Fifteen-year Follow-up Research Articles

Extracardiac modification of the Fontan operation without use of prosthetic material

Extracardiac modification of the Fontan operation without use of prosthetic material

Management of allergic bronchopulmonary aspergillosis without maintenance oral corticosteroids: a fifteen-year follow-up

Five non-smoking patients were diagnosed as having allergic bronchopulmonary aspergillosis in 1978/9. All have been treated since then with inhaled corticosteroids, using short courses of self-administered oral corticosteroids for symptomatic exacerbations. Over a mean 15 years of follow-up, they have required on average less than one course of oral drugs per annum. Regular monitoring of spirometry has shown no evidence of deterioration, and all have close to normal gas transfer. All have some localized bronchiectasis on CT scanning, in two cases probably occurring after treatment started, but in no case is there any respiratory disability. We conclude that this is a safe and effective method for the management of allergic bronchopulmonary aspergillosis when diagnosed before persistent hyphal colonization of the airways has occurred.

Relation between coronary risk and coronary mortality in women of the Renfrew and Paisley survey: comparison with men

Most epidemiological and intervention studies in patients with coronary artery disease have focused on men, the assumption being that such data can be extrapolated to women. However, there is little evidence to support this belief. We have completed a fifteen-year follow-up of 15 399 adults, including 8262 women, who lived in Renfrew and Paisley and were aged 45-64 years when screened between 1972 and 1976. We identified 490 deaths from coronary heart disease (CHD) in women and 878 in men. Women were more likely to have high cholesterol, to be obese, and to come from lower social classes than men, but they smoked less and had similar blood pressures. The relative risk—top to bottom quintile (95% Cl)—of cholesterol for coronary death after adjustment for all other risk markers was slightly greater in women (1·77 [1·45, 2·16]) than in men (1·56 [1·32, 1·85]), but absolute and attributable risk were lower. Thus, women in the top quintile for cholesterol had lower coronary mortality (6·1 deaths per thousand patient years) than men in the bottom quintile (6·8 deaths per thousand patient years). Moreover, it was estimated that there would have been only 103 (21 %) fewer CH D deaths in women, yet 211 (24%) fewer in men, if mortality had been the same for women and men in the lowest quintiles of cholesterol. Trends showing similar relative risks in these women, but lower absolute and attributable risks than in men, were present for smoking, diastolic blood pressure, and social class. There was no relation between obesity and coronary death after adjustment for other risks. Our results suggest that some other factors protect women against CHD. The potential for women to reduce their risk of CH D by changes in lifestyle may be less than for men.

Five- to fifteen-year follow-up after Fontan operation.

The purpose of this study was to estimate survival and quality of outcome and assess factors associated with outcome for patients out 5 to 15 years from their Fontan operation. We studied 352 patients who had the Fontan operation prior to 1985. The overall 1-, 5-, and 10-year survival was 77%, 70%, and 60%, respectively. The following factors were significantly associated with lower survival: univentricular heart or complex congenital anomalies other than tricuspid atresia, early calendar year of operation, heterotaxia syndromes, early age at operation, increased pulmonary artery pressure, atrioventricular valve dysfunction, and higher (worse) New York Heart Association class. Reoperations were necessary for 103 of the 352 patients. At least 20% of the survivors have or have had cardiac arrhythmias requiring antiarrhythmic medication or mechanical pacemaker insertion. Between 7% and 10% of the patients have had or had protein-losing enteropathy/hypoproteinemia. At 5 years postoperatively, 122 patients (34.7%) were alive with a better New York Heart Association functional classification than preoperatively. Fifty-eight patients (16.5%) were alive and in the same functional classification, but 126 (35.8%) died within the first 5 years or were in a worse functional classification. Thirty-nine patients were doing excellently and 29 patients poorly 5 years after the operation. Of the surviving patients, 43% can do as much exercise as their peers, whereas 3% are incapable of exercise. To assure good functional long-term outcome in addition to survival, clinicians must exclude from selection for Fontan operation patients known to be at high risk for death or poor outcome.

Order without design: Information production and policy making

This is a retrospective study of 155 patients with Stages A and B prostatic carcinoma, first diagnosed between 1930 and 1967, who had either delayed or immediate endocrine therapy. Patients were divided into two groups: less than seventy years of age and over seventy years. Fifteen-year crude survival of the less than seventy group was 42 per cent (expected survival 54 per cent) and that of the over seventy group was 16 per cent (expected survival 7 per cent). Therefore, patients more than seventy years who have early prostatic carcinoma treated conservatively will survive as long as if they did not have this neoplasm, but patients less than seventy will live less long than expected. The ten-year survival of the less than seventy group (66 per cent) was only slightly less than the expected survival (71 per cent), but there was a significantly greater difference in the fifteen-year survival (42 versus 54 per cent) and twenty-year survival (23 versus 35 per cent). Therefore, a ten-year follow-up period is not long enough to document the effectiveness of treatment. Of patients who lived fifteen years or more, there was no significant difference in the two groups in regard to clinical evidence of cancer at the time of the fifteen-year follow-up. The number of patients who died of cancer before fifteen years was not significantly different in the two groups. However, of the patients who died of cancer after fifteen years, 14 per cent belonged to the less than seventy group and none was in the over seventy group. The grade of malignancy was approximately the same in each group, but diffuse lesions (A2 and B2) were more common in the less than seventy group (51 per cent) compared with the seventy-plus group (35 per cent).

Fifteen-year follow-up for double internal thoracic artery grafts

The internal mammary artery (IMA) is the conduit of choice for myocardial revascularization. From 1972 to 1989, 586 patients received bilateral IMA and supplemental vein grafts. There were 506 men (86%) and 79 women (14%) with a mean age of 55.5 years (range 32-77 years). Unstable angina was present in 138 patients (24%), insulin-requiring diabetes mellitus in 83 (14%) and previous myocardial infarction (MI) in 25 (4%). Preoperative angiography demonstrated triple-vessel disease in 286 patients (49%) and double-vessel disease in the remaining 300 patients (51%). Left main coronary artery disease (stenosis greater than or equal to 50%) was present in 53 (9%). The mean left ventricular score was 7.4 with a range of 5 to 20. The mean number of grafts performed was 3.4 per patient. Hospital mortality was 3.6% (21 patients). Follow-up was done through direct patient contact, via the patient's physician or by telephone contact with the patient themselves or surviving family members. Follow-up was complete in 518 hospital survivors and ranged from 1 month to 17.5 years with a cumulative follow-up of 911 patient years. At 10 and 15 years, respectively, the actuarial freedom from MI was 78% and 72% and freedom from reoperation was 93% and 86%. Actuarial survival at 10 and 15 years was 85% and 70%, respectively. This longitudinal analysis demonstrates that bilateral IMA grafting has a low operative risk. The data suggest that utilization of two IMA grafts yield excellent freedom from recurrent symptoms and provides excellent long-term survival.

Radical prostatectomy versus expectant primary treatment in stages I and II prostatic cancer A fifteen-year follow-up

A fifteen-year follow-up of a prospective, randomized study comparing placebo withradical prostatectomy as the primary treatment of early prostatic cancer is presented. A total of 111 patients with clinical Stage I or II prostatic cancer, normal acid phosphatase levels, and negative findings on skeletal x-ray film were evaluable. Thirty Stage I patients and 20 Stage II patients received placebo only; 31 Stage I and 30 Stage II patients underwent radical prostatectomy. The survival status for 95 patients (86%) was established at the fifteen-year follow-up. No significant differences in crude survival occurred in either stage or in both stages combined. Moreover, the survival curves closely followed reference curves based on expected U. S. mortality for men of comparable ages and races. A statistically significant association between a high Gleason histologic score and poor survival was established. In this study, initial treatment with radical prostatectomy did not yield longer survival than initial placebo treatment alone. However, the findings should be interpreted with caution, since sample size was small and staging procedure was simplified.

Are three substages of clinical B prostate carcinoma useful in predicting disease-free survival?

The B1 nodule, a 1.5 cm area of induration surrounded on at least two sides byprostatic tissue of normal consistency, was defined by Jewett in 1968 as the stage of prostatic cancer best suited for treatment and cure by radical prostatectomy (RP). The area of prostatie induration suitable for RP was subsequently extended to less than one lobe (Stage BI); this extension of induration was supported by the study of Walsh and Jewett in 1980 showing a 51 percent survival free-of-disease at fifteen-year follow-up. Subsequently, clinical staging systems evolved which substaged clinical B into three categories of induration: B1N = less than 1.5 cm nodule, B1 = greater than 1.5 cm but less than one lobe, and B2 = one lobe or both lobes. To determine if digital assessment of these, progressively greater degrees of induration would translate into different intervals to first progression, whether local or distant, we reviewed prostate diagrams and descriptions of all Stage B patients treated by Iodine-125 interstitial implant and external beam radiation therapy between 1974 and 1985 at our institution. Forty-six patients had B1 nodules, 78 patients B1 (less than one lobe), and 52 patients B2 (one lobe or greater). Mean follow-up was fifty-five months. We found B1N, which was also associated with well-differentiated grade and a normal acid phosphatase, to have the longest interval to progression.

Changing profile of Latvian school students: A fifteen-year follow-up

Changing profile of Latvian school students: A fifteen-year follow-up

Changing profile of Latvian school students: A fifteen-year follow-up

Changing profile of Latvian school students: A fifteen-year follow-up

Lovastatin vs Cholestyramine Therapy for Primary Hypercholesterolemia

To the Editor.— A multicenter study 1 published in the July 15 issue of JAMA compared lovastatin and cholestyramine resin for treating severe primary hypercholesterolemia and concluded that lovastatin was both more effective and better tolerated. There is no argument that lovastatin is better tolerated than cholestyramine; however, I am not convinced that it is more effective. The Lipid Research Clinics Coronary Primary Prevention Trial 2 and the more recently published Helsinki Heart Study 3 —both long-duration primary prevention trials—demonstrated that coronary heart disease morbidity and mortality can be reduced by favorably altering lipoprotein levels using cholestyramine in the former and gemfibrozil in the latter trial. Unfortunately, neither trial resulted in a decrease in overall mortality in the groups receiving drug treatment. Fifteen-year follow-up of a secondary prevention trial 4 did reveal a decrease in coronary heart disease mortality and overall mortality in the niacin-treated group. Cholestyramine, gemfibrozil, and niacin

The Nine- to Fifteen-Year Follow-up of One-Stage Bilateral Total Hip Arthroplasty

Careful selection and preoperative evaluation of patients with bilateral hip disease for one-stage bilateral total hip arthroplasty can yield satisfactory results consistent with those published for unilateral hip disease. These patients are generally younger and more active than patients undergoing unilateral total hip arthroplasty and require meticulous attention to both technique and prosthetic design. The authors found that the Charnley design remains the gold standard against which other prostheses must be measured in the long-term follow-up.

A Fifteen-Year Follow-up Study of One Hundred Charnley Low-Friction Arthroplasties

This two-part study concerns the fate of 100 Charnley low-friction arthroplasties performed in 92 patients at The Hospital for Special Surgery. The first part of the study is a clinical and radiographic evaluation of the 40 hips that were available for follow-up at an average of 15.3 years after surgery. The second part is a survival analysis of the arthroplasty, the individual components, and the patients, using data from all 100 arthroplasties. The authors conclude that the vast majority of older patients who undergo cemented total hip arthroplasty will not require a subsequent arthroplasty, and will have satisfactory pain relief for the remainder of their lives.

Fifteen-year follow-up of all patients in a study of post-operative chemotherapy for bronchial carcinoma

Fifteen-year follow-up of all patients in a study of post-operative chemotherapy for bronchial carcinoma

Fifteen-Year Follow-up of a Behavioral History of Attention Deficit Disorder

A 15-year longitudinal study of 369 children originally classified in second grade as exhibiting or not exhibiting behaviors commonly associated with attention deficit disorder was made. Diagnostic data were collected on these children in second, fourth, and fifth grades and subsequent school performance was evaluated after ninth and twelfth grades. Interviews were conducted 3 years after their graduation from high school. The ninth and twelfth grade records reveal that those who had previously been identified as showing behavior related to attention deficit disorder later performed significantly more poorly in school and had poorer social adjustment. Interviews in early adulthood continued to reveal differences in outcome between normal subjects and those earlier classified as having attention deficit disorder. Many of these differences could not be directly attributed to poor academic performance. A subgroup of students who were rated favorably by their elementary school teachers were found to perform better during high school than other members of the normal group in academic areas, but they generally did not differ from normal subjects in nonacademic areas.

Overt psychopathology in rheumatoid arthritis. A fifteen-year follow-up study.

A 15-year follow-up study of 74 female patients (mean age 57.9 years) with definite or classic rheumatoid arthritis (RA) was performed, with special emphasis on overt psychopathology during the clinical course of the illness. Catamnestic investigation revealed that in 46% of the patients psychiatric disturbances necessitating treatment had appeared during the follow-up period. Generally, the psychiatric syndromes observed were of neurotic type not infrequently associated with depressive symptomatology. At the time of investigation 41% of the patients exhibited overt psychopathology, of whom the majority had depressive reactions (40%) or other forms of neurotic syndromes (18%). Only one patient was diagnosed as psychotic. In 5 instances distinct signs of chronic organic brain syndrome were noted. The importance of identifying clinical depression and of instituting adequate drug treatment and psychotherapy is emphasized.

Natural history of hepatitis B virus infection in renal transplant recipients--a fifteen-year follow-up.

Hepatitis B virus (HBV) markers were measured in 83 immunosuppressed renal transplant patients who were followed for periods of 2 to 15 years. Sixty-nine patients were negative for HBsAg before transplantation, of whom 14 were positive for anti-HBs. The remaining 14 patients were HBsAg positive prior to transplantation. Eighteen patients were identified as being HBsAg positive during the follow-up period. Four patients acquired primary type B hepatitis; one died of submassive hepatic necrosis and the remaining three became chronic HBV carriers with positive HBeAg, DNA polymerase, and HBV DNA. Several patterns of HBV expression were observed in HBsAg-positive patients. Four patients were HBsAg, HBeAg, DNA polymerase, and HBV DNA positive prior to transplantation, and these markers persisted. Reactivation of HBV replication occurred in eight patients, seven of whom were HBsAg positive and HBeAg and anti-HBe negative originally; one patient was anti-HBc positive. A single patient was HBsAg and anti-HBe positive and remained so for 22 months. The remaining previously HBsAg-positive patient is currently HBsAg negative. These serological data suggest that reactivation of HBV replication or continued hepatitis B virion replication occurs as commonly or more commonly than de novo infection in renal transplant recipients. The presence of HBeAg in serum predisposes to long-term Dane particle expression in immunosuppressed patients, whereas anti-HBe-positive carriers may not always be susceptible to reactivation of HBV replication despite immunosuppression.

Effects of the Timing of Marriage and First Birth of the Spacing of Subsequent Births

Analyzing data from a fifteen-year follow-up survey of high school students originally surveyed in 1957-58 and resurveyed in 1973-74, this paper examines the effects of the timing of marriage and first birth on subsequent childspacing, holding constant the effects of other variables that may be sources of spuriousness. The results suggest that age at first marriage has a causal effect on the occurrence of a short first birth interval and that age at first marriage and premarital pregnancy interact in their effect on the occurrence of a short second birth interval. Age at first marriage has no causal effect on the spacing of the second birth for those whose first child was maritally conceived. The spacing of the first birth, however, appears to have a causal effect on the spacing of the second.

Conservative treatment of early carcinoma of prostate Comparison of patients less than seventy with those over seventy years of age

This is a retrospective study of 155 patients with Stages A and B prostatic carcinoma, first diagnosed between 1930 and 1967, who had either delayed or immediate endocrine therapy. Patients were divided into two groups: less than seventy years of age and over seventy years. Fifteen-year crude survival of the less than seventy group was 42 per cent (expected survival 54 per cent) and that of the over seventy group was 16 per cent (expected survival 7 per cent). Therefore, patients more than seventy years who have early prostatic carcinoma treated conservatively will survive as long as if they did not have this neoplasm, but patients less than seventy will live less long than expected. The ten-year survival of the less than seventy group (66 per cent) was only slightly less than the expected survival (71 per cent), but there was a significantly greater difference in the fifteen-year survival (42 versus 54 per cent) and twenty-year survival (23 versus 35 per cent). Therefore, a ten-year follow-up period is not long enough to document the effectiveness of treatment. Of patients who lived fifteen years or more, there was no significant difference in the two groups in regard to clinical evidence of cancer at the time of the fifteen-year follow-up. The number of patients who died of cancer before fifteen years was not significantly different in the two groups. However, of the patients who died of cancer after fifteen years, 14 per cent belonged to the less than seventy group and none was in the over seventy group. The grade of malignancy was approximately the same in each group, but diffuse lesions (A 2 and B 2) were more common in the less than seventy group (51 per cent) compared with the seventy-plus group (35 per cent).

Benign osteoblastoma of the thoracic spine. Case report with fifteen-year follow-up.

Benign osteoblastoma of the thoracic spine. Case report with fifteen-year follow-up.