Long-term Follow-up Of Treatment Research Articles

Two-year long-term follow-up of treatment with the Optilume BPH catheter system in a randomized controlled trial for benign prostatic hyperplasia (The PINNACLE Study)

BackgroundPatient outcomes were assessed 2 years after treatment with the Optilume BPH Catheter System, a minimally invasive surgical therapy for the treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).MethodsOne-hundred forty-eight adult males with symptomatic BPH were enrolled and randomized in a 2:1 fashion to Optilume BPH or Sham (100 Optilume BPH; 48 Sham). Long-term measures include International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), Post-Void Residual Urine (PVR), quality of life measures and sexual function. Follow-up beyond one year was limited to those treated with Optilume BPH.ResultsAt 2 years, 67.5% (56/83 CI 56.3%, 77.4%) of participants in the Optilume BPH arm were symptomatic responders as defined by ≥30% improvement in IPSS without medical or surgical retreatment. IPSS significantly improved from 23.4 ± 5.5 (n = 100) to 11.0 ± 7.0 (n = 74). Qmax improved by 116.8.% (8.9 ± 2.2 (n = 97) to 19.0 ± 16.3 (n = 65)), while PVR showed a slight reduction (83.7 ± 70.3 (n = 99) to 65.9 ± 74.5 (n = 65)). Improvement in uroflowmetry measures was consistent across all prostate volumes. BPH-II improved from 7.0 ± 2.9 (n = 98) to 2.3 ± 2.5 at 1 year (n = 89) and remained consistent at 2.3 ± 2.9 at the 2-years (n = 74), representing a 53.9% improvement. IPSS QoL also improved from 4.6 ± 1.3 (n = 100) at baseline to 2.2 ± 1.5 (n = 74). The most common adverse events reported in the Optilume BPH arm were hematuria and urinary tract infection (UTI). No device and/or treatment related serious adverse events were reported occurring beyond 12 months post-procedure. There was no impact to sexual function.ConclusionsIn the PINNACLE study, participants treated with the Optilume BPH Catheter System demonstrated continued and durable results at 2 years, affirming tolerability, safety, and the enduring effectiveness. The Optilume BPH Catheter System provides lasting results that are comparable to the more invasive therapies, while preserving the advantages with being a minimally invasive therapy.RegistrationClinicalTrials.gov NCT04131907.

A long-term follow-up of treatment for young children with obesity: a randomized controlled trial

BackgroundEarly childhood obesity interventions supporting parents have the largest effects on child weight status. However, long-term follow-ups are lacking.ObjectiveTo examine weight status 48 months after obesity treatment initiation for 4- to 6-year-olds.Methods177 families were recruited to the More and Less study, a 12-month randomized controlled trial (RCT) conducted in Sweden (2012–2017); 6 children were excluded due to medical diagnoses. Thus, 171 families (non-Swedish origin 59%, university degree 40%) were eligible for this 48-month follow-up with modified intention-to-treat (n = 114 had 48-month data, n = 34 dropped out, n = 23 lost to follow-up). The RCT compared 3 treatment approaches: a 10-week parent support program (1.5 h/w) with follow-up booster sessions (PGB) or without (PGNB), and standard outpatient treatment (ST). Treatment effects on primary outcome (BMI-SDS) and secondary outcomes (BMI, %IOTF25 i.e., the distance, in percent, above the cut-off for overweight) were assessed. Clinically significant reduction of BMI-SDS (≥0.5) was assessed with risk ratio. Sociodemographic factors and attendance were examined by three-way interactions.ResultsAfter 48 months (mean 50 months, range 38–67 months) mean (95% CI) BMI-SDS was reduced in all groups: PGB −0.45 (−0.18 to −0.73, p < 0.001), PGNB −0.34 (−0.13 to −0.55, p < 0.001), ST −0.25 (−0.10 to −0.40, p < 0.001), no significant difference between groups. A clinically significant reduction of BMI-SDS ≥ 0.5 was obtained in 53.7% of PGB which was twice as likely compared to ST, 33.0%, RR 2.03 (1.27 to 3.27, p = 0.003), with no difference to PGNB, 46.6% (p = 0.113). %IOTF25 was unchanged from baseline for PGB 4.50 (−1.64 to 10.63), and significantly lower compared to ST 11.92 (8.40 to 15.44) (p = 0.043). Sociodemographics or attendance had no effect.ConclusionThe intensive parent-support early childhood obesity intervention led to better weight status outcomes over time, though BMI-SDS alone did not reflect this. Further research should investigate how to assess weight changes in growing children.Clinical trial registrationClinicaltrials.gov, NCT01792531.

Long-term Follow-up of treatment of chronic foot wounds with recombinant human epidermal growth factor in patients with different complications of diabetes mellitus

BACKGROUND: Diabetic foot ulcer (DFU) is a dangerous complication of diabetes mellitus (DM), which can lead to the development of chronic wounds and amputations. Recombinant human epidermal growth factor (rhEGF) can be used as an adjuvant treatment for chronic wounds resistant to standard treatment. Studies have demonstrated its clinical efficacy, however, there is insufficient information on the long-term results of treatment, its safety and the effect on the progression of diabetes complications, adverse cardiovascular events and the development of cancer.AIM: To assess the long-term results of rhEGF therapy for trophic foot ulcers in individuals with multiple complications of diabetes.METHODS: The study included 20 patients with type 1 and type 2 diabetes and various forms of DFS without critical ischemia, who had previously been treated with DFS using rhEGF in order to assess the general condition, progression of microand macrovascular complications of diabetes, adverse cardiovascular events, the development of cancer and the quality of life.RESULTS: There was a statistically significant difference between the area of wound defects, the percentage of granulation tissue that filled the wound defect, before the start of rhEGF treatment and at the time of discharge from the hospital (p &lt;0.05). During treatment with rhEGF, mild adverse events were observed in 35%. Complete epithelialization of wounds in most patients occurred in 3 [2; 4] months. In 11.76%, the wound was not completely epithelialized. Relapse occurred in 5.8% due to non-compliance with limb unloading. Minor amputation was performed in 1 patient. Progression of diabetic retinoand nephropathy was revealed in 23.5%. 11.76% suffered myocardial infarction of unknown age, 1 patient (5.88%) suffered acute cerebrovascular accident. Serious adverse events in the form of PE with a fatal outcome and critical ischemia of the lower limb were recorded in 5.8%.CONCLUSIONS: As a result of the study of long-term results of rhEGF treatment of chronic foot wounds, a low percentage of relapses and small amputations, the absence of high amputations and oncological diseases, the development of serious adverse events in 2 patients, the progression of diabetic retinoand nephropathy in 4 patients, the development of IM of unknown age in 2 patients was recorded. and stroke in 1 patient after rhEGF therapy.

Predictive factors of long-term follow-up in treatment of Korean alcoholics with naltrexone or acamprosate

Medication is integral in treating alcohol use disorder. However, because of the small to medium effect size, much effort is being exerted to identify predicting factors for effective pharmacological treatment in alcohol abuse disorder. Rather than focusing on abstinence days, alcohol craving, or frequency of drinking, which has been the focus of previous studies. Recently, there have been several studies which focused on follow-up length as an indicator of pharmacological treatment effe ctiveness. The purpose of this study was to investigate the predicting factors of long-term follow-up in treating Korean alcoholics with naltrexone or acamprosate. A retrospective study was conducted. Medical records of all patients diagnosed from November 2008 to May 2017 with alcohol abuse or alcohol dependence at psychiatric clinics at PNUYH were reviewed. We examined total days of which naltrexone or acamprosate were prescribed, and investigated if there were predicting factors maintaining follow-up at least 180 days or more. With these data, logistic regression analysis was conducted. In naltrexone long group compared to naltrexone short group, factors of having medical comorbidities [odds ratio (OR) = 5.477, P = 0.012] showed higher OR. In acamprosate long group, factors of age (OR = 1.083, P = 0.030), and use of more than four psychotropic medications (OR = 7.107, P = 0.030), showed higher OR. In both medications, predicting factors were different from the other. Further study to investigate the reasons would provide us with a new insight.

Management of partial vaginal agenesis according to the Wharton-Sheares-George technique – a long-term follow-up

The purpose of this study was to explore the long-term follow-up of treatment of congenital partial vaginal agenesis using the Wharton-Sheares-George technique. The technique was performed on 52 patients with congenital partial vaginal atresia from January 2009 to December 2017. As a result, the mean operating time of the Wharton-Sheares-George technique procedure was 25.6 ± 2.2 min. The mean estimated blood loss was 16.7 ± 4.7 mL. The average length of stay in hospital for the patients was 2.3 ± 0.2 days. There were no intraoperative and postoperative complications. The median duration of follow-up was 58 months. All of the patients experienced a resumption of menses. The mean vaginal length at 3 months was 7.3 ± 0.8 cm. Vaginal stenosis and adhesion did not occur in any cases during the follow-up. Twenty patients had sexual activities and the mean value of the FSFI questionnaire was 31.2 ± 4.0. Six cases became pregnant. There were four cases who each delivered one child and two cases who both delivered two children.IMPACT STATEMENTWhat is already known on this subject? It has been reported that the Wharton-Sheares-George technique provides, functionally and anatomically, very satisfactory results for the patients with Mayer-Rokitansky-Küster-Hauser syndrome. However, a study of the Wharton-Sheares-George technique in patients with congenital partial vaginal agenesis has not been reported previously in the medical literature.What the results of this study add? Our results have indicated that the Wharton-Sheares-George technique provides short operation time and length of stay, little blood loss intraoperatively, a satisfactory vaginal length and sexual activity in patients with congenital partial vaginal agenesis.What the implications are of these findings for clinical practice and/or further research? The study suggests that the Wharton-Sheares-George technique provides very satisfactory results in function and anatomy for congenital partial vaginal agenesis.

Corneal Apical Scar After Hyperopic Excimer Laser Refractive Surgery: Long-term Follow-up of Treatment With Sequential Customized Therapeutic Keratectomy.

To evaluate long-term results of sequential customized therapeutic keratectomy (SCTK) in highly aberrated corneas with apical scars consequent to hyperopic excimer laser refractive surgery. Fifteen eyes of 12 patients treated with SCTK for a corneal apical scar after hyperopic excimer laser refractive surgery were retrospectively evaluated. SCTK is a sequence of custom therapeutic excimer laser keratectomies where the results are monitored step-by-step by intraoperative corneal topography. In the preoperative and postoperative course, corrected distance visual acuity (CDVA), corneal topography and aberrometry, Scheimpflug tomography, and anterior segment optical coherence tomography were compared before and after SCTK. The postoperative follow-up comprised 7 patients with 1 year and 8 patients with more than 2 years of follow-up. Functional results showed a significant increase of CDVA from 0.36 ± 0.31 to 0.14 ± 0.25 logMAR at the last available follow-up. Mean sphere did not change significantly from the baseline, demonstrating that SCTK does not induce hyperopic shift. Higher order aberrations decreased significantly from 2.57 ± 1.92 to 0.80 ± 0.42 µm at the last follow-up. Topographic indexes (irregular astigmatism index, surface asymmetry index, and surface regularity index) showed a significant improvement after SCTK. Pachymetry 3 months postoperatively showed no significant reduction during the entire follow-up in either minimum or central thickness. Long-term results demonstrate that SCTK can treat this sight-threatening complication of hyperopic excimer laser refractive surgery, achieving significant improvements in visual acuity and in many corneal morphological parameters. [J Refract Surg. 2018;34(2):113-120.].

The role of clinical hypnosis and self-hypnosis to relief pain and anxiety in severe chronic diseases in palliative care: a 2-year long-term follow-up of treatment in a nonrandomized clinical trial.

Patients with severe chronic diseases and advanced cancer receiving palliative care, have a complex range of pain and anxiety that can arise early in the course of illness. We studied two groups of patients with severe chronic diseases who participated in a nonrandomized clinical trial of early integration of clinical hypnosis in palliative care versus standard pharmacological care. The purpose of this investigation was to evaluate whether a long-term intervention of 2 years with clinical hypnosis and self-hypnosis as an adjuvant therapy in chronic pain and anxiety, is more effective than pharmacological therapy alone. The study was performed at the Center of Anesthesiology, Intensive Care and Pain Therapy at the University of Verona, Italy. The study population consisted of 50 patients, 25 in the hypnosis group and 25 in the control group. Fourteen men and 36 women participated in the study. Evaluations with Visual Analog Scale (VAS) for pain and Hamilton Anxiety Rating Scale (HAM-A) for anxiety and the evaluation of the use of opioids and analgesic medicines were conducted at baseline and for a long-term follow-up (after 1 and 2 years). The two groups were homogeneous in the distribution of sex, age, type and subtypes of diseases and use of opioids and analgesic medicines at baseline. The patients suffered from 3 main types of severe chronic diseases: rheumatic (n=21), neurologic (n=16) and oncologic (n=13). The VAS score at baseline was similar in both the hypnosis group and control group (mean ± standard deviation, SD: 78±16 and 77±14, respectively). The average VAS value for the hypnosis group decreased from 81.9±14.6 at baseline to 45.9±13.8 at 1-year follow-up, to 38.9±12.4 at 2-year follow-up. The average VAS value for the control group decreased from 78.5±14.8 at baseline, to 62.1±15.4 at 1-year follow-up, to 57.1±15.9 at 2-year follow-up. The variance analysis indicated that the decrease in perceived pain was more significant in the hypnosis group patients than in the control group, after 1- and 2-year follow-up (P=0.0001). The average HAM-A Hamilton anxiety score decreased from 32.6 at baseline to 22.9 and 17.1 respectively at 1-year and 2-year follow-up for the hypnosis group, but it remained almost the same in the control group (29.8, 26.1 and 28.5 at baseline, first and second year respectively). ANOVA showed that the difference between the two groups was statistically significant (P<0.0001). Univariate analysis showed a 4-times greater risk of increasing analgesic medicines and opioids in the control group (adj.IRR: 4.36; 95% CI: 1.59-12.0) after 2-year follow-up. The patient group receiving hypnosis as an adjuvant therapy showed a statistically significant decrease in pain and anxiety and a significantly lower risk of increasing pharmacological pain treatment in a long term follow-up after 1 and 2 years compared to the control group. Clinical hypnosis can be considered an effective adjuvant therapy for pain and anxiety control in cancer as well as in severe chronic diseases for patients receiving palliative care.

Investigating the Effect of Nurse-Centered Strategies on Functional Chronic Constipation of Children aged 3-14 years Referring to Imam Reza Clinic of Shiraz University of Medical Sciences in 2014

Background: Functional constipation is among the most common problems of childhood. Children’s life quality is affected by constipation. In addition, constipation can bring about undesirable physical and psychic consequences. However, follow-up programs can solve the problem and assure the patient about continuing treatment. Objectives: This study aimed to investigate the impact of nurse-based approaches on functional chronic constipation in children. Methods: This is a clinical trial study conducted from August to December 2013 in Imam Reza clinic. The sample size was 95 children who were randomly assigned to two groups of experimental (47 persons) and control (48 persons). The mean age in the experimental and control groups was 6.25 ± 2.71 and 6.21 ± 2.68 years, respectively. The experimental group received a combination of nurse-centered and education program as well as conventional medical treatment while the control group received only the usual medical treatment. The data were collected using a data collecting form and bowel diary. The recovery percentage was assessed based on Rome 3 criteria in three periods of 1, 2, and 3 months after the intervention compared to before the intervention. The collected data were analyzed by SPSS version 16 software using chi square and Mc Nemar tests. Results: Before the intervention, the similarity of people in the study groups that is necessary for clinical trials was observed. In all variables such as constipation status, sex, weight, duration of constipation, previous therapy, and family history of constipation, there was no statistically significant difference between the two groups (P value > 0.05). The results showed improvements in both the groups. The percentage of improvement assessed by chi square test in the intervention group was 70.2%. This percentage increased to 83% about 2 and 3 months after the intervention; in comparison with the control group, the improvement was higher by 14 and 10%, respectively (P value > 0.05). Conclusions: Nurse-based clinics should be established at gastroenterology clinics to minimize the frustration of parents and children in remission and treatment discontinuation through routine follow-up of long-term treatment (either by phone or in person) that may lead a greater number of patients to achieve remission after treatment.

TCT-318 Ten-year All-cause Mortality after Simple versus Complex Stenting of Coronary Artery Bifurcation Lesions in the Randomized Nordic Bifurcation Study

Long-term follow-up in treatment of coronary bifurcation lesions have indicated worse outcome after planned two-stent techniques compared to treatment by the provisional side branch stenting technique. Here we report 10-year all-cause mortality in the randomized Nordic Bifurcation study. Patients

Communication restriction in adults who stutter: Part III

ABSTRACTThis is the third article in a series examining communication restriction in adults with stuttering (AWS). The aim was to explore interpersonal communication behaviour in AWS at long-term treatment follow-up, using systemic functional linguistics (SFL) as an analytical framework. The performance of 10 AWS within 10-minute conversation samples was compared across pretreatment (T1), post-treatment (T2), and 12-month follow-up (T3), in terms of language productivity and complexity, modality, and appraisal. At T1 and T3, comparisons were also made to a control group (AWNS). Post-treatment increases in (1) language complexity, (2) frequency of modal operators, and (3) expression of appraisal were maintained in the AWS group at T3. No significant differences in these areas were found between AWS and AWNS at T3. The findings suggest that intensive comprehensive stuttering treatment can affect lasting functional change in interpersonal language use for AWS.

Long-term treatment follow-up of children with sickle cell disease monitored with abnormal transcranial Doppler velocities

AbstractStroke risk in sickle cell anemia (SCA), predicted by high transcranial Doppler (TCD) velocities, is prevented by transfusions. We present the long-term follow-up of SCA children from the Créteil newborn cohort (1992-2012) detected at risk by TCD and placed on chronic transfusions. Patients with normalized velocities and no stenosis were treated with hydroxyurea, known to decrease anemia and hemolytic rate. Trimestrial Doppler was performed and transfusions restarted immediately in the case of reversion to abnormal velocities. Patients with a genoidentical donor underwent transplant. Abnormal time-averaged maximum mean velocities (TAMMV) ≥200 cm/s were detected in 92 SCA children at a mean age of 3.7 years (range, 1.3-8.3 years). No stroke occurred posttransfusion after a mean follow-up of 6.1 years. Normalization of velocities (TAMMV < 170 cm/s) was observed in 83.5% of patients. Stenosis, present in 27.5% of patients, was associated with the risk of non-normalization (P < .001). Switch from transfusions to hydroxyurea was prescribed for 45 patients, with a mean follow-up of 3.4 years. Reversion, predicted by baseline reticulocyte count ≥400 × 109/L (P < .001), occurred in 28.9% (13/45) patients at the mean age of 7.1 years (range, 4.3-9.5 years). Transplant, performed in 24 patients, allowed transfusions to be safely stopped in all patients and velocities to be normalized in 4 patients who still had abnormal velocities on transfusions. This long-term cohort study shows that transfusions can be stopped not only in transplanted patients but also in a subset of patients switched to hydroxyurea, provided trimestrial Doppler follow-up and immediate restart of transfusions in the case of reversion.

Long-Term Follow-up of Treatment for Synthetic Mesh Complications

Transvaginal synthetic mesh products were introduced more than 10 years ago to improve success rates of traditional pelvic organ prolapse and stress urinary incontinence repair methods. However, limited data are available showing symptomatic benefits of transvaginal mesh use. Moreover, with increased use of vaginal mesh, there has been increasing incidence of mesh complications, including vaginal mesh exposure and contraction. Although several treatments of mesh complications have been investigated, it is unclear whether these treatments alleviate their symptoms, especially long-term. This retrospective study had 2 aims. The first was to describe the presenting symptoms, findings, and treatment of complications resulting from placement of synthetic vaginal mesh. The second was to describe the self-reported improvement and function at least 6 months after treatment of complications. Women presenting with mesh complications at a single urogynecology center between 2006 and 2011 were identified by diagnostic codes. Data were abstracted from a chart review of medical records; the women were asked to complete a follow-up questionnaire consisting of several validated survey instruments. One hundred eleven women met criteria for inclusion and were evaluated for complications associated with synthetic mesh. The mean interval from the placement of mesh to presentation for evaluation of symptoms was 2.4 years. Of the 111 women, 93 (84%) were referred from outside hospitals. Mesh complications occurred with the following index surgeries: vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (38%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (4.5%). The most common complications reported were mesh extrusion (65%), mesh contraction (17%), chronic pelvic pain (16%), and obstructive voiding (9%). Ninety-eight women (88%) underwent multidisciplinary treatment by urogynecologists, pelvic pain specialists, or physical therapists; 85 (87%) of these underwent mesh excision. Follow-up data were provided by 84 (76%) of the patients at a mean interval since management of the complication of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory and EuroQol-5 Dimension questionnaire index scores were 98 (67) and 0.69 (0.23), respectively. Vaginal discharge was reported by 22% of the women; 15% had vaginal bleeding or spotting, and 45% sexually inactive women were abstinent because of mesh-related problems. At follow-up, 71% of the women reported being overall better than their status when presenting with the mesh complication, whereas 29% were the same or worse. These data show that, 2 years after multidisciplinary treatment of vaginal mesh complications, symptoms are still reported that negatively impact quality of life. Mesh complications are difficult to treat successfully. Most patients require surgical intervention.

Long-term follow-up of treatment for synthetic mesh complications.

The objectives of this study are (1) to describe the presenting symptoms, findings, and treatment and (2) to describe the self-reported improvement and function at least 6 months after presentation in women presenting to 1 urogynecology division for complications associated with synthetic vaginal mesh. Women evaluated between 2006 and 2011 were identified by diagnostic codes. We abstracted information from the medical record and attempted to contact all women to complete a follow-up telephone survey questionnaire consisting of several validated instruments. A total of 111 women were evaluated for complications associated with synthetic vaginal mesh. The mean interval from index surgery was 2.4 years. Of these, 84% were referred from outside hospitals. Index surgeries included vaginal mesh kits/vaginally placed mesh (47%), midurethral mesh slings (37%), abdominally placed vaginal mesh (11%), and vaginal mesh kit with concomitantly placed mesh sling (5%). The most common complications were extrusion (65%), contraction (17%), and chronic pelvic pain (16%). A total of 98 women underwent some type of treatment (85 surgical) by urogynecologists, pelvic pain specialists, or physical therapists. Eighty-four (76%) provided follow-up information at mean interval since presentation of 2.3 years. At follow-up, the mean (SD) Pelvic Floor Distress Inventory score was 98 (67), the mean (SD) EQ-5D index score was 0.69 (0.23), and 22% reported vaginal discharge, 15% vaginal bleeding or spotting, and 45% sexual abstinence due to problems related to mesh. A total of 71% reported being overall better, whereas 29% were the same or worse. Two years after tertiary care level multidisciplinary treatment of vaginal mesh complications, many women still report symptoms that negatively impact their quality of life.

Long-term follow-up of peripheral lymphocyte subsets in a cohort of multiple sclerosis patients treated with natalizumab

Natalizumab, an anti-alpha4 integrin monoclonal antibody inhibiting the adhesion of lymphocytes to the endothelium, is a widely accepted drug treatment for relapsing-remitting multiple sclerosis (RRMS). A peripheral increase of T and B lymphocytes has already been observed as an early treatment effect. This retrospective observational study was aimed to evaluate the peripheral lymphocyte subsets during a long-term treatment follow-up. We included 23 RRMS patients treated with natalizumab for at least 24-48 months who had pretreatment lymphocyte evaluation. Baseline values of lymphocyte subsets and CD4/CD8 ratio did not differ significantly from the 23 matched healthy subjects. The periodic (every 3-6 months) assessment of immune cell subsets was performed by flow cytometry on peripheral blood collected before drug injection. Therapy with natalizumab was confirmed to be effective during the observational period. For all patients, the increase in lymphocytes during natalizumab therapy compared to baseline at every assessment was significantly higher compared to that of overall white blood cells (2·1- and 1·3-fold, respectively, P < 0·0001). Both T cell subsets were proportionally modified and the CD4/CD8 ratio did not change significantly, while B cells increased significantly compared to T and NK cells (3·2-, 1·88- and 1·92-fold, respectively, P < 0·0001). These changes remained constant throughout the 25-48-month period of therapy. In conclusion, effective natalizumab treatment of RRMS patients was associated with the persistence of its biological effects through a stable increase of peripheral lymphocytes, mainly B cells, and an unchanged proportion of T cell subsets in long-term follow-up.

Commentary on Berger et al. The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

Commentary on Berger et al. The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

Long-term follow-up of treatment with imatinib in eosinophilia-associated myeloid/lymphoid neoplasms with PDGFR rearrangements in blast phase

Long-term follow-up of treatment with imatinib in eosinophilia-associated myeloid/lymphoid neoplasms with PDGFR rearrangements in blast phase

The long-term follow-up of treatment with corticosteroid injections in patients with carpal tunnel syndrome. When are multiple injections indicated?

The objective of this prospective study was to investigate the long-term effect of one or more local corticosteroid injections in patients with carpal tunnel syndrome and whether a good response can be predicted. Follow-up visits took place at 3 weeks, 6 months, and 1 year after the first corticosteroid injection. Thirty of the 120 patients (25%) had a good outcome with a single injection, 11 additional patients (9%) needed a second injection, and five patients (4%) needed a third injection to reach a good outcome after 1 year. Of patients with an initial good treatment response, 28 (52%) had a good outcome after 1 year compared with 18 (27 %) who had an initially moderate or no response to treatment. One-third of patients with carpal tunnel syndrome had a long-term beneficial effect from corticosteroid injection, especially when they had a good initial response.

Action on AMD. Optimising patient management: act now to ensure current and continual delivery of best possible patient care

In recent years, there have been significant advances in the clinical management of patients with wet age-related macular degeneration (wet AMD)—a rapidly progressing and potentially blinding degenerative eye disease. Wet AMD is responsible for more than half of registered severe sight impairment (blindness) in the United Kingdom, and patients who are being treated for wet AMD require frequent and long-term follow-up for treatment to be most effective. The clinical workload associated with the frequent follow-up required is substantial. Furthermore, as more new patients are diagnosed and the population continues to age, the patient population will continue to increase. It is thus vital that clinical services continue to adapt so that they can provide a fast and efficient service for patients with wet AMD. This Action on AMDdocument has been developed by eye health-care professionals and patient representatives, the Action on AMDgroup. It is intended to highlight the urgent and continuing need for change within wet AMD services. This document also serves as a guide for eye health-care professionals, NHS commissioners, and providers to present possible solutions for improving NHS retinal and macular services. Examples of good practice and service development are considered and can be drawn upon to help services meet the recommended quality of care and achieve best possible outcomes.

Rituximab in treatment of idiopathic glomerulopathy

The aim of our study was to assess the role of rituximab (Mabthera) in the treatment of patients with corticosteroid-resistant and calcineurin-inhibitors ± cellcept refractory idiopathic nephrotic syndrome (INS). A total of 83 patients who had required the previous treatment for a minimum of two years were included in the study. Our protocol included the use of rituximab in four-weekly slow infusions. Five patients were excluded as they could not tolerate rituximab infusion for allergic reaction. As expected, none of the patients had a decline in the total circulating lymphocyte counts yet all had achieved decline of their initially normal CD20 to < 0.5% one month after infusion. The decline persisted for eight to ten months later. In the minimal change disease (MCD) group, 31 of the 32 patients had complete remission (CR) and were off any immunosuppressive therapy and one of the previous non-responders (NR) did not respond. Excluding two patients who had required retreatment, the others remained in CR (17 up to 28 months and six up to 36 months). Treatment with rituximab resulted in amelioration of NS in 17 of the 18 patients with focal segmental glomerulosclerosis (FSGS), while only one patient remained NR. Although renal function remained stable, proteinuria reappeared by eight to 12 months. Retreatment with rituximab resulted in a similar response with stable kidney function. In the 28 patients with membranous glomerulopathy (MG), 24 had achieved CR. Two patients failed to respond and two had partial remission. By 12 months, all patients relapsed. The response was within one month following treatment in patient with MCD, but was gradual within three months in FSGS and MG. Relapsers in all groups responded in a similar pattern to repeat dosing with the drug subsequently. Our prospective study represents an adequate number of patients with biopsy-proven subgroups of INS in both children and adults with long-term follow-up of treatment with rituximab. The drug is effective and safe for treatment of patients refractory to the conventional agents.

Long-Term Follow-Up of Treatment of Pulmonary Arteriovenous Malformations with AMPLATZER Vascular Plug and AMPLATZER Vascular Plug II Devices

Purpose To assess the feasibility, complications, and long-term success of embolization of pulmonary arteriovenous malformations (PAVMs) with the AMPLATZER Vascular Plug and AMPLATZER Vascular Plug II. Materials and Methods The study included 15 consecutive patients (19 embolization episodes) who had embolization of PAVMs between April 2004 and April 2009 with an AMPLATZER Vascular Plug or AMPLATZER Vascular Plug II. There were 4 men and 11 women, with a mean age of 56 years (range 24–74 years). A prospective database of all cases of PAVM embolization is kept in the department. Patient history, detailed procedural records, and clinical and radiological follow-up were reviewed. Results Among the 19 PAVMs, an AMPLATZER Vascular Plug was deployed in 11, and an AMPLATZER Vascular Plug II was deployed in 8. The technical success of the procedure was 100% for PAVM occlusion; 30-day mortality in the group was zero. Successful radiologic follow-up with the AMPLATZER Vascular Plug was a mean of 28 months (range 0–60 months) and with the AMPLATZER Vascular Plug II was a mean of 18 months (range 12–36 months). There was one recanalization of an AMPLATZER Vascular Plug 36 months after embolization giving an annual event rate of 0.03 recanalizations per AMPLATZER Vascular Plug or AMPLATZER Vascular Plug II per year. There were no major complications. Clinically, there was one (1 of 18 cases [5%]) immediate complication of chest pain that resolved in 24 hours with simple analgesia. There were no early or late clinical complications. Conclusions The treatment of PAVM with either an AMPLATZER Vascular Plug or an AMPLATZER Vascular Plug II is safe and effective and associated with a low reintervention rate. Further follow-up is ongoing to ensure continued occlusion of treated PAVMs.