Lung function in simple complete transposition after intracardiac repair

Pulmonary function was measured in 35 patients (mean age 11.6 years) with simple complete transposition 4.4 years after intracardiac repair. A disturbance in the lung function (greater than 2 SD from the normal value) was found in 88% of the patients. A marked increase in static recoil pressure (P less than 0.001) was most frequent (in 66%). Static lung compliance was only 75.1% of the predicted values. Values of mean vital and total lung capacity were decreased (P less than 0.01 and 0.001). Residual volume, the ratios of functional residual versus total lung capacity and residual volume versus total capacity were all increased. The signs of decreased patency of the airways were found in only 4 patients. A negative correlation was detected between the indices of lung stiffness and the age of assessment of lung function. A positive correlation was found between the ratios between functional residual and total capacity and pulmonary blood flow. No other correlation between lung function data and pulmonary arterial pressure or flow was proved. Increased lung stiffness, restriction of lung volume and hyperinflation could influence unfavorably the long-term results in successfully treated patients with simple complete transposition.     

Long-term outcome after the mustard repair for simple transposition of the great arteries: 28-year follow-up

Objectives. This study examines the late outcome in patients with simple transposition of the great arteries (TGA) after a Mustard operation.Background. Continuing medical follow-up for patients after the Mustard procedure, now extending to three decades, is required. The quality of life of adult survivors has not been well documented.Methods. Survival and quality of life among 113 hospital survivors of the Mustard operation performed for simple TGA between 1964 and 1982 were assessed by medical review and a lifestyle questionnaire. The incidence of right ventricular failure and echocardiographic right ventricular dysfunction (RVD) were determined. A measure of lifestyle, the ability index, was determined.Results. Actuarial survival was 90%, 80%, and 80% at 10, 20, and 28 years, respectively, with 76% of survivors being New York Heart Association class 1. Sudden death, with an incidence of 7% without identifiable risk factors, was the most common cause of late demise. RVD was identified in 18% of patients who had echocardiography, but there was right ventricular failure in only two patients. Seventy-five percent of current survivors lead a normal life, 20% have some symptoms or lifestyle modification, and 5% are unable to work.Conclusions. The survival of patients to 28 years with the Mustard repair has been good. Late sudden death is the most worrisome feature. There is a 97% freedom from right ventricular failure to date. The quality of life of late survivors is good, most achieving a normal level of education and employment.     

Long-term outcome after overlapping anterior anal sphincter repair for fecal incontinence

Purpose

The aim was to assess long-term results and quality of life following anterior anal sphincter repair for anal incontinence.

Patients and methods

Twenty-three female patients underwent anterior anal sphincteroplasty over a 10-year period between January 1999 and January 2009 in a gynecological surgery department. Patients were asked to complete pre- and postoperative questionnaires comprising the Jorge and Wexner incontinence score. The secondary objective was to assess pre- and post-sphincteroplasty symptom severity and sexual quality of life. Mean follow-up was 87 months (median, 91.5 months). Kaplan-Meier time-to-event analysis was applied.

Results

Mean age was 52 years (±15.2), and mean postoperative Jorge and Wexner score, 7.5/20 (±4.1). Seventeen patients (85 %) declared themselves satisfied by the repair; 12 (60 %) showed good fecal continence. Fecal incontinence had a negative impact on quality of life for 15 % and on sexuality for 50 % of patients. Kaplan-Meier analysis showed 85 % conservation of anal continence correction at 1 year, 74 % at 48 months, 67 % at 60 months, and 48 % at 84 months.

Conclusions

Overlapping anterior anal sphincter repair provided lasting improvement in fecal incontinence, with satisfactory long-term functional results. At 84 months’ follow-up, 48 % of patients maintained good fecal continence, with a satisfaction rate of 85 %. Anal sphincteroplasty may be a first-line attitude in young female fecal incontinence patients with a recent sphincter defect following initially undiagnosed obstetric trauma and also restores perineal comfort.     

Long-term outcome of bioprostheses

The major advantage of cardiac bioprostheses, apart from the good haemodynamic performance of recent models, is that they are not thrombogenic, so that the patient does not have to follow a life-long anticoagulant treatment. However, their major disadvantage, in comparison with the mechanical prostheses, is that they deteriorate over time. This study defines the durability of bioprostheses over the first seven years and beyond seven years. During the first seven years, if we compare the risk of thromboembolic and haemorrhagic complications of anticoagulant treatment to the risks of tissue deterioration, there is a clear advantage in favour of the bioprostheses. However, this is only true in adults, as in patients under the age of 20, the bioprostheses deteriorate much more rapidly. Few statistics are available concerning the followup of bioprostheses beyond seven years. However, on the basis of these statistics, absence of deterioration was observed in 75% of cases at 9 years and in 65% of cases at 10 years. These figures demonstrate that the great majority, if not all, cases of bioprostheses implanted at the present time will not need to be changed before 8 to 15 years. These results justify the research currently underway in various centres to determine the cause of these deteriorations and to try to prevent them.     

Long-term outcome of lung transplantation

Lung transplantation (LTx) nowadays is an established therapeutic option for various end-stage lung diseases in despite of an optimal medical therapy in selected patients affected with various pathologies such as emphysema/chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF) and various forms of bronchiectasis, pulmonary fibrosis and pulmonary hypertension. Progress and refinement over the last two decades in both surgical techniques and medical management including especially the introduction of cyclosporine A, have been impressive. Patient survival improved significantly over time. According to the most recent data of the International Registry of Lung Transplantation (ISHLT), actuarial survival is 79%, 63%, 52% and 29% at 1, 3, 5 and 10 years respectively, with a current overall survival half-life of 5.3 years, and more than 7 years for those who survived 1 year or more. However, survival depends on different parameters such as the underlying disease, data relative to the donor, the recipient and/or the transplant procedure. Major limitation of long-term survival is still chronic allograft dysfunction, which is histologically represented by an obliterative bronchiolitis and functionally by the bronchiolitis obliterans syndrome (BOS). In uncomplicated cases near-normalization of pulmonary function is the rule, with more than 80% of survivors at 1, 3, 5 and 10 years reporting no activity limitations. Functional results after single LTx remain lower than those of the bilateral LTx, and depend on the potential worsening of the underlying disease and complications arising on the native lung. Exercise performance usually is approximately 50% of predicted, suggesting extrapulmonary causes such as side effects of immunosuppressive drugs. Quality of life improves significantly in all domains including employment status.     

Long-term outcome of autoimmune pancreatitis

Purpose  Autoimmune pancreatitis (AIP) is a unique form of pancreatitis and can be complicated with various extrapancreatic lesions. Little is known about the long-term clinical course of AIP. Here we aimed to document the clinical course of AIP. Methods  For this study, we recruited 21 patients, averaging 66.5 years in age (range, 19–84 years) and observed them at a mean interval of 40.8 months (range, 18–130 months). Three of the patients were also diagnosed with retroperitoneal fibrosis, 3 had sialoadenitis, 2 had chronic thyroiditis, 1 had interstitial nephritis, and 1 had interstitial pneumonia. Three of the patients underwent surgical therapy, 12 patients received methylprednisolone (PSL) treatment, and the 6 remaining patients received no treatment. Results  Enlargement of the pancreas was attenuated in all the PSL-treated patients. Seven of the 21 patients showed pancreatic atrophy, of whom 2 were non-PSL-treated patients. Three patients developed chronic pancreatitis. One patient was diagnosed with pancreatic cancer after 50 months of PSL therapy. Conclusions  As with chronic pancreatitis patients, AIP patients should be observed closely for abnormality in pancreatic function.     

Long-term outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study

Background

The aim of this retrospective study was to evaluate the peri-operative and long-term outcome after early repair with a hepaticojejunostomy (HJ).

Methods

Between 1995 and 2010, a nationwide, retrospective multi-centre study was conducted. All iatrogenic bile duct injury (BDI) sustained during a cholecystectomy and repaired with HJ in the five Hepato-Pancreatico-Biliary centres in Denmark were included.

Results

In total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Post-operative morbidity was 36% and mortality was 4%. Forty-two patients (30%) had a stricture of the HJ. The median follow-up time without stricture was 102 months. Nineteen out of the 42 patients with post-reconstruction biliary strictures had a re-HJ. Twenty-three patients were managed with percutaneous transhepatic cholangiography and dilation. The overall success rate of re-establishing the biliodigestive flow approached 93%. No association was found between timing of repair, concomitant vascular injury, level of injury and stricture formation.

Conclusion

In this national, unselected and consecutive cohort of patients with BDI repaired by early HJ we found a considerable risk of long-term complications (e.g. 30% stricture rate) and mortality in both the short- and the long-term perspective.