Long-term Follow-up Monitoring Research Articles

The association between preterm birth and hypertension

In recent years, the number of premature births worldwide has been increasing, and their long-term prognoses, particularly the cardiovascular outcomes of preterm individuals in adulthood, have become a growing concern. Adults who were born prematurely are at a higher risk for cardiovascular diseases, which may be related to changes in cardiovascular structure, renal structure alterations, changes in body composition, and overactivation of the hypothalamic-pituitary-adrenal axis. To improve the outcomes for preterm individuals, long-term follow-up monitoring and effective prevention and treatment measures are necessary. This article aims to review the relevant literature, summarize the risks and mechanisms of hypertension during childhood and adulthood in those born prematurely, and enhance awareness and understanding of the risk of hypertension in adults who were born prematurely.

3D Analysis of Breast Morphological Changes after Vertical-Scar Reduction Mammoplasty: A Prospective Study.

In addition to symptom relief, the crucial objective of reduction mammoplasty is to achieve a stable and esthetically pleasing postoperative breast shape. However, the morphological changes in breasts following reduction mammoplasty have not been comprehensively understood. In this study, we applied three-dimensional (3D) scanning technology for long-term follow-up monitoring of breast morphological changes to discern their changing trends. Our goal was to provide a reliable basis for assessing postoperative effects and determining follow-up time points. This prospective study included patients undergoing vertical-scar reduction mammoplasty. We utilized a combination of linear measurements and 3D scanning to measure various parameters, including breast volume, breast volume distribution, nipple position, and scar length at various time points: pre-surgery, immediately post-surgery, 3-month postoperative, 6-month postoperative, and 1-year postoperative. A total of 115 patients were enrolled in this study. Throughout the initial 3 months of postoperative follow-up, there was a gradual reduction in breast volume, which tended to stabilize from 3 to 12months. The nipple position showed a gradual shift both laterally, inferiorly, and posteriorly. The volume of the lower and lateral part of the breast increased gradually. Notably, at 1year after surgery, the scar length was approximately 6.3% shorter compared to the immediate postoperative measurement. Our 3D analysis unveiled comprehensive changes in breast morphology: The overall breast volume shifted laterally and inferiorly, the nipple position moved laterally, inferiorly, and posteriorly, and there was a significant reduction in scar length. Concurrently, breast volume exhibited a gradual decrease and stabilization after 3months, establishing it as a suitable follow-up point for assessing postoperative results. Additionally, surgical plans can be formulated based on the overall trend of changes in breast volume and distribution, combined with methods such as three-dimensional scanning, to enhance surgical outcomes and patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to authors www.springer.com/00266 .

Temporal variation in environmental radioactivity and radiation exposure doses in the restricted areas around the Fukushima Daiichi Nuclear Power Plant

Temporal variation and fluctuation in environmental contamination in Futaba town and Okuma town, the location of the Fukushima Daiichi Nuclear Power Plant (FDNPP), were evaluated based on a car-borne survey conducted from October 2021 to November 2022. Although the environmental radioactivity in the interim storage facility area (ISF) was higher than that in open areas (i.e., the evacuation order lifted areas in Futaba town and the Specific Reconstruction and Regeneration Base area [SRRB] in Okuma town), only minor temporal changes were seen in the ambient dose and detection rate of radiocesium (the proportion of radiocesium detected points per all measuring points) in those areas, respectively. These findings suggest that the observed variations may result from physical decay and environmental remediation. Resuspension caused by human activities and weather could also affect the detection rate of radiocesium. The annual external effective doses in Futaba town and Okuma town were estimated to be at a limited level (< 1 mSv/year). Nevertheless, to help ensure the safety and future prosperity of residents and communities in the affected areas around the FDNPP, long-term follow-up monitoring of temporal exposure dose levels during the recovery and reconstruction phases is extremely important.

Staghorn Calculus: A Comprehensive Review of Epidemiology, Clinical, Diagnosis and Treatment

Staghorn calculus is a urological condition characterized by the presence of large, branching kidney stones in the renal collecting system. Although it is a relatively uncommon entity, its high recurrence rate and associated complications represent a significant clinical challenge. In this article, a comprehensive review of the epidemiology, clinical, diagnostic, and treatment of chorioriform lithiasis is performed. Risk factors, clinical manifestations and associated complications are discussed. In addition, the different diagnostic tools are described in detail, from clinical history and physical examination to urinalysis and imaging studies. Regarding treatment, therapeutic options such as antibiotic therapy, endourological techniques and correction of underlying metabolic disorders are discussed. The importance of long-term follow-up and regular monitoring to prevent recurrence and complications is emphasized. In conclusion, this article provides a comprehensive overview of chorioriform lithiasis, providing health care professionals with up-to-date guidance for the successful management of this complex urologic condition.

Discontinuation of treatment and retreatment of neovascular age-related macular degeneration in the real-world: Bundang AMD cohort study report 5.

This single-center retrospective cohort study investigated the incidence rate and risk factors for the discontinuation of anti-vascular endothelial growth factor (VEGF) injections and retreatment in typical neovascular age-related macular degeneration (tnAMD) and polypoidal choroidal vasculopathy (PCV) in the real-world setting. A total of 488 eyes with either tnAMD (n = 334) or PCV (n = 154) followed up for ≥3 years were analyzed. The discontinuation of treatment was defined as the cessation of anti-VEGF injections for 1 year or longer. Eyes with discontinuing treatment were subdivided into group A: eyes with stable responses (complete or incomplete resolution) and group B: those with no expectation of visual gain or poor response. The proportion and median time of discontinuation of treatment or retreatment were analyzed. The visual prognosis and the associated risk factors for the discontinuation of treatment or retreatment were also investigated. The mean follow-up period was 8.1 ± 3.4 years. Of 488 eyes, discontinuation of the treatment occurred in 322 eyes (66.0%), and the median time to discontinuation was 1.5 years after the initial injection. Of 297 eyes with discontinuation of treatment excluding 25 eyes with vitrectomy or photodynamic therapy after the discontinuation of the injection, 277 eyes belonged to group A and the remaining 20 eyes belonged to group B. Of the 277 eyes discontinuing treatment with a stable response, 185 eyes (66.8%) were given retreatment. The median time to retreatment was 3.3 years after the discontinuation of the injections. PCV and the lower annual number of injections were the significant factors associated with discontinuation. Younger age, male gender, and PCV were the significant factors for the retreatment. Our long-term real-world study showed that two-thirds of eyes with neovascular age-related macular degeneration (nAMD) had the discontinuation of the anti-VEGF injections and two-thirds of eyes discontinuing treatment with stable responses experienced retreatment. Long-term follow-up and regular monitoring are needed to detect the recurrence.

The lived experience of long-term follow-up clinical care for haematopoietic stem cell recipients in England: a qualitative exploration

PurposeDespite a haematopoietic stem cell transplant (HSCT) being a potentially curative treatment option for malignant and non-malignant disorders, patients may develop complex physical and psychological post-transplant complications. Consequently, transplant centres remain responsible for patients’ life-long monitoring and screening practices. We sought to describe how HSCT survivors experience long-term follow-up (LTFU) monitoring clinics in England.MethodA qualitative approach was adopted with data collected from written accounts. Seventeen transplant recipients were recruited from across England, and the data was analysed using thematic analysis.ResultsData analysis elicited four themes: Transfer to LTFU care: ‘will there be a change in my care, or will appointments just become less frequent?’; Care Coordination: ‘it is good to know I am still in the system’; Relationship continuity: ‘a good knowledge of me, my health and what is important to me’; and Late-effects Screening: ‘there was not much information about what to expect or be aware of’.ConclusionsHSCT survivors in England experience uncertainty and lack of information regarding the transfer from acute to long-term care and clinic screening practices. However, patients gain reassurance from remaining on a healthcare pathway and maintaining relationships with healthcare professionals.Implications for cancer survivorsHSCT recipients entering LTFU monitoring clinics are a growing population of cancer survivors. Understanding and acknowledging this cohort of patients’ needs may inform the development of tailored support to help patients navigate the complicated healthcare pathway.

Xenoestrogen Status of Wuling Farm to Surrounding Water Bodies: An Application of Biochemical Parameters Using Onychostoma barbatulum

The aim of this study was to apply biochemical parameters to Onychostoma barbatulum to understand whether Wuling Farm activities have caused organic pollution from xenoestrogens to flow into surrounding streams and thereby affected area aquatic ecosystems. Individuals of the Taiwan shovel-jaw carp (O. barbatulum) were collected by fyke netting in the Cijiawan, Kaoshan, and Yusheng Rivers in the protected area of Shei-Pa National Park and in the Ikawan River outside the protected areas from 4–5 June 2015 to 20–21 September 2015. The collected male individuals of O. barbatulum were divided into two groups. In the first group monooxygenase (Mon) activity, glutathione S-transferase (GST) activity, and vitellogenin (VTG) concentration in the liver were measured right after they were captured. Those in the second group were acclimated for 14 days and then exposed to 0 (control) or 10 ng/L 17β-estradiol for 10 days and then measured for changes in Mon, GST, and VTG in their livers. The value of VTG concentrations in O. barbatulum individuals collected from the Ikawan River was 2.12 ± 1.62 μg PO42+/g protein, which was the highest among all samples, followed by those collected from the Yusheng River (0.78 ± 1.00 μg PO42+/g protein). Individuals collected from the Yusheng River had the highest liver Mon activity (4.16 ± 1.08△A650/30 min/g protein) and the highest GST activity (1.58 ± 1.13 △A340/20 min/g protein), followed by those from the Ikawan River (Mon: 3.63 ± 1.13 △A650/30 min/g protein; GST: 1.24 ± 0.73 △A340/20 min/g protein). Comprehensive analyses showed that Mon and GST activities and VTG concentrations in livers measured right after being collected were lower than individuals exposed to 10 ng 17β-estradiol/L in the laboratory. Induced VTG concentrations were 9.87 ± 0.89 μg PO42+/g protein, Mon activity 8.02 ± 1.74 △A650/30 min/g protein, and GST activity 3.24 ± 0.62 △A340/20 min/g protein, indicating that farming activities have not significantly affected these aquatic organisms. However, pollution sources are still releasing pollutants containing xenoestrogens into the Yusheng River and Ikawan River. The impact of xenoestrogens is worthy of continuous long-term follow-up monitoring.

Clinical Profile and Outcomes of Multisystem Inflammatory Syndrome in Children: A Multicentric Observational Study

Background and objectiveMultisystem inflammatory syndrome in children (MIS-C) is a postinfectious, generalized, hyperimmune state and is potentially lethal. There is scarce data on the clinical presentation and epidemiology of MIS-C in India. In light of this, we conducted this study to describe clinical presentations and outcomes in children diagnosed with MIS-C.MethodologyThis was a 15-month hospital-based prospective observational study conducted in the Departments of Pediatrics at Jagannath Hospital and Hitech Medical College, Bhubaneswar. The study included all patients diagnosed with MIS-C and treated at these hospitals between May 1, 2020, and August 31, 2021. The inclusion criteria were as follows: patients who were reverse transcription-polymerase chain reaction (RT-PCR)-positive, antibody-positive, or had known contact with those infected with coronavirus disease 2019 (COVID-19). We reviewed patient medical records to collect demographic data such as age, sex, body mass index (BMI), duration of illness, clinical symptomatology, findings of initial echocardiography, and outcomes. We followed each case for three months. We analyzed descriptive statistics using percentages and means and conducted the statistical analysis using SPSS Statistics for Windows, Version 25.0. (IBM Corp., Armonk, NY).ResultsA total of 30 cases were included in the study, consisting of 16 boys (53.3%) and 14 girls (46.7%). The mean age of the study population was 6.7 years, and 43% had a BMI in the overweight range. All patients (100%) had a fever, 66.7% had lethargy (n=20), and 64.3% (n=19) had abdominal symptoms in the form of vomiting, diarrhea, and abdominal pain. Respiratory distress at admission was found in 16 cases (53.3%), while hypotension at admission was found in 18 (60%) cases. Our population's average duration of pediatric ICU stay was 3.7 ± 1.2 days, and the average duration of inotropy was 2.2 ± 0.5 days. Fifteen cases (50%) required only oxygen support; 10 (33%) required noninvasive ventilation, and only one patient required invasive ventilation. Twenty-two patients (74%) needed fluid boluses. Outcomes of coronary artery dilatations were favorable, regressing to normal (Z-score <2.5) in affected patients within 90 days of follow-up.ConclusionsMIS-C has myriad presenting signs, symptoms, and severity. It is often associated with circulatory failure or shock. However, most patients demonstrated good early outcomes, improved left ventricle (LV) function, normalization of coronary abnormalities, and no mortality. This study provides additional data on the clinical presentation of MIS-C and highlights the importance of close, long-term follow-up monitoring of this patient population.

The evaluation of the immune status of COVID-19 recovered subjects with persistent abnormal lung CT after one year: A longitudinal cohort study

ObjectivesCOVID-19 is an immune-related disease caused by novel Coronavirus SARS-COV-2. Lung lesions persist in some recovered patients, making long-term follow-up monitoring of their health necessary. The mechanism of these abnormalities is still unclear. In this study, the immune status was observed to explore the immune mechanism of persistent lung CT abnormalities in one-year COVID-19 recovered subjects. MethodsOne-year follow-up of 73 recovered patients from COVID-19 confirmed in Taizhou City, Zhejiang Province, was conducted to collect laboratory indicators such as blood immune cells, cytokines, complement series, immunoglobulin, and lung imaging; According to the results of lung CT, 60 patients were divided into normal CT group (n = 40) and abnormal CT group (n = 20). We compared the dynamic changes of immune indexes at three timepoints namely onset (T1), discharge (T2), and 1-year follow-up (T3), and studied the relationship between immune indexes and pulmonary sequelae. ResultsCompared with the healthy control, there was no significant difference in immune-related indexes, and immune levels had recovered. Patients with elder age, high BMI, severe patients, and those with underlying diseases (hypertension or diabetes) had a higher CT abnormal rate after recovery. Longitudinal observation showed that immunoglobulin increased first and then decreased, immune cell TBNK decreased in the onset period and increased in the recovery period, cytokine level increased significantly in the onset period and decreased to the normal level in the recovery period, and complement series C1q, C3 and C4 increased at the onset and decreased during the one-year follow-up. Complement C3 remained at a high level in the CT abnormal group (CT normal group vs CT abnormal group; P = 0.036). Correlation analysis showed that C3 negatively correlated restrictive ventilation index (TLC-He (ratio) (r = −0.302, P = 0.017). The above results suggest that complement C3 is a negative factor correlating abnormal pulmonary function 1 year after the recovery. ConclusionAfter one year recovering from COVID-19, the subjects were with stable immune indicators. High levels of complement C3 were associated with persistent lung abnormalities in COVID-19 recovered subjects.

Pulmonary Sequelae in Patients After Recovery From Coronavirus Disease 2019: A Follow-Up Study With Chest CT.

Objective: The pulmonary sequelae of coronavirus disease 2019 (COVID-19) have not been comprehensively evaluated. We performed a follow-up study analyzing chest computed tomography (CT) findings of COVID-19 patients at 3 and 6 months after hospital discharge.Methods: Between February 2020 and May 2020, a total of 273 patients with COVID-19 at the Shenzhen Third People's Hospital were recruited and followed for 6 months after discharge. Chest CT scanning was performed with the patient in the supine position at end-inspiration. A total of 957 chest CT scans was obtained at different timepoints. A semi-quantitative score was used to assess the degree of lung involvement.Results: Most chest CT scans showed bilateral lung involvement with peripheral location at 3 and 6 months follow-up. The most common CT findings were ground-glass opacity and parenchymal band, which were found in 136 (55.3%) and 94 (38.2%) of the 246 patients at 3 months follow-up, and 82 (48.2%) and 76 (44.7%) of 170 patients at 6 months follow-up, respectively. The number of lobes involved and the total CT severity score declined over time. The total CT score gradually increased with the increasement of disease severity at both 3 months follow-up (trend test P < 0.001) and 6 months follow-up (trend test P < 0.001). Patients with different disease severity represented diverse CT patterns over time.Conclusions: The most common CT findings were ground-glass opacity and parenchymal bands at the 3 and 6 months follow-up. Patients with different disease severity represent diverse CT manifestations, indicating the necessary for long-term follow-up monitoring of patients with severe and critical conditions.

Abstract 13439: Long-Term Outcomes From Continuous Rhythm Monitoring After Hybrid Convergent Procedure in Longstanding Persistent Atrial Fibrillation Patients

Introduction: Endocardial catheter ablation has suboptimal effectiveness and durability in patients with longstanding persistent atrial fibrillation (LSPAF). Hybrid convergent ablation combines epicardial and endocardial ablation to create a transmural lesion set that isolates the left atrial posterior wall and pulmonary veins. The study objective was to evaluate long-term outcomes assessed by continuous rhythm monitoring in LSPAF patients who received hybrid convergent ablation. Methods: This was a single-center IRB-approved, observational study. Eligible patients were identified by retrospective chart review and included patients who received hybrid convergent procedures between September 2011 and November 2017. Patients were consented for prospective long-term follow-up visits and continuous cardiac monitoring (7-day ePatch). Baseline characteristics, procedural outcomes, and follow-up data were entered into the TRAC-AF registry. This analysis focused on the patient subgroup with pre-operative LSPAF (AF duration &gt;1 year). Results: Of 77 consented patients, 60 had pre-operative LSPAF. Mean age was 66.1 ± 7.9 years, 70% were male, and duration of AF was 6.8 ± 4.8 years. Mean CHA2DS2-VASc score was 2.6 ± 1.4; mean BMI was 32.1 ± 5.9, and 55% (33/60) of patients had previous catheter ablation. Thirty-day major adverse event rate was 5% (3/60) and included 2 inflammatory pericardial effusions and one major bleeding. On continuous monitoring, 71% (41/58) of patients had 0% AF burden at mean follow-up of 61.7 ± 18.9 months. Eight patients (13%) had repeat catheter ablation at mean 21.6 ± 16.3 months since index procedure. Comparison of baseline and follow-up left ventricular ejection fraction (LVEF) from echocardiography revealed a trend of 12.4 ± 13.0 units improvement at mean follow-up of 18.2 ± 23.7 months since baseline in 5 patients with severely reduced (&lt;40%) baseline ejection fraction (p=0.063). Conclusions: Long-term follow-up with continuous monitoring revealed a majority of patients with pre-operative LSPAF had 0% AF burden after a mean 61.7 months since the hybrid convergent procedure. These results are aligned with published studies and the CONVERGE trial on the effectiveness of hybrid convergent ablation in LSPAF.

Мультисистемный воспалительный синдром, ассоциированный с SARS-CoV-2, у ребенка

The COVID-19 infection occurs much less commonly in children than in adults, presumably due to the predominance of asymptomatic variants. Nevertheless, single deaths by the COVID-19 were reported in children worldwide. Some of these deaths result from multisystem inflammatory syndrome (MIS) that develops at late stages or after the COVID-19. MIS is characterized by acute onset, steady fever, skin and mucosal damage, and multiorgan failure. Unlike the classic variant of Kawasaki disease, MIS is associated with more frequent shocks and a more severe course. This paper addresses a case report of MIS with a favorable course and outcome in a 7-year-old boy. Practitioners should be aware that severe intoxication and inflammation with increased inflammatory markers emerging at late stages or after respiratory infections are potential manifestations of MIS. In these cases, tests for the COVID-19 should be timely performed; if found, pathogenic therapy is promptly initiated. Taking into account the insufficient knowledge of the pathogenesis and the knowledge of the consequences of MIS associated with SARS-CoV-2, long-term follow-up monitoring is required. KEYWORDS: coronavirus infection, COVID-19, SARS-СoV-2, multisystem inflammatory syndrome, Kawasaki-like syndrome, Kawasaki-like disease. FOR CITATION: Nagovitsyna N.M. SARS-CoV-2-associated multisystem inflammatory syndrome in a child. Russian Journal of Woman and Child Health. 2021;4(4):375–377 (in Russ.). DOI: 10.32364/2618-8430-2021-4-4-375-377.

Systematic review and meta-analysis: dipeptidyl peptidase-4 inhibitors and rheumatoid arthritis risk.

This review evaluated the risk of rheumatoid arthritis in patients with type 2 diabetes treated with dipeptidyl peptidase-4 inhibitors (Dpp-4i). The MEDLINE (via PubMed), Embase, the Cochrane Library databases and web of science were used to search the effects of Dpp-4i on rheumatoid arthritis in patients with type 2 diabetes from inception to 7 September, 2020. We included studies that met the following criteria:(i) A randomized controlled trial (RCT), prospective or retrospective cohort study examining the relationship between Dpp-4i and rheumatoid arthritis. Exclusion criteria included the following: Reviews and researches related to other diseases or subjects; and studies without data on the prevalence of rheumatoid arthritis were excluded. Risk of Bias table contained in Review Manager 5.3 and Newcastle-Ottawa scale (NOS) were used for quality assessment of included RCT and observational studies separately. Meta-analysis was used to estimate the risk of disease. We conducted a subgroup analysis of duration of follow-up, adjusted (adjusted RR or unadjusted RR), sample size and study design. A total of 10 independent studies assessing 1,420,414 patients were included in this analysis. In this meta-analysis, we found that there was nonsignificant increase of rheumatoid arthritis with Dpp-4 inhibitor exposure (RR 0.96, 95%CI (0.69-1.32)). Our results revealed that Dpp-4 inhibitors do not seem to increase the risk of rheumatoid arthritis. Long-term follow-up monitoring is necessary.

Epileptic Negative Myoclonus as the First and Only Symptom in a Challenging Diagnosis of Benign Epilepsy With Centrotemporal Spikes.

Objective:To investigate the clinical and neurophysiological characteristics of epileptic negative myoclonus as the first and only ictal symptom of benign epilepsy with centrotemporal spikes.Methods:Electrophysiological evaluations included polygraphic recordings with simultaneous video electroencephalogram monitoring and tests performed with patient’s upper limb outstretched in standing posture. Epileptic negative myoclonus manifestations, electrophysiological features, and responses to antiepileptic drugs were analyzed.Results:The authors report 2 patients with benign epilepsy with centrotemporal spikes, who had epileptic negative myoclonus as the first and only seizure type. Video electroencephalogram monitoring results showed that their negative myoclonus seizures were emanating from the contralateral central and the parietal regions. Epileptic negative myoclonus was controlled by administration of valproate and levetiracetam.Conclusion:Epileptic negative myoclonus can be the first and only seizure type of benign epilepsy with centrotemporal spikes, and long-term follow-up monitoring should be the care for the recurrence and/or presence of other types of seizures.

Ostre ogniskowe bakteryjne zapalenie nerek u dzieci (AFBN) jako proces wyprzedzający tworzenie się ropni nerek

AFBN is a rarely reported pattern of kidney parenchyma bacterial infection with tendency to form local abscesses. The local infection develops within the bloodstream – transmitted material is coming from distant foci or is the result of ascending urinary tract infection, mainly in cases of congenital lower urinary tract defects. Clinical pattern is dominated by the presence of high fever, non-specific abdominal pain and high values of inflammatory markers. Renal ultrasound (USG) and renal CT scan are used as supportive diagnostic tools. We present the results of clinical analysis of 14 cases diagnosed as AFBN. All 14 children presented high values of CRP, variable leukocyturia and infection with E.coli or Staph. epidermidis. The USG was not quite informative, while renal CT scan revealed extensive inflammatory infiltrates in kidney parenchyma with trend to form local abscesses. Long-term wide-range antibiotic therapy was used. This treatment stopped the abscess formation and made surgical management unnecessary. We observed that the incidence of AFBN increased in recent years and included predominantly the pubertal girls. Static renal scyntygraphy will be the diagnostic tool in long-term follow-up monitoring.

Management of neurogenic bladder in patients with multiple sclerosis.

Lower urinary tract (LUT) dysfunction is common in patients with multiple sclerosis and is a major negative influence on the quality of life of these patients. The most commonly reported symptoms are those of the storage phase, of which detrusor overactivity is the most frequently reported urodynamic abnormality. The clinical evaluation of patients' LUT symptoms should include a bladder diary, uroflowmetry followed by measurement of post-void residual urine volume, urinalysis, ultrasonography, assessment of renal function, quality-of-life assessments and sometimes urodynamic investigations and/or cystoscopy. The management of these patients requires a multidisciplinary approach. Intermittent self-catheterization is the preferred option for management of incomplete bladder emptying and urinary retention. Antimuscarinics are the first-line treatment for patients with storage symptoms. If antimuscarinics are ineffective, or poorly tolerated, a range of other approaches, such as intradetrusor botulinum toxin A injections, tibial nerve stimulation and sacral neuromodulation are available, with varying levels of evidence in patients with multiple sclerosis. Surgical procedures should be performed only after careful selection of patients. Stress urinary incontinence owing to sphincter deficiency remains a therapeutic challenge, and is only managed surgically if conservative measures have failed. Multiple sclerosis has a progressive course, therefore, patients' LUT symptoms require regular, long-term follow-up monitoring.

Elevated Lipid Profiles in Patients with Acute Transverse Myelitis

Background: The associations and clinical relevance of serum lipid profiles in patients with acute transverse myelitis (ATM) are unknown. Our study aimed at investigating the status of serum lipid variables (including total cholesterol (TC), triglycerides (TGs), high/low density lipoproteins (HDL/LDL), apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB) and cholesterol to HDL ratio) in ATM, and to explore whether there was a correlation between serum lipid levels and disease characteristics of ATM. Methods: We retrospectively evaluated serum lipid levels of 92 patients with ATM, 43 with multiple sclerosis (MS) on relapse and 112 healthy controls (HC). The changes of serum lipid profiles were analyzed. Results: We found that ATM patients had higher serum TC, TG, LDL levels and T/H ratio than HC, but had lower levels of serum ApoA-I and ApoB. Besides, there were no significant differences between ATM and MS on relapse (except ApoB). Third, longer disease duration was associated with higher TG; higher HDL was associated with a trend for lower Expanded Disability Status Scale scores. Conclusions: Our findings showed that serum lipid levels were elevated in patients with ATM, among serum TG and HDL might be associated with clinical features. These results illustrate that a long-term follow-up and regular monitoring of serum lipid profiles are important for ATM patients.

A Giant Aggressive Angiomyxoma of the Pelvis Misdiagnosed as Incarcerated Femoral Hernia: A Case Report and Review of the Literature.

Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumor that is mostly derived from the female pelvic and perineal regions. AA is a locally infiltrative slow growing tumor with a marked tendency to local recurrence. Painless swelling located around the genitofemoral region is the common symptom; thus, it is often misdiagnosed as a gynecological malignancy or a groin hernia. A 35-year-old female patient who previously underwent surgery for left femoral hernia operation resulting in surgical failure was reoperated for a giant AA located in the pelvis. The tumor was completely excised with free margins. Histopathologic examination revealed an AA. The tumor size was measured as 24 × 12 × 6 cm with a weight of 4.2 kg. Immunohistochemically, the cells show positive staining with vimentin, desmin, estrogen, and progesterone receptor. S100, MUC4, CD34, and SMA were negative in the tumor cells. AA should be considered in the differential diagnosis of any painless swelling located in the genitofemoral region, particularly in women of reproductive age. The principle treatment should be complete surgical excision with tumor-free margins. Long-term follow-up and careful monitoring are essential due to its high tendency of local recurrence in spite of wide excision of the tumor. Adjuvant antihormonal therapy yields promising results for preventing recurrence.

Emergency Conditions in the Patients with Myasthenia Gravis. Clinical Case of Complicated Course of Generalized Myasthenia Gravis after Thymthymomectomy

Myasthenic crisis may be defined as respiratory failure or delayed extubation after surgical treatment for more than 24 hours resulting from myasthenic weakness. Myasthenic crisis results from weakness of upper airway muscles leading to obstruction and aspiration, weakness of respiratory muscles leading to reduced tidal volumes, or weakness of both muscle groups. About 1/5 of patients with myasthenia gravis experience crisis, usually within the first year of illness. Over the last four decades, prognosis from myasthenic crisis has dramatically improved from a mortality rate of 75 % to the current rate of less than 5 %. Myasthenic crisis should not be fatal, as long as patients receive timely respiratory support and appropriate immunotherapy to reduce myasthenic weakness of the respiratory muscles. In the last years there are more reports about the development of urgent conditions in patients with myasthenia gravis in the early postoperative period after thymectomy. Long-term follow-up monitoring for the study effects of thymectomy in patients with myasthenia gravis, conducted in the department of thoracic surgery of State Institution «Institute of General and Emergency Surgery named after V.T. Zaitsev of National Academy of Medical Sciences of Ukraine» showed that the incidence of early postoperative myasthenic crisis amounted 9.2–12.3 % of cases and was associated with the degree of compensation of bulbar and respiratory disorders before the surgery. This reflects the importance of an adequate selection of the dose of anticholinesterase drugs in the preoperative stage for effective compensation neurosomatic disorders and favorable postoperative prognosis. As an example, the complicated course of generalized myasthenia gravis after thymthymomectomy was described.

Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms

ObjectiveVertebrobasilar dissecting aneurysm (VBDA) management is challenging despite the availability of multiple treatment strategies. We reviewed our experiences using endovascular treatment for VBDA patients to assess the efficacy and safety of several VBDA treatment strategies. MethodsAssisted by intra-arterial digital subtraction angiography, 35 patients in our hospital were treated using various VBDA treatment strategies, including stent-assisted coil embolization (20 patients), placement of single or multiple overlapping stents (5 patients) or coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+PT; 10 patients). We retrospectively reviewed the perioperative records of all 35 patients and the post-procedure angiographic and clinical outcomes of 31 available patients. ResultsOf the 25 cases with ruptured VBDAs, 14 underwent stent-assisted coil embolization, 2 underwent multiple overlapping stent placement and 9 underwent CE+PT. Perioperative complications occurred in four cases (16.0%), including one aneurysm rupture and one parent artery thrombosis during the procedure and two incidences of brainstem ischemia after the procedure. Clinical outcome evaluations were performed using the Modified Rankin Scale and resulted in the following scores: 0–2 for 22 patients (22/25, 88.0%), 5 for one patient (1/25, 4.0%) and 6 for two patients (2/25, 8.0%). No cerebral bleeding events or deaths occurred during the follow-up period. Of the 10 cases with unruptured VBDAs, six underwent stent-assisted coil embolization, three underwent single or multiple overlapping stent placement and one patient underwent CE+PT. All 10 of the patients with unruptured VBDAs had favorable clinical and radiologic outcomes without procedure-related complications. ConclusionsFor patients with ruptured VBDAs, the complication rate associated with endovascular treatment is acceptable. CE+PT is better than stent coiling in preventing aneurysmal rerupture, but is associated with a high incidence of ischemic stroke. For unruptured VBDAs, endovascular treatment is associated with good clinical outcome without perioperative complications, including rerupture and ischemic stroke. However, the high postoperative recurrent aneurysm risk suggests the necessity of long-term angiographic follow-up monitoring of VBDA patients who undergo endovascular treatments.