Chronic bronchitis: a 10-year follow-up

A 10-year follow-up of 327 civil servants with bronchitis (301 men and 26 women) is presented. A further 14 were lost sight of during the period, so that the follow-up was 96% complete. More than one half (54%) of the men died during the 10-year period, some 57% of the deaths being attributed to respiratory causes and a further 8% to carcinoma of the bronchus. Mortality from these diseases was higher than among the general population, but other causes of death showed the normal pattern. The degree of dyspnoea noted at the first interview gave a useful estimate of prognosis, the mild, moderate, and severe groups showing progressively higher death rates. Neither the length of history nor the age at onset of symptoms could be related to mortality. The proportion of smokers among the patients was greater than expected in the general population, and although this may have been a factor contributing to the excess mortality of the group as a whole, it was not possible to determine any effect of smoking within this study.     

Hip squeaking: a 10-year follow-up study

The aim of the study was to analyze the incidence of squeaking with ceramic-on-ceramic total hip arthroplasty (THA) after 10 years of follow-up and the potential complications that could occur related to this phenomenon. One hundred THAs implanted between November 1999 and December 2000 were evaluated. Incidence of squeaking was investigated clinically with a questionnaire. Implant positioning was analyzed on x-rays and computer tomography. Of the 100 THAs, 5 patients presented with squeaking. All of them were active, sporty, and heavy men. Functional scores were comparable with nonsqueaking patients. There was no malpositioning on the x-ray analysis, no wear, and no loosening. We could not demonstrate any relation between squeaking and ceramic fracture. Squeaking noise appeared at a mean of 66 months postsurgery. It appears to be an isolated phenomenon without any consequences at 10-year follow-up.     

Right ventricular cardiomyoplasty: 10-year follow-up

BACKGROUND: Chronically depressed right ventricular (RV) function presents an unsolved therapeutic challenge in cardiac surgery. Despite recent advances in medical and surgical therapies, prognosis remains poor and patient's quality of life and mortality are frequently unacceptable. The aim of this study is to present the first clinical report and long-term results of RV dynamic cardiomyoplasty applied in patients with RV failure caused by isolated RV cardiomyopathies. METHODS: Seven consecutive patients (5 males, 2 females; mean age, 40 +/- 9 years; range, 15 to 63 years) from a series of 113 cardiomyoplasty procedures performed at Broussais and Pompidou Hospitals were evaluated. The mean duration of follow-up was 10 +/- 3.5 years. All patients had predominant RV dysfunction, associated with tricuspid regurgitation in 6 patients. The cause of RV failure was arrhythmogenic cardiomyopathy (4 patients), ischemic (2 patients), and Uhl's disease (1 patient), and endomyocardial fibrosis (1 patient). Six patients were in preoperative New York Heart Association functional class III and 1 was in intermittent class III/IV. The mean preoperative ejection fraction (measured by isotopic technique) was 18% +/- 5.7% for the right ventricle and 40% +/- 13% for the left ventricle. Right ventricular dynamic cardiomyoplasty consists of wrapping the RV free walls with the left latissimus dorsi muscle flap. The distal part of the latissimus dorsi muscle is fixed to the diaphragm and then electrostimulated. Six patients required associated tricuspid valve surgery. RESULTS: There were no perioperative deaths. The mean duration of follow-up was 10 +/- 3.5 years. Six patients are alive with a remarkable quality of life, 4 are in New York Heart Association functional class I and 2 are in class II. One patient who was in New York Heart Association functional class II died in postoperative year 7 caused by stroke. At last follow-up, mean RV ejection fraction was 33% +/- 11.8% and left ventricular ejection fraction was 52% +/- 12.6%. CONCLUSIONS: The results of this long-term study demonstrate hemodynamic and functional improvements after RV cardiomyoplasty without perioperative mortality, no long-term malignant arrhythmias, and RV dysfunction related deaths. We believe that RV cardiomyoplasty, associated with tricuspid valve surgery when required, could be an effective treatment for severe RV failure.     

Proximal row carpectomy: a minimum 10-year follow-up study

PURPOSE: To assess the long-term clinical and radiographic results after a proximal row carpectomy (PRC). METHODS: Twenty patients with various degenerative and posttraumatic disorders of the wrist were evaluated. The evaluation consisted of a physical examination, plain radiographs, and completion of a questionnaire that assessed patient satisfaction, return to work status, occupational and recreational activities and restrictions, and pain level. RESULTS: Two patients (10%) had persistent pain after a PRC requiring a radiocapitate arthrodesis. The remaining 18 patients were evaluated at an average follow-up of 13.1 years (range, 10.0-17.2 y). The average wrist range of motion was 63% and the average maximal grip strength was 83% of the opposite extremity, respectively. Seventeen patients were satisfied with their outcome. One patient complained of persistent pain and was not satisfied but did not want further surgery. All but 2 patients returned to their original occupation and activity level including all 5 patients involved in workers' compensation. Follow-up radiographs showed flattening of the proximal capitate in 6 patients. Radiocapitate arthrosis was absent/minimal in 13 patients and moderate/severe in 4 patients. The presence of radiographic changes did not correlate with patient satisfaction or degree of wrist pain. CONCLUSIONS: Proximal row carpectomy is a dependable and durable procedure that results in satisfactory pain relief in the majority of patients, maintenance of functional wrist motion and grip strength, high patient satisfaction, and ability to return to work. Progressive symptomatic deterioration of the radiocapitate articulation was not observed.     

Denham total knee arthroplasty: a 10-year follow-up study

We reviewed 72 patients with 89 Denham total knee arthroplasties (Biomet, Warsaw, IN) (TKAs) 10 to 15 years after the operation. Of 8 TKAs that were considered as failures, 5 had been revised at the time of review for pain and aseptic loosening, and 3 others were considered to have failed because of breakage of the polyethylene tibial plateau, dislocation, and infection. Survival analysis suggested a 10-year survival rate of 92.7%. There were 36 patients with 45 TKAs alive at the time of follow-up. We reviewed 32 of the patients with 40 Denham TKAs that had not failed. Their average age was 81 years (range, 58-93 years). They were reviewed at an average of 11.8 years after TKA. Nine knees (6 patients) had some anterior knee pain from the unresurfaced patella. Restriction of function was mainly due to medical conditions and old age. Survival analysis performed with the living patients found the 10-year survival to be 91.1%. Long-term survival shows that the Denham knee prosthesis is effective despite its simplicity.     

Arthroscopic acromioplasty: a 6- to 10-year follow-up

Arthroscopic acromioplasty has become a common procedure for the treatment of chronic impingement syndrome. Short-term studies have consistently shown good results; however, long-term data have not previously been reported in the literature. Of 102 consecutive patients undergoing arthroscopic acromioplasty at our institution from 1984 to 1988, 82 patients (83 shoulders) were available for evaluation. The patients were reviewed after a mean of 8 years, 5 months from their original surgery. There were 16 failures (19%) with unsatisfactory results following surgery; 13 patients (15%) required further surgery to relieve persistent pain. Thirty-three percent of all patients previously involved in sports were unable to return to overhead and throwing sports due to pain and lack of power with throwing. Overall, 81% of patients in our series had good to excellent results after 6 to 10 years. To optimize the indications for the procedure, other causes of impingement, such as occult instability and degenerative joint disease, should be ruled out. Throwers may have difficulty returning to their sport at the same level of intensity, and should be addressed independently.Arthroscopy 1998 May-Jun;14(4):382-8     

One-stage Duhamel-Martin procedure for Hirschsprung's disease: a 5-year follow-up study

BACKGROUND/PURPOSE: With the introduction of the Endo-GIA stapling device the 1-stage Duhamel-Martin procedure became feasible for neonates and infants. Early results were promising. So far there were no meaningful data on the long-term functional results. This study shows the 5-year follow-up results after 1-stage Duhamel-Martin procedure for Hirschsprung's disease in neonates and infants. The results are compared with a historical group of patients from the same institution undergoing a 3-stage procedure. METHODS: Between September 1991 and December 1993 Hirschsprung's disease was diagnosed in 29 children. In 22 of them the disease was found within the first 2 months of life. In 19 children aganglionosis was restricted to the rectosigmoid colon. In 10 the innervation disturbance extended further, twice with involvement of the distal ileum. Initial treatment consisted of daily rectal irrigation. Postoperative follow-up on a regular out-clinic basis was 6 years (range, 5 to 7 years). Patients were scored for fecal continence, soiling, the use of laxatives, cannulae or rectal irrigation, enterocolitis, gain of body weight, and length. RESULTS: There were no intraoperative complications. The median postoperative stay was 7.7 days. Seven children encountered complications for which admission was necessary. Ultimately, 15 children have normal spontaneous defecation. Eight children display irregular soiling, without using laxatives. At 5-year follow-up 6 children are still on some sort of laxative or rectal irrigation. Mean growth and body weight is along the P50 and P50 to 90, respectively. These functional results are no different from those in the patients after 3-stage Duhamel-Martin procedure. CONCLUSIONS: There appears to be no difference in functional outcome after 1- or multiple-stage Duhamel-Martin procedure for Hirschsprung's disease after 5 to 7 years. The majority of children seem to fare well with restrictive need of laxatives. The advantage of a 1-stage procedure is the prevention of stoma-related complications, 1 or 2 additional operations, and extra scar formation.     

The Insall-Burstein total knee replacement in osteoarthritis: a 10-year minimum follow-up.

A total of 99 Insall-Burstein posterior stabilized (IBPS) knee replacements were implanted in 86 osteoarthritic patients. We reviewed 60 knees with a 10- to 15-year follow-up. Using the Knee Society score, 35 knees (58%) were excellent, 15 (25%) good, 4 (7%) fair, and 6 (10%) poor. Flexion at follow-up was 106 degrees on average. Moderate patellofemoral crepitation was present in 5 knees (9%), and 11 knee required excision of a synovial nodule proximal to the patella. Radiographic analysis showed 5 osteolytic lesions (8%) around well-fixed tibial and femoral components and minimal (1 mm) narrowing of the medial polyethylene thickness in 7 knees (12%). There were 6 (10%) failures requiring reoperation because of aseptic loosening (4 knees), deep infection (1 knee), and recurrent patellar dislocation (1 knee). Survivorship analysis using revision as the endpoint showed a cumulative success rate of 92% at 10 years. In this study, the IBPS knee has shown good long-term results with low rates of aseptic loosening and no failures attributable to polyethylene wear.     

Prednisolone and azathioprine in membranous nephropathy: a 10-year follow-up study

BACKGROUND: Idiopathic membranous nephropathy (IMN) is the most common cause of nephrotic syndrome in adults. Although its clinical course is usually benign, some patients develop chronic renal failure. Combination of corticosteroids with cytotoxic drugs and cyclosporin have been used in the treatment of the disease. Conflicting results are reported with the use ofprednisolone and azathioprine. In this study, the effect of treatment with prednisolone and azathioprine and the parameters related to a poor outcome over a follow-up period of 10 years is estimated. METHODS: 50 patients were included in this study; 33 were treated with prednisolone (initially 60 mg/day) and azathioprine (initially 2 mg/kg body weight/day) in gradually reduced doses for 26 +/- 9 months, whereas 17 patients received no immunosuppressive drugs. The clinical course was estimated using the end-points of doubling of baseline serum creatinine and/or end-stage renal failure (ESRF). The contribution of clinical and histological parameters in the clinical outcome was examined by univariate and multivariate analyses. RESULTS: Doubling of baseline serum creatinine was observed in 20 of 50 patients (40%), 14 from treated and 6 from the untreated group (42% vs. 35%, p=NS). ESRF developed in 10 of 50 patients (20%), 7 from treated and 3 from the untreated group (21% vs. 18%, p=NS). Most patients from both groups who reached the end-points had impaired renal function at presentation and persistent nephrotic syndrome during the follow-up period. Both parameters were identified as independent risk factors related to an unfavorable clinical outcome. No difference in the remission rate of nephrotic syndrome was observed between treated and untreated patients (51% vs. 58%, p=NS). CONCLUSION: Treatment with prednisolone and azathioprine seems to be of no long-term benefit in ameliorating the clinical course of nephrotic patients with membranous nephropathy. Thus, other therapeutic regimens including cyclophosphamide, chlorambucil or cyclosporin should be used in nephrotic IMN patients with poor prognostic features.     

Albuminuria after fetal pancreatic islet transplantation: a 10-year follow-up

Aim of the study: The prevention of diabetic nephropathy is as yet an unresolved issue. The aim of our study was to assess the effects of transplantation of long-term cultured and cryopreserved fetal pancreas islets on metabolic control and the development of diabetic nephropathy. Methods: Serum C-peptide, glucose, HbA1c, insulin requirements, urinary albumin excretion rate, and blood pressure of 10 insulin-dependent diabetic patients after transplantation were compared with a group of 27 insulin-dependent diabetic controls on insulin therapy only during a 10-year follow-up. Results: In the first year after transplantation mean insulin requirement decreased from 53.6±2.2 to 35.8±1.2 units. C-peptide levels appeared (0.55±0.08 ng/ml) and remained detectable throughout the follow-up.. Blood glucose and HbA1c were significantly (P<0.05) lower than in the controls. Mean albumin excretion rates of the transplant and the control groups during the follow up were 18.8±8.5 and 11.7±2.0, 16.6±6.6 and 14.0±2.3, 15.0±5.0 and 15.1±2.7, 15.3±7.5 and 20.4±4.2, 19.8±6.2 and 36.7±11.1, 11.7±3.6 and 51.3±14.6, 14.1±4.2 and 71.4±23.1, 22.7±8.6 and 92.0±28.1, 18.0±5.9 and 107.6±35.6, 21.7±11.0 and 101.5±29.2 &mgr;g/min respectively. From the 6th year the difference between the two groups was significant (P<0.001). In the transplant group initial mean systolic and diastolic blood pressure values were 132.0±3.3 and 81.5±1.5 mmHg, in the controls 130.4±3.4 and 79.6±1.6 mmHg respectively. Significant changes (P<0.05) of blood pressure during the follow-up or differences between the two groups were not observed. Conclusions: We conclude that fetal islet transplantation is effective in achieving good long-term diabetes control and in the prevention of diabetic nephropathy. Key words: albuminuria; diabetic nephropathy; diabetes mellitus; diabetes control; fetal pancreas islet transplantation      

Self-expanding stent insertion for urethral strictures: a 10-year follow-up

OBJECTIVE: To evaluate the safety and efficacy of the Urolume endourethral self-expandable metallic stent (American Medical Systems, MI, USA) in treating urethral strictures, based on a follow-up of> 10 years. PATIENTS AND METHODS: Between November 1989 and June 1990, the Urolume stent was inserted into 15 patients (aged 25-77 years) who had recurrent urethral strictures. The mean duration of stricture before stent insertion was 10.9 years. The patients (all men) were followed using a questionnaire and uroflowmetry, and if necessary, retrograde cysto-urethrography and/or urethroscopy and/or X-ray urodynamics. RESULTS: Two failures were caused by excessive tissue proliferation in the stent, which ended in stent removal or a suprapubic catheter. Another two stents were removed because of discomfort or pain. Two patients developed stenosis in the stent after 7 and 9 years. In the final evaluation only two of the 15 patients were satisfied with their stent. The mean maximum urinary flow rate at the last follow-up was 15 mL/s, and half the patients noted 'stent' incontinence. Lower urinary tract infections, urge and stress incontinence, and discomfort with ejaculation, were all symptoms perceived at the last follow-up. CONCLUSION: The long-term results of the Urolume stent in this study weaken the optimistic early results. Only two of the 15 patients were satisfied with their stent.     

Treatment of hallux valgus by modified McBride procedure: a 6-year follow-up

Background  

Surgical decision-making was reevaluated by comparison with an algorithm designed to analyze treatment of hallux valgus deformities.     

Right atrial chemodectoma with atypical chest pain: a 6-year surgical follow-up

Paragangliomas are rare neoplasms of neural crest origin and arise from the chromaffin (pheochromocytomas) or chemoreceptor (chemodectomas) tissues. Patients with cardiac chemodectomas, hormonally inactive paragangliomas, may have chest pain or various obstructive or compressive symptoms, depending on the location of the tumor. We report the case of a right atrial chemodectoma causing atypical chest pain. The tumor was discovered at transthoracic echocardiography. Coronary angiography showed a vascular tumor fed by a branch of the circumflex artery. En bloc tumor resection was carried out under cardiopulmonary bypass, with an uneventful surgical course. After 6 years of follow-up, the patient remains asymptomatic and disease-free.     

Traumatic posterior shoulder dislocation: a case with modification of Gerber procedure for humeral head reconstruction at 10-year follow-up

We report a case of acute traumatic posterior shoulder dislocation in a 41-year-old patient, which we treated surgically by a modification of the procedure described by Gerber for humeral head reconstruction in such cases. The diagnosis was confirmed by CT scan, which also helped us to assess the size of the antero-medial humeral head defect or impaction secondary to the dislocation; the size of this defect being a determinant element for the indication. Because the shoulder was unstable after closed reduction and almost 50% of the humeral head was impacted, we carried out a surgical treatment using an original technique as mentioned above. Radiologic and surgical features of acute traumatic posterior shoulder dislocation are discussed with special emphasis on diagnosis, indications and surgical aspects of this rare lesion, which represent 2–4% of acute traumatic shoulder dislocations.     

The Dwyer procedure in the treatment of idiopathic scoliosis. A 10-year follow-up review of 21 patients

Despite the well-known Dwyer procedure, developed in 1969, comprehensive reports on its use, with long-term follow-up, are relatively scarce. The purposes of this study were to detect eventual late complications and to compare late results with postoperative angular curve correction. This article reports on 21 children operated on between October 1972 and October 1975 and reviewed with a minimum follow-up of 10 years (10 other patients were lost to follow-up after 5 years). Patients had idiopathic lumbar or thoracolumbar curves (average curve, 56 degrees). Results are discussed with a special reference to longitudinal observation. There is a great correction of the instrumented curve (postoperative, 5 degrees), but a loss of correction of 10 degrees is generally observed, prevented by a complete immediate correction or even hypercorrection. The upper curve, noninstrumented, also shows improvement (mean preoperative, 38 degrees; postoperative, 22 degrees; 10 years, 22 degrees) but re-equilibration cannot be predicted. Pseudarthrosis of one intervertebral space occurs frequently, and may cause failure of the cable with a loss of correction of 10-20 degrees. Kyphosis (or simple loss of lumbar lordosis) is commonly observed but should be balanced with correction of rotation. The following conclusions were made: morbidity is not severe, despite the advanced surgical technique. The technique is difficult and has a direct consequence on the quality of results; pseudarthrosis is a frequent complication, followed by important loss of correction; indications should be discussed carefully in idiopathic lumbar and thoracolumbar curves. It is still too early to advocate either anterior instrumentation of Zielke (VDS) or segmental posterior instrumentation (C. D. Luque) because of short-term follow-up.     

Natural history of allergic fungal rhinosinusitis: a 4- to 10-year follow-up.

BACKGROUND: Numerous studies have noted the high rate of recidivism after the initial treatment of allergic fungal rhinosinusitis (AFS). Short-term studies have revealed varying recurrence rates based on therapy; however, little is currently known about the long-term natural history of the disease. OBJECTIVE: Our goal was to address the question of long-term outcomes in AFS patients and make observations about the natural history of the disease. Patients and Methods: Seventeen patients with follow-up ranging from 46 to 138 months were examined and interviewed, and their charts were reviewed. A quality-of-life survey was completed, and blood was drawn to measure immunoglobulin levels. RESULTS: All patients initially underwent treatment with a combination of surgery, systemic and/or topical corticosteroids, and immunotherapy to pertinent fungal and nonfungal antigens. Normalization of sinonasal mucosa (Kupferberg stage 0) was seen in 5 (29%) of 17 patients, whereas 76% demonstrated either normal or slight mucosal edema (Kupferberg stage 0 or 1). Serologic testing revealed fungus-specific IgE significantly elevated in all 17 patients. CONCLUSION: The initial choice of therapy did not appear to affect the long-term outcome, and patients tended to be doing well overall. These results suggest that after successful initial treatment and control of AFS, many patients can achieve a quiescent disease state.     

Kinematic total knee arthroplasty: a 10- to 14-year prospective follow-up review.

To understand better the type and incidence of long-term complications in total knee replacement, 306 primary Kinematic total knee arthroplasties performed between June 1978 and December 1982 were prospectively reviewed in detail. The Kinematic knee is a nonconstrained, posterior cruciate-retaining prosthesis that has right and left femoral components to afford anatomic tracking of the patella. The overall revision rate was 6.5%. The most common cause for revision surgery was patellar complications. Ten revisions (3.06%) were for patellar component loosening. Two knees were revised for patella subluxation (0.65%); 1 was in a resurfaced rheumatoid patella, and 1 in an unsurfaced osteoarthritic patella. Stair climbing was better with an unsurfaced patella. Anterior knee pain was 21.8% in the unsurfaced patella and 11.2% in the replaced patella. These data suggest patella replacement is not appropriate with this design.