Uncemented hip prostheses with more than 10 years follow-up

European Journal of Orthopaedic Surgery &; Traumatology -     

Long-term outcome of simultaneous kidney-pancreas transplantation: analysis of 61 patients with more than 5 years follow-up

BACKGROUND: The long-term outcome of simultaneous kidney pancreas transplant recipients is not well established. METHODS: We retrospectively reviewed all patients who underwent simultaneous kidney-pancreas transplantation with bladder drainage at our center between January 1989 and December 1991. A total of 57 patients (93%) were alive with functioning grafts 1 year after transplantation and were followed for a minimum of 5 years. These patients formed the study group. RESULTS: Five-year actual patient, kidney and pancreas survival rates were 95%, 85%, and 88%, respectively. Fasting serum glucose fell from 198 mg/dL preoperatively to 94 mg/dL and remained stable thereafter. Glycohemoglobin levels decreased from 9.8% preoperatively to 4.8% 1 year after transplantation and remained normal thereafter. Kidney function remained good, with mean serum creatinine of 2.0 and creatinine clearance of 56 ml/min throughout the follow-up period. Hospital admissions decreased significantly with increasing time after transplantation from a mean of 1.2 admissions per patient in the 1st year to a mean of 0.2 admissions per patient 6 years after transplantation. Of the readmissions, 42% were for <48 hr and the most common reasons for readmission were infection, surgery, and dehydration. Mean systolic blood pressure decreased from 166 mm Hg before the transplant to 142 mm Hg 1 year after the transplant. CONCLUSIONS: Simultaneous kidney pancreas transplantation is a safe and effective method to treat advanced diabetic nephropathy and is associated with stable metabolic function, decreased cholesterol, improved hypertension control, improved rehabilitation over time, and little morbidity or mortality after the 1st year.     

Heart transplantation: echocardiographic assessment of morphology and function after more than 10 years of follow-up

BACKGROUND: Over recent years, heart transplantation (HTX) developed into a successful option for long-term treatment of end-stage heart failure. Ten-year survival ranges between 40% and 50%. Little is known, however, about function and morphology of transplanted hearts during follow-up of more than 10 years. METHODS: In a consecutive cohort of 65 patients (55 male, 54.6 +/- 12.1 years at the time of transplantation), graft function was assessed by color Doppler echocardiography 12.5 +/- 1.4 years after heart transplantation (10 to 15 years). RESULTS: Left atrial and ventricular dimensions were found in a normal range (LA 37.7 +/- 8.9 mm, LV enddiastolic 45.6 +/- 6.4 mm, 30 to 71 mm). Ejection fraction (EF) of 71 +/- 11.7% and a fractional shortening of 35.3 +/- 10.3% presented with normal values. Left ventricular mass (male 263.8 +/- 111.4 g, female 373.0 +/- 181.1 g) was slightly increased resulting in mild hypertrophy in women. Focused on right ventricular morphology, enlargement of both the right atrium and the right ventricle (RA 40.7 +/- 11.8 mm, RV 37.4 +/- 8.3 mm) was observed in the majority of the patients. Tricuspid valve insufficiency (> grade II) was present in 46 of 65 patients; 5 patients had previously undergone tricuspid valve replacement. Atrial filling waves were detectable in only 47 of 65 patients, thus, 28% of patients showed signs of LA-dysfunction. CONCLUSIONS: More than 10 years post-HTX, cardiac grafts were characterized by normal left ventricular dimensions and ejection fraction. LA-dysfunction and RV-enlargement associated with tricuspid insufficiency were frequent findings, however, not associated with clinical signs of congestive heart failure in the majority of patients.     

开窗腰椎间盘切除再手术的远期疗效

目的探讨开窗腰椎间盘切除再手术治疗初次开窗髓核摘除术失败患者的远期疗效和影响因素。方法回顾性研究51例行第二次开窗腰椎间盘切除术的患者临床资料,随访时间120~203个月,平均随访146.8个月。按MacNab分类和JOA评分标准评价满意度和远期功能。对放射学资料完整的患者进行手术前后椎间隙高度对比研究。结果51例患者中,结果优良率70.6%,失败率15.7%,患者总体满意率78.4%。除了8例失败患者,远期随访的43例患者JOA评分平均提高(64.6±18.2)%,术后行走能力明显改善。对手术节段椎间隙高度测量发现术后椎间隙高度明显下降,但不影响远期功能结果。吸烟、是否有外伤等发病诱因、合并纤维化和初次术后症状未缓解期对远期结果有影响。心理社会因素与预后可能存在一定关系。结论开窗腰椎间盘切除再手术治疗初次开窗髓核摘除术失败患者疗效满意,但手术复杂性高,明确术前诊断和严格手术指征非常重要。JOA评分被证明为易于患者和医师实施,量化主观数据的评估法。     

Evaluation of standard nucleotomy for lumbar disc herniation using the Love method: results of follow-up studies after more than 10 years

A retrospective analysis of long-term follow-up results more than 10 years after a standard nucleotomy for lumbar disc herniation with the Love method was done to determine the effectiveness of this procedure. Nucleotomy according to Love was the standard treatment for lumbar disc herniation before the various minimally invasive alternatives were recently introduced. Without long-term follow-up analysis of Love operations, evidence-based evaluation of those new methods is impossible. We believe that the standard nucleotomy procedure should now be evaluated precisely. In this study we present a comparison of 1-year follow-up results to the results more than 10 years after lumbar nucleotomy. Seventy-six consecutive patients who had undergone lumbar nucleotomy were identified. It was possible to assess 54 (71.1%) of the cases more than 10 years after surgery. The initial and final outcomes were assessed using the MacNab classification and the Japanese Orthopaedic Association (JOA) score. With the MacNab classification a successful outcome 1 year after surgery was achieved in 87.0% of the cases. At the final follow-up, this result was reduced to 74.1%. Seven patients required a second operation and patients under 21 years of age were at risk for reoperation. Patient overall satisfaction with the results of the standard nucleotomy was high. The disc height of the operation site significantly decreased after surgery; nevertheless, this did not affect the clinical outcome. A standard lumbar nucleotomy according to Love is a safe and reliable method of treating selected patients with lumbar disc herniations.     

Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years

STUDY DESIGN: A retrospective analysis of the long-term outcomes of standard discectomy for lumbar disc herniation. OBJECTIVES: To investigate the long-term outcomes of standard discectomy to address postoperative problems, including residual low back pain and recurrent herniation. SUMMARY OF BACKGROUND DATA: Most previous investigators found that favorable outcomes of standard discectomy were maintained for the long-term postoperative period. Although they observed postoperative complications such as residual low back pain and recurrent herniation, detailed analyses of these results have not been conducted. METHODS: The long-term follow-up results in patients who were observed for a minimum of 10 years after standard discectomy were evaluated by using the Japanese Orthopedic Association scoring system through direct examinations and questionnaires. Radiography also was used in patients who agreed to visit the hospital, and findings were compared with those on preoperative radiographs. RESULTS: The average recovery rate calculated by using Japanese Orthopedic Association scores was 73.5 +/- 21.7%. Even though residual low back pain was found in 74.6% of the patients, only 12.7% had severe low back pain. The majority of the patients with severe low back pain were under 35 years of age at the time of operation, with preoperative advanced disc degeneration. The final Japanese Orthopedic Association scores in the patients with decreased disc height were significantly lower than those in patients with no decrease. However, the disc height of patients with a recurrent herniation was preserved. CONCLUSION: The long-term outcome of standard discectomy in this series was favorable. Although patients with preserved disc height generally had favorable results, the risk of recurrent disc herniation was high in this population.     

Long-term results of the Hassab operation in portal hypertension: 10 year's follow-up

Seventy-three patients with portal hypertension who underwent Hassab operation before June 30, 1976 and were alive postoperatively were analysed. Among these patients, portal hypertension was caused by hepatic schistosomiasis in fifty-seven, and by portal cirrhosis in seventeen. According to Child's classification there were 14 in class A, 19 in class B, 30 in class C, and 10 were not classified. Thirty-two patients were subjected to therapeutic operation, forty-one to prophylactic operation. Seventy-one patients were followed-up (97.3%). The postoperative 5, 10 and 15 year cumulative survival rate were 85.5%, 75.8%, and 70.4% respectively. The survival rates in Child A, B patients were much higher than that in Child C patients (P less than 0.05). The postoperative bleeding rate was 11.3%, and the bleeding most often occurred in 1-9 year postoperatively. The esophageal varices disappeared in 64.3% of patients; ascites disappeared in 91.7% of patients; liver function improving or unchanging was seen in 93.6% of patients. There was no postoperative encephalopathy. Long term follow-up showed no difference in patient's survival rate between hepatic schistosomiasis and portal cirrhosis.     

Clinical study of patients with renal carcinoma surviving for more than 10 years after nephrectomy.

Of 207 patients with renal carcinoma we studied 50 who survived for more than 10 years after nephrectomy. These 50 patients were younger than the others at the time of operation and included more females. They had lower stage and lower grade tumours. Recurrence was detected in 18/50 patients and 6 died from cancer. Recurrence developed approximately 10 years after nephrectomy. Eleven patients with recurrences had metastases to a single organ and 9 received multidisciplinary treatment, mainly surgery and radiotherapy. The survival rate 10 years after nephrectomy was lower in patients with recurrences than in those without recurrent tumours and there was a significant decrease in the survival rate 17 years after nephrectomy. Although the patients had low grade and low stage tumours 10 years after nephrectomy, careful follow-up is recommended in such cases as it is possible that they may have dormant tumours.     

Long-term follow-up studies in 211 patients with tetralogy of Fallot after corrective surgery over 10 years

A total number of 427 patients with tetralogy of Fallot who underwent corrective surgery between 1960 and March 1990, in whom 211 patients who survived the surgery over 10 years were evaluated for the follow-up studies. Hemodynamic and cardiac function studies were carried out in 101 patients at the mean interval of 15.7 years (ranges 2 to 21 years). Three methods indicated that patients with muscle resection and pulmonary valvulotomy without patch enlargement (NP) had worse results than the groups with RV patch below valve (RP) and with transannular patch (TP). Also, Holter ECG revealed ventricular arrhythmias in patients with NP were more common than the groups with RP and TP. Sixteen patients (13 with NP, 2 with TP and one with RP) were required reoperation for residual ventricular shunt in 13, residual pulmonary stenosis in 11 and tricuspid regurgitation in 2. All of these 16 patients survived operation and obtained excellent clinical status. It is concluded that patients with TOF after corrective surgery should be carefully followed with short term interval to prevent sudden death and postoperative complications.     

Clinical results of posterolateral fusion for degenerative lumbar spinal diseases: a follow-up study of more than 10 years

 The objective of this retrospective study was to evaluate the long-term clinical outcomes and the effects on unfused motion segments of posterolateral fusion. This study involved 35 cases (37 intervertebral levels) of posterolateral fusion performed to treat degenerative lumbar spinal diseases. There were 20 male and 15 female patients ranging in age from 30 to 67 years, with a mean age of 49 years. The postoperative period ranged from 10 years to 17 years and 8 months, with a mean period of 13 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score for assessment of treatment for low back pain. The effects on unfused motion segments were investigated with radiographic and magnetic resonance (MR) imaging. Postoperative satisfactory improvement (mean recovery rate, 66.9%) reached a plateau at 1 year and was maintained at final follow-up. Radiographically, the union rate was 86.5%. There were few cases of induced instability of unfused motion segments. On MR imaging, increased signal intensity in both T₁- and T₂-weighted images was seen in the paravertebral muscles in 15 of 20 cases (75.0%). Posterolateral fusion is a useful technique for the treatment of degenerative lumbar spinal diseases. Clinical outcomes were stable throughout follow-up. Instability of unfused motion segments rarely occurred. Received: March 19, 2001 / Accepted: January 14, 2002     

Long-term results of heart transplantation in patients older than 60 years

BACKGROUND: Advanced age has been traditionally considered a relative contraindication for heart transplantation. Older patients are now considered as potential candidates for heart transplantation. The objective of this study was to evaluate the long-term results of heart transplantation in patients older than 60 years. METHODS: Between 1986 and 2001, 81 patients aged between 60 and 70 years (mean, 63 +/- 2 years) underwent heart transplantation. These patients were compared with 403 adult recipients younger than 60 years (mean, 47 +/- 11 years) who underwent transplantation during the same period. RESULTS: Thirty-day mortality was 6% (5/81) and 6% (25/403) in the older and younger patients, respectively (P = NS). Actuarial survival at 1, 5, and 10 years was 88% +/- 4% versus 83% +/- 2%, 75% +/- 5% versus 69% +/- 2%, and 50% +/- 9% versus 51% +/- 3% in the older and younger patients, respectively (P = NS). Older patients had significantly fewer rejection episodes (P =.003). Freedom from allograft coronary artery disease at 1, 5, and 10 years was 98% +/- 2% versus 92% +/- 2%, 85% +/- 6% versus 76% +/- 3%, and 81% +/- 7% versus 68% +/- 3% (P =.1). The incidences of infectious complication, cytomegalovirus infection, and posttransplant lymphoproliferative disorder were similar between the 2 groups, but older recipients were more likely to have a nonposttransplant lymphoproliferative disorder cancer (P =.002). Age at transplantation was not identified as an independent risk factor for early and late death. CONCLUSION: Heart transplantation in selected patients aged 60 years and older results in survival comparable with that of younger patients. Older patients have a lower risk of rejection but an increased risk of development of a nonposttransplant lymphoproliferative disorder cancer. Advanced age per se should not be considered as an exclusion criterion for transplantation.     

Roentgenographic changes after arthroscopic meniscectomy: five-year follow-up in patients more than 45 years old.

Fifty knees with a mean follow-up time of greater than 5 years after arthroscopic meniscectomy were evaluated clinically and roentgenographically. Clinically, patients did well, with 98% patient satisfaction and 90% good or excellent results based on a modified Lysholm score. Although postoperative roentgenography showed some progression of Fairbank's changes in 61% with significant progression in 15% of knees, when changes in the nonoperative knee were considered, only 40% of operative knees showed progression, with only 4% of these knees showing significant progression. Normal results on preoperative anteroposterior roentgenography with the patient weight bearing and an anatomic tibiofemoral axis of greater than or equal to 4 degrees of valgus correlated with better long-term roentgenographic results.     

Repair of interrupted aortic arch: results after more than 20 years

Background. This study focused on the influence of concomitant anomalies, the individual surgical approach, and the probability for reinterventions.

Methods. Between 1975 and 1999, 94 patients with interrupted aortic arch were evaluated for short- and long-term results after surgical treatment.

Results. Interrupted aortic arch was associated mainly with a ventricular septal defect (85%) and left ventricular outflow tract obstruction (LVOTO, 13%). Mean follow-up was 6.7 years (median 6.9 years, 628.4 patient years). A single-stage operation was performed in 76 cases. Early mortality for two-stage procedures was 37% and late mortality was 26%, compared with single-stage procedures, with an early mortality of 12% and a late mortality of 20%, respectively. Early mortality in patients with additional LVOTO was 42% and late mortality was 50%. Freedom from reoperation at 5 years was 62%, and at 10 years was 49%. Reinterventions were performed mainly for residual arch stenosis, also with bronchus or tracheal compression, or LVOTO.

Conclusions. Arch continuity and repair of associated anomalies can be achieved with an acceptable overall risk in this often complex entity. Associated anomalies play an important role in the outcome. Single-stage repair with primary anastomosis of the arch should be the surgical goal. The long-term probability for reoperation is high.     

Evaluation of the results of the treatment of male urethral stricture with a follow-up of more than 5 years

149 cases of urethral stricture were treated in the Urology Department from 1971 to 1984. All of these patients have therefore been treated with a minimal follow-up of 5 years. There were 87 cases of post-traumatic stricture, 53 of whom were lost to follow-up during the survey, 8 died and 26 patients were able to be reviewed. The remaining 62 cases consisted of post-infectious strictures, with 37 patients lost to follow-up during the survey, 1 patient who died and 24 patients who were reviewed. The patients reviewed were assessed according to the criteria of the SFU (French Urology Society) survey. Direct vision internal urethrotomy was performed in 33 cases with 18 very good or good results (54%), segmental resection was performed in 10 cases with 7 very good or good results, urethroplasty was performed in 4 cases with 2 good results and 2 urethral dilatations were performed with 2 good results. The failures were essentially treated by more complex surgery (urethroplasty).     

Liver transplantation in childhood with more than 10 years of follow-up: analysis of a single-center experience

We pioneered pediatric liver transplantation (OLT) in Spain (June 1985). The aim of this study was to evaluate the current status of our OLT recipients with more than 10 years follow-up. MATERIALS AND METHODS: The 50 patients with >10 years follow-up had a mean age at OLT of 5.6 years with 60% showing a main indication of biliary atresia. All but one (tacrolimus) received cyclosporine. RESULTS: No patient loss occurred among these patients. Eighteen patients had follow-up >15 years and 12 >20 years. The incidence of acute rejection was 56%; chronic rejection, 16%; and lymphoproliferative disorders, 12%. Seven (14%) required retransplantation at a mean of 4.2 years after the first OLT due in four instances to chronic rejection. After 10 years of follow-up, one patient developed portal vein thrombosis and three biliary strictures. All patients remain on immunosuppression. In 64% cyclosporine was switched to tacrolimus or another agent. One patient developed acute rejection at 19.2 years. In 14% of patients the liver function test is abnormal with serum creatinine is >1.5 mg/dL in 10%; one requires insulin and three, antihypertensive drugs. Noncompliance with medications was detected in 10%. Three recipients had offspring. CONCLUSIONS: OLT was an effective treatment with a good quality of life also on long-term follow-up.