Long-term follow-up of 453 rheumatoid arthritis patients treated with methotrexate: an open, retrospective, observational study

A total of 453 rheumatoid arthritis (RA) patients were followed up for 35.2 +/- 27.9 months (range 3-106). The clinical parameters decreased significantly after 6 months. Twenty-eight patients were in remission (6.4%). Rheumatoid factor (RF) positivity was less common in the group of patients in remission, with a higher frequency of visits and methotrexate (MTX) onset after 65 yr. There was a significant degradation of radiographic lesions (n = 60). A total of 101 patients (23.1%) stopped MTX, for toxicity (n = 61) and failure (n = 20). The onset of MTX after 65 yr, a low number of visits and the occurrence of side-effects were predictive of MTX withdrawal. A total of 259 patients (59.3%) had side-effects. A Ritchie's index < or = 10, a lower polymorphonuclear cell count and the absence of RF were predictive of side-effects. The probability of being on MTX at 5 yr was 73%. This study confirms the high efficacy of MTX in RA.     

Long-term follow-up of patients who lost weight in a cognitive-behavioral treatment program.

Surveyed 111 clients 6–10 yrs after cognitive-behavioral treatment for obesity concerning their current approaches to weight control during times of maintenance, loss, and gain. When the responses of 36 Ss who had maintained their postprogram weight losses were compared to 75 Ss who gained weight, it was found that Ss who had maintained reduced weights had more carefully planned snacks with regard to time, selection, and calories, and had engaged in more regular physical exercise. The desire to eat was more frequently displaced by other activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term follow-up of konzo patients

Nine patients with konzo, a symmetric spastic paraparesis of acute onset that occurs during agricultural crises in cassava-growing areas, were re-examined after 14 years. Konzo outbreaks are associated with eating insufficiently processed bitter cassava and a low intake of essential amino acids. Bitter cassava contains cyanogenic glycosides; processing breaks them down to acetone cyanohydrin and hydrogen cyanide. This long-term follow-up showed that the neurological signs in konzo patients remained constant. Four severely affected patients, however, showed functional improvement. This non-progression clearly distinguishes konzo from myelopathy associated with human T lymphotropic virus type I infection. One child, originally classified as a konzo case, showed signs of cretinism at follow-up.     

Behavioral treatment of Raynaud's disease: Long-term follow-up.

Conducted 2- and 3-yr follow-up assessments of 13 Raynaud's disease patients who were treated with finger temperature feedback or finger temperature feedback under cold stress in a study by R. Freedman et al (see record 1983-33246-001) that reported symptom reductions of 66.8 and 92.5%, respectively, 1 yr after treatment. The present data show that these significant reductions in attack frequency were maintained for 3 yrs after treatment. The possible involvement of capillary blood flow in this phenomenon is discussed. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term follow-up of patients with chronic hepatitis C after interferon-alpha treatment

In this study, 72 patients with chronic hepatitis C virus (HCV) were followed prospectively for a mean period of 27 months after interferon treatment. Fifty-seven percent (20/35) of the patients with complete response, 18/20 with HCV-RNA-negative serum, had a sustained biochemical remission. Reactivation was seen in 43% of these patients after a mean follow-up of 7.3 months. A late relapse after more than 12 months of follow-up occurred in only 2/15 patients. Patients with a long-term complete response had significantly lower pretreatment serum HCV RNA levels than complete responders with relapse (106,239 vs. 345,649 mEq/ml, p = 0.0213). A delayed sustained biochemical remission was seen in 3/37 patients with partial or no response. Thus, long-term response is achieved in 32% of the patients treated with interferon, clearly associated with a suppression of serum HCV RNA. Patients with normal ALT values and undetectable levels of HCV RNA for more than 12 months of follow-up may usually be considered as sustained responders. Thus, for the first time, the pretreatment HCV RNA level in serum was identified as predictive of long-term response.     

Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms

The mortality and causes of death in 115 patients (80 women), born 1902-1937, with untreated scoliosis were compared to the expected according to official Swedish statistics. Subgrouping for cause and onset of scoliosis was done. Fifty-five patients had died; 21 of respiratory failure and 17 of cardiovascular diseases. The mortality was significantly (P less than 0.001) increased. The increased risk was apparent at 40-50 years of age. The mortality was significantly increased in infantile (P less than 0.001) and juvenile (P less than 0.01) scoliosis but not in adolescent scoliosis. The mortality was also increased in post-polio scoliosis, scoliosis combined with rickets and scoliosis of unknown etiology indicating an increased mortality in idiopathic scoliosis. Among the surviving patients anti-hypertensive treatment was frequent (23 of 50).     

Long-term evaluation of root-resected molars: a retrospective study

Thirty-two consecutively treated patients were included in this study of 49 root-resected molars that were under regular recall of 3 to 6 months for a mean of 11.5 years (2 to 23 years). Treatment modalities for all patients were very similar. Endodontic treatment was conservatively performed prior to resection with maximum preservation of tooth structure. No threaded posts were used. Provisional restorations were in place prior to periodontal therapy (pocket reduction with or without osseous surgery). Most patients were treated with complete-mouth reconstructions. Ninety-two percent of all resected molars survived an average of 12 years. Teeth failed because of recurrent caries or for endodontic and strategic reasons. If proper treatment is rendered periodontically involved molars can be maintained for a long period of time and serve successfully as abutments in complete-mouth restorations. Great care must be taken throughout the whole process of case selection, reevaluation, and endodontic, periodontal, restorative, and maintenance therapies.     

Carbon dioxide laser resurfacing. Long-term follow-up in 2123 patients

Carbon dioxide (CO2) laser resurfacing has become increasingly popular as a method of facial rejuvenation, enabling the surgeon to repair sun-damaged skin, wrinkles, and acne scars precisely. This article presents the results of the authors' histologic studies with all of the current CO2 laser systems as well as the conclusions of her experience with 2123 patients over a 5-year period. Improvements obtained from CO2 laser resurfacing appear to be long lasting, especially when combined with other procedures, and it is likely that laser resurfacing will remain in the armamentarium of facial rejuvenation for some time.     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect. However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term follow-up of patients with biliary atresia successfully treated with hepatic portoenterostomy. The importance of sequential treatment

Castleman's disease, also known as benign giant lymph node hyperplasia, is a lymphoproliferative disorder which can occur either in a localized or multicentric form. The latter is characterized by the development of malignant lymphoma, Kaposi's sarcoma or carcinoma in 32% of cases. By contrast, localized Castleman's disease has exceptionally been reported in association with non-Hodgkin's lymphoma and - to the best of our knowledge - never at the same anatomic site. Here we describe the occurrence in the same lymph node of localized Castleman's disease (with monotypic plasma cell component) and an apparently unrelated peripheral small B-lymphocytic lymphoma.     

Long-term follow-up of ventriculoureteral shunts for treatment of hydrocephalus

We report on an 18-week fetus with cyclopia, alobar holoprosencephaly, complex congenital heart defect, anal atresia, oligosyndactyly, cystic hygroma, and skeletal abnormalities with trisomy 4. Structural anomalies were detected on routine ultrasound of the pregnancy of a 17-year-old G3 P1 TAB1 woman with sickle cell trait. Trisomy 4 conceptuses usually miscarry in the first trimester. We are aware of no other reports of a fetus with trisomy 4 and cyclopia. Causal association of chromosome abnormalities and holoprosencephaly sequence may be more apparent in embryos and early fetuses than term fetuses because of poor viability of affected conceptuses.     

Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis

Patients with gastroparesis frequently present challenging clinical, diagnostic, and therapeutic problems. Data from 146 gastroparesis patients seen over six years were analyzed. Patients were evaluated at the time of initial diagnosis and at the most recent follow-up in terms of gastric emptying and gastrointestinal symptomatology. The psychological status and physical and sexual abuse history in female idiopathic gastroparesis patients were ascertained and an association between those factors and gastrointestinal symptomatology was sought. Eighty-two percent of patients were females (mean age: 45 years old). The mean age for onset of gastroparesis was 33.7 years. The etiologies in 146 patients are: 36% idiopathic, 29% diabetic, 13% postgastric surgery, 7.5% Parkinson's disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudoobstruction, and 6% miscellaneous causes. Subgroups were identified within the idiopathic group: 12 patients (23%) had a presentation consistent with a viral etiology, 48% had very prominent abdominal pain. Other subgroups were gastroesophageal reflux disease and nonulcer dyspepsia (19%), depression (23%), and onset of symptoms immediately after cholecystectomy (8%). Sixty-two percent of women with idiopathic gastroparesis reported a history of physical or sexual abuse, and physical abuse was significantly associated with abdominal pain, somatization, depression, and lifetime surgeries. At the end of the follow-up period, 74% required continuous prokinetic therapy, 22% were able to stop prokinetics, 5% had undergone gastrectomy, 6.2% went onto gastric electrical stimulation (pacing), and 7% had died. At some point 21% had required nutrition support with a feeding jejunostomy tube or periods of parenteral nutrition. A good response to pharmacological agents can be expected in the viral and dyspeptic subgroups of idiopathics, Parkinson's disease, and the majority of diabetics, whereas a poorer outcome to prokinetics can be expected in postgastrectomy patients, those with connective tissue disease, a subgroup of diabetics, and the subset of idiopathic gastroparesis dominated by abdominal pain and history of physical and sexual abuse. Appreciation of the different etiologies and psychological status of the patients may help predict response to prokinetic therapy.     

Adolescents who attempt suicide: A retrospective clinical chart review of hospitalized patients.

In a review of pediatric hospital admissions over 4 years, we identified 173 adolescents who had attempted suicide. Of these individuals, 104 (60.1%) were female and 69 (39.9%) were male. The age range was 10–20 years, with approximately 60% of the population being 17–20 years old. The three characteristics most often exhibited by an adolescent in the year prior to the attempt were alcohol use, drug use, and rebellion toward authority. Only 10% of the attempters were reported to have come from a harmonious family. Depression, impulsivity, and anger were the most predominant personality characteristics reported. The suicide attempts were usually precipitated by conflicts with a significant person, either a parent or a boy- or girlfriend, and were accomplished by drug overdose. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A thirty-year follow-up of treatment effects.

Over 500 men, half of whom had been randomly assigned to a treatment program to prevent delinquency (E. Powers and H. Witmer, 1951) that lasted approximately 5 yrs (1939–1944), were traced 30 yrs after termination of the project. Although subjective evaluations of the program by those who received its benefits would suggest that the intervention had been helpful, comparisons between the treatment and control groups indicate that the program had negative side effects as measured by criminal behavior, death, disease, occupational status, and job satisfaction. Several possible processes are suggested in explanation of these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of behavior therapy: A 12-month follow-up.

19 female undergraduates who underwent various behavioral treatments designed to reduce a specific fear were paid to return for follow-up 1 yr. later. In general, treated Ss' rat fears were less intense 1 yr. after treatment than they had been prior to treatment, with those treated by systematic desensitization slightly less fearful than those treated with "rational therapy." Subsequently, the desensitized Ss eliminated a snake fear by themselves, but the effects of this self-administered desensitization were not maintained. Additionally, 6 children treated by operant conditioning techniques for various problems were reevaluated 1 yr. later. All behavior change was maintained, but only those who had graduated to social reinforcement showed additional improvement. No evidence for symptom substitution was obtained from either group of Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation.

105 abused and nonabused women were examined for patterns of adult psychopathology associated with childhood sexual abuse and to test the extent to which these patterns are independent of other pathogenic properties of the family environment. Clinical and nonclinical Ss completed the Family Environment Scale, the MMPI, the Rorschach, and the Stanford Hypnotic Susceptibility Scale. Greater nonspecific impairment among abused women may be a consequence, at least in part, of pathogenic family structure rather than sexual abuse per se. However, MMPI and Rorschach responses suggest sexual abuse may render victims especially vulnerable to specific disturbances involving soma and self. Abuse was associated with greater use of dissociation, but covariance analysis revealed this effect to be accounted for by family pathology. There was no evidence that sexual trauma is associated with hypnotizability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Retinal detachment following intracapsular and extracapsular cataract extraction. A comparative, retrospective follow-up study

In a retrospective study we reviewed the post-operative incidence of retinal detachment in a consecutive series of 762 eyes operated on with intracapsular cataract extraction and a consecutive series of 1351 eyes operated on with extracapsular cataract extraction. Follow-up time was 2 1/2-4 1/2 years in both series. The incidence of retinal detachment was 0.79% after intracapsular cataract extraction and 0.44% after extracapsular cataract extraction. The difference was not statistically significant. Age below 70 years was not statistically significantly correlated to retinal detachment.     

Long-term follow-up of anatomic heart transplantation. Apropos of 60 patients with a mean follow-up of 36 months

The aim of this study was to collect different problems seen in long-term evolution of patients who had anatomical cardiac transplantation and to compare with those seen in patients with standard transplantation. During the mean follow-up of 36 months, we analysed different data of 60 patients mean aged 51, who underwent anatomical cardiac transplantation. Six patients (10%) died within the 30 days after surgery. No patient needed the use of permanent pacemaker. Echocardiographic examination found normal atrial shape. One month after surgery, echocardiography described 16 tricuspid regurgitations (22.66%) and 8 mitral regurgitations (13.33%), 1 year later, there was respectively 13.33 and 6.66% tricuspid and mitral regurgitation. We had 8 late deaths: 1 sudden death, 2 chronic rejections, 1 pancreatitis and 4 cancers. The survival analysis pointed out 84% at 1 year, 80 at 2 years, 78 at 3 years and 73 at 5 years. Six months after surgery, 80% of patients were treated for high blood pressure; 85% had serum creatinine level equal or superior to 13 mg/L, with mean serum ciclosporin at 130 ng/mL. At the 3rd month, 6 endomyocardial biopsies were equal or superior to grade 2 rejection (International Society for Heart Transplantation). Between the 3rd and 12th month, 3 endomyocardial biopsies were equal or superior to grade 2 rejection, and the same between the 12th and 24th month. The infections rate was 0.8 episode per patient. Long term follow-up of anatomical cardiac transplantation faces the same problems as in standard cardiac transplantation. It is better to perform anatomical cardiac transplantation because of its early postsurgical advantages. Long term care is the same as in standard cardiac transplantation.