scholarly journals Residual Pulmonary Hypertension More than 20 Years after Repair of Shunt Lesions

Medicina ◽  
2020 ◽  
Vol 56 (6) ◽  
pp. 297
Author(s):  
Dovilė Jančauskaitė ◽  
Virginija Rudienė ◽  
Gabrielius Jakutis ◽  
Laurie W Geenen ◽  
Jolien W Roos-Hesselink ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Surgical Repair ◽  
Significant Proportion ◽  
University Hospital ◽  
Right Heart ◽  
Long Term Outcome ◽  
Right Heart Catheterisation ◽  
Study Results

Background and Objectives: After successful surgical repair of a congenital shunt lesion, pulmonary hypertension (PH) often disappears. However, PH can persist long-term after the closure. This study aimed to assess the prevalence of PH long-term after surgical repair of congenital heart disease (CHD), and to evaluate the outcomes and preoperative factors related to residual PH. Materials and Methods: In this retrospective cohort study, we reviewed patients who underwent right heart catheterisation in Vilnius University Hospital Santaros Klinikos during the period of 1985–2007. Among 4118 right heart catheterisations performed, 160 patients underwent congenital systemic-to-pulmonary shunt repair at a young age (<18 years) and had pre-operative PH. Half of the patients were foreigners whose follow-up data were unavailable. Eventually, 88 patients with available follow-up data were included in this study. Results: The median age at diagnosis of CHD with PH was 0.8 (0.6–3.0) and 1.1 (0.6–3.9) years at surgery (50% females). Residual PH was assessed 9.5 years after surgery and observed in 30.7% (n = 27) of the patients. It was associated with having more than one shunt (44.4% (n = 12), p = 0.016) and higher median pulmonary vascular resistance (3.4 (2.5–6.5) vs. 2.2 (1.0–3.7), p = 0.035) at baseline. After a median follow-up of 21 (15–24) years, 9.1% of the patients were deceased. Kaplan–Meier survival analysis revealed significantly higher mortality in the residual PH group (p = 0.035). Conclusions: Residual PH affects a significant proportion of patients after surgical repair of a shunt lesion and is associated with worse long-term outcome.

scholarly journals Very long-term follow-up of aplastic anemia treated with immunosuppressive therapy or allogeneic hematopoietic cell transplantation

2020 ◽  
Vol 99 (11) ◽  
pp. 2529-2538
Author(s):  
Beatrice Drexler ◽  
Felicitas Zurbriggen ◽  
Tamara Diesch ◽  
Romaine Viollier ◽  
Joerg P. Halter ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Immunosuppressive Therapy ◽  
Hematopoietic Cell Transplantation ◽  
Clonal Evolution ◽  
University Hospital ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Survivors

Abstract Introduction Since the 1970s outcome of aplastic anemia (AA) patients has improved significantly due to the introduction of immunosuppressive therapy (IST) and allogeneic hematopoietic transplantation (HCT). However, patients may suffer from persistent disease, relapse, clonal evolution, graft-versus-host disease and other late effects. Here, we analyse very long-term outcome of all AA patients at our institution comparing not only survival, but also response status and complications. Methods Patient charts of all 302 AA patients treated between 1973 and 2017 at the University Hospital Basel, Switzerland, were retrospectively analysed. Results First line treatment was IST in 226 (75%) and HCT in 76 (25%) patients. Overall survival at 30 years was similar in patients treated initially by HCT and IST (44% (±14%), and 40% (± 9%) respectively, with better results in more recent years. Partial and no response occurred more frequently after IST, relapse incidence after IST was 24 %, whereas non-engraftment and graft failure was documented in 15 patients (19 %) after HCT. Clonal evolution to myelodysplastic syndrome / acute myeloid leukemia was 16 % at 25 years in IST patients, 1.3 % in HCT patients, iron overload (18 versus 4 %, p = 0.002) and cardiovascular events (11 versus 1 %, p=0.011) occured significantly more often in IST than HCT treated patients. The majority of long-term survivors, 96% of those alive at 25 years, were in complete remission at last follow up, irrespective of the initial treatment modality. Conclusion Very long term survivors after AA are those with stable hematopoietic recovery.

Ear injuries caused by lightning: report of 18 cases

2001 ◽  
Vol 115 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Ivo Glunčić ◽  
Željka Roje ◽  
Vicko Glunčić ◽  
Kolja Poljak
Keyword(s):  
Clinical Management ◽  
Neuropsychological Testing ◽  
University Hospital ◽  
Psychotherapeutic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Membrane Rupture ◽  
Hearing Function

The clinical management and long-term outcome in lightning survivors with subsctantial ear damage treated at the Department of Otorhinolaryngology, University Hospital Split during the 1984–1999 period are reviewed. Results of clinical management and outcomes of lightning ear damage in 18 patients (mean age 35.3 ± 5 years) were retrospectively analyzed. On admission, all patients complained of severe pain, tinnitus and hearing impairment. Otomicroscopy revealed tympanic membrane rupture in 12 patients. The active therapeutic approach included immediate otomicroscopy, aseptic aspiration toilet, and eversion of perforation edges. In all patients, the ruptures healed well, and restitution of the hearing function was achieved. Follow-up examination performed in 1999 (13.2 ± 2.9 years later) in 11 patients (mean age 52.3 ± 6.1 years) revealed an almost identical audiogram as on discharge from the hospital, however, neuropsychological testing revealed numerous sequelae. Tympanic injury caused by lightning should be actively treated. Lightning survivors require additional psychotherapeutic treatment.

Long-term Outcome Analysis of the Supraclavicular Surgical Release for the Treatment of Thoracic Outlet Syndrome

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1085-1092 ◽  
Author(s):  
Esther Vögelin ◽  
Lorenz Haldemann ◽  
Mihai A. Constantinescu ◽  
Ariane Gerber ◽  
Ulrich Büchler
Keyword(s):  
Standard Deviation ◽  
Thoracic Outlet Syndrome ◽  
University Hospital ◽  
Outcome Analysis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up ◽  
Surgical Release

Abstract OBJECTIVE This is a long-term outcome analysis of patients who underwent surgical treatment with a supraclavicular release for thoracic outlet syndrome (TOS). METHODS All patients undergoing supraclavicular release between January 1, 1987, and December 31, 2000, at University Hospital, Inselspital, Bern, Switzerland, were included in this study. Of 29 treated patients, 22 patients (24 TOS) underwent both long-term clinical follow-up (median 12.5 years, standard deviation 3.5 years, range 5–18 years) and short-term clinical follow-up (median 6.6 months, standard deviation 4.5 years, range 3–12 months). RESULTS Eleven patients (12 TOS operations) were classified as having a neurogenic cause of TOS, whereas the other 11 (12 TOS operations) were classified as having disputed TOS. Patient data, including various outcome parameters, such as pain and disabilities of arm, shoulder, and hand scores, were evaluated pre- and postoperatively and at long-term follow-up by an independent examiner. The surgical supraclavicular technique is described in detail. In 21 of 24 surgical release procedures, the first rib was resected. There was a marked permanent long-term postoperative reduction of symptoms in both neurogenic and disputed TOS groups. The pain and disabilities of arm, shoulder, and hand scores improved significantly after surgery, regardless of the etiology, in the short- and long-term postoperative observation periods. There were no patients with workers' compensation or litigation issues. CONCLUSION This study demonstrates the successful, constant long-term relief of symptoms in carefully selected patients with neurogenic and disputed TOS using the described surgical supraclavicular release technique.

scholarly journals Recovery from psychotic illness: A 15- and 25-year international follow-up study

2001 ◽  
Vol 178 (6) ◽  
pp. 506-517 ◽  
Author(s):  
G. Harrison ◽  
K. Hopper ◽  
T. Craig ◽  
E. Laska ◽  
C. Siegel ◽  
...  
Keyword(s):  
Late Phase ◽  
Significant Proportion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Course Variables ◽  
Study Designs ◽  
Predictive Strength ◽  
Incident Cases

BackgroundPoorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.AimsTo describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.MethodHistoric prospective study. Standardised assessments of course and outcome.ResultsAbout 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.ConclusionsA significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.

Acute hemodynamic changes and long term prognostic impact of pulmonary hypertension in patients undergoing percutaneous mitral valve edge to edge repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Koell ◽  
S Ludwig ◽  
O Bhadra ◽  
A Gossling ◽  
N Schofer ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Pulmonary Artery ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Prognostic Impact ◽  
Right Heart ◽  
The Impact

Abstract Background Pulmonary hypertension (PH) due to left heart disease is the most common form of PH. Published literature suggests increased perisurgical mortality in patients undergoing surgical repair in the setting of preexisting PH. The data on the impact of preexisting PH on clinical outcomes after percutaneous Mitral Valve Edge-to-Edge Repair (pMVR) is limited to observational studies and rely mostly on echocardiographic data. Purpose The aim of the current study is to evaluate the influence of preexisting PH in patients undergoing pMVR analyzing periprocedural invasive right heart catheterization data. Methods Between September 2008 and July 2018, a total of 911 patients with moderate-to-severe or severe mitral regurgitation (MR) underwent pMVR at our center. This analysis includes 331 patients with a complete data set for pre- and postprocedural right heart catheterization and echocardiographic assessment as well as available follow-up information after the implantation. Patients are divided according to the etiology of PH. The combined primary endpoint consists of all-cause mortality and rehospitalization for heart failure. Furthermore, a sub-analysis is performed for all patients with preexisting post-capillary PH. Patients with post-capillary PH are divided into two groups based on a postprocedural decrease of pulmonary artery wedge pressure (mPAWP) below the threshold of 15mmHg. Univariate and multivariate Cox regression analyses are performed to assess the influence on long-term outcome. Results Of all 331 patients (57.7% [n= 191] male) undergoing pMVR, 195 (62.1%) had functional MR. Median ejection fraction was 40.5% (29.3, 54.0). Patients were followed-up for a maximum of 4.41 years and the median follow-up time was 1.98 years. Preexisting PH (mean pulmonary artery pressure ≥25 mmHg) was found in 236 (71.1%) patients: 49 patients had pre-capillary PH (≤15 mmHg), 187 had post-capillary PH (pcPH; n=183; mPAWP &gt;15 mmHg). In Kaplan-Meier analysis, no statistically significant difference could be found in overall mortality in patients without or with PH, irrespective of etiology (p=0.43). However, in patients suffering from post-capillary PH, patients with a postprocedural reduction of mPAWP below the threshold of 15mmHg showed a significantly lower risk for overall long-term mortality compared to patients without a relevant mPAWP reduction (p=0.018). Multivariate analysis revealed acute postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH to have a significant influence on mortality (HR 2.81 [1.35, 5.86]; p=0.006; Figure 1). Conclusion In contrast to previously published findings, the present results were not able to show a significant impact of PH, disregarding its etiology, on outcome. Nevertheless, a postprocedural decrease of mPAWP below 15mmHg in patients with post-capillary PH is associated with a favorable outcome. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Gastric epithelial dysplasia: Characteristics and long-term follow-up results after endoscopic resection according to morphological categorization.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 190-190
Author(s):  
Bong Eun Lee ◽  
Gwang Ha Kim ◽  
Dong Hoon Baek
Keyword(s):  
Endoscopic Resection ◽  
Epithelial Dysplasia ◽  
University Hospital ◽  
Clinicopathologic Characteristics ◽  
Morphologic Characteristics ◽  
Study Results ◽  
National University ◽  
Long Term Follow Up

190 Background: Gastric epithelial dysplasia (GED) can be morphologically categorized into adenomatous and foveolar types. To date, there have been few studies on the clinical characteristics of GEDs according to the morphologic types. Therefore, we here aimed to elucidate the clinicopathologic characteristics of patients with GED and the long-term follow-up results after endoscopic resection according to the morphologic characteristics of GEDs. Methods: A total of 357 patients who underwent endoscopic resection for GEDs at Pusan National University Hospital between January 2008 and December 2009 were included in the study. Results: Patients with GED were divided into 3 groups: adenomatous (n = 167, 46.8%), foveolar (n = 103, 28.9%), and hybrid (n = 87, 24.3%) types. Compared to the adenomatous type, foveolar type lesions were more frequently located in the antrum/pylorus, flat/depressed lesions, and normal/reddish in color; and showed more frequent high-grade dysplasia. During the follow–up period (median, 37.3 months), the overall incidence of synchronous and metachronous lesions was 20.8% and 20.1%, respectively; of these, the incidence of synchronous and metachronous gastric cancer was 8.7% and 5.4%, respectively. There were no significant differences in the incidence of synchronous and metachronous lesions according to morphologic types. Conclusions: GEDs appear to have different clinicopathologic characteristics according to morphologic types. Irrespective of the morphology, synchronous and metachronous gastric cancers are commonly found after endoscopic resection of GEDs. Therefore, close follow-up surveillance after endoscopic resection of GEDs should be performed for all patients.

scholarly journals Long-term outcome of patients undergoing surgical repair of isolated pulmonary valve stenosis. Follow-up at 20-30 years.

Circulation ◽  
1988 ◽  
Vol 78 (5) ◽  
pp. 1150-1156 ◽  
Author(s):  
S L Kopecky ◽  
B J Gersh ◽  
M D McGoon ◽  
D D Mair ◽  
C J Porter ◽  
...  
Keyword(s):  
Surgical Repair ◽  
Pulmonary Valve ◽  
Pulmonary Valve Stenosis ◽  
Term Outcome ◽  
Long Term Outcome

Management and long-term follow-up review of children with lipomyelomeningocele, 1952–1987

1990 ◽  
Vol 73 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Paul M. Kanev ◽  
Ronald J. Lemire ◽  
John D. Loeser ◽  
Mitchel S. Berger
Keyword(s):  
Surgical Repair ◽  
Medical Center ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cutaneous Manifestations ◽  
Content Type ◽  
Initial Surgery ◽  
Long Term Follow Up

✓ The medical records of patients at Children's Hospital and Medical Center treated for lipomyelomeningocele repair were reviewed to assess the long-term outcome of surgery. In total, 108 children were cared for between 1952 and 1987, and long-term data are available for 80 of 96 children who underwent surgery. Cutaneous manifestations and associated malformations were common. Surgical repair was performed at ages 1 week to 17 years; there was no operative mortality. Thirty-five of 38 children with normal preoperative examination were without deficits on long-term follow-up review. Bowel and bladder paralysis was present in 42 children and did not recover after release of cord tethering. Eleven children had return of symptoms and were reexplored 3 to 8 years after initial surgery. Surgical repair with release of cord tethering at the time of diagnosis is advocated, regardless of patient age.

The Long-Term Outcome of Depressive Illness

1988 ◽  
Vol 153 (6) ◽  
pp. 752-757 ◽  
Author(s):  
L. G. Kiloh ◽  
Gavin Andrews ◽  
Megan Neilson
Keyword(s):  
Endogenous Depression ◽  
Depressive Illness ◽  
Index Admission ◽  
University Hospital ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Considerable Morbidity ◽  
Adequate Data

One hundred and forty-five patients with primary depressive illness admitted to a university hospital between 1966 and 1970 were followed up an average of 15 years later. Adequate data were obtained on 133 (92%) of the 145. During the follow-up period, 7% of the 133 had suicided, 12% had remained incapacitated by illness and only 20% had remained continuously well. Patients for whom the index admission was not their first were especially likely to be readmitted during the follow-up period. Patients with endogenous depression, none of whom developed schizophrenia during the follow-up period, were more likely to need readmission than patients with an index diagnosis of neurotic depression. In all other respects the prognosis for the two types of depression was the same, with considerable morbidity evident in both.

Sign in / Sign up

Export Citation Format

Share Document