DKA between 1 March 2020 and 30 May 2020 were included. Patients were categorised as COVID-positive or COVID-negative based on the swab test. A pre-COVID group was established using data from 01 March 2019 to 30 May 2019 as external control. Data regarding demographics, diabetes type, pH, bicarbonate, lactate, glucose, DKA duration, complications and outcome were collected. Results A total of 88 DKA episodes were included in this study. There was no significant difference in the severity or duration of DKA between the three groups. COVID-positive T1DM were more hyperglycaemic on admission compared to COVID-negative and pre-COVID patients. There was an over representation of T2DM in COVID-positive patients with DKA than in pre-COVID or COVID-negative groups. Conclusion COVID-19 appears to influence the natural history of DKA differently in T1DM and T2DM. Patients with T1DM and COVID-19 presented with more hyperglycaemia (60 mmol/L (35.9–60.0) vs 31.4 mmol/L (28.0–39.1) vs 24 mmol/L (20.2–33.75), respectively). Patients with T2DM were unusually presenting in DKA when infected with COVID-19 with greater ICU need and higher mortality rates. A collaborative, multi-centre study is needed to provide more definitive results.

scholarly journals The early natural history of albuminuria in young adults with youth-onset type 1 and type 2 diabetes

2018 ◽  
Vol 32 (12) ◽  
pp. 1160-1168 ◽  
Author(s):  
Anna R. Kahkoska ◽  
Scott Isom ◽  
Jasmin Divers ◽  
Elizabeth J. Mayer-Davis ◽  
Lawrence Dolan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Young Adults ◽  
Natural History ◽  
Onset Type ◽  
History Of

Testicular lymphoma: improved outcome with early brief chemotherapy.

1988 ◽  
Vol 6 (5) ◽  
pp. 776-781 ◽  
Author(s):  
J M Connors ◽  
P Klimo ◽  
N Voss ◽  
R N Fairey ◽  
S Jackson
Keyword(s):  
Natural History ◽  
Study Groups ◽  
Chemotherapy Group ◽  
Testicular Lymphoma ◽  
Field Radiation ◽  
History Of ◽  
Involved Field ◽  
The Impact ◽  
Primary Testicular Lymphoma

We investigated the impact of early brief chemotherapy on the natural history of primary testicular lymphoma. We compared the outcome for patients seen before 1980--a group primarily managed with orchiectomy and regional radiation--with those seen from 1980 to 1986--a prospectively and consecutively gathered group who were offered brief chemotherapy in addition to standard orchiectomy and irradiation. The historical and study groups were similar in clinical characteristics. However, the chemotherapy group had a better relapse-free survival, 93% v 50% (P less than .02), and overall survival, 93% v 50% (P less than .02). With a median follow-up of 44 months in the chemotherapy group, it is clear that the use of early, brief chemotherapy strongly alters the natural history of testicular lymphoma by preventing relapses, the large majority of which occur early after regional therapy. We conclude that a program incorporating orchiectomy, early brief chemotherapy, and involved-field radiation therapy confers the following benefits on patients with primary testicular lymphoma: (1) laparotomy is not needed for staging; (2) relapses, including those in the opposite testicle and CNS, are largely prevented; and (3) toxicity can be kept to a modest level acceptable in elderly patients.

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