Fifteen year follow-up of lung function in obstructive and non-obstructive pulmonary tuberculosis

Pulmonary function (VC, FEV1, RV) was assessed in patients with pulmonary tuberculosis discharged in 1958/59 as cured or markedly improved. According to FEV1/VC% the patients were divided into 40 obstructive and 59 non-obstructive cases and the tests were repeated by the same method in 1974. The control included physical and X-ray examinations, a questionnaire and the assessment of airway resistance (Rt). In the non-obstructive group the change in VC in 15 years was only -27.7 ml/year, in the obstructive group, -54.3 ml/year. There was little difference between the two groups in the diminution of FEV1 (28.8 and 35.3 ml/year, respectively). The material was subdivided into surgically and drug treated groups and studied statistically. The only significant change of function in the surgically treated group was in RV, whereas in the other group nearly all of the functional changes were significant statistically.     

Vasectomy—a two year follow-up

A report is given of 200 consecutive vasectomy operations performed by a general practitioner and with anaesthesia by a general practitioner. There was a bias among patients towards the upper social classes, perhaps because of better use of sources of information. The reasons for seeking vasectomy are analysed and seem to be more complex than the interviewer/operator assumed. One hundred and seventy-five couples followed up reported physical and emotional relationships to have improved in over 50 per cent of cases and to have been unchanged in virtually all the rest. An analysis of the 28 couples who were not followed up does not show any characteristics indicating a likelihood of their differing from the follow-up group.     

Delusional depression. A one year follow-up

Fifty-two unipolar delusional depressives were matched to 52 unipolar nondelusional depressives on the basis of sex, age at index episode of depression and age at first episode of depression. In a one year follow-up after discharge from inpatient treatment, the delusional depressives had a poorer clinical course than the nondelusional depressives as manifested by significantly higher rates both of major depression or delusions lasting longer than 9 months and of being in a major depressive episode at the end of the follow-up period.     

Five year follow-up study of gastritis.

This paper describes a five year follow-up study of the incidence and course of gastritis affecting the antrum and body of the stomach of 50 patients, most of whom presented with non-ulcer dyspepsia and a few with peptic ulceration. We have shown that antral gastritis, like gastritis affecting the fundus, becomes more severe in a proportion of patients as time goes by. Perhaps more important is the increased severity and progression of atrophic and metaplastic change in the antrum compared with the fundus. The significance of these changes with regard to the development of peptic ulceration and malignancy is discussed.     

Six year follow-up of cryopreserved human embryos1

In 1987, we became aware of the importance of remaining in contactwith couples whose embryos had been cryopreserved for >1year. As a result, a questionnaire was designed to follow thefate of these embryos. Of 407 couples with cryopreserved embryos,262 couples opted to use them within 1 year with the intentionof fulfilling a parental plan. The remaining 145 couples werequestioned by six successive questionnaires sent out between1987 and 1992.By the end of the study, 336 of the 407 couples(82.5%)had chosen to utilize their embryos in a parental plan.In most cases, the maximum delay of response (5 years accordingto the Council of State) was respected. The remaining 71 couples(17.5%) either abandoned the parental plan or had not givenany information by the end of the study. Initially, anonymousdonation to another couple was chosen in preference to destroyingthe surplus embryos (32 versus 18 couples, P < 0.05). Latterly,however, these differences have balanced out (24 versus 28,not significant). Only those couples who initially opted todonate embryos to another couple changed their attitude in lateryears. In the long run, 62 couples decided not to pursue theirparental plan; of these, 24 couples chose to make a gift toanother couple, 28 couples opted for destruction,and 10 choseto make a gift to research. Nine couples (out of 71) declinedto make a decision, but they had all achieved a pregnancy duringan in-vitro fertilization (IVF) attempt.Three of these werelost to follow-up, i.e. 0.7% of all couples benefiting fromthe freezing technique.     

EEG's of prematures: 3-8 year follow-up study

A classification of apparently normal neonatal EEG's into 4 classes (A-D) on the basis of progressive maturity was devised and applied to 273 EEG's of 117 apparently normal newborns recorded between 24 and 50 weeks conceptional age (CA). Both the order in which the 4 classes of EEG's occurred for subjects upon whom more than 1 EEG was obtained, and the distributions of the ages over which the 4 classes were observed confirmed that the classes do indeed represent a maturational sequence of EEG pattern changes. Of the 81 original premature subjects, 46 underwent comprehensive clinical evaluation between 3 yr 9 months and 8 yr 7 months of age. Various features of their neonatal EEG's were evaluated in the light of clinical outcome. The results do not demonstrate the usefulness of the routine EEG as a prognostic indicator in neonates not displaying specific pathology at birth. They do offer some evidence of a relationship between immaturity of the EEG relative to CA in the neonatal period and the later manifestation of congenital disorders involving the brain, but the tendency, even if confirmed, may not prove strong enough to warrant prognostic decisions in individuals.     

Arthroscopic ACL reconstruction: a 5-9 year follow-up

Arthroscopic ACL reconstruction has a satisfactory functional outcome of up to 90%, but there are few long-term prospective studies. This prospective study presents the outcomes of ACL reconstruction in terms of laxity, function and degenerative change, after a mean follow-up of 7 years. Function was assessed using the Lysholm and Tegner Activity Scores, laxity using the Stryker Knee Laxity Tester, employing maximum manual effort, and degenerative change was assessed as joint line narrowing on standardised radiographs. At latest follow-up, the mean Lysholm score improved from 70 to 87 and the Tegner from 4 to 7 (P<0.001). AP translation also improved (P<0.001). The incidence of early degenerative change was 50% and although this appeared to be associated with a previous meniscectomy, the correlation was not significant (P=0.06). In conclusion, the improved functional scores and laxity are sustained beyond 7 years but the 50% incidence of early degenerative change may be a cause for concern.     

Polyurethane-covered mammary prosthesis: a nine year follow-up assessment.

We have examined ten tissue capsules from patients ranging from five months to nine years of mammary implantation. Contrary to published reports of polyurethane foam "fragmentation" or "disappearance" in the capsules evaluated, the polyurethane foam was still present and embedded in the surrounding tissue capsule. The foam was nearly always invisible by gross observation, or manual palpation. Only after enzymatic digestion of the tissue capsule did the foam become clearly visible as continuous sheets. ESCA analyses show that explanted foams are devoid of nitrogen peaks. Only carbon, oxygen and silicone signals are observed. The same foams do show nitrogen peaks (due to urethane linkages) when probed by FTIR. Since ESCA only analyzes the first 40-50 Angstroms of a surface, we believe that a "protective coating" composed of soft segments has formed. Beneath this "coating" the original polyurethane composition is still present as evidenced by FTIR analysis. Three possible explanations are advanced: (1) The surface hydrolysis, which takes place within the soft segment of the polyurethane polymer, results in the formation of oligomer(s). These oligomers, devoid of urethane linkages, appear to protect the polymer from further bioresorption, by significantly retarding the rate of additional surface hydrolysis. (2) Chain cleavage occurs in the soft segment producing a hydrophilic polyester chain end which orients into the interfacial area. These chain ends then produce a skin effect which increases the distance from the surface to the hard segments, or urethane-containing linkages. (3) Macromolecular motion in the soft segment phases of the polymer could be reorienting under the influence of the in vivo environment, thus producing a surface layer or "coating" which is predominantly soft segment in composition. Regardless of which of the three hypotheses proves to be most plausible, we interpret the data as showing that the polyurethane foam cover undergoes very slow bioresorption, even after 9 years of human implantation. The data further suggests that the in vivo surface of the polyurethane foam cover is biocompatible and interfacial interactions with inflammatory cells are downregulated or reduced because of the apparent biocompatibility of the material.     

Pathogenesis of lung cancer: 100 year report

Over the past 100 years, our understanding of the pathogenesis of lung cancer has advanced impressively. Environmental carcinogens and a gene locus determining susceptibility have been identified. The pathology of lung cancer has been classified into categories with major clinical implications. The cellular and molecular genetic changes underlying lung cancer have become better understood over the past 25 years, but the stepwise progression of respiratory epithelium from normal to neoplastic is not yet well demarcated, limiting abilities to advance early detection and chemoprevention. The translation of improved understanding of dominant signal transduction pathways in lung cancer to rationally designed therapeutic strategies has had recent successes, demonstrating a proof of principle for targeted therapy in lung cancer. Improvement in overall patient outcomes has been stubbornly slow and will require concerted efforts.     

Longitudinal follow-up of lymphocyte subsets during the first year of life

A longitudinal study of lymphocyte subsets during infancy was evaluated by using the flow cytometric immunophenotyping method. Two hundred and thirteen blood samples were obtained from 92 healthy, full-term infants of the following ages: 1-7 days old (n = 43), 3 months old (n = 55), 6 months old (n = 57) and 11 months old (n = 58). The absolute numbers of CD3+ and CD3+/CD4+ T lymphocytes increased from birth to 3 months of age, and remained stable thereafter. The absolute number of CD3+/CD8+ T lymphocytes increased from birth to 11 months of age. The absolute number of CD19+ B lymphocytes and NK cells increased rapidly (3 months) after birth and continued to increase throughout the study period. However, the changes in the relative counts of lymphocyte subsets did not always correspond with the changes in their absolute numbers. These results demonstrate the age-related changes in lymphocyte subpopulations and provide reference ranges for lymphocyte subsets during infancy.     

Motor cortex excitability in Alzheimer disease: one year follow-up study

Seventeen patients affected by Alzheimer disease (AD) underwent two transcranial magnetic stimulation (TMS) studies separated by an interval of 12 months, in order to monitor possible changes in motor cortex excitability. After the first examination, all patients were treated with cholinesterase inhibitor drugs. Motor threshold (MT), amplitude of motor evoked potentials and central motor conduction time were considered. After one year, the mean MT values showed a decrease significantly correlated with the severity of cognitive involvement, evaluated by means of the Mini Mental State Examination (MMSE). The difference in MT between the two recording sessions showed no significant correlation with the difference in MMSE score. One year of treatment with cholinesterase inhibitor drugs did not stop the progressive increase in motor cortex excitability. Serial analysis of TMS might represent a method to monitor the rate of change in motor cortex excitability in patients with AD.     

Expressed emotion and early onset schizophrenia: a one year follow-up

Key relatives of 33 first or early admission psychotic patients (mainly schizophrenics) were interviewed to determine household levels of expressed emotion (EE). The patients were followed up for 12 months from index admission, during which time 13 (39%) experienced psychotic relapse. There was no association between relapse rate and household EE, but correlations between individual components of EE and pre-morbid measures suggest that level of criticism may be related to less acute onset of index episode, greater elapsed time since first signs of illness, and poor adjustment in the realm of work/study. The results are discussed in the context of continuing uncertainties about the precise nature of the relationship between EE and relapse.     

Ten year follow-up of depression after diagnosis in general practice.

BACKGROUND: Depression is a serious illness with a high recurrence rate, mortality, and suicide rate, and a substantial loss of quality of life. Long-term course of depression, in particular of patients not referred to specialist care, is not completely clear. We performed a study in which the course of depression in general practice was studied for 10 years after the first diagnosis. AIM: To learn more about long-term course and outcome of patients with depressive illness for a full 10 years after diagnosis. METHOD: A historic cohort study with 386 patients classified as depressive before January 1984, recruited from four general practices belonging to the Continuous Morbidity Registry of the University of Nijmegen in The Netherlands. This cohort was followed up for 10 years. Mortality was compared with a control group matched for age, sex, social class, and practice. Of 222 patients out of this cohort who could be followed up for a full 10 years after diagnosis, the case records were studied in detail. RESULTS: No statistically significant difference was found in mortality between the 386 patients and the control group. Recurrence of depressive episodes did not occur in about 60% of the 222 patients (confidence interval 54% to 67%). Of the depressive patients, 15% were referred to secondary care and 9% were admitted to hospital. CONCLUSION: Mortality, suicide, and recurrence rate were lower than expected, taking into account what is known from depression studies in psychiatry. These results stress the importance of long-term prospective follow-up studies of all patients with depression because of the emphasis on case-finding and treatment without exact knowledge of long-term course and outcome of patients who were not referred.     

Clinical evaluation of terbinafine on onychomycosis with a 2 year follow-up]

Over the 2 year period from October, 1997 to September, 2005, the clinical efficacy of 125 mg/day of terbinafine was evaluated in 356 patients with onychomycosis. Of these, 253 patients were followed up for 6 months after oral treatment of terbinafine, 120 for 1 year, and 56 for 2 years. The improvement ratio increased depending on follow-up period: 30.4% in 6 months, 65.0% in 1 year, and 67.9% in 2 years. However, in 25 patients who showed regression from onychomycosis at the 1 year period, 8 patients (32.0%) relapsed. The muddy rate of the first toenail was decreased from pre-treatment with terbinafine in 92.1% at 6 months, 91.7% at 1 year and 87.5% at 2 years. It is considered that efficacy of this medication is maintained within 1 year after the treatment, but the number of patients who experience a relapse is likely to increase from 1 year to 2 years.