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PubMed1995

The effect of accident mechanisms and initial findings on the long-term course of whiplash injury.

The aim of this study was to assess the relationships between accident mechanisms as well as initial findings and the long-term course of whiplash injury. A representative sample of 117 consecutive patients referred by primary care physicians was followed-up over 12 months., Fractures or dislocations of the cervical spine, head trauma and pre-existing neurological disorders were exclusion criteria. The interval between the accident and the baseline examination was 7.4 days (SD 4.2 days). Assessment included accident features (e.g. passenger position in the car, head restraint, head position, type of collision), initial symptoms (e.g. intensity and onset of pain, symptoms of neurological dysfunction, multiple symptom score), and signs (restricted neck movement, neurological deficits). At the 1-year examination, patients were divided into an asymptomatic and a symptomatic group and were compared with respect to accident features and baseline findings. Twenty-four percent of patients were still symptomatic after 1 year. Analysing accident mechanisms separately, rotated or inclined head position was the primary feature related to symptom persistence (P = 0.005). The symptomatic group scored higher at baseline on the multiple symptom rating (P = 0.004) and had a higher incidence of initial headache (P = 0.004) and neurological symptoms (P = 0.008) together with a higher intensity of headache (P = 0.0002) and neck pain (P = 0.0009).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Traffic↗
PubMed2001

[Long-term course of childhood or adolescence onset obsessive-compulsive disorder: psychosocial adaptation in adulthood].

OBJECTIVE: The aim of the study was to investigate the long-term course of obsessive-compulsive disorder (OCD) with onset in childhood or adolescence. This presentation focuses on the social adjustment of the former patients in adulthood. METHODS: Fifty-five out of 116 patients with childhood OCD classified according to DSM-IV criteria were interviewed personally using structured interviews. Mean age at onset of OCD was 12.5 years, and mean follow-up time was 11.2 years. RESULTS: Despite the evident burden of mental disorder at the time of the follow-up, 76% led their own lives without being overly dependent upon their parents. 84% had no problems that impaired either school or their occupation. 73% were rated as maintaining satisfying social contacts, but only 54% were in a relationship at follow-up. CONCLUSIONS: In agreement with other studies we found an association between the level of psychosocial adjustment and the course of obsessive-compulsive symptoms. Summing up, social adjustment and psychosexual functioning seem to be more impaired than occupational functioning. The relatively good adjustment of our sample indicates that most patients have found a way of managing their lives, albeit still suffering from mental disorders.

Adaptation, Psychological↗
PubMed1998

[Effect of smoking on the long-term course of ulcerative colitis].

OBJECTIVE: To evaluate the effects of smoking on the long term clinical course in patients with ulcerative colitis. METHODS: The medical charts of 556 patients with ulcerative colitis were reviewed retrospectively. Patients were classified as smokers (n = 85) or nonsmokers (n = 471) according to their smoking status during the course of the disease. Extent of colonic lesions, complications, medical requirements, and actuarial rate of colectomy were compared in smokers and nonsmokers. RESULTS: Mean follow-up (+/- SD) was longer in smokers than in nonsmokers (116 +/- 107 mo, vs 87 +/- 94 mo.). Less smokers than nonsmokers required oral steroids (52 vs 63%, P = 0.05). No difference between the groups was observed regarding the use of salicylates, the need for intravenous steroids, for immunosuppressive drugs, for colectomy, and the occurrence of complications. The actuarial rate of colectomy was less in smokers than in nonsmokers (32 +/- 12% and 42 +/- 6% at 10 years respectively. P = 0.04). Initial and cumulative extent of the disease process did not differ between the groups. However, in the subgroup of patients with limited disease at onset, development of pancolitis was less frequent in smokers than in nonsmokers (14 and 26%, respectively, P = 0.04). CONCLUSION: The lesser need for oral steroids and the lower actuarial rate of colectomy in smokers suggest that ulcerative colitis in smokers is characterized by a less severe clinical presentation and a better long term prognosis than in nonsmokers.

Actuarial Analysis↗
PubMed1997

The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study.

OBJECTIVE: To assess the long-term course of recovery and relapse and predictors of outcome in anorexia nervosa. METHOD: A naturalistic, longitudinal prospective design was used to assess recovery and relapse in patients ascertained through a university-based specialty treatment program. Patients were assessed semiannually for 5 years and annually thereafter over 10-15 years from the time of their index admission. Recovery was defined in terms of varying levels of symptom remission maintained for no fewer than 8 consecutive weeks. RESULTS: Nearly 30% of patients had relapses following hospital discharge, prior to clinical recovery. However, most patients were weight recovered and menstruating regularly by the end of follow-up, with nearly 76% of the cohort meeting criteria for full recovery. Relapse after recovery was relatively uncommon. Of note, time to recovery was protracted, ranging from 57-79 months depending on definition of recovery. Among restrictors at intake, nearly 30% developed binge eating, occurring within 5 years of intake. A variety of predictors of chronic outcome and binge eating were identified. There were no deaths in the cohort. CONCLUSION: The course of anorexia nervosa is protracted. Predictors of outcome are surprisingly few, but those identified are in keeping with previous accounts. The intensive treatment received by these patients may account for the lower levels of morbidity and mortality when considered in relation to other reports in the follow-up literature.

Adaptation, Psychological↗
PubMed2006

Predicting the long term course of low back pain and its consequences for sickness absence and associated work disability.

BACKGROUND: Low back pain is characterised by a dynamic pattern of episodes and recovery but little is known about the long term course of back pain due to lack of cohort studies with sufficiently long follow up periods. METHODS: A cohort of 523 workers in nursing homes and homes for the elderly was followed for two years. Physical load was measured by observations at the workplace. Psychosocial factors at work, individual characteristics, and low back pain were determined by questionnaire once a year. The effect of work load on low back pain and the transition of low back pain into sickness absence was calculated with logistic regression analysis. A Markov model was used to construct a hypothetical cohort of workers with follow up of 40 years (40 cycles of 1 year) with transitional probabilities between no complaints, low back pain, and sickness due to low back pain. Permanent disability was used as end state of health. RESULTS: The transitional probability from no complaints to low back pain varied between p = 0.25 and p = 0.29, from low back pain to sickness absence between p = 0.09 and p = 0.25, and recurrence of sickness absence varied between p = 0.27 and p = 0.50, depending on the level of physical load. During a 40 year career, total sickness absence due to low back pain was approximately 140 weeks (6.6%) among workers with high physical load and about 30 weeks (1.4%) among those with low physical load. CONCLUSION: The Markov approach illustrated the potential impact of physical load on (permanent) disability due to low back pain among workers with exposure to physical load. These consequences may go unnoticed in cohort studies with follow up periods of a few years.

Adult↗
PubMed1994

[Epidemiologic findings on the spontaneous long-term course of psychogenic disease over 10 years].

207 individuals were selected from a random sample of the adult urban population of Mannheim according to the criterion of medium psychogenic impairment (high-risk population) and investigated three times between 1979 and 1991 with regard to prevalence and severity of psychogenic disorders. In contrast to clinical investigations, the present data render statements on the spontaneous course of psychogenic disorders in the general population. The existing psychogenic impairment was determined by means of various operationalizations (symptomatology, ICD-diagnoses, severity of impairment). The available data indicate a high stability of psychogenic impairment in the spontaneous course. Group statistically the severity of impairment even increases in the long term course. However, different subtypes of course in the investigated high-risk population can be identified by a cluster analysis.

Adult↗
PubMed2006

[Long-term course of necrobiotic xanthogranuloma with ocular involvement].

The clinical features of necrobiotic xanthogranuloma (NX) have been presented in a series of case reports, but there are hardly any reports on the clinical long-term course of this rare and usually chronic entity. Therapeutic recommendations are mostly based on individual observations, lacking general therapeutic guidelines. To illustrate a typical chronic and progressive course of NX, we report the case of a 64-year-old woman with periorbital NX, ocular involvement and IgG paraproteinemia. Diagnosed with NX for the first time in 1993, the patient was already presented in this journal in 1995. Since then a series of therapeutic options including medication with dapsone, chlorambucil, interferon-alpha, clofazimine, melphalan, fumaric acid esters, surgical treatment and other physical therapies such as radiation, plasmapheresis, and photodynamic therapy have been applied. None of these therapeutic approaches, however, showed a satisfying long-term effect. At present the patient is undergoing cyclophosphamide-dexamethasone pulse therapy.

Eye Diseases↗
PubMed1989

Unipolar and bipolar schizoaffective disorders: a comparative study. II. Long-term course.

Seventy-two schizoaffective patients were investigated longitudinally (mean follow-up period 25.6 years). Of these, 37 were classified as unipolar and 35 as bipolar schizoaffectives. Their long-term courses were compared. Bipolar schizoaffectives were found to have shorter cycles, i.e. more frequent relapses and more episodes. Bipolars displayed much more variation in symptomatology. Unipolar schizo-affectives had longer periods of remission (that is the last relapse-free period if longer than 3 years) and more frequently showed suicidal symptomatology than did bipolar schizoaffectives. Altogether bipolar schizoaffective disorders had a more unfavourable course than unipolar disorders.

Adaptation, Psychological↗
PubMed2001

Elective splenectomy in the elderly--perioperative and long-term course.

BACKGROUND: The hazards of elective splenectomy in the elderly have not been thoroughly investigated. The aim was to assess such a well-defined cohort with respect to perioperative and long-term outcome. METHODS: Fifty-two consecutively splenectomised patients during the period 1971-1995, aged 65 years or older, were followed until death (44 cases) or the end of 1999 (8 cases). RESULTS: No intraoperative deaths occurred, while three patients (5.8%) died postoperatively in the 1970s. Twenty-four patients suffered from thirty-four postoperative complications, dominated by infections and haematomas. No differences were seen comparing patients with and without complications related to the American Society of Anesthesiologists' classes, total transfusion rate, steroid medication, preoperative risk diseases, "giant spleens" or the time period during which the operations were performed. In 69% of the patients, the splenectomy was beneficial. During the long-term follow-up, 25 patients suffered from 59 infectious and thromboembolic episodes and 1 surgical complication. The dominating causes of death were the primary disease (29%), myocardial infarction (20%), sepsis (12%) and cerebrovascular lesions (12%), i.e. not directly related to late effects of the operation. CONCLUSION: High-risk patients older than 65 years with haematological disorders can safely undergo splenectomy with a low mortality rate and a reasonable rate of morbidity. The long-term course demonstrates a fair response rate, minimal surgically related complications, but thromboembolic and infectious events, and the majority of deaths unrelated to late effects of the splenectomy.

Aged↗
PubMedDate not supplied

[Comparison of long-term course of perforating and non-perforating Crohn disease].

OBJECTIVES: To evaluate the influence of the indication of the first surgical procedure on the prognosis of Crohn's disease. METHODS: We compared retrospectively the long-term course of 179 patients operated on for a perforating disease and 322 patients operated on for a nonperforating disease. Mean follow-up was 11 years and 2 months in the two groups. RESULTS: Forty of 179 (25%) and 106 of 322 (33%) patients with perforating and nonperforating diseases underwent a second intestinal resection, respectively. The patients who had been operated on for a perforating disease were significantly more often reoperated on for the same indication, and conversely. Patients with perforating diseases experienced less second resections (actuarial rates: 37 +/- 11% vs 51 +/- 8% at ten years respectively), less post-surgical handicaps (mean index 24.9 vs 27.9), and fewer patients required immunosuppressive drugs (25 vs 35%). CONCLUSION: Long-term prognosis of perforating Crohn's disease does not appear to be more severe than that of nonperforating disease.

Adult↗
PubMed2001

Long term course of chronic posttraumatic stress disorder in traffic accident victims: a three-year prospective follow-up study.

The purpose of the present study was to gather prospective longitudinal data on the long-term course and outcome of chronic posttraumatic stress disorder (PTSD). The target population for this study was 74 injured traffic accident victims who had been previously followed-up for one year after the trauma. Nineteen of the original 24 PTSD subjects (79%) and 39 of the original 50 Non-PTSD subjects (78%) were available for this study, which took place during the fourth year after the accident. Our results show that 10 (53%) of the 19 patients with PTSD at one-year still suffered from PTSD after another two-year follow-up interval, while 9 recovered from PTSD during this follow-up period. Only 2 of the 39 without PTSD at one year developed delayed onset PTSD. The best predictor of recovery from chronic PTSD was the initial level of posttraumatic reaction immediately after the accident. These results demonstrate that spontaneous recovery from PTSD can occur even among patients who are currently considered chronic. Severity of initial reaction to the trauma appears to be a major risk factor for non-remitting chronic PTSD.

Accidents, Traffic↗
PubMed2003

Mulibrey heart disease: clinical manifestations, long-term course, and results of pericardiectomy in a series of 49 patients born before 1985.

BACKGROUND: Mulibrey nanism is a rare inherited disease characterized by growth failure and multiorgan manifestations, including constrictive pericarditis. Its long-term course, the results of pericardiectomy, and the details of myocardial involvement have not been reported previously. METHODS AND RESULTS: We studied 49 patients (26 men) born before 1985 and followed for up to 25 years. By 1999, 25 patients (51%) had developed congestive heart failure (CHF), 19 (39%) had undergone pericardiectomy for constrictive pericarditis, 10 (22%) had died of cardiac causes, and 5 (10%) had died of noncardiac causes. Of the 19 pericardiectomized patients, 12 derived lasting clinical benefit, whereas 1 patient suffered an early noncardiac death and 6 died later of unrelieved or recurrent CHF. At echocardiography in 34 living patients, left ventricular mass adjusted for body height and weight averaged (+/-SEM) 149+/-5 g in 21 unoperated patients, 144+/-8 g in 13 pericardiectomized patients, and 104+/-7 g in 16 healthy persons matched for age and sex (P=0.000). Autopsies of 11 patients showed fibrotic thickening of the pericardial leaves with myocardial hypertrophy and variable but mostly mild myocardial fibrosis. Endocardial thickening was seen in 3 patients. CONCLUSIONS: Constrictive pericarditis, myocardial hypertrophy, and variable myocardial fibrosis constitute the main elements of Mulibrey heart disease. At least one half of patients ultimately develop CHF. Pericardiectomy generally provides clinical benefit, but in approximately one third of patients, CHF may recur because of coexisting myocardial involvement.

Adolescent↗
PubMed1976

The long-term course of carcinoma in situ of the uterine cervix.

The malignant potential of carcinoma in situ (CIS) of the uterine cervix has been the subject of great controversy. Despite refinements and additions to knowledge in this area, few reports on the long-term course of the disease have appeared in the past decade. Recent developments in diagnostic and therapeutic techniques coupled with changes in the patient population with this disease have prompted renewed interest in conservative management. Results of long-term observation of a group of patients followed initially without ablative therapy are reported. The data indicate that CIS of the uterine cervix is not the inevitably progressive disease that it has been considered to be. Unequivocal invasive cancer develops in only a small percentage of cases and can be controlled, if not cured, by current therapeutic modalities. The intraepithelial lesion, however, tends to persist despite conization, and eventually requires ablative therapy in most cases. Conservative procedures should be regarded as temporizing, at least until their long-term benefits can be recorded.

Adult↗
PubMed2002

Long-term course of restless legs syndrome in dialysis patients after kidney transplantation.

Restless legs syndrome (RLS) is a common cause of sleep disturbance and is frequently experienced by hemodialysis patients. Factors triggering the disease in uremia have not yet been identified. To our knowledge, the course of RLS symptoms after kidney transplantation has not been investigated systematically. We investigated the clinical long-term course of RLS in hemodialysis patients who underwent kidney transplantation. Patients were given a standardized questionnaire three times: at baseline, and twice after their kidney transplants. The severity of RLS was rated by the patients (0 =no symptoms, 10 = very severe symptoms). The description of the final outcome was based on the last follow-up visit. Eleven of 64 hemodialysis patients with RLS received a transplant (5 men, 6 women; severity of RLS at baseline, 7.8 +/- 0.7 [mean +/- SEM]). In all patients, RLS symptoms disappeared within 1 to 21 days after transplantation. At follow-up visits, 4 patients whose transplanted kidneys still functioned well were still free of RLS symptoms up to the longest follow-up period of 9 years. In 3 other patients, RLS symptoms gradually reappeared (severity, 1 +/- 0). In 3 of 11 patients, the transplant failed and RLS symptoms reoccurred within 10 days to 2 months (severity, 7.3 +/- 2.6). RLS symptoms reoccurred in 1 patient with failure of the transplant but disappeared again after a second, successful transplant. Kidney transplantation has a strong and positive influence on RLS symptoms in hemodialysis patients. Hemodialysis patients can expect a substantial improvement of RLS symptoms after a successful kidney transplant.

Adult↗
PubMed1981

[Periarteritis nodosa with a long-term course in childhood and adolescence].

An observation of long-term periarteritis nodosa (15 years) in a girl of 19 is described. Despite massive hormonal therapy leading to the development of the Icenko-Cushing syndrome, the disease ran its course with numerous exacerbations which produced significant changes in organs and tissues. The death was due to adrenal insufficiency during an episode of the disease exacerbation.

Adult↗
PubMed1999

Left ventricular filling in the hypertensive patient: long-term course and influence of treatment.

BACKGROUND: Hypertension is accompanied by abnormalities in left ventricular filling; however, there is a lack of agreement on the extent of the influence of antihypertensive treatment on them. HYPOTHESIS: The present study was designed to evaluate the long-term course of these abnormalities in both treated and untreated hypertensive patients. METHODS: Left ventricular filling assessed by pulsed Doppler echocardiography of mitral flow was studied over a long follow-up period in both untreated and treated hypertensive patients. This retrospective study included 73 hypertensive patients who had not received any treatment. They had been followed up for at least 3 years and were divided a posteriori into two groups: Group 1 comprised the untreated patients, while Group 2 included the patients who had received antihypertensive treatment throughout the follow-up period. RESULTS: In the overall population, age and heart rate measured during the Doppler examination were the only parameters that correlated significantly with mitral flow. No significant changes in blood pressure or left ventricular mass were observed in Group 1 (14 patients) over the study period. There was a slight but nonsignificant decrease in E/A ratio of mitral flow. In the treated patients, there was a drop in heart rate-adjusted E/A ratio, despite a reduction in blood pressure and left ventricular mass, at mean follow-up of 5 years. CONCLUSION: Antihypertensive therapy did not arrest the long-term reduction in E/A ratio in hypertensive patients despite reduction in blood pressure and left ventricular mass.

Adult↗
PubMed1993

Subtypes in schizophrenic disorders: frequencies in long-term course and premorbid features.

The subclassification of schizophrenic disorders according to four diagnostic systems (DSM-III-R, ICD-10, the positive vs. negative dichotomy and Schneider's first rank symptoms) was compared over the long-term course of the disease in 148 narrowly defined schizophrenic patients. A total of 595 episodes were classified over a mean observation period of 23 years (range 10-50 years). Initially, paranoid/positive subtypes predominated, while later in the course episodes fulfilling the symptomatological criteria of residual/negative subtypes became more frequent. Disorganised/hebephrenic and catatonic subtypes were found to be rare. Some premorbid features were investigated as non-symptomatological validators for subclassification. Significant differences were found with regard to age at onset. Patients whose first episode was paranoid or positive had the highest age at onset. Patients with initial disorganised/hebephrenic or "residual" episodes had the most unfavourable premorbid social adjustment, even when the influence of age at onset was discounted. The diagnostic systems investigated showed similarities and differences as a result of the underlying concepts. Methodological implications are discussed.

Adult↗
PubMedDate not supplied

[Long-term course of infarct of the right ventricle].

The long-term evolution of 36 patients surviving the phase of hospitalization after a postero-inferior infarction with extension to the right ventricle was studied. Patients included 7 women and 29 men with a mean age of 55 years. Follow-up time averaged 39 months (range: 4 to 78 months). The evolution of acute phase was analyzed and correlated with mortality, complications and long-term evolution of functional capacity. Mortality at the end of follow-up period was 5.5%. Five patients developed another myocardial infarctions (16%). No patient manifested right heart failure; in one case tricuspid regurgitation was evident. The majority of the patients (55.5%) were in functional class I of the NYHA, while 36.6% were in class II and 8.3% in class III. We conclude that long-term mortality of those patients with right ventricular infarction is not greater than that of other patients with myocardial infarction, and that the great majority have a favorable evolution in regard of functional capacity. Impared function is generally due to left ventricular failure secondary to the severity and extension of coronary lesions. The subgroup of patients with severe right ventricular dysfunction during the acute phase of the infarction did not have a worse long-term prognosis.

Adult↗