Long-term follow-up of patients with rotationplasty

Introduction and importanceRotationplasty considered a limb-salvage procedure and has a lot of advantages when comparing it with endoprostheses or above-knee amputation.Case presentationWe report two cases of young patients with osteosarcoma with rotationplasty being performed for both of them.Clinical discussionPatients with rotationplasty have less restrictions in daily life activities due to pain comparing with patients with endoprostheses.ConclusionOur aim here is to confirm that rotationplasty is an applicable, successful and alternative procedure to endoprostheses or above-knee amputation, when doing it based on an accurate indication and patients regain their previous daily life activities and satisfaction.     

Long-term follow-up of patients with gastroschisis

Long-term follow-up of children with gastroschisis has been made possible by the increased survival of these infants over the past 20 years. We have observed that children with isolated gastroschisis defects exhibit normal growth and development beyond 5 years of age without significant bowel sequelae. Infants with gastroschisis with concomitant bowel atresia or complications who require small bowel resection are at a greatly increased risk for long-term bowel problems and abdominal complaints.     

Long-term follow-up study of 50 patients with pancreaticoduodenectomy for chronic pancreatitis

From 1963 to 1976, fifty patients, all male and alcoholic, underwent pancreaticoduodenectomies for chronic pancreatitis. Prior operation(s) had already been performed for 17 patients.There was 1 postoperative death. The main late complications were anastomotic peptic ulcer (5 cases) and acute cholangitis (3 cases). In 1981, four patients were lost to follow-up, 23 patients were dead, and 22 patients were reviewed with a mean follow-up period of 10.7 years. Secondary deaths mainly occurred during the 5 years following surgery (17 of 23). Other complications of chronic alcoholism, together with smoking-related diseases, were the cause of death in 8 patients. Symptomatic and clinical results were excellent or good in 16 of 22 reviewed patients. Persistent alcoholism (50% in patients who died and 10% in living patients) and low socioeconomic level were the main factors affecting long-term survival.

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Resumen Cincuenta pacientes, todos hombres alcohólicos con severos ataques de dolor abdominal, fueron sometidos a pancreatoduodenectomía por pancreatitis crónica entre 1963 y 1976. La técnica operatoria prefirió una larga anastomosis entre la porción distal del páncreas y el yeyuno. El procedimiento de Whipple con esta anastomosis pancreáticoyeyunal latero-lateral combina las ventajas de la pancreatectomía cefálica con la wirsungo-yeyunostomía.La edad promedio fue 41,7 años. La sintomatología incluyó dolor abdominal (100%), pérdida de peso mayor de 10 kg (70%), diabetes (24%), ictericia (20%) y otras complicaciones (20%). Operaciones previas habían sido realizadas en 17 pacientes. A la laparotomía las lesiones pancreáticas aparecieron difusas pero localizadas predominantemente en la cabeza del páncreas en el 90% de los casos, con gran dilatación del canal colédoco en el 60% y seudoquistes en la cabeza del páncreas en el 30%.Hubo una muerte post-operatoria. Las principales complicaciones tardías fueron úlcera péptica anastomótica (5 casos) y colangitis aguda (3 casos). El periodo de seguimiento post-operatorio varió entre 5 y 18 años. Cuando este estudio fue realizado en 1981, 4 pacientes se habían perdido en el seguimiento, 23 pacientes habfan muerto, y 22 fueron revisados con un seguimiento medio de 10,7 años. La mortalidad secundaria ocurrió principalmente en el curso de los primeros 5 años después de la cirugía (17 de 23). La pancreatitis crónica y el procedimiento de Whipple fueron la causa de muerte sólo en 6 pacientes, entre los 16 en quienes la causa de muerte fue conocida. Otras complicaciones del alcoholismo crónico junto con enfermedades relacionadas con el hábito de fumar, constituyeron la causa de muerte en 8 pacientes. Los resultados, tanto sintomáticos como clínicos, fueron excelentes o buenos en 16 de 22 pacientes revisados. Cuando los resultados se encontraron satisfactorios a los 5 años después de la operación y cuando el patiente logró abstenerse del alcohol, el pronóstico pareció estabilizarse. El alcoholismo persistente (50% en los pacientes que murieron y 10% en los pacientes vivos) y el bajo nivel socio-económico aparecen como los principales factores que afectan la supervivencia a largo plazo.

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Résumé De 1963 à 1976, une duodénopancréatectomie céphalique a été réalisée chez 50 malades, tous des hommes et des éthyliques, atteints de pancréatite chronique calcifiante. Une ou plusieurs interventions avaient été préalablement effectuées chez 17 d'entre eux.Il y a eu un décès postopératoire précoce. L'ulcère anastomotique (5 cas) et l'angiocholite (3 cas) ont été les principales complications tardives observées. En 1981, 4 malades étaient perdus de vue, 23 malades étaient décédés et 22 malades ont été revus avec un recul moyen de 10,7 ans. Les décès secondaires sont surtout survenus dans les cinq ans qui ont suivi la duodénopancréatectomie céphalique (17 sur 23). Les autres complications de l'alcoolisme chronique et du tabagisme associé ont été la cause de la mort chez 8 malades. Le résultat fonctionnel était excellent ou bon chez 16 malades parmi les 22 malades revus. La poursuite de l'alcoolisme (50% chez les malades ultérieurement décédés et 10% chez ceux qui étaient en vie) et l'existence d'un niveau socio-économique bas ont été les principaux facteurs de gravité dans l'analyse des résultats lointains de la duodénopancréatectomie céphalique.

     

Long-term follow-up of patients with necrotizing enterocolitis

Background/Purpose: Despite the rise in the incidence of necrotizing enterocolitis (NEC), there is a paucity of data regarding long-term patient outcome. The authors examined functional outcome of infants with NEC (n = 103) treated at our institution between 1991 and 1995. Methods: The authors reviewed the medical records of infants who were treated both operatively and nonoperatively, n = 103. Variables examined included gestational age, birth weight, Bell stage (I through III), operations performed, and mortality rate. Telephone interviews assessed school enrollment, developmental delay, bowel function, and nutritional status. Results: Children treated operatively had a lower gestational age than those in the nonoperative group. Likewise, birth weight in the operative group was significantly lower. Sixty-three percent of patients had stage III, and the remainder had stage II disease. The telephone response rate was 61%. Mean age at follow-up was 7.5 [plusmn] 2.5 years. All children ate by mouth. Nearly all children were toilet trained. All children were less than the 50th percentile for height and weight, and the majority (83%) were enrolled in school full time. Conclusion: Infants with stage II and III NEC who are treated operatively or nonoperatively have a favorable long-term outcome. J Pediatr Surg 37:1048-1050.     

Long-term follow-up of patients with geomedic prostheses

Of 122 Geomedic arthroplasties performed, 85 were possible to follow up. The mean observation period was 58 months. The original position of the prosthesis was analyzed with respect to its effect on the clinical condition. A score system was used for this purpose. A normal alignment was obtained in 51%. No statistically significant correlation could be shown between a high radiographic score and a high clinical score. A resorption zone of 2mm or more, considered a sign of loosening, arose in 37% and a coexisting change of position in 12%. There is no difference in radiographic score between the prostheses which were judged as loose and the other prostheses. Twelve percent of the patients were reoperated because of loosening. The patients consider their condition to be very good or good in 93% of cases. Pain at rest and pain on weight bearing were totally absent in 87% and 72% of cases respectively.     

Long-term follow-up of patients with geomedic prostheses

Summary Of 122 Geomedic arthroplasties performed, 85 were possible to follow up. The mean observation period was 58 months. The original position of the prosthesis was analyzed with respect to its effect on the clinical condition. A score system was used for this purpose. A normal alignment was obtained in 51%. No statistically significant correlation could be shown between a high radiographic score and a high clinical score. A resorption zone of 2 mm or more, considered a sign of loosening, arose in 37% and a coexisting change of position in 12%. There is no difference in radiographic score between the prostheses which were judged as loose and the other prostheses. Twelve percent of the patients were reoperated because of loosening. The patients consider their condition to be very good or good in 93% of cases. Pain at rest and pain on weight bearing were totally absent in 87% and 72% of cases respectively.     

Long-term follow-up of patients with idiopathic infantile hypercalcaemia

Idiopathic infantile hypercalcaemia (IIH) is a rare disorder of unknown etiology that presents with hypercalcaemia in a child's first year of life. There is only a limited number of published reports of the natural history of this condition, and the long-term prognosis is largely unknown. The presentation, treatment and long-term follow-up of 11 children with IIH treated at our institution since 1993 are described. Hypercalcaemia resolved in the majority of children by the time they were 3 years of age, but nephrocalcinosis and persistent hypercalciuria were common, and, in some cases, urinary calcium excretion increased after initially becoming normal. This study suggests that clinical and biochemical abnormalities may persist for longer than previously reported and implies the need for ongoing surveillance of patients with IIH.     

Long-term follow-up study of patients with cavernous sinus aneurysm treated by proximal occlusion

Proximal occlusion of the internal carotid artery (ICA) is still the treatment of choice for a large cavernous sinus aneurysm. Endovascular occlusion or trapping of the ICA with or without an extracranial-intracranial bypass is sometimes performed. We analyzed the results of the long-term follow up of 11 patients with a giant or large cavernous sinus aneurysm treated by only proximal occlusion between 1975 and 1989. Proximal occlusion of the carotid artery was performed by Selverstone clamping. The follow-up period ranged from 6 to 21 years (mean 13.9 years). Eight of the 11 patients showed improvement of cranial nerves paresis or headache, and four became asymptomatic. None of the original aneurysms ruptured. The final outcomes were nine good recovery, one moderately disabled, and one severely disabled by the Glasgow Outcome Scale. The causes of morbidity were early ischemia and subarachnoid hemorrhage from a newly formed aneurysm. Late complications included ischemia in two patients, and new formation and enlargement of aneurysms at a site other than the original aneurysm in two patients, 13 and 17 years later. Therapeutic carotid artery occlusion requires strict test ICA occlusion. In addition, long-term follow up by periodical cerebral angiography using magnetic resonance, computed tomography, or digital subtraction angiography is necessary, and postoperative medical treatment is important to reduce the risk of late complications.     

Long-term follow-up of patients with high-risk congenital diaphragmatic hernia

Background/Purpose

Recent advances including prenatal diagnosis, high-frequency oscillatory ventilation, and nitric oxide inhalation therapy have gradually improved the survival of high-risk congenital diaphragmatic hernia. However, the factors affecting the long-term outcome of these patients have not been well established.

Methods

Thirty-three children with ages 4.1 ± 2.5 years underwent clinical examination including growth measurements, echocardiography, ventilation, and perfusion scintigraphy.

Results

No late death was observed. Common complications were frequent respiratory tract infection (13 patients) and bowel obstruction (5 patients underwent surgery). Although frequent respiratory tract infection decreased with increasing age, patients with frequent respiratory tract infection had a decreased uptake of lung ventilation and perfusion scintigraphy on the affected side and had a decreased height for age and weight for height. No significant difference in lung ventilation and perfusion scintigraphy was observed between patients treated with and without extracorporeal membrane oxygenation, those requiring oxygen more than 1 month, and between those with and without prenatal diagnosis. Patients with a patch repair had decreased uptake on lung perfusion scintigraphy. Although frequent respiratory tract infection may be owing to hypoplasia of the ipsilateral lung, it may impair recovery of the hypoplastic lung.

Conclusion

These results indicate that monitoring for respiratory tract infection in addition to nutritional assessment should be required in the follow-up of patients with congenital diaphragmatic hernia at high risk.     

Long-term follow-up after surgery for patients with biliary atresia

Long-term results after surgery for biliary atresia (BA) in 48 patients, ranging in age from 10 to 33 years, were examined. There were 19 males and 29 females. Twelve had correctable type BA and 36 had the noncorrectable type. Forty-one cases had no jaundice; seven did. Thirty-seven of the 48 cases were leading normal lives. Among them, six cases were enjoying their lives after overcoming sequelae, such as portal hypertension. The main morbidities of the remaining 11 long-term survivors were jaundice and portal hypertension. The growth of most cases were comparable to those of the normal Japanese population. The data of liver function tests were variable and disclosed a moderate degree of abnormality in patients mainly complicated by cholangitis. Eleven cases, including six jaundice cases, required treatment for esophageal varices and/or hypersplenism. In conclusion, the cured states of most cases without jaundice are satisfactory and these former patients have achieved a favorable quality of life. Early operations are essential to obtain good short-term results as well as good long-term results.     

Long-term psychosocial adjustment in patients with severe burn injuries: a follow-up study.

An investigation of the long-term psychosocial adjustment of patients with severe burn injuries is presented. In the selected 13-year period (1968-80) 46 patients fulfilled the entry criteria: burns covering more than 30 per cent body surface area (deep dermal or full skin thickness). Seventeen patients died early and one later. Of the remaining 28 patients, contact was made with 25 (89.3 per cent) who all participated. The observation time ranged between 7 and 21 years. The patients received a semi-standardized interview adjusted for age at the time of burn injury, a psychiatric interview and a physical examination to assess the permanent character and functional loss. The principal findings were: no correlation could be found between degree of disfiguration/function loss and the long-term psychosocial adaptation after severe burn injuries. The determinant factor was the premorbid psychiatric/psychological integration and, to some extent, support from staff and relatives.