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PubMed1981

Wegener's granulomatosis - clinical-pathologic correlations and long-term course.

Although Wegener's granulomatosis is a relatively well defined clinical-pathologic entity, there are few long-term reports of large numbers of patients followed at a single institution. This has hindered appreciation of the diagnosis, management, and course of the syndrome. We report an analysis of 18 patients followed at one medical center. Delay in treatment can be obviated by awareness of this potential diagnosis in any patient with combined respiratory and renal manifestations. Biopsy of involved respiratory tissue yields a high probability of establishing a specific diagnosis, while biopsy of renal tissue often provides confirmatory evidence of a vasculitic disease process. The initial degree of renal involvement as manifested by serum creatinine, proteinuria, and light microscopic morphology correlates well with eventual prognosis. The availability of modern immunosuppressive therapy and of modalities to treat end-stage renal disease appears to have greatly influenced the course of the disease.

Adult↗
PubMed2003

Long term course of the H reflex after selective tibial neurotomy.

OBJECTIVES: This study was conducted to evaluate the long term clinical and electrophysiological outcome by recording the H reflex in a consecutive series of six patients treated by selective tibial neurotomy for spastic equinus foot. METHOD: The amplitudes of Hmax reflexes, Mmax responses, and Hmax:Mmax ratio were recorded in six patients with chronic lower limb spasticity, before and after surgery, at day 1 and 8 months and 24 months after selective tibial neurotomy. The passive range of movement, the stretch reflex score according to the Tardieu scale, the osteoarticular and tendon repercussions, and the quality of motor control of dorsiflexion were evaluated preoperatively and postoperatively. RESULTS: At the end of the study, all patients presented a reduction of equines. Gait and Tardieu's score of spasticity had improved in all patients. Active dorsiflexion of the ankle was unchanged in four patients, but two improved by 5 degrees to 12 degrees. In five cases, fascicular resection of the superior nerve to soleus was, alone, sufficient to reduce spastic equinus foot, without recurrence, for a mean follow up of 28 months. Two patients were reoperated on, one for remaining spasticity related to an underestimated spasticity of the gastrocnemius muscles, and the other for painful claw toes. Hmax, Mmax, and Hmax:Mmax ratios were significantly lower the day after surgery. The reduction of Hmax and Hmax/Mmax ratio remained stable over time and was still statistically significant two years after the operation. However, the value of Mmax eight months postoperatively was no longer significantly different from the preoperative value. CONCLUSION: This study shows the long term efficacy of the selective tibial neurotomy as treatment of spastic equinus foot. Neurotomy confined to fibres supplying the soleus muscle is sufficient in most cases and acts by decreasing sensory afferents without significant long term motor denervation.

Adolescent↗
PubMed1984

[Effect of social factors on the long-term course of schizophrenia].

On the basis of the literature and of his own research concerning the long-term-evolution and the vocational rehabilitation of schizophrenics, the author shows that social factors play an important role in the long-term-evolution of schizophrenia. Of particular importance is the influence of the therapeutic setting, of overtaxing "life-events", of the family atmosphere, of the institutional infrastructure, of the expectations of the social environment, and of several socio-economic and cultural factors. Biological and psychosocial influences can be combined into a multiconditional model of schizophrenia in three phases, in which the vulnerability- und information-processing-hypothesis are central. This model leads to interesting consequences for the prevention and the therapy of schizophrenia.

Antipsychotic Agents↗
PubMed1998

Short and long term course of elderly patients with peptic ulcer bleeding--analysis of factors influencing fatal outcome.

OBJECTIVE: To study long and short term survival in patients aged 60 years or over admitted with a peptic ulcer bleeding and find out which factors influence outcome. DESIGN: Cohort study with matched controls. SETTING: Two emergency hospitals, Sweden PATIENTS: 676 of the 687 patients aged 60 years or over admitted to the two emergency hospitals serving Gothenburg, Sweden during 1989-1993 who fulfilled the diagnostic criteria and whose case notes were available for study. MAIN OUTCOME MEASURES: Seven year survival rates and odds ratios for risk factors based on multiple logistic regression analyses. RESULTS: 37 patients died and the timing was evenly distributed within the first 30 days of admission with a cumulated case-fatality rate of 5.5% at day 30. Mortality was increased among the patients compared with the control group during the subsequent years. Factors that influenced day 30 mortality were age and Forrest class. CONCLUSION: Mortality is increased among patients with peptic ulcer bleeding even long after the event. Old age and signs of recent haemorrhage increase the risk.

Age Factors↗
PubMed1997

The long-term course of childhood-onset schizophrenia: a 42-year followup.

This article presents results of a 42-year long-term followup of 44 patients (19 males, 25 females) with childhood-onset schizophrenia. Age at onset ranged from 6 to 14 years (mean =11.8 years). The patients and their first-degree relatives were interviewed in 1994, 27 years after the first followup, by the same investigator with the Present-State Examination (PSE) and the Disability Assessment Schedule. The clinical records were analyzed with the Instrument for the Retrospective Assessment of Onset of Schizophrenia and with sections of the PSE. The cases were rediagnosed according to DSM-III-R, based on longitudinal data obtained between onset and the first hospital admission. Although cumulative prevalence is earlier in females than in males, no gender differences exist in average age at onset. An acute onset was significantly more frequent after 12 years of age. An early age at onset was correlated with high social disability scores. Of the patients, 25 percent were completely, 25 percent partially, and 50 percent were poorly remitted at the second followup. None of the patients with chronic onset remitted completely. The results are discussed with respect to epidemiology, gender differences, and etiological hypotheses of childhood schizophrenia.

Adolescent↗
PubMed1994

The very-long-term course of polycythaemia: a complement to the previously published data of the Polycythaemia Vera Study Group.

The very-long-term follow-up of patients initially included in the PVSG protocols provides useful information. The excess risk of cancer after chlorambucil appears to persist for 5 years after stopping this treatment. The risk of leukaemia induced by marrow suppression (32P or chemotherapy) was marked before the 10th year, but low thereafter. Phlebotomy is unacceptable as permanent treatment because of the poor clinical tolerance and the frequency of vascular complications. This treatment is also associated with a risk of early progression towards myelofibrosis with myeloid splenomegaly. In the very long term, 15 years or more after the diagnosis, this complication is the major clinical risk, affecting almost 50% of our patients surviving at this time. The prevention of this type of complication could constitute one of the objectives of future protocols dealing with this disease.

Aged↗
PubMed1994

[Long-term course after electric ablation of the bundle of His in the treatment of supraventricular tachycardia].

The authors report the long term results of His bundle ablation for supraventricular tachycardia in a series of 49 patients. This retrospective study was based on a patient population of 27 men and 22 women with an average age of 59 at the time of ablation, between 1984 and 1993. The indication for His bundle ablation was invalidating supraventricular tachycardia resistant to antiarrhythmic therapy in all cases. One group of patients (Group I, n = 31 patients) underwent high energy electrical shock and the second group (Group II, n = 18 patients) recruited after 1991, underwent radiofrequency catheter ablation. Complete atrioventricular block was obtained in the first group in 1 to 4 sessions whereas 17 patients of Group II were treated in a single session. During a follow-up period of an average of 40 months, 2 patients were lost to follow-up and 6 died, 3 of cardiac failure, 1 of a cerebrovascular accident, 1 of pulmonary carcinoma and 1 of unknown cause. In Group I, atrioventricular conduction persisted in 1 patient (primary failure) and reappeared in one other patient, but, in Group II, complete atrioventricular block persisted even in the patient in whom the interruption was not obtained with a single session of radiofrequency ablation. The patients were generally physically improved and satisfied not to have any palpitations. A decrease in exercise capacity estimated by the NYHA classification was observed in 38% of patients without apparent cardiac disease who developed dyspnea. On the other hand, 43% of patients with cardiac disease and in NYHA class > or = 2 were improved.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2000

Long-term course in schizophrenia: concepts, methods and research strategies.

OBJECTIVE: This paper summarizes current knowledge about course and outcome in schizophrenia by selecting particular information and by drawing conclusions in the light of theoretical and methodological considerations, in order to illustrate future research strategies, as well as to consider novel targets of treatment. METHOD: Based on examples from the literature the concepts of course and outcome as well as intervening factors of course and outcome are discussed by considering study results within their methodological and theoretical framework restrictions. RESULTS: The heterogeneity of the disorder, manifest in its variable phenomenology, illness course, treatment response and outcome, complicates research but at the same time offers clues to elucidate the heterogeneity of aetiology and pathogenesis. The search for intervening factors and predictors is of particular interest in order to explore the illness mechanisms. CONCLUSION: Future research should focus on the biopsychosocial determinants of course and outcome in methodologically improved long-term studies.

Humans↗
PubMed2004

Long term course of WHO grade II astrocytomas of the Insula of Reil after I-125 interstitial irradiation.

OBJECTIVE: To present long-term results after interstitial iodine-125 irradiation of adult patients with de-novo World Health Organization (WHO) Grade II astrocytomas and oligoastrocytomas of the insula of Reil with special respect to the treatment-related risk. METHODS: 55 consecutively treated patients (from 1979 to 1992) with circumscribed tumors with a diameter < 5 cm (astrocytomas: 46 patients, oligoastrocytomas: 9 patients) were included. The reference dose-calculated to the outer boundary of the tumor-was in the range of 60-100 Gy and the dose rate was low (< 10 cGy/h). Progression-free survival, risk of malignant transformation, survival, and the incidence of radiogenic complications were estimated by the Kaplan-Meier method. Prognostic factors were obtained from the Cox-model. RESULTS: Median follow up for the survivors was > 10 years. 5-year (10-year) progression-free survival was 40.7 % (20.2 %), and 5-year (10-year) survival 54.6 % (28.4 %). Malignant transformation occurred in 42.4 % after 5 years. Neither of the Kaplan-Meier curves showed a leveling off over time. Transient (progressive) radiogenic complications were observed in 13 [4] patients (one-year overall complication rate: 18%), and were significantly associated with a tumor diameter >3.5 cm (p<0.001). No long term side-effects were detected and delayed external beam irradiation (in case of tumor progression) did not enhance the risk. Tumor enhancement on CT was the only unfavorable predictor for survival. CONCLUSION: A limited overall prognosis for adult patients with insular WHO grade II astrocytomas and oligoastrocytomas was detected. Interstitial I-125 irradiation offers a minimal-invasive and low-risk treatment option for circumscribed tumors with a diameter < 3.5 cm. Larger tumors require further evaluation for optimal treatment.

Adult↗
PubMed1975

[Long-term course of tricuspid insufficiency operated during the surgical correction of mitral and mitro-aortic valve diseases].

This study concerns 120 patients with tricuspid incompetence (TI) combined with mitral or mitral-aortic valve disease. This second part is devoted to the 72 patients whose TI was corrected together with the mitral-aortic valve lesions, and the long-term post-operative course (average 40 months) was analysed. The results were correlated with pre-operatice clinical intensity of the TI: un unfavourable course (persistent TI and right ventricular failure) was noted in 56% of the cases of TI judged to be intense and in 29% only of the cases of TI judged to be clinically negligible (p is less than 0.5). The course varied according to the mode of tricuspid valve repair with a good long-term result in 37% of the 30 cases with Kay's annuloplasty, 62% of the 26 prosthetic valve replacements and 69% of the 13 cases treated by Carpentier's annuloplasty. This latter technique seems to represent the most efficient means of correction for TI, when the anatomical lesions allow for it. In the group of the patients studied, the course is independent from the degree of heart enlargement and from the pulmonary artery pressure level before operation.

Aortic Valve↗
PubMed1995

[The long-term course of depression (epidemiology and clinical aspects)].

Depression recurs in three quarters of cases; it is therefore necessary to undertake long-term studies in order to understand the clinical and epidemiological implications. Current classifications schematically distinguish depressive episodes according to their more or less permanent and complete semiological expression (at least five symptoms over at least two weeks for a major depressive episode, versus at least two criteria for the greater part of the time over at least two years) or their time-scale (isolated or recurrent episodes; recurrent brief depressive episodes...). The terminology of therapeutic strategies is based on the temporal definitions of the depressive process. Thus one speaks of curative treatment during the acute phase of the illness (two months), maintenance treatment during recurrence (four to six months), and prophylaxis against later possible recurrences (more than six months). Epidemiological findings emphasize the importance not only of recurrence of depression (50% in the year following an index episode), but also that of becoming chronic (20%), of partial remissions (15 to 20%), and the "bipolarisation" of a unipolar illness (10 to 15%). Finally, certain risk factors for recurrence have been identified. The most important of these is a large number of previous depressive episodes.

Adult↗
PubMed1994

[Portal hypertension. Report of a case with a long-term course].

The AA report a clinical case of Portal Hypertension with a long period of survival, more than 12 years, during which it was not possible to clarify the etiology. The presence of chronic ethylism conditioned the attribution of the etiology to a chronic alcoholic hepatopathy, but a hepatic biopsy denied that cause. Through the re-examination of the differential diagnosis of the several causes of Portal Hypertension and through Echographic findings, the Budd-Chiari Syndrome diagnosis was established. The AA broach the causes, the means of diagnosis and the therapeutics of this syndrome and conclude that the etiological diagnosis of any Portal Hypertension must be done exhaustively, using all the available means, so that effective therapeutics can be achieved.

Budd-Chiari Syndrome↗
PubMed2003

The long-term course of rapid-cycling bipolar disorder.

BACKGROUND: Rapid cycling among patients with bipolar affective disorders is important because of its implications for long-term prognosis and for the use of antidepressants. To our knowledge, no prospective study has, as yet, described the course of this phenomenon beyond 5 years. METHODS: From 345 patients with bipolar I or bipolar II disorder followed up for a mean (SD) of 13.7 (6.1) years as part of the National Institute of Mental Health Collaborative Depression Study, 89 (25.8%) were identified who, during 1 or more years of follow-up, manifested a pattern that met DSM-IV criteria for rapid cycling. These patients were compared with the remaining bipolar patients by demographics, overall affective morbidity, morbidity during specific treatment conditions, and the likelihood of suicidal behavior. Analyses assessed whether the use of tricyclic antidepressants for depressive symptoms was associated with the persistence of rapid cycling or with tendencies to switch from depressive to manic or hypomanic phases. RESULTS: The 89 patients who showed a rapid cycling pattern were significantly more likely to have had an illness onset before 17 years of age and were more likely to make serious suicide attempts. In 4 of 5 cases, rapid cycling ended within 2 years of its onset. Resolutions were not associated with decreases in tricyclic antidepressant use. Throughout follow-up, patients prone to rapid cycling experienced more depressive morbidity than other bipolar patients, particularly when lithium carbonate was being used without tricyclic antidepressants. The use of these antidepressants was not more likely in the weeks preceding shifts from depression to mania or hypomania. CONCLUSIONS: These results indicate that bipolar patients who develop a rapid cycling pattern suffer substantial depressive morbidity and are at high risk for serious suicide attempts. These findings do not implicate tricyclic antidepressants or, by inference, serotonin reuptake inhibitors in the promotion of affective instability.

Adult↗
PubMed1992

Long-term course of hospitalization for schizophrenia: Part II. Change with passage of time.

This analysis examines the notion of progressive deterioration in schizophrenia, using long-term followup data on hospital episodes in defined cohorts from psychiatric case registers in Victoria, Australia; Denmark; and Salford, England. The analyses differentiate heterogeneity existing at the first hospitalization for schizophrenia, which produces a widely varying natural course, from heterogeneity that develops over time, as episodes of hospitalization occur. Episodes of hospitalization for schizophrenia tend to cluster earlier rather than later in the treatment career, suggesting a progressive amelioration rather than deterioration. When overall chronicity is adjusted, each additional episode of hospitalization lowers the risk for a further hospitalization by about 10 percent.

Adolescent↗
PubMed1988

Syndrome shift in the long-term course of schizoaffective disorders.

Seventy-two patients diagnosed as having schizoaffective disorders (Cologne study) were investigated with regard to syndrome shift. During long-term follow-up (mean 25.6 years) they had 400 episodes (the duration of an episode being defined as the time between the beginning and end of inpatient or inpatient-like treatment). A total of 61% of the patients had a polymorphous course, i.e. displayed more than one type of episode. The first syndrome shift was found in the early stages of the course (in 61% of the cases as early as the second episode, in 84% at latest by the third episode). Using diagnostic criteria considering the longitudinal approach, 88% of schizoaffective disorders could be definitively diagnosed as such at the latest by the second episode. The only difference in the course between polymorphous and monomorphous (with only one type of episode) schizoaffective disorders was that the former relapsed more frequently. On the basis of the findings of the present study we suggest a longitudinally based dichotomy of schizoaffective disorders into bipolar and unipolar.

Adult↗
PubMed1985

[Aortocoronary bypass operation in the elderly patient: favorable long-term course].

Age has been identified as an independent risk factor for coronary artery bypass grafting (CABG). We evaluated, therefore, the perioperative phase and long-term prognosis of all patients over the age of 64 (n = 80), who had been operated on for coronary heart disease at the University Hospital of Basel/Switzerland between 1979 and 1983. These elderly subjects were compared to 80 patients, 50 to 60 years old at the time of CABG, who were matched for degree of angina pectoris, coronary artery disease, left ventricular ejection fraction, sex and year of operation (matched-pairs analysis). Evaluation of long-term prognosis was based on regular clinical controls and on a questionnaire, sent to the patients in June 1984. During the perioperative phase 3 patients over 64 died versus 0 in the group of patients 50-60 years old. There were more complications in the older group (perioperative myocardial infarction 10 vs. 4, pulmonary embolism 2 vs. 0, cerebro-vascular insult 4 vs. 0). Three vs. one permanent pacemaker had to be implanted for irreversible AV-block. The difference in hospital stay, 21 vs. 19 days, was not significant. The cumulative survival rate was in both groups 95% after one year and 86 vs. 92% 5 years after CABG (difference not significant), despite the fact that significantly more elderly patients have had myocardial infarction prior to CABG. After an average follow-up of 28 months, 72% vs. 60% were without thoracic pain; 63 vs. 49% considered themselves in a good overall condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗