Data Of Long-term Follow-up Research Articles

(240) Evaluation of Factors Associated with Reoperation Rates for Penile Prosthetic Implantation in Erectile Dysfunction: A Medicare Analysis

Abstract Introduction As the prevalence of erectile dysfunction (ED) in the U.S. continues to rise due to an aging population, the use of penile prostheses (PP) to treat refractory ED is expected to increase. In 2017, Onyeji et al analyzed a New York state surgical database and found that the highest quartile implanters had lower re-operation rates in long-term follow-up. Due to a higher risk of infection and morbidity in PP reoperations, compared to primary surgery, minimizing PP reoperations is important. Objective This study evaluates the association between patient/clinical characteristics and reoperation rates at 90-days and 1-year among men undergoing PP implantation using a national database. Methods This retrospective claims data analysis used the 100% Medicare Standard Analytical Files (SAF) to identify men aged ≥65 who received PP (malleable and inflatable) between 2017 and 2020. The patients were required to have a continuous enrollment 1-year pre- and post-index PP encounter. The outcomes of interest were reoperation rates (defined as removal, repair, and removal and replacement of PP with or without infection) at 90 days and 1 year following initial implantation. Multivariable logistic regression was used to examine the relationship between reoperation rates and patient demographics and comorbidities: age, geographic region, race (White, Black, and Others [American Indian, Asian, Hispanic, Other, Unknown]), urbanization, baseline Charlson Comorbidity Index (CCI) and comorbidities (diabetes and prostate cancer therapy), primary diagnosis at the index PP implantation, type of index PP procedure, and prosthetic surgeon procedure volume. Urbanization was categorized as urban vs rural based on patient’s county of residence and the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties. The prosthetic surgeon procedure volume was split into low (1-24 surgeries) and high-volume (≥25 surgeries) based on the 2022 PP International Consensus Forum definition. Results This study included 12,350 patients who underwent PP implantation. Nearly 50% were aged 65-69 years, 77.2% White, 82.6% in urban areas, and 56.2% had a CCI score of 0 (Table 1). Most of these men (96.0%) received an inflatable PP and 91.2% had ED as their primary diagnosis. The overall reoperation rates at 90-day and 1-year post-implant were 2.19% and 6.15%, respectively. Logistic regression found that low-volume implanters were associated with a 34% (OR 1.34; 95% CI 1.01, 1.78) and 35% (OR 1.35; 95% CI 1.14, 1.60) higher odds of reoperation at 90-day and 1-year post-implant, respectively, compared to high-volume implanters. Men with a baseline CCI of 0 had 19% higher odds of 1-year reoperation (OR 1.19; 95% CI 1.01, 1.40) compared to their counterparts with a CCI of ≥1. Black patient race was associated with 35% lower odds of 90-day reoperation compared to White patients (OR 0.65; 95% CI 0.43, 0.99) but this difference did not persist at 1-year of follow-up. Conclusions This study highlights that higher case volume reduces the risk of reoperation in the short to medium term, consistent with state-specific data of long-term follow-up. The impact of race and comorbidities warrants further evaluation to optimize patient counseling as they seek surgical treatment of ED. Disclosure Yes, this is sponsored by industry/sponsor: Boston Scientific. Clarification: Industry funding only - investigator initiated and executed study. Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast, BK Medical.

Transcatheter aortic valve implantation in severe aortic stenosis does not necessarily reverse left ventricular myocardial damage: data of long-term follow-up.

Aortic stenosis (AS) is causing myocardial damage and replacement is mainly indicated based on symptoms. Non-invasive estimation of myocardial work (MW) provides a less afterload-dependent too for assessing myocardial function. We sought to look at the impact of transcatheter aortic valve implantation (TAVI) on the myocardium at long-term follow-up and according to current indications. We conducted an observational, cross-sectional, single-centre study. Patients were selected based on the validated indication for a TAVI. Standardized echocardiographies were repeated. A total of 102 patients were included. The mean age was 85 years, 45% were female, 68% had high blood pressure, and 52% had a coronary disease. One-fifth was suffering from low-flow-low-gradient AS. A follow-up was performed at 22 ± 9.5 months after the TAVI. No TAVI dysfunction was observed. Left ventricular (LV) ejection fraction was stable (62 ± 8%), and global longitudinal strain had improved (-14.0 ± 3.7 vs. -16.0 ± 3.6%, P < 0.0001). No improvement of the MW parameters was noticed (LV global work index 2099 ± 692 vs. 2066 ± 706 mmHg%, P = 0.8, LV global constructive 2463 ± 736 vs. 2463 ± 676 mmHg%, P = 0.8). Global wasted work increased [214 (149; 357) vs. 247 (177; 394) mmHg%, P = 0.0008]. In a population of severe symptomatic AS patients who had undergone a TAVI, the non-invasive myocardial indices that assess the LV performance at long-term follow-up did not improve. These results are questioning the timing of the intervention and the need for more attention in the pharmacological management of these AS patients.

Effect of body mass index on symptomatic venous thromboembolism and prosthesis revision risk after total knee arthroplasty: a long-term study from China

ObjectiveTo investigate the effect of body mass index (BMI) on the risk of symptomatic VTE and prosthesis revision after total knee arthroplasty (TKA).MethodsSeven thousand one hundred eighty-two patients with primary unilateral TKA treated in our hospital from 2011 to 2020 were divided into four groups according to BMI: BMI < 25 kg/m2, BMI 25 kg/m2–29.9 kg/m2, BMI 30 kg/m2–34.9 kg/m2 and BMI ≥ 35 kg/m2. Incidence, Odds ratio and Kaplan-Meier survival analysis were used to evaluate the effects of BMI on symptomatic VTE and prosthesis revision risk after TKA.ResultsThe incidence of VTE after TKA was 8.9‰(64/7182). There was no significant difference in the incidence of VTE among different BMI groups(P = 0.452). Deep vein thrombosis mainly occurred in the distal lower extremities, especially in intermuscular veins. Revision rate of prosthesis after TKA was 6.4‰(46/7182). There was no significant difference in revision rate among different BMI groups(P = 0.718). In the univariate analysis of TKA, compared with patients with normal BMI, the risk of postoperative VTE and prosthesis revision in patients with overweight, obesity class I and obesity class II did not increase. Higher prosthesis revision rate and lower prosthesis survival rate were observed in BMI ≥ 35 kg/m2 group, although the difference was not statistically significant.ConclusionsThrough such a retrospective large sample data of long-term follow-up, we believe that the higher BMI was not associated with the increased risk of symptomatic VTE and prosthesis revision after TKA. When TKA was used for appropriate indications, high BMI should not be considered as a contraindication.

The early and long-term outcomes of coronary artery bypass grafting added to aortic valve replacement compared to isolated aortic valve replacement in elderly patients: a systematic review and meta-analysis

In aged population, the early and long-term outcomes of coronary revascularization (CABG) added to surgical aortic valve replacement (SAVR) compared to isolated SAVR (i-SAVR) are conflicting. To address this limitation, a meta-analysis comparing the early and late outcomes of SAVR plus CABG with i-SAVR was performed. Electronic databases from January 2000 to November 2021 were screened. Studies reporting early-term and long-term comparison between the two treatments in patients over 75 years were analyzed. The primary endpoints were in-hospital/30-day mortality and overall long-term survival. The pooled odd ratio (OR) and hazard ratio (HR) with 95% confidence interval (CI) were calculated for in-early outcome and long-term survival, respectively. Random-effect model was used in all analyses. Forty-four retrospective observational studies reporting on 74,560 patients (i-SAVR = 36,062; SAVR + CABG = 38,498) were included for comparison. The pooled analysis revealed that i-SAVR was significantly associated with lower rate of early mortality compared to SAVR plus CABG (OR = 0.70, 95% CI 0.66–0.75; p < 0.0001) and with lower incidence of postoperative acute renal failure (OR = 0.65; 95% CI 0.50–0.91; p = 0.02), need for dialysis (OR = 0.65; 95% CI 0.50–0.86; p = 0.002) and prolonged mechanical ventilation (OR = 0.57; 95% CI 0.42–0.77; p < 0.0001). Twenty-two studies reported data of long-term follow-up. No differences were reported between the two groups in long-term survival (HR = 0.95; 95% CI 0.87–1.03; p = 0.23). CABG added to SAVR is associated with worse early outcomes in terms of early mortality, postoperative acute renal failure, and prolonged mechanical ventilation. Long-term survival was comparable between the two treatments.

Psychotherapy, psychological education, medical education in the work of a particular child / adolescent psychiatrist

In order to develop a comprehensive methodology for outpatient psychiatric care for children and adolescents that can improve the social adaptation of patients, we analyzed the data of long-term clinical catamnestic follow-up of a cohort of patients with various mental disorders in childhood and adolescence. The methods of psychotherapy, psycho-education and medical education suitable for outpatient care are discussed.

P1492Comparison of the long-term performance of the quadripolar IS-4 and the bipolar IS-1 left ventricular lead for cardiac resynchronization therapy

Abstract BACKGROUND The implantation of left ventricular (LV) leads for cardiac resynchronization therapy (CRT) and the management of lead-related complications can be challenging. The introduction of the quadripolar IS-4 LV lead may have facilitated the implantation procedure and may have reduced lead-related complications. Data of long-term follow-up (FU) comparing the IS-4 lead with the IS-1 LV lead are rare and conflicting. PURPOSE Comparison of lead-related complications and all-cause mortality between CRT patients who received an IS-4 or an IS-1 LV lead in the long-term FU. METHODS Adults with an indication for a CRT-Defibrillator or CRT-Pacemaker, a successful endovascular IS-4 or IS-1 LV lead implantation, and a minimal FU of three years were included in this retrospective study. The combined primary endpoint was freedom from lead-related complications defined as (i) occurrence of persisting high pacing threshold (&amp;gt;2.75V/0.4ms), (ii) unresolved phrenic nerve stimulation, (iii) LV lead dislodgement/disruption, (iv) the necessity of re-interventions affecting the LV lead, and (v) LV lead deactivation/explantation. Secondary endpoints were all singular complications and all-cause mortality. RESULTS Eligible for the study were 133 patients (IS-4 n = 66; IS-1 n = 67) with a mean FU of 4.03 ± 1.93 years. Baseline characteristics of both patient groups did not differ significantly. Freedom from lead-related complications was higher in patients with an IS-4 lead as compared to an IS-1 lead (Figure 1; 87.9% vs. 65.7%; p = 0.002). The secondary outcomes showed a higher rate of LV lead dislodgement/disruption (4.5% vs. 17.9%; p = 0.015) in the IS-1 patient group and more patients suffered from unresolved phrenic nerve stimulation with an IS-1 lead (3.0% vs. 13.4%; p = 0.029). LV lead deactivation/explantation during FU and LV lead-related re-interventions were fewer in case of an IS-4 lead (4.5% vs 22.4%; p = 0.003; 6.1% vs. 17.9%; p = 0.036, respectively). The rate of persisting high pacing thresholds and all-cause mortality did not differ (4.5% vs. 9.0%; p = 0.492; 22.7% vs 25.4%; p = 0.721, respectively). CONCLUSION The quadripolar IS-4 LV lead showed in this retrospective study a better long-term performance than the bipolar IS-1 lead. Abstract Figure 1

Long and winding road: from infant wheeze to adult asthma.

This review aims to recognize the multifactorial cause of asthma, from the influence of mother until adulthood, highlight the main characteristics of the disease at different ages and summarize the evidence of potential prevention strategies. To date, regarding the prenatal period, the presence of specific genes, maternal asthma, drugs, and tobacco exposure are the most relevant predisposing features for an asthmatic offspring. For newborns, preterm, bronchopulmonary dysplasia, and low birth weight has been associated with low lung function. Among young children, atopic dermatitis, lower respiratory tract infections, and increased levels of total Immunoglobulin E (IgE) and allergen-specific IgE are important determinants.Breastfeeding has been demonstrated being protective for the onset of asthma. Allergen immunotherapy has also been shown to have significant preventive effect decreasing asthma development. Inhaled corticosteroids use in early childhood prevents exacerbations but does not alter the natural history of asthma. Other interventions, such as the use of palivizumab, probiotics, vitamin D supplementation, and fish consumption presented controversial results. A good knowledge of risk factors for asthma development, from prenatal period to adulthood, may lead to efficacious preventive strategies. Further data of long-term follow-up in population-based studies according to different phenotypes are needed.

Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region.

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n = 45 vs. non-CAD group: n = 41) and DM (DM group: n = 50 vs. non-DM group: n = 36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

Acromioclavicular joint dislocation treated with Bosworth screw and additional K-wiring: results after 7.8\xa0years \u2013 still an adequate procedure?

BackgroundThe acromioclavicular (AC) joint dislocation is a major reason for shoulder instability. Different concepts of treatment and surgical methods are described in the literature. Thus, the purpose of this study was to present our data of long-term follow-up of patients having undergone treatment of acromioclavicular (AC) joint dislocation using the Bosworth Screw with additional K-wiring.MethodsThis study was conducted as a retrospective single centre data analysis. All patients treated operatively for AC joint dislocation with a Bosworth screw and additional K-wire fixation at our Department were asked to participate in this study.ResultsThe study population consisted of 22 patients, 20 male and 2 female, with a mean age of 40 years ±15.6 years. Three grade-II lesions, 13 grade-III lesions, four grade-IV lesions and two grade-V lesions according to the Rockwood classification were found. The overall mean clinical outcome at the latest follow up was: Constant 95, DASH 6.4, ASES 94.6, SST 99.02, UCLA 33.1, ACJI 91.82 and VAS 0.29 – representing a good-to-excellent long-term outcome in all patients after at least 2 years follow-up (range; 2 - 19 years). Overall, 19 patients (86%) reported to be very satisfied with the achieved result, 15 patients (68%) reported to be able to participate in every sports activity and 16 patients (73%) reported to be able to perform their daily work without limitations. Overall, complications occurred in three patients (14%). Only one patient remained unsatisfied with the achieved result.ConclusionSummarizing, our reported results showed that surgical fixation of acute AC joint dislocation with a Bosworth screw and additional K-wire fixation leads to good-to-excellent functional outcome and highly satisfactory results in the majority of patients. Despite its complications, in accordance with our results, Bosworth screw fixation with additional K-wiring in AC joint dislocation represents an adequate surgical procedure.Level of Evidence: Level IV, retrospective study.

MRI findings in lumbar spine following O2–O3 chemiodiscolysis: A long-term follow-up

Intradiscal O2-O3 injections are conventionally used as a minimally invasive treatment for lumbar disc herniation in patients not responding to conservative treatments. The aim of the present study is to report data of long-term imaging follow-up (3 years) of patients treated with intradiscal O2-O3 lumbar chemiodiscolysis. We evaluated the changes of disc volume and the modifications in disc appearance (in terms of disc degeneration) and endplate changes (according to Modic), comparing the results with a control group of patients. Our results showed a stable reduction of the disc herniation volume in patients treated compared with the control group, while we did not find statistically significant differences in terms of disc degeneration and endplate changes (Modic). We concluded that the O2-O3 discolysis, despite leading to a significant shrinkage of the disc herniation, does not involve - in the long term - biomechanical changes of the spine in terms of acceleration of the disc degeneration process in comparison with the natural course.

Long-Term Follow-Up of Patients with Congenital Myasthenic Syndromes: What Do We Learn?

Background: Congenital myasthenic syndromes (CMS) form a heterogeneous group of disorders caused by defects of the neuromuscular transmission. The clinical picture of CMS varies widely between mild and life-limiting forms. Until now, data of long-term follow-up are rare.

Chronic Obstructive Pulmonary Disease as a Factor of Unfavorable Cardiovascular Prognosis After Percutaneous Coronary Interventions in Ischemic Heart Disease

to elucidate effect of concomitant chronic obstructive pulmonary disease (COPD) on remote results of percutaneous coronary intervention (PCI) with stent implantation in patients with ischemic heart disease (IHD). We analyzed data of long term follow-up of 346 IHD patients after PCI with stenting. Groups of patients with and without COPD had comparable baseline clinical and functional characteristics. During follow-up we registered cardiovascular events (cardiovascular death, myocardial infarction, stroke, revascularization), as well as time to first event with the construction of Kaplan-Meier curves. Difference in relative frequency of occurrence of studied events between groups was not significant (24 and 17% among patients with and without COPD respectively, p=0.13), but in patients with COPD events occurred significantly earlier (p=0.02). Patients with adverse cardiovascular events during follow-up at baseline had lower exercise tolerance and glomerular filtration rate, more often had diabetes.

Risk prediction of cardiac events and cardiac death after acute myocardial infarction by speckle tracking imaging: a long-term follow-up study

Objective To analyze cardiac function of patients with first onset acute myocardial infarction (AMI) by speckle tracking imaging (STI). With clinical data of long-term follow-up, to explored the prognostic value of left ventricular functional reservation and damage after AMI. Methods Seventy-eight patients with first onset AMI were enrolled in the study. Dynamic images were acquired before primary percutaneous coronary intervention for the analyses of longitudinal peak systolic strain (LPSS), radial peak systolic strain (RPSS) and circumferential peak systolic strain (CPSS). Clinical data of long-term follow-up, results of electrocardiogram and coronary angiography were used for the evaluation of the recurrence risk of cardiac events and cardiac death after AMI. All the baseline clinical data and parameters of echocardiography were compared between patients with and without cardiac events and cardiac death during follow-up. Results Baseline clinical data of electrocardiogram and coronary angiography didn′t show significant differences for the comparison of AMI patients with and without cardiac events and cardiac death during long-term follow-up. Compared to patients without cardiac events during follow-up, LPSS and CPSS (P<0.001) of patients with cardiac events were relatively lower and the prognostic value of CPSS (HR=1.4096) for the recurrence risk of cardiac events was better. For the risk prediction of cardiac death, LPSS (P<0.001, HR=1.5735) was relatively better. Conclusions Left ventricular functional reservation and damage after AMI were accurately assessed by STI, which helped predicted the recurrence risk of cardiac events and cardiac death of AMI patients. CPSS and LPSS were optimal indicators for the prediction of cardiac events and cardiac death, respectively. Key words: Echocardiography; Myocardial infarction; Speckle tracking imaging; Recurrence of cardiovascular events

Neurological tests and quality of life measurements in patients after minimal-invasive mitral valve surgery

Objective: Clinical benefit of mitral valve reconstruction (MVR) is well documented, but comparative data of long term follow-up (> 12 months period) in postoperative quality of life (QoL) and mental power are missing. We hypothesised that mitral valve reconstruction with isolated mitral valve disease have neuropsychological benefits in 1-years follow-up.

Three-Year Follow-up after Unilateral Subretinal Delivery of Adeno-Associated Virus in Patients with Leber Congenital Amaurosis Type 2

The aim of this study was to show the clinical data of long-term (3-year) follow-up of 5 patients affected by Leber congenital amaurosis type 2 (LCA2) treated with a single unilateral injection of adeno-associated virus AAV2-hRPE65v2. Clinical trial. Five LCA2 patients with RPE65 gene mutations. After informed consent and confirmation of trial eligibility criteria, the eye with worse visual function was selected for subretinal delivery of adeno-associated virus (AAV2-hRPE65v2). Subjects were evaluated before and after surgery at designated follow-up visits (1, 2, 3, 14, 30, 60, 90, 180, 270, and 365 days, 1.5 years, and 3 years) by complete ophthalmic examination. Efficacy for each subject was monitored with best-corrected visual acuity, kinetic visual field, nystagmus testing, and pupillary light reflex. Best-corrected visual acuity, kinetic visual field, nystagmus testing, and pupillary light reflex. The data showed a statistically significant improvement of best-corrected visual acuity between baseline and 3 years after treatment in the treated eye (P<0.001). In all patients, an enlargement of the area of visual field was observed that remained stable until 3 years after injection (average values: baseline, 1058 deg(2) vs. 3 years after treatment, 4630 deg(2)) and a reduction of the nystagmus frequency compared with baseline at the 3-year time point. Furthermore, a statistically significant difference was observed in the pupillary constriction of the treated eye (P<0.05) compared with the untreated eye in 3 patients at 1- and 3-year time points. No patients experienced serious adverse events related to the vector in the 3-year postinjection period. The long-term follow-up data (3 years) on the 5-patient Italian cohort involved in the LCA2 gene therapy clinical trial clearly showed a stability of improvement in visual and retinal function that had been achieved a few months after treatment. Longitudinal data analysis showed that the maximum improvement was achieved within 6 months after treatment, and the visual improvement was stable up to the last observed time point. Proprietary or commercial disclosure may be found after the references.

Long term follow-up in quality of life after mitral valve surgery

Objective: Clinical benefit of mitral valve reconstruction (MVR) is well documented, but comparative data of long term follow-up (>5years period) in postoperative quality of life (QOL) in different subsets of patients are missing. We hypothesised that mitral valve reconstruction in combination with other valves and CABG procedures have benefits in this population compared to healthy age matched population, regardless of the valve pathology.

Response and long-term effect of patients with triple-negative breast cancer receiving neo-adjuvant anthracycline-based chemotherapy

OBJECTIVE The breast cancer lack of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2) is defi ned as the Triple-negative breast cancer (TNBC). Our purpose is to compare the response and long-term effect of the TNBC and non-TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy, and to investigate the mechanisms of TNBC aff ecting the survivals. METHODS Data of long-term follow-up (median, 5.4 years) of 326 patients who received neo-adjuvant chemotherapy with anthracycline-based regimen, during a period from 2000 to 2003, were analyzed. Expressions of ER, PR, HER-2, P53, Ki-67 and E-cadherin were determined using immunohistochemical staining method. A multivariate Cox regression analysis was used to analyze independent prognostic factors affecting the relapse-free survival (RFS) and overall survival (OS) rates. Clinical effects of the neo adjuvant anthracycline-based chemotherapeutic regimen and the RFS and OS rates were compared between the patients with TNBC and non-TNBC, and the correlations among the triple-negative phenotype (TNP), tumor grading and the expressions of P53, Ki-67 and E-cadherins were analyzed. RESULTS TNP, TNM staging, histological grades, clinical response of the neo-adjuvant chemotherapy and pathological complete remission (pCR) rate were the independent prognostic factors a ff ecting the survival rates. Furthermore, 70 (21.5%) of the 326 patients suffered TNBC. Compared with the subjects in non-TNBC group, the patients with TNBC had a significantly higher pCR rate ( P = 0.046) and clinical response rate ( P = 0.037), but also decreased 5-year RFS ( P = 0.001) and OS ( P = 0.004) rates. The RFS and OS rates were not improved in the TNBC patients who achieved a clinical remission at er the neo-adjuvant chemotherapy. The triple-negative phenotype was positively correlated with the level of P53, Ki-67 expression ( P = 0.007, P = 0.028), but negatively correlated with level of E-cadherin ( P = 0.034). CONCLUSION Both clinical remission rate and pCR rate of the TNBC patients receiving neo-adjuvant anthracycline-based chemotherapy are high, however, the long-term effect is poor. The mechanism may relate to a strong potential of proliferation and invasive metastasis, as well as lack of an effective therapeutic target in the TNBC patients.

Long-Term Follow-Up After Endoscopic Treatments for Common Bile Duct Stones

Aims: The aim of this study was to evaluate the long-term outcomes of endoscopic treatments for common bile duct stones (CBDs), and risk factors for stone recurrence after endoscopic treatments were also assessed. Methods: From April 1991 to December 2007, a total of 971 patients with initial CBDs were successfully treated by endoscopic procedures at our institutions. We obtained their data of long-term follow-up from telephone interviews or postal questionnaires. Risk factors influencing stone recurrence were examined using a multivariate analysis. Results: The follow-up data was obtained for 777 patients. They had undergone endoscopic sphincterotomy (EST) in 453 patients and endoscopic papillary balloon dilation (EPBD) in 324 patients. There were 434 males and 343 females with a mean age of 68.3 years (range: 6-95 years) at the time of endoscopic treatment. The number of CBDs ranged from 1 to 30 (mean 3.0), the largest diameter of CBDs ranged from 2 to 118 mm (mean 11.3), and the diameter of CBDs ranged from 5 to 42 mm (mean 13.8). Periampullary diverticulum was observed in 222 cases (29%). Previous cholecystectomy had undergone in 112 patients (14.4%). Subsequent cholecystectomy after endoscopic treatment was performed in 253 patients (32.6%), gallbladder was left in situ in 409 patients (53%), and gallbladder stones were left in situ in 265 patients (34%). Median follow-up period was 59 months (range: 1-197 months), and 66 patients have experienced recurrence of CBDs. To assess the risk factors for stone recurrence, the following parameters were selected: treatment method (EPBD or EST), sex, age, number and diameter of CBDs, diameter of the bile duct, periampullary diverticulum, gallbladder left in situ or not, and gallbladder stones left in situ or not. As a result, EST was the only significant and independent factor influencing CBDs recurrence (p=0.03, risk ratio 0.6847: 0.4950-0.9535). The cumulative incidence of the CBDs recurrence at 10 years was 17.0% after EST and 7.8% after EPBD, respectively (p=0.007). Conclusions: The recurrence rate of CBDS was significantly lower after EPBD than after EST. The preservation of the papillary function after endoscopic treatment may result in prevention of CBDs recurrence.

Long-Term Results of Concomitant Boost Radiation Plus Concurrent Cisplatin for Advanced Head and Neck Carcinomas: A Phase II Trial of the Radiation Therapy Oncology Group (RTOG 99-14)

The feasibility of combining concomitant boost-accelerated radiation regimen (AFX-C) with cisplatin was previously demonstrated in this Phase II trial. This article reports the long-term toxicity, relapse patterns, and survival in patients with advanced head and neck carcinoma. Between April and November 2000, 84 patients with Stage III-IV HNC were enrolled, and 76 patients were analyzable. Radiation consisted of 72 Gy over 6 weeks. Cisplatin dose was 100 mg/m(2) on Days 1 and 22. Tumor and clinical status were assessed, and acute-late toxicities were graded. The median follow-up for surviving patients is 4.3 years. The 2- and 4-year locoregional failure rates were 33% and 36%, respectively, and the 2- and 4-year survival rates were 70% and 54%, respectively. The worst overall late Grade 3 or 4 toxicity rate was 42%. The prevalence rates of a gastrostomy at any time during follow-up, at 12 months, and at 48 months were 83%, 41%, and 17%, respectively. Five of 36 patients (14%) alive and without disease at last follow-up were gastrostomy-tube dependent. These data of long-term follow-up of patients treated with AFX-C with cisplatin show encouraging results with regard to locoregional disease control and survival, with few recurrences after 2 years. The late toxicity rates are relatively high. However, although prolonged dysphagia was noted in our preliminary report, its prevalence does decreased over time. A Phase III trial comparing AFX-C plus cisplatin against standard radiation plus cisplatin has completed accrual.

頸部内頸動脈狭窄症に対するステント留置術の長期成績―自己拡張型ステントの再狭窄について―

Carotid artery stenting has emerged as an acceptable treatment alternative in patients with carotid artery stenosis. Although early clinical results of carotid artery stenting have shown promise, long, term clinical results remain less certain. We report the frequency, management, and clinical results of in-stent restenosis after carotid artery stenting using a self-expandable stent. Between August 1998 and September 2004, 80 carotid artery stenting procedures in 78 patients were performed. We evaluated 76 of the 80 procedures in 75 of the 78 patients treated during this period who had a minimum 6-month clinical and imaging (ultrasound and/or magnetic resonance angiography) follow-up. Recurrent stenosis (≧50%) after carotid artery stenting occurred in 3 (3.9%) patients. The recurrent stenosis occurred within one year after the procedure in all cases. The low rate of in-stent restenosis using self-expandable stent suggested that carotid artery stenting may be an effective alternative treatment for carotid artery stenosis, but more data of long-term follow-up are required.