Long-term Follow-up Visits Research Articles

Comparison of Conventional Instruments and Mechanical Debriders for Surgery of Patients with Chronic Sinusitis

This article compares the use of the microdebrider as a form of powered instrumentation designed to decrease mucosal trauma with traditional surgical instruments for endonasal sinus surgery. Surgery was performed with the shaver or conventional instruments using an endonasal approach in 24 patients with bilateral chronic rhinosinusitis. Each patient served as his/her own control, meaning that one side was operated on with conventional instruments and the opposite side was operated on with the microdebrider to evaluate postoperative recovery, healing, and incidence of complications. They were stratified preoperatively and reassessed during 3- and 6-month follow-up and long-term (mean, 13 month) follow-up visits, which included nasal endoscopy, saccharin transport time, assessment of mucociliary transport times and clinical symptoms. In this prospective randomized study we were unable to find a statistical difference (p > 0.05) in surgical outcome for patients when using either conventional instruments or mechanical debriders. In the literature, mechanical debriders are supposed to provide for mucosal preservation and faster healing. However, for surgical outcome, the use of microdebriders in our study was not better than the results at 3-, 6-, and at 13-month follow-up visits when compared with conventional instruments. Synechia formation, patency of middle meatal antrostomy, and ostial reocclusion were the same in both groups. The incidence of polxyposis as a sign of recurrent or persistent infection was similar. Functional results using the saccharin transport time, as a marker of mucociliary function, or episodes of recurrent purulent secretions, again, were identical.

Endonasal Sinus Surgery: Extended versus Limited Approach

This study was designed to investigate whether two different surgical approaches in endonasal sinus surgery lead to different postoperative results in patients with chronic rhinosinusitis. Sixty-five patients suffering from chronic rhinosinusitis were operated on with either a limited approach or an extended approach. They were examined preoperatively and reassessed during 3 months, 6 months, and long-term follow-up visits that included endoscopy, saccharin transport time, and the assessment of symptoms. The concept of this study was prospective, randomized, and multicenter (Mainz, Germany, and Moscow, Russia). The results of the two different surgical approaches were compared with each other. Surgical results and symptomatology were similar in both groups of patients, suggesting that a conservative approach may be sufficient in most patients.

Pelvic venoablation with ethanol for the treatment of erectile dysfunction due to veno-occlusive dysfunction

Objectives. To perform pelvic venoablation with ethanol injection into the deep dorsal vein for the treatment of 10 patients with venogenic erectile dysfunction. This procedure was easily performed without any selective embolization technique. The efficacy and safety of this technique are discussed. Methods. A total of 10 patients with veno-occlusive dysfunction, severe enough to make vaginal insertion impossible, underwent pelvic venoablation with ethanol. The mean patient age was 67.1 years. Under spinal anesthesia, after the venous leaks were identified by cavernosography, a 20-gauge flexible needle was inserted into the deep dorsal vein. The pelvic venogram obtained with deep dorsal venography was included in what was revealed by the venogram obtained with cavernosography. A mixture of absolute ethanol and contrast medium (4:1) was used as a sclerosing agent. Under fluoroscopic control, the sclerosing agents were injected into the deep dorsal vein through a flexible needle. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Results. The follow-up ranged from 25 to 37 months (mean 32.3). At the short-term follow-up visit (less than 6 months), 7 patients (70%) reported erections sufficient for vaginal insertion; at the long-term follow-up visit, 5 men (50%) reported sustained, sufficient potency and 5 (50%) reported persistent erectile dysfunction. No serious complications occurred. Conclusions. Our pelvic venoablation technique using ethanol was effective, minimally invasive, and cost-effective.

Chronic pain as an outcome of surgery. A review of predictive factors.

ONE potential adverse outcome from surgery is chronic pain. Analysis of predictive and pathologic factors is important to develop rational strategies to prevent this problem. Additionally, the natural history of patients with and without persistent pain after surgery provides an opportunity to improve the understanding of the physiology and psychology of chronic pain. Ideally, studies of chronic postoperative pain should include (1) sufficient preoperative data (assessment of pain, physiologic and psychologic risk factors for chronic pain); (2) detailed descriptions of the operative approaches used (location and length of incisions, handling of nerves and muscles); (3) the intensity and character of acute postoperative pain and its management; and (4) follow-up at intervals to 1 yr or more. In addition, there would be information about postoperative interventions that may influence pain, such as radiation therapy or chemotherapy. At long-term follow-up visits, patient function, physical signs, and symptoms would be evaluated using a standardized algorithm, including quantitative and descriptive pain assessments. We found no studies that contain all of these data. For this review, we specifically sought population data that reflect the incidence of chronic postoperative pain or predictors (medical, physiologic, and psychologic) of chronic pain. We selected five groups of surgeries (limb amputations, breast surgery, gallbladder surgery, lung surgery, and inguinal hernia surgery). These surgeries were selected because the incidence of pain is known to be high, thus improving the probability of detecting predictive factors. They also represent a range of major surgical procedures.

Continuous axillary brachial plexus analgesia with low dose morphine in patients with complex regional pain syndromes

In this prospective pilot study, nine patients suffering from complex regional pain syndrome of the arm were treated with morphine 0.16 mg h−1 (3.84 mg day−1) applied continuously through an axillary brachial plexus catheter. In all of them an oral analgesic medication including the less potent opioid tramadol had not provided sufficient pain relief. During regional treatment, patients were kept in hospital and physiotherapy was carried out frequently in order to improve strength and function of the affected arm. Pain at rest and during movement as well as grip strength were assessed at first visit, during morphine infusion and at a long-term follow-up visit. All assessments improved significantly during plexus analgesia. There were no major opioid related side-effects. The results from this pilot study indicate that continuous axillary brachial plexus analgesia with low dose morphine might be beneficial in patients suffering from complex regional pain syndrome of the arm.

Long-term clinical outcomes of abutments treated with guided tissue regeneration

Statement of problem. Guided tissue regeneration (GTR) is an efficacious and predictable treatment modality for deep intrabony defects around natural teeth and abutments. However, long-term prognosis of abutments treated with regeneration has to be proven. Purpose. This study investigated the long-term stability of clinical outcomes obtained with regeneration in strategically important abutments. Material and methods. Sixteen deep intrabony defects around strategically important abutments in 16 patients were treated according to the principles of GTR. After completion of initial periodontal therapy and placement of long-term provisional fixed partial dentures, nonresorbable membranes were applied. Membranes were removed after 6 weeks. All patients remained in a supervised recall program. Final fixed partial dentures were placed 1 year after surgery. Clinical outcomes were evaluated at 1 year and then 4 to 8 years after surgery. Results. Clinical attachment level gains of 5.3 ± 1.8 mm, reductions in pocket depth (6.1 ± 2 mm), and increases in the percentage of radiographic bone support (31% ± 18%) were observed at 1 year. At long-term follow-up visits, clinical attachment levels remained stable with respect to 1 year (–0.1 ± 0.6 mm; P =.4). The percentage of radiographic bone support slightly increased as compared with 1 year (1% ± 3%, P =.04), and pocket depths (0.8 ± 0.8 mm, P =.004). Conclusions. This study indicated that tooth support can be gained with GTR and maintained over time in patients recalled regularly. (J Prosthet Dent 1999;81:305-11.)

Comparison of efficacy and safety of oral fluconazole and topical clotrimazole in the treatment of tinea corporis, tinea cruris, tinea pedis, and cutaneous candidiasis

The safety and efficacy of oral fluconazole 150 mg once weekly were compared with those of topical clotrimazole 1% cream twice daily in the treatment of tinea corporis, tinea cruris, tinea pedis, and cutaneous candidiasis. A total of 391 patients were enrolled in 19 centers in 12 countries. Treatment lasted 2 to 4 weeks for patients with tinea corporis, tinea cruris, or cutaneous candidiasis, and up to 6 weeks for patients with tinea pedis. Fluconazole and clotrimazole were relatively comparable in clinical outcome in nearly all infections at the end of therapy and at the long-term follow-up visit (28 to 35 days after the last dose). No statistically significant between-group difference was observed in the rate of eradication of the original pathogen for tinea corporis, tinea cruris, or cutaneous candidiasis. For tinea pedis, however, fluconazole was less effective than clotrimazole. Safety profiles were comparable in the two treatment groups—both agents were well tolerated with minimal adverse events. Results of this trial demonstrated that oral fluconazole 150 mg once weekly and topical clotrimazole 1% cream twice daily are comparable in safety and efficacy for the treatment of certain superficial fungal infections. In addition, fluconazole provides convenient once-weekly dosing, which may lead to greater patient compliance.

Inferior Turbinate Reduction Surgery in Children

We assessed the effectiveness and safety of surgical reduction of the inferior turbinate in 64 children, ages three to 15 years, who were operated on between January 1985 and November 1995. All patients/parents were interviewed and assessed by means of a questionnaire one to 10 years postoperatively. All patients had follow-up and were evaluated clinically at one and two weeks postoperatively. Long-term follow-up visits occurred at six, 12 and 24 months. Eighty-nine percent of the children/parents reported a sustained improvement in their nasal airways. No cases of serious postoperative hemorrhage, excessive dryness nor long-term crusting of the nose were observed or reported. We conclude that in the treatment of children with severe nasal obstruction, surgical reduction of the inferior turbinate is a safe and effective operation, alone or in combination with other airway procedures, and may increase the effectiveness of subsequent medical management.

Full-time Atropine, Intermittent Atropine, and Optical Penalization and Binocular Outcome in Treatment of Strabismic Amblyopia

The purpose of the study is to evaluate the monocular and binocular outcome of three types of "penalization" (blurring of the sound eye) treatment of amblyopia: traditional full-time atropine or optical penalization and a new intermittent atropine regimen involving atropine instillation 1 to 3 days a week. The study design was a retrospective study. A total of 163 patients with strabismic amblyopia treated by full-time atropine (n = 38), intermittent atropine (n = 73), or optical (n = 52) penalization participated. Logarithm of the minimum angle of resolution (logMAR) visual acuity, and binocularity index were determined. All three forms of penalization produced statistically significant mean reduction in amblyopia (1.7-2.7 logMAR lines) and mean improvement in binocularity by the end-of-treatment or long-term follow-up visit or both, with minimal mean loss after discontinuation or slight mean improvement on these measures at long-term mean follow-up of 1.9 to 4 years across groups. Few patients achieved high-grade stereoacuity. Compliance was high. Comparable efficacy was found for all three treatment groups after controlling for age, depth of amblyopia, and binocularity at the initial visit. Initial-visit amblyopia depth was strongly and significantly associated with amblyopia depth at both post-treatment visits. Pretreatment and post-treatment binocularity showed a similar strong relationship. Surprisingly, however, there was no consistent or significant association found between depth of amblyopia and binocularity in any visit combination. Post-treatment measures of these two variables also were not associated with initial-visit age or refractive error at any clinically significant level. Mean treatment duration was 1.1 to 2.9 years and was not found to be associated with visual outcome. Amblyopia reversal was found in one (full-time atropine) case at a clinically important level. The authors confirmed previous reports of penalization's efficacy as a primary treatment of moderate amblyopia (20/100 or better acuity) and, in some cases, relatively severe amblyopia (>20/100) and also confirmed its ability to significantly improve mean binocularity. Amblyopia and binocularity appear to respond to treatment independently and, within the postinfancy age range of the sample studied, the responses appear to be independent of initial-visit age. The high acceptability to patients and parents of atropine penalization, and particularly of the intermittent regimen introduced here, suggests the need for prospective-study-based re-evaluation of the relative merits of penalization and occlusion as the standard of care for mild-to-moderate amblyopia.

Mini-Slit Graft Hair Transplantation Using the Ultrapulse Carbon Dioxide Laser Handpiece

The new Ultrapulse carbon dioxide (CO2) laser technology has added a new dimension to many cosmetic surgery procedures including hair transplantation. Early reports by Unger and David (Laser Hair Transplantation. J Dermatol Surg Oncol 1994;20:515-21) have been encouraging with the potential of minimal bleeding, ease of placing transplanted grafts, and an overall shortened operative time. A 2-mm slit handpiece has been recently created to expedite this procedure. The purpose of this study is to further investigate the use and efficiency of the new Ultrapulse CO2 laser slit handpiece in hair transplants. Mini-slit graft hair transplants using the new Ultrapulse CO2 laser slit handpiece were done on 25 patients in 30 transplant sessions. Donor minigrafts were obtained by the strip harvesting technique using a triple-blade scalpel. Approximately 200-400 recipient slits were made with the 2-mm slit handpiece at the laser setting of 350 mJ, 12 W, 0.8 seconds per pulse. All grafts were easily placed into recipient sites with minimal bleeding and charring. The procedure was done in half the time of the conventional non-laser technique. Postoperatively, patients were quite satisfied with little pain and swelling. Histologic exams of the laser-treated slits showed minimal adjacent tissue necrosis. Long-term follow-up visits showed good regrowth of hair in these grafts. The new Ultrapulse CO2 laser slit handpiece proved to be an effective tool for mini-slit graft hair transplantation.

A Family Physician Smoking Cessation Program: An Evaluation of the Role of Follow-up Visits

Our purpose in this randomized clinical trial was to compare a two-visit smoking cessation intervention by family physicians with the same intervention supplemented by additional follow-ups. Forty-one southern Ontario family physicians volunteered for the study and subsequently participated in a four-hour training program on smoking cessation techniques. Physicians advised patients who smoked and indicated an interest in attempting to quit with the help of their physician to stop smoking at the end of a regularly scheduled visit. Physicians instructed patients to make a specific appointment for an evaluation of their smoking habits. Six hundred forty-seven patients returned for that assessment and were than randomized into either the two-visit intervention group (with risk assessment, support, the setting of a cessation date, self-help literature, and a prescription for nicotine gum, where appropriate) or into the other intervention group (with the same maneuvers as well as the offer of four more supportive follow-up visits). We found no statistically significant difference in one-year, biochemically validated, sustained cessation rates between the group offered the long-term follow-up visits (12.5%) and the group given the brief intervention (10.2%). The 95% confidence interval on the difference between the groups was 2.8% in favor of the brief intervention group to 7.3% in favor of the group offered follow-up. The results do not support the value of long-term follow-up visits for smokers.

Long-term follow-up of laparoscopic sterilizations by electrocoagolation, the Hulka clip and the tubal ring

A follow-up study of 499 women who underwent sterilization between August 1973 and May 1976 at the Siriraj Hospital in Bangkok, Thailand, and had long-term (4–12 years post-surgery) follow-up is described. Women were sterilized through participation in one of three studies conducted at this hospital. In the first study, 124 underwent sterilization using the Hulka clip via laparoscopy; 67.7% of these women returned for a long-term follow-up visit. In the second study, 300 women were randomly allocated to the Hulka clip or to unipolar electrocoagulation (cautery) via laparoscopy; 70.7% of the women from this study returned for a long-term follow-up visit. The final study was a randomized trial comparing the tubal ring and unipolar electrocoagulation occlusion techniques in 300 cases. Long-term follow-up visits were recorded for 207 women (69.0%) from this study. Five technical failures (procedures not performed or completed as planned) and six non-interval cases were excluded from follow-up analyses. A total of 713 interval patients were eligible for follow-up. Long-term follow-up was initiated in 1978 and continued through 1986. Late sequelae of sterilization, including pregnancies and pelvic surgery, are discussed with regard to type and time of tubal occlusion. One intrauterine and two ectopic pregnancies were reported among women who were sterilized with cautery; one ectopic pregnancy was reported by a woman sterilized with the Hulka clip. Pelvic or abdominal surgeries were reported in 27 cases. Most (<98%) women indicated that they were satisfied with their sterilization procedure.

Transplantation of mandibular third molar in seventh decade: Long-term follow-up and evaluation

Transplantation of a nonfunctional mandibular third molar into the opposite mandibular second molar site, where it was necessary to remove the second molar of a 61-year-old patient, has been reported. There was long-term follow-up and evaluation, with radiographs and clinical examination during the ninth postoperative year. The patient had no complaints related to the transplant at the long-term follow-up visit. The periodontal tissues were in excellent condition. The tooth was firm, and the radiograph demonstrated growth of new attachment by showing lamina dura and periodontal ligament space. There was filling-in of bone in the lateral and periapical areas, and there was no evidence of resorption. A root canal filling had been acquired in the transplant between the second and ninth postoperative years.

Long-term follow-up and evaluation of transplantation of fully developed teeth

Five cases of transplantation of fully developed third molars to second or first molar sites have been reported. Three of the transplants were in the mandibular molar region and two were in the maxillary molar region. There has been long-term follow-up and evaluation of the patients in these cases up to 13 years postoperatively. None of the patients had any complaint about the transplanted tooth at the long-term follow-up visit. In all five cases, at the long-term follow-up visit, the periodontal tissues were in excellent condition and there was growth of new attachment, as demonstrated by lamina dura and periodontal membrane space in the follow-up radiographs, deposition of secondary calcification of varying amounts within the root canals and pulp chamber, and regeneration of bone in the periapical and lateral areas. There was very little, if any, resorption demonstrated in any of these five cases. The ages of patients ranged from 17 to 23 years at the time of transplantation. Regeneration of the buccal plate was demonstrated by photographs in one of the two cases where there was surgical exposure of the region of the buccal plate at a postoperative follow-up visit.

Squamous cell and basal cell carcinomas: preliminary study of 3,817 primary skin cancers.

A series of patients with 3,817 cutaneous carcinomas of different types observed in a private practice setting is reported. Preliminary computerized analyses indicate that 88% of these squamous cell and basal cell carcinomas were less than 25 mm. Scalpel surgery, curettage and desiccation, or radiation therapy was used for most tumors and an overall cure rate of greater than 98% was obtained. A pretreatment biopsy allowed for selection of the most appropriate management and authoritative instructions for long-term follow-up visits and prophylaxis.