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At least 19 recordsLinked to original sources
PubMed1998

Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course.

The long-term results after arthroscopic partial meniscectomy of 119 patients with a mean follow-up of 12 years are presented in this study. The same series of patients had an earlier follow-up 4 years postoperatively. Thus, an evaluation of the actual long-term course and not only a single result after partial meniscectomy is presented. Arthroscopic partial meniscectomy is shown to be the definitive means of therapy for meniscal lesion of the knee joint; 91.7% of patients had an excellent or good result 4 years after surgery, and 78.1% rated excellent or good 12 years after surgery. Full recovery regarding ability to work and sports activity level was achieved in a very high percentage of patients. Early results were mostly representative and did not change significantly during the long-term course for the isolated meniscal lesion. The factor with the highest impact on long-term results was damage to the articular cartilage, which did not influence knee function for several years after surgery but became increasingly symptomatic over time after 5 years and more. Only 62% of patients with additional cartilage damage rated excellent and good 12 years after surgery, in contrast with 94.8% good and excellent results in patients with isolated meniscal tears. Similar observations were made for the untreated rupture of the anterior cruciate ligament.

Adult↗
PubMed1991

Natural history of schizophrenia subtypes. II. Positive and negative symptoms and long-term course.

The natural history and long-term course of schizophrenia divided by pervasiveness of positive and negative symptoms was explored among 187 schizophrenic patients from the Chestnut Lodge follow-up study. Schizophrenia with many negative symptoms was associated with poor premorbid functioning, insidious onset, partial or no remissions during the first several years of illness, and in most cases a progressive course leading to permanent disability. Schizophrenia with few negative symptoms was associated with good premorbid functioning, acute onset, intermittent early course, and a better prognosis. Positive symptoms predicted future hospitalizations but were less powerful and specific as indicators of differential illness history, course, and long-term functional incapacity. As predictors of long-term outcome, negative symptoms were of greater value measured at index admission several years after illness onset than at first hospital admission. Multivariate analyses indicated that two negative symptoms (anhedonia and affective flattening) contribute significantly to outcome variance independent of their association with premorbid functioning or positive symptoms. Patients with the poorest long-term outcome tended to show an increase in negative symptoms during the early years of their illness. Progressive negative symptoms early in the course of schizophrenia may thus reflect or signal a process leading to long-term functional disability.

Age Factors↗
PubMed1989

[Antibiotic therapy and long-term course in spondylodiscitis].

Long-term outcome and therapy are reported in 29 patients with vertebral osteomyelitis. Antibiotics were administered for a mean period of 21 (6-102) weeks. In 13 patients surgery was additionally necessary. After a mean follow-up of 53 (10-136) months only one relapse had occurred. Radiographs and erythrocyte sedimentation rate were the best indicators of successful treatment.

Adult↗
PubMed1999

A decade of spontaneous long-term course of psychogenic impairment in a community population sample.

BACKGROUND: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. METHOD: Beginning in 1979 (nt1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (nt3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). RESULTS: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. CONCLUSION: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention.

Adult↗
PubMed2001

Mortality and long-term course in schizophrenia with a poor 2-year course: a study in a developing country.

BACKGROUND: The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied. AIMS: To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course. METHOD: The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups. RESULTS: Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died - a nine times higher mortality rate than among patients with other 2-year course types. CONCLUSIONS: In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.

Adult↗
PubMed2004

Etiopathogenetic mechanisms in long-term course of schizophrenia.

Schizophrenia is a severe mental disorder with a relapsing long-term course in 80 % of the sufferers. The underlying neurobiological principles of the long-term course are widely unknown. Therefore an attempt is made to evaluate data from structural imaging and neuropsychology to shed some light on these mechanisms. Interestingly there was a significant correlation between length of illness and volume reduction in the prefrontal grey matter in schizophrenia. There was a lack of such a correlation for the whole brain volume, white matter volume or the grey matter volume outside the prefrontal lobe. Furthermore none of the neuropsychological measures correlated with length of illness. Both findings are supported by data from prospective studies up to five years demonstrating a significant loss of frontal grey matter volume, but no change of cognitive dysfunction in the course of time. The attempt is made to connect prefrontal grey matter loss with post-mortem findings of reduced neuropil but preserved cytoarchitecture leading to recently described candidate genes and their function.

Brain↗
PubMed1978

[Acute purulent arthritis of the limbs in the infant and child. Long term course (author's transl)].

The authors study the long term course of 37 cases of purulent arthritis of the limbs in the child, for which complete radiological documents covering a period of more than a year were available. They describe in particular the sequelae observed in 25 cases, classifying them by joint and by increasing order of severity. They then attempt, in the light of their own findings and of other published series, to draw conclusions concerning the main factors in prognosis--the age at the time of onset of the arthritis, the treatment given and the joint involved. The prognosis is all the more gloomy when a newborn or young infant is involved, when there is a delay before treatment is started or in the absence of joint aspiration-drainage and when the hip is affected.

Acute Disease↗
PubMed2003

[Pulmonary thromboembolism: long term course and clinical epidemiology].

BACKGROUND: Long-term clinical course of pulmonary thromboembolism is not well-known. Our aim was to know the events which occur to in-patients diagnosed of pulmonary embolism. METHODS AND PATIENTS: This is a prospective observational study from May-92 to December-2002 with all in-patients diagnosed of pulmonary thromboembolism at a clinical area of Internal Medicine. Main targets were to know survival, relapses, major hemorrhage rate (Defined as those episodes of bleeding which needed blood transfusion and readmission) and cancer associated rate (Previous and newly diagnosed cancer). Follow up were carried out with telephone contacts with patients and relatives in case of death, and with the computerized system of patients and clinical events of Health Service of Navarra. RESULTS: One hundred and sixteen patients were included in the study (Mean age 72 SD 11 years male 54%). During index episode 4 (3.7%) patients dead. Ten patients were lost in follow up. The rest 102 patients were traced for 31.81 SD 31.23 months (Range 1-127). Relapse rate was 19.6% that occurred 22.64 SD 24.57 (Range 1-73) months after index episode (Twelve pulmonary embolisms, 5 deep venous thromboses and 3 sudden death with dyspnea). Major hemorrhage rate was 10.4%. During follow up 14 (13.7%) new cancers were diagnosed (Lung 4, prostate 2, bladder 2, and colorectal, ovary, breast, liver and kidney one each one). At all prevalence of cancer associated with pulmonary thromboembolism was 31%. Mortality rate was 37% (Men 25%, women 49%, p < 0.01). Main causes of death were cancer (32%) and relapse of pulmonary thromboembolism when joined with treatment complications 24%. Half of deaths occurred in the first year of follow up, showing a shortened survival those patients with cancer (p = 0.02) and patients with relapses of pulmonary embolism (p = 0.06). Beyond the first year, mortality declines to a rate of 10% per year mainly because of cardiovascular causes. Mortality associated factors were age > 75 years (p < 0.001) gender female (p < 0.01), a delayed admission and treatment from the beginning of symptoms (p < 0.05), higher LDH level (p < 0.01) and coexistence of cancer (p < 0.05). In logistic-regression analysis age, delayed admission and treatment and higher LDH levels were predictors of long-term death. CONCLUSIONS: Patients with pulmonary embolism show a high mortality rate, with a critical period during the first year after index episode, being deaths associated to cancer and to a composite of relapse of venous thromboembolic disease and bleeding complications. Mortality rate beyond the first year declines, being deaths explained because of cardiovascular causes. An advanced age, a delayed diagnosis and treatment and serum LDH may predict long-term mortality.

Aged↗
PubMed1993

Supervised four-week heliotherapy alleviates the long-term course of psoriasis.

The long-term effects of psoriasis heliotherapy were studied in a randomized cross-over trial with a 2-year follow-up. We allocated 95 patients randomly to receive a 4-week heliotherapy course, either at the onset or in the middle of the follow-up period. After a highly significant immediate alleviation of psoriasis about 50% of the patients still had a reduction of psoriasis 6 months later and about 25% one year later. A favourable carry-over treatment effect was still observed during the second follow-up year. Taking advantage of the cross-over design, the effect of heliotherapy was calculated to be statistically significant during the first follow-up year, and the apparent long-term alleviation of psoriasis after the heliotherapy was reflected in a significant period effect. The alleviation of psoriasis was accompanied by a significant decrease in the use of antipsoriatic treatments.

Adult↗
PubMed2004

[The classification of functional psychoses: the impact of ICD-10 diagnoses (research diagnostic criteria) for the prediction of the long-term course].

One major objective of Emil Kraepelin's system of the functional psychoses was to establish a prognostically relevant diagnostic classification. Following this idea, 197 first admitted inpatients from the years 1980 - 1982 were examined 15 years later in order to determine the impact of ICD-10 diagnoses (derived from first hospitalisation) for the long-term course. The long-term course was divided into the three course types single episode, episodic-remitting course and chronic course. The results showed that 57 % of the patients with schizophrenia, 50 % of the patients with persistent delusional disorders, 20 % of the patients with acute and transient psychotic disorders, 10 % of the patients with schizoaffective disorders and only 3 % of those with affective disorders developed a chronic course type. Using a logistic regression analysis, the predictive validity of the ICD-10 diagnoses was compared with those of a dimensional model based on psychopathological and demographic data. The results revealed that the predictive validity of the dimensional model (77 %) does not exceed the predictive validity of ICD-10 diagnoses (78 %).

Adult↗
PubMed2000

Chronic inflammatory demyelinating polyradiculoneuropathy: long-term course and treatment of 60 patients.

The objective of this study was to assess the long-term course and treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We evaluated, according to a predefined protocol, a series of 60 CIDP patients who received a long-term course of steroids and immunosuppressants. Eighteen of them also had monoclonal gammopathy of undetermined significance (MGUS). Mean follow-up was 4.4 years and was similar for CIDP and CIDP-MGUS patients. At the end of the follow-up, improvement was ascertained in 60% of patients (69% CIDP, 39% CIDP-MGUS). Complete remission was achieved in 13%. Out of 26 patients receiving steroids as a monotherapy, 19 improved (73%). The following variables were predictive of a better outcome: female gender, younger age at onset, relapsing-remitting course, and absence of axonal damage at neurophysiologic study. In the multivariate analysis, younger age at onset and demyelination without axonal damage still retained an independent positive value.

Adolescent↗
PubMed2004

Alterations in glucose metabolism associated with liver cirrhosis persist in the clinically stable long-term course after liver transplantation.

With increasing long-term survival rates after orthotopic liver transplantation (OLT), metabolic alterations complicating the clinical course, such as diabetes mellitus (DM), become increasingly important. Liver cirrhosis is associated with severe alterations in glucose metabolism. However, it is currently unclear whether these changes are reversed by successful OLT. We therefore characterized glucose metabolism in patients with liver cirrhosis and normal fasting glucose levels before OLT (cir), in the clinically stable long-term course after OLT (OLT), and control subjects (con) using oral glucose tolerance tests (cir = 100, OLT = 62, con = 32), euglycemic-hyperinsulinemic clamps (cir = 10, OLT = 27, con = 14), and positron emission tomography (PET) scan analysis with 18F-fluorodeoxyglucose (FDG) as a tracer (cir = 7, OLT = 7, con = 5). Fasting insulin and C-peptide levels were significantly elevated in patients with liver cirrhosis compared with both control subjects (P <.001) and patients after OLT (P <.001). After OLT, insulin was normalized, whereas C-peptide remained elevated (P < 0.01). In the patients with liver cirrhosis, 27% had a normal glucose tolerance, 38% had an impaired glucose tolerance (IGT), and 35% were diabetic. After OLT, 34% had a normal glucose tolerance, 29% an IGT, and 37% were diabetic. Comparison of the same patients before and after OLT demonstrated that IGT or diabetes before OLT was the major risk factor for these conditions after OLT, which was independent of either immunosuppression (cyclosporine vs FK506) or low-dose prednisolone. Total glucose uptake was reduced in patients with liver cirrhosis to less than half the values in control subjects (21.2 +/- 2.8 vs 43.7 +/- 2.4 micromol/kg/minute, respectively, P <.001), whereas patients after OLT showed intermediate values (35.7 +/- 1.4 micromol/kg/minute, P < 0.05 vs con, P < 0.01 vs cir). This difference was caused by a reduction in nonoxidative glucose metabolism in patients with liver cirrhosis compared with control subjects (7.4 +/- 1.9 vs 28.7 +/- 1.8 micromol/kg/minute, respectively, P <.01) and patients after OLT (20.1 +/- 1.4 micromol/kg/minute, P < 0.05 vs con and OLT). In the PET study, skeletal muscle glucose uptake was significantly reduced in patients with liver cirrhosis compared with control subjects (3.5 +/- 0.4 vs 11.8 +/- 2.5 micromol/100g/minute, respectively, P <.05). After OLT, muscle glucose uptake improved compared with patients with liver cirrhosis (5.9 +/- 1.0 micromol/100g/minute, P <.05) but remained significantly lower than in control subjects (P <.05). In conclusion, these results demonstrate that preexisting IGT or diabetes are the major risk factors for IGT and diabetes after OLT. This finding was independent of the immunosuppressive medication. The peripheral insulin resistance in cirrhosis is characterized by a decrease in nonoxidative glucose disposal that is improved, but not normalized, after OLT.

Adult↗
PubMed1986

The long-term course of primary generalized epilepsy with persisting absences.

The long-term course of primary generalized epilepsy with absences persisting after the age of 30 to 61 years was studied in 26 patients, each followed clinically and by EEG for 20 to 37 years. Whether treated or not, absences became less frequent, but only rarely ceased, and 92% of patients with persisting absences eventually developed generalized convulsions. EEG background activity did not deteriorate, and the classic spike and wave complexes remained typical in 84% of patients. In 36% of cases, almost all of them women, psychomotor slowing was observed, which did not affect job performance. It was not related solely to duration or severity of epilepsy, or to antiepileptic drugs, and some hormonal mechanism may be partly responsible.

Adult↗
PubMed2003

Long-term course of schizophrenic illness: Bleuler's study reconsidered.

OBJECTIVE: The influential 1972 study by Manfred Bleuler on the long-term course of schizophrenic illness has been reconsidered. The authors tested the diagnosis of schizophrenia in all patients and investigated how the distribution of the types of illness course and outcome would change after exclusion of patients whose diagnosis of schizophrenia could not be confirmed by modern diagnostic standards. METHOD: Clinical charts and Bleuler's research notes on the original sample were assessed, and all patients were rediagnosed with the help of DSM-IV, DSM-III-R, ICD-10, the Research Diagnostic Criteria (RDC), Schneider's criteria, and an operationalized version of the criteria of Eugen Bleuler. RESULTS: The diagnosis of schizophrenia was not confirmed in about 30% of the sample; the majority of these patients were rediagnosed with schizoaffective disorder. High diagnostic agreement was found between DSM-IV, DSM-III-R, ICD-10, and RDC; there was much less agreement with Bleuler's and Schneider's criteria. After exclusion of patients whose schizophrenia diagnosis was not confirmed, the proportion of patients with undulating course and recovery slightly decreased, and the proportion of patients with severe end state slightly increased. Nevertheless, the distribution of the types of long-term course did not significantly change, and even among patients with strictly defined schizophrenia, half had an undulating course with remissions and 12%-15% recovered. CONCLUSIONS: Schizophrenic illness remains heterogeneous with regard to illness course and outcome even when narrowly diagnosed with the help of modern operationalized diagnostic criteria. Contemporary differentiation between schizophrenic and schizoaffective disorders is prognostically valid.

Adolescent↗
PubMed2006

Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort.

OBJECTIVE: Few studies exist that have examined the spectrum and natural long-term course of eating disturbance in the community. We examine the lifetime prevalence and long-term course of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS) in an adult female twin population. METHOD: Female twins (n = 1002) from the Australian Twin Registry, aged 28-39 years, were assessed using the Eating Disorder Examination, revised to yield lifetime diagnostic information. For women with lifetime eating disorders, the assessment occurred, on average, 14.52 years (SD = 5.65) after onset of their disorder. RESULTS: In accordance with other community studies, we found a 1.9% lifetime prevalence of AN, with an additional 2.4% who met the criteria for 'partial AN' (absence of amenorrhea). Criteria for BN were met by 2.9% of the women, an additional 2.9% of women met criteria for binge eating disorder, while 5.3% met criteria for purging disorder unaccompanied by binge eating (EDNOS-p). Eleven (7%) of the women with lifetime eating disorders had a current eating disorder. Each diagnostic group continued to be differentiated by current eating pathology from women without lifetime eating disorders. Although approximately 75% of the women had a good outcome, less than 50% of each diagnostic group was asymptomatic. CONCLUSIONS: Eating disorders tend to improve over time often reaching subdiagnostic levels of severity, but only a minority of sufferers becomes asymptomatic. The DSM-IV diagnosis EDNOS needs to be considered in studies of the prevalence and course of eating disorders.

Adult↗
PubMed1988

The heterogeneity of the long-term course of schizophrenia.

Research has demonstrated considerable heterogeneity in the long-term course of schizophrenia. In the period preceding the onset of frank psychosis (onset), patients vary relative to the rapidity of onset, the presence or absence of associality, and the presence or absence of semipsychotic symptoms. Following the onset of psychosis (middle course), patients may suffer from episodic or unremitting psychosis, and may or may not exhibit the deficit syndrome. In late adult life (late course), patients vary relative to the presence or absence of an improvement in psychosis and social capability. The usual approach to the study of putative course subtypes is to define a subtype by a number of features; they may include features of more than one epoch. In addition, the course of psychosis has not been distinguished from enduring personality impairments in these subtypes. Another approach to defining putative course subtypes would be based on dichotomizing patients according to the presence or absence of a particular feature of a single epoch. This second approach has important advantages: the availability of larger study populations and a diminished liability for confounding due to the correlates of features other than those under scrutiny.

Follow-Up Studies↗
PubMed1999

[The endoscopic diagnosis and therapy as well as the long-term course of Dieulafoy ulcer hemorrhage].

OBJECTIVE: To assess the effectiveness of endoscopic diagnosis and treatment as well as the long-term course in patients with bleeding from Dieulafoy's ulcer (DU). PATIENTS AND METHODS: Data were gathered on all cases coded "bleeding from Dieulafoy's ulcer" in an endoscopic data-bank. The following items were obtained from the case-notes: clinical symptoms, mean haemoglobin concentration, demand for infusion of erythrocyte concentrates and endoscopic procedures undertaken for diagnosis and treatment. There were 15 patients (mean age 64.8 years; 9 men and 6 women), seen between 1985 and 1998 with the diagnosis of DU. All lesions were located in the proximal stomach. The effectiveness of the various parameters was analysed. The long-term course was ascertained by telephone interviews with the patients and (or) their general practitioner. RESULTS: The suspected diagnosis of DU was confirmed by additional endoscopic means such as endoscopic Doppler sonography or endosonography. A combination of endoscopic techniques of stopping the bleeding (epinephrine injection and, if necessary, haemoclip application) was effective in 14 of the 15 patients, operative intervention being required in one. Three patients died during follow-up, none of bleeding. No recurrence of bleeding had occurred in the 10 patients followed for a mean of 20 (6-31) months. CONCLUSIONS: The endoscopic diagnosis of DU bleeding can be confirmed by endoscopic Doppler sonography or endosonography. It remains to be proven whether miniscope endosonography is of additional value. The combined method of stopping the bleeding has been effective in this patient collective, both during hospitalization and on long-term follow-up.

Adult↗
PubMed1997

Psychosocial factors and the long-term course of major depression.

Fifty-nine subjects participated in a telephone follow-up interview 6 years after being hospitalized with a severe major depressive episode and 5 years after completing a 12 month follow-up study. Patient information was used to provide a rating of symptom-free (n = 19), episodic (n = 30), or chronic (n = 10) that described each patient's long-term course of illness. Few variables from the acute stage were related to long-term course of illness; however, early patterns of global and family functioning, number of life events, and rapid reduction in depressive symptomatology were found to be of prognostic significance. For patients whose depression is severe enough to warrant hospitalization, the pattern of functioning in the first few months after discharge from hospital is a strong indicator of the future long-term course.

Adult↗