Medium-term Follow-up Study Research Articles

Postoperative medium-term follow-up of patients with bilateral, massive primary vesicorenal reflux and reduced renal function at presentation

We report the results of a medium-term follow-up study of 52 patients with bilateral, massive primary vesicorenal reflux (PVRR) with renal damage at presentation. Ten infants between 2 and 5 months of age, with a total of 19 renal units, had a temporary vesicostomy followed by ureteral reimplantation after 12-15 months; 42 patients with 81 renal units had primary ureteral reimplantation. The postoperative observation period covered 9.5 years on average (20 months - 21.5 years). The study showed that: (1) urinary specific gravity remained reduced in about 61% of patients; (2) proteinuria improved significantly, in a direct proportion to the favorable evolution of renal function; (3) the frequency of acute pyelonephritis decreased significantly from 98% to 23%. Postoperatively, 27 patients (51%) had one or more episodes of urinary tract infection (UTI) and 12 (23.0%) still had episodes of acute pyelonephritis. (4) At follow-up 7 patients (13.5%) had stable hypertension, while 3 others had unstable hypertension (19.2%); 8 had chronic renal insufficiency or end-stage renal disease. When only adolescents more than 12 years old were considered, the incidence of hypertension increased to 34.4% (10.29). (5) Some renal scarring developed despite successful antireflux surgery, and parenchymal growth, which was severely impaired prior to surgery, restarted although it remained below - 2 standard deviations from the mean. (6) In the overall series glomerular filtration rates (GFR) significantly improved after successful surgery. However, this improvement was much more evident in patients operated upon within the 1st year of life and in those who had had a temporary vesicostomy. In the subgroup of patients operated upon after 6 years of age, successful surgery had no effect on the further decline of renal function when this was already severely compromised. We conclude that early antireflux surgery or, in selected cases, temporary vesicostomy followed by ureteral reimplantation was effective in significantly improving GFR and sharply decreasing febrile UTIs in patients with massive bilateral PVRR and renal damage at presentation.

Tricuspid valve replacement with the St. Jude Medical valve

A study was conducted on 20 patients who underwent tricuspid valve replacement (TVR) with the St. Jude Medical (SJM) valve. Isolated TVR was performed on 9 patients, and additional mitral, or mitral and aortic valve replacements were performed on 11 patients. Four patients (20%) died in the early postoperative period, but there were no deaths related to the SJM valve in the tricuspid position. The mean follow-up period of the 16 survivors was 74.4 months, and there have been no deaths during the follow-up period. The postoperative actuarial survival rate was 80%, 10 years after surgery. Three patients, representing 0.25%/patient-months, developed valve thrombosis, the valve thrombosis-free rate being 72.8%, 10 years after surgery, while entrapment of a leaflet by endothelial pannus was found in one patient, representing 0.08%/patient-months. Thus, the incidence of all prosthetic valve-related complications was 0.34%/patient-months, and the postoperative complication-free rate was 65.3%, 10 years after surgery. The medium-term follow-up study of TVR with the SJM valve revealed no prosthetic valve-related deaths and a relatively low incidence of prosthetic valve-related complications. However, as with other mechanical valves, valve thrombosis was a major risk posed by the SJM valve in the tricuspid position.

Chronic Active Gastritis after Eradication of Campylobacter (now: Helicobacter) pylori: Results of a Medium Term Follow-Up Study

11 patients with C.p.-associated chronic gastritis underwent a triple therapy with bismuth-subsalicylate, amoxicillin susp. and metronidazole. The C.p.-status and the inflammation parameters "polymorphonuclear leucocytes in the epithelium". "polymorphonuclear leucocytes in the lamina propria", "lympho-plasmacellular infiltrate in the lamina propria", "congestion and edema of the lamina propria" and "inflammatory alteration of the epithelium" were determined semi-quantitatively in semi-thin-sections by light microscopy in the same sections. The C.p.-status was verified further by means of the CLO-test and cultures. The biopsy probes were taken before treatment, immediately after treatment, 1 month following treatment and in differing time intervals up to 9 months following treatment. Eradication of C.p. could not be attained in 2 of the patients. Spherical forms and vibrioforms of C.p. exhibiting degenerative alterations could be demonstrated by electron microscopy. Throughout the study the inflammatory parameters "intraepithelial polymorphonuclear leucocytes", "polymorphonuclear leucocytes in the lamina propria", "inflammatory alterations of the epithelium" showed concordance in their reactions. They were closely correlated with the light microscopical demonstration of C.p.-organisms in the biopsy specimens. The regression of the lympho-plasmacellular infiltrate was still incomplete after 5 months of eradication. The time relationship between the end of treatment and complete remission differed. The results of our studies suggest that C.p. was the sole etiological factor for the development of chronic active gastritis in at least 4 of the 11 patients.

Medium- and Long-Term Prognosis of Patients with Acute Poststreptococcal Glomerulonephritis

The prognosis of acute poststreptococcal glomerulonephritis (APSGN) is still a matter of considerable debate. In an attempt to elucidate this controversy, the medium-term prognosis was evaluated in 40 patients 5-9 years after the onset of the disease, and the long-term prognosis in 88 patients 10-17 years after the onset of the disease. All were sporadic cases. In the medium-term follow-up study, abnormalities were revealed in 5.0% (2/40) of the patients. Hypertension and proteinuria were the only abnormalities detected. In the long-term follow-up study, abnormalities were revealed in 6.8% (6/88) of the patients. Hypertension was found in 3.4, proteinuria in 2.3, and microhaematuria in 2.3% of the patients. In both studies, all patients had normal creatinine clearance. We conclude that the medium- and long-term outcome of patients with APSGN is excellent.