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PubMed1996

Effects of cigarette smoking on the long-term course of Crohn's disease.

BACKGROUND & AIMS: In Crohn's disease, smoking increases the risk for surgical procedures. The influence of smoking on the overall severity of the disease remains controversial. The purpose of the study was to examine the effects of smoking on the long-term course of Crohn's disease and the relationship between smoking and therapy. METHODS: The medical charts of 400 consecutive patients whose smoking habits were specified by direct interview were reviewed. RESULTS: Frequency and extent of excisional surgery were not significantly different in smokers and nonsmokers, but smokers required more glucocorticoids and immunosuppressive drugs. The effect of smoking on the need for immunosuppressive drugs was dose-dependent and was significant in women but not in men. For female smokers, the 10-year risk of immunosuppressive therapy was 52% +/- 11% compared with 24% +/- 10% for nonsmokers (P < 0.001). The risk of surgery increased only in patients who smoked and did not take immunosuppressive drugs. The surgical rate increased significantly during smoking in 19 patients who started smoking after diagnosis and decreased significantly in 34 patients who stopped compared with matched controls. CONCLUSIONS: Patients who smoke, particularly women and heavy smokers, run a high risk of developing severe disease. Immunosuppressive therapy neutralizes the influence of smoking on surgical rates.

Actuarial Analysis↗
PubMed1994

[Permanent repetitive nonparoxysmal ventricular tachycardia. II. The results of using anti-arrhythmia preparations and the characteristics of its long-term course].

A total of 20 patients with repetitive nonparoxysmal ventricular tachycardia (RNVT) underwent Holter ECG monitoring to test efficacy of successive oral antiarrhythmic drugs. The response was recorded in 50% of the patients. Although the effect of the drugs persisted for a few months only, RNVT ran without severe symptoms, in contrast to paroxysmal ventricular tachycardia. Long-term course of RNVT is characterized by dilatation of the left ventricular compartment under increasing ejection fraction and absence of cardiac insufficiency. A close relationship exists between the end-diastolic volume, ejection fraction of the left ventricle and RNVT duration. This is attributed to heart adaptation to long-term activity in the conditions of tachycardia.

Adolescent↗
PubMed1995

Long-term course of neonatal diabetes.

BACKGROUND: Neonatal diabetes mellitus--defined here as hyperglycemia occurring within the first month of life that lasts for at least two weeks and requires insulin therapy--is a very rare form of the disease. Little is known about it, particularly with respect to its long-term course. METHODS: We studied two brothers who had neonatal diabetes and obtained follow-up information on 34 patients described in the literature as well as information on 21 additional patients. Forty-seven of the patients had neonatal diabetes, as defined above, and in 10 others the onset was between the first and third month of life. RESULTS: Twenty-six of the 57 infants had permanent diabetes, 18 had transient diabetes, and 13 had transient diabetes that recurred when they were 7 to 20 years old. Neonatal diabetes was associated with the Wolcott-Rallison syndrome in six infants, hyperuricemia due to phosphoribosyl-ATP pyrophosphatase hyperactivity in two, and celiac disease in two. Forty-one of 45 neonates in whom the duration of gestation and birth weight were known were small for their gestational ages. There were two pairs of affected twins and four other families with two or more infants with neonatal diabetes, but only three parents had diabetes. The incidence of neonatal diabetes mellitus in Germany has been estimated to be 1 in 500,000 neonates. CONCLUSIONS: Neonatal diabetes differs from insulin-dependent diabetes in that its course is highly variable. Some patients have permanent diabetes, but others have transient or lasting remissions.

Diabetes Mellitus↗
PubMed2004

Long-term course and outcome of obsessive-compulsive patients after cognitive-behavioral therapy in combination with either fluvoxamine or placebo: a 7-year follow-up of a randomized double-blind trial.

Longitudinal studies with very long follow-up periods of patients with obsessive-compulsive disorder (OCD) who have received adequate treatment are rare. In the current study, 30 of 37 inpatients (81%) with severe OCD were followed up 6-8 years after treatment with cognitive-behavioral therapy (CBT) in combination with either fluvoxamine or placebo in a randomized design. The significant improvements (with large effectsizes) in obsessive-compulsive symptoms from pre- to post-treatment (41% reduction on the Y-BOCS) remained stable at follow-up (45 %). Responder rates, defined as > or = 35% reduction on the Y-BOCS, were 67% and 60%, respectively. Depressive symptoms decreased significantly not only from pre- to post-treatment but also during follow-up. Re-hospitalization, which occurred in 11 patients (37 %), was associated with more severe depressive symptoms at pre-treatment and living without a partner. Full symptom remission at follow-up, defined as both Y-BOCS total score < or = 7 and no longer meeting diagnostic criteria for OCD, was achieved by 8 patients (27 %). Patients without full remission at follow-up had a significantly longer history of OCD, assessed at pretreatment, compared to remitted patients. The shortterm treatment outcome had no predictive value for the long-term course. Throughout the naturalistic follow-up, nearly all patients (29 patients) received additional psychotherapy and/or medication. This might indicate that such chronic OCD patients usually need additional therapeutic support after effective inpatient treatment to maintain their improvements over long periods.

Adult↗
PubMed1989

[Etiology and long-term course of subclavian vein thrombosis with reference to acute therapy].

Contrary to deep venous thrombosis of the lower extremity, subclavian vein thrombosis (SVT) is rather rare. Although the problem has been known for more than 100 years, the rarity of its incidence accounts for the persistent uncertainty concerning the indication and modalities of acute therapy as well as the long-term course. In the majority of 96 patients observed between 1976 and 1983 SVT was due to central venous catheter, neoplasm and thoracic outlet syndrome. 2 of 96 patients developed pulmonary embolism. 45 patients without malignancy were available for follow-up studies. Acute therapy included anticoagulation in 27, fibrinolysis in 10 and rib resection in 8 cases. The mean follow-up averaged 6.3 years and confirmed a favorable course independent of the acute therapy modality. There were none of the trophic alterations so often found in the lower extremity and no patient was unable to work as a consequence of SVT. However, minor late sequelae occurred quite frequently: slight symptoms in one third, and minor incapacity for sport in 25% of the cases. 75% of the patients showed clinical signs of stasis, such as venous bypass circulation, edema and/or cyanosis. The average post-thrombotic score (1.3 out of a possible 4) confirms the minor significance of the findings. A rather important reduction in venous backflow was found by plethysmography in 4% of the patients. We favor immediate anticoagulation, mainly to cover the risk of pulmonary embolism. This should be continued for at least 3 months in order to prevent early recurrence of thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed2001

Clinical and subclinical acute rejection early after liver transplantation: contributing factors and relevance for the long-term course.

Routine transplant aspiration cytology (TAC) after liver transplantation gives detailed information that concerns immunologic events in the graft. TAC can be helpful for diagnosis of acute rejection, but it also detects morphological signs of rejection without clinical correlate ("subclinical rejection"). The aim of this study was to systematically evaluate factors that influence the development of early clinical and subclinical rejection and to analyze the relevance of these early immunologic processes for the long-term course. The study includes the course of 340 patients after liver transplantation between 1988 and 1995 in whom TAC was performed routinely and who were followed for a minimum of 3 years. TAC findings were correlated with the following various clinical parameters: (1) Overall early clinical rejection occurred in 17.4%, subclinical rejection in 59.1%, and no immune activation was seen in 23.5% of patients. (2) Incidence of early clinical and subclinical rejection was markedly influenced by type of immunosuppression. (3) Basic disease and extent of preservation injury had only a minor influence; there was a trend towards lower early rejection associated with more severe preservation damage, increased patient age, and early retransplantation. (4) Presence of early clinical or subclinical rejection was not associated with a higher incidence of chronic dysfunction. (5) Falsely indicated antirejection treatment was associated with inferior graft survival. Subclinical rejection is very frequent early after liver transplantation, requires no treatment, and has no long-term adverse effect. Incidence of early clinical rejection is mainly determined by initial immunosuppression; its occurrence has no negative long-term effects and may even be associated with a lower risk for later immunological complications. Thus, the incidence of early acute rejection is no adequate parameter for evaluating the quality of an immunosuppressive treatment protocol.

Acute Disease↗
PubMed1994

Successful long-term course after heart transplantation for anthracycline cardiomyopathy in a young boy despite neurological complications.

A now 14-year-old boy underwent orthotopic heart transplantation at the age of 13 for anthracycline cardiomyopathy which was a sequela of polychemotherapy for embryonal teratocarcinoma at the age of 1 year. Despite perioperative cerebellar infarction with signs of herniation which required emergency right cerebellar hemispherectomy the long-term course after 18 months turned out to be favorable with complete medical and psychosocial rehabilitation.

Adolescent↗
PubMed2003

Low back pain: what is the long-term course? A review of studies of general patient populations.

It is often claimed that up to 90% of low back pain (LBP) episodes resolve spontaneously within 1 month. However, the literature in this area is confusing due to considerable variations regarding the exact definitions of LBP as well as recovery. Therefore, the claim--attractive as it might be to some--may not reflect reality. In order to investigate the long-term course of incident and prevalent cases of LBP, a systematic and critical literature review was undertaken. A comprehensive search of the topic was carried out utilizing both Medline and EMBASE databases. The Cochrane Library and the Danish Article Base were also screened. Journal articles following the course of LBP without any known intervention were included, regardless of study type. However, the population had to be representative of the general patient population and a follow-up of at least 12 months was a requirement. Data were extracted independently by two reviewers using a standard check list. The included articles were also independently assessed for quality by the same two reviewers before they were studied in relation to the course of LBP using various definitions of recovery. Thirty-six articles were included. The results of the review showed that the reported proportion of patients who still experienced pain after 12 months was 62% on average (range 42-75%), the percentage of patients sick-listed 6 months after inclusion into the study was 16% (range 3-40%), the percentage who experienced relapses of pain was 60% (range 44-78%), and the percentage who had relapses of work absence was 33% (range 26-37%). The mean reported prevalence of LBP in cases with previous episodes was 56% (range 14-93%), which compared with 22% (range 7-39%) for those without a prior history of LBP. The risk of LBP was consistently about twice as high for those with a history of LBP. The results of the review show that, despite the methodological variations and the lack of comparable definitions, the overall picture is that LBP does not resolve itself when ignored. Future research should include subgroup analyses and strive for a consensus regarding the precise definitions of LBP.

Adolescent↗
PubMed2000

[Prognostic and therapeutic relevance of cognitive characteristics for the long-term course of schizophrenic illness following psychoeducational psychotherapeutic treatment].

In a prospective, randomized clinical trial cognitive characteristics of schizophrenic patients were examined as predictors of the efficacy of a psychoeducational psychotherapeutic intervention. The aim of this study was to select adequate cognitive predictors. The reduction of the selected cognitive deficits by means of a psychoeducational psychotherapy was measured. Additionally, the prophylactic effects of the improvement of cognitive deficits were examined. Predictors of the course of illness were basic cognitive deficits and metacognitive constructs of 106 schizophrenic outpatients. Additionally, the modification of the cognitive skills of these patients was taken into account. Relevant factors of the course of illness representing the therapeutic effect of the intervention were investigated within a five-year follow-up. By means of logistic regression analyses thought disorders (AMDP system) and idiosyncratic and fatalistic assumptions (KK-scale) were obtained as appropriate cognitive predictors of the long-term course of illness. Thought disorders and attentional deficits could not be improved significantly. Though, there was a correlation between the therapeutic improvement of idiosyncratic and fatalistic assumptions and the rehospitalization rate within the follow-up.

Adult↗
PubMed2006

The Wuerzburg Research Initiative on Adult Attention-Deficit/Hyperactivity Disorder (WURIN-AADHD): multi-layered evaluation of long-term course.

Although the neurobiological basis of the clinical entity of attention-deficit/hyperactivity disorder (ADHD) is evident, data from studies on pathomechanism-phenotype correlations are inconsistent. There are several obvious limitations of the DSM-IV diagnostic criteria to describe an adequate phenotype of adult ADHD. A dimensional model of neurobiologically based endophenotypes is therefore more likely to be compatible with the genetic model of quantitative trait loci. The primary goal of the Wuerzburg Research Initiative on Adult Attention-Deficit/Hyperactivity Disorder (WURIN-AADHD) is to test the validity of two endophenotypes, deficit in response inhibition and impairment of working memory, using various psychometric and neurobiological strategies of investigation in adult patients with ADHD. An additional objective is the investigation of the long-term course of adult ADHD. The conclusive description of valid endophenotypes of ADHD is an ongoing process that may result in a comprehensive neurobiological model for ADHD or its symptom dimensions integrating genetic, neural, cognitive, and behavioral mechanisms. This model will eventually facilitate description of complete causal connections occurring across the lifespan from early development to adulthood and is also likely to accelerate development of more specific and efficient therapeutic strategies in adult ADHD.

Adult↗
PubMed1998

Long-term course of acute brief psychosis in a developing country setting.

BACKGROUND: This study in North India compared acute brief psychosis--defined by acute onset, brief duration and no early relapse--with other remitting psychoses, over a 12-year course and outcome. METHOD: In a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD-10 criteria. RESULTS: At 12-year follow-up, the proportion with remaining signs of illness was 6% (n = 1) for acute brief psychosis versus 50% (n = 18) for the comparison group (P = 0.002). Using ICD-10 criteria, the majority in both groups were diagnosed as having schizophrenia. CONCLUSIONS: Acute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD-10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD-10 criteria need modification.

Acute Disease↗
PubMed2003

Different long-term course between chest pain and exercise-induced ST depression in syndrome X.

The aim of the present study was to assess the long-term clinical course of patients with syndrome X, focusing on different courses between exercise-induced ST depression and chest pain. Forty-three patients with syndrome X were followed up for 6.4 +/- 3.8 years. They were divided into the 3 groups according to chest pain: disappeared (n = 24), improved (n = 14), or unchanged (n = 5). No patients had cardiac events and all had a favorable long-term prognosis. In patients showing disappearance of chest pain, exercise-induced ST depression and rate-pressure product (RPP) at peak exercise did not change during follow-up. However, ST depression and RPP decreased significantly in those with improved chest pain. These observations suggest that abnormal pain perception plays an important role in the development of chest pain.

Adult↗
PubMed2003

Altered alanine plasma levels despite normalized hepatic alanine extraction in the long-term course after liver transplantation.

BACKGROUND: The amino acid (AA) metabolism in cirrhosis is deranged, reflected by an altered plasma AA profile. Alanine is a unique AA with predominant production by muscle and the highest hepatic extraction rate. METHODS: We studied circulating levels and hepatic alanine extraction in 52 patients with advanced cirrhosis, 16 stable patients more than 6 months after orthotopic liver transplant (OLT), and 50 controls. In addition, hepatic hemodynamics (portal pressure, hepatic blood flow, and splanchnic percent indocyanine green extraction) and parameters of hepatic metabolism (splanchnic oxygen uptake and splanchnic glucose production) were assessed. RESULTS: Circulating alanine levels decreased independently of the clinical stage in cirrhosis (262+/-15 micromol/L vs. 330+/-14 micromol/L in controls, P<0.001) and decreased even further after OLT (209+/-10 micromol/L, P<0.001). Hepatic alanine extraction decreased dependently on the clinical stage in cirrhosis (59+/-7 micromol/min) and was normalized after OLT (100+/-10 micromol/min, P<0.001), indicating that decreased plasma alanine levels in OLT patients are the result of changes in extrahepatic metabolism. Hepatic alanine extraction correlated with splanchnic oxygen uptake (r=0.64, P<0.001) and hepatic glucose production (r=0.65, P<0.001). CONCLUSIONS: These results demonstrate that significant alterations in muscular AA metabolism persist even in the clinically stable long-term course after OLT when the hepatic AA metabolism is normalized.

Adult↗
PubMed2004

[Long-term course of reflux symptoms following Helicobacter pylori eradication].

BACKGROUND AND OBJECTIVE: Conflicting data regarding new onset or deterioration of gastroesophageal reflux disease (GORD) following eradication of Helicobacter pylori infection have been reported. Successful eradication therapy may influence gastric acid output. The study aimed to to investigate whether patients with pre-existing GORD or peptic ulcer disease may experience deterioration of GORD. PATIENTS AND METHODS: 75 consecutive patients of a prospective longitudinal study (median age 66 years, n = 45 males) had received successful H. pylori eradication therapy because of the following main diagnosis: peptic ulcer (n = 37), GORD (n = 16), functional dyspepsia (n = 22). Two to three years later, they had an interview regarding the course of their dyspeptic and reflux symptoms. Negative H. pylori status at present was confirmed by (13)C-urea breath test in all patients. Ten patients were excluded because of proton pump inhibitor treatment. RESULTS: Patients with deterioration of GORD (new onset or increasing reflux symptoms) were found significantly more frequently in the group with functional dyspepsia (36 %) compared to pre-existing GORD (16 %) or peptic ulcer disease (5 %). Improvement of pre-existing reflux complaints were reported mostly by patients with peptic ulcer disease. There was no significant impact of initial reflux manifestations like reflux symptoms or reflux oesophagitis on the course. CONCLUSIONS: During long-term follow-up after H. pylori eradication, patients experience improvement as frequently as deterioration of reflux symptoms. There is a tendency towards improvement of reflux symptoms if peptic ulcer disease had been the indication for eradication, but towards deterioration in patients with initial functional dyspepsia. A clinical relevant prediction, however, is not feasible.

Adult↗
PubMed1995

[Preclinical resuscitation--which factors influence the long-term course? A 5-year follow-up].

OBJECTIVE: The factors that influence long-term survival after out-of-hospital resuscitations were investigated. PATIENTS AND METHODS: Between 1985 and 1989, out of a total of 8403 responded emergency calls, 505 resuscitations were undertaken out of hospital by the emergency medical service in Göppingen. All emergency calls were recorded uniformly. Of the 505 resuscitations, 154 were primarily successful (30.5%), and 58 were secondarily successful, i.e. the patients were ultimately discharged from hospital. In 56 of them the further course could be followed at least 5 years after the resuscitation (45 males, 11 females; mean age 57 [10-83] years). The patients' charts were analysed; in 51 cases data could be obtained from the family doctor, from ambulant care or from home visits. RESULTS: 34 patients (60.4%) were still alive 5 years after the resuscitation. The highest death rate (16%) was in the first post-resuscitation year. Prognostically unfavourable factors were: advanced age (P < 0.01), underlying cardiac disease (n = 49; P < 0.025), especially coronary heart disease (n = 34; P < 0.01). Patients with primary ventricular fibrillation and previous myocardial infarction (n = 10) had a poorer prognosis than those with acute infarction (n = 24; P < 0.05). Reduced survival chances occurred in those with impaired left ventricular function, as measured echocardiographically (P < 0.05), or with cardiac arrhythmias, Lown classes III and IV (P < 0.05), as well as in those with severe neurological sequelae (n = 8; P < 0.08). CONCLUSION: Long-term prognosis depends, in the first instance, on the resuscitated patient's basic condition and not so much on the circumstances of the resuscitation.

Adolescent↗
PubMed1980

[Long-term course of patients with myocardial infarction and bundle branch block].

The long-term outcome of myocardial infarction (MI) with bundle branch block (BBB) was studied retrospectively by a direct questionnaire and a registry enquiry in order to define the prognostic significance of data obtained during hospitalisation and to discuss the possible indications of permanent pacing in these patients. Out of 2 720 acute MI hospitalised between October 1969 and April 1977, 231 and BBB (unknown before infarction): 58 right, 53 left and 120 bilateral BBB. 113 patients survived the acute phase of MI and 111 patients were followed up for 72 +/- 24 months: 80 patients died, and 30 survive - a global survival rate of only 13% at 6 years. The post-admission mortality rate was not related to the type of BBB or the site of infarction. It was significantly higher in patients with previous myocardial infarction and in a sub group of patients without advanced AV block in the acute phase who had severe cardiac failure (Classes III and IV, Killip). The hospital mortality was higher in patients with advanced AV block in the acute stage (62,5% compared to 45,9%) in patients without advanced AV block, p < 0,025. On the other hand, the post-admission mortality was not significantly different in these two sub groups (77,8% compared to 69,8% : NS). Stokes-Adams syncope was rarely authentified in the post-admission course of the patients. An increased risk of secondary sudden death directly related to a conduction defect has not been proved. The indications for permanent pacing therefore remain uncertain. They should not be widened further than the indications for permanent pacing in chronic degenerative block.

Bundle-Branch Block↗
PubMed1994

Effect of chemotherapy on the larval mass and the long-term course of alveolar echinococcosis. Swiss Echinococcosis Study Group.

The efficacy of long-term chemotherapy in nonresectable alveolar echinococcosis is debated, particularly because of the difficulty in defining therapeutic success. In this study the effect of chemotherapy on the parasitic mass was evaluated in a series of 37 patients. The patients had larval lesions documented by serial computed tomography studies at least 1.5 yr after chemotherapy (mean = 6.4 yr, range = 1.5 to 10.7 yr). The therapeutic regimen consisted of mebendazole (n = 34) or albendazole (n = 3) as previously described. The maximal areas of the parasitic lesions were assessed morphometrically by means of digital image analysis, utilizing the point-integration method, before and after chemotherapy. Marked regression of larval tissue occurred in 18 patients (group A; 48.6%), stationary lesions were noted in 13 patients (group C; 35.1%) and progression was found in 6 patients (group B; 16.2%). The three groups did not differ significantly with regard to age, plasma drug levels, duration of chemotherapy or initial size and composition of lesions (e.g., cystic cavities, degree of calcification). Despite morphologically successful chemotherapy in moist patients (e.g., 84%; groups A and C), late cholestatic complications after 1.5 to 11 yr of chemotherapy occurred in 10 patients (group A, n = 7; group C, n = 3; 4 of them died) and esophageal variceal bleeding occurred in 3 patients (relieved by sclerotherapy). These late complications were probably mainly due to posttherapy fibrosis of hilar structures. In conclusion, our data support the efficacy of chemotherapy. However, chemotherapy is not curative, and severe late complications were observed in patients with hilar (fibrotic) involvement.

Adult↗