Periodic Follow-up Visits Research Articles

Retained Intrathecal Catheter Fragment After Spinal Drain Insertion

The placement of lumbar spinal drains is being done with increasing frequency to facilitate high-risk surgical procedures. One risk associated with these procedures is catheter shearing, resulting in a retained foreign body in the intrathecal space. Unlike retained epidural fragments, there are no guidelines on the management of this complication. The purpose of this article was to synthesize the literature on this subject to come up with guidelines for preventing and managing this complication. Case report and review of all published cases. Most cases of retained catheters are associated with difficulty inserting or advancing the catheter. Among those cases treated conservatively, approximately one third of patients developed symptoms. Factors that must be considered when weighing the decision to surgically remove the retained catheter include patient comorbidities and desires, size and location of the fragment, infectious risk, the presence of neurologic symptoms, and scheduled surgical procedure. A retained intrathecal catheter can be managed conservatively in certain contexts. Periodic follow-up visits, with or without repeat imaging, are recommended in these circumstances.

Transmigrant impacted mandibular canines: A retrospective study of 15 cases

Transmigration of mandibular canines across the midline is rare. The authors describe the clinical and radiologic characteristics of patients with transmigrant impacted mandibular canines. The authors conducted a retrospective observational study of 14 patients with transmigrant canines. They diagnosed transmigrant canines in all of the patients on the basis of the clinical and radiological findings, and they obtained the data from the patients' case histories and panoramic radiographs. They considered a canine to be transmigrant when one-half or more of its length crossed the mandibular midline. There were 15 transmigrated canines in 14 patients aged 16 to 60 years. Primary canines were present in 10 cases. One case involved a pericoronal infection, two involved supernumerary teeth, one was associated with an odontoma, and in two a pericoronal radiolucency was seen that was compatible with a follicular cyst. Treatment consisted of surgical extraction for eight patients, and periodic clinical and radiologic follow-up visits for six patients. Radiographic examination is necessary to diagnose impacted transmigrant canines, among other anomalies. Surgical extraction is the treatment of choice for patients with transmigrant canines involving associated pathology. In some cases, the management of asymptomatic impaction can be limited to periodic clinical and follow-up visits. The absence of the permanent canine within the arch beyond the normal time of eruption suggests the presence of an impacted canine. A transmigrant canine may develop an associated pathology.

Papiloma invertido: Aportación de dos casos y revisión de la literatura

Inverted papilloma is a rare polypoid lesion of the urothelium, known as a different entity since 1963. Not many more than 100 cases have been published. Although its malignant potential is still unknown, several scientific publications have noted it. We report to cases of inverted papilloma and perform a detailed bibliographic review. Both patients were diagnosed by the Pathology Department and entered periodic follow-up visits, being free of recurrence at 24 and 18 months respectively. The possibility that inverted papilloma is a lesion with malignant potential should be considered in every case, and we suggest that patients with this diagnosis should enter a follow-up protocol like any bladder neoplasia.

La educación terapéutica en el asma

All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required.

Leiomiosarcoma del cordón espermático: aportación de dos casos

Radical surgery is the only feasible and successful treatment for paratesticular sarcomas, with the exception of rabdomyosarcoma. The inguinal approach is the ideal and obligatory one, including excision of the spermatic cord and adjacent testicle. Long-term periodic follow-up visits are mandatory because relapses may ocurre even long time after diagnosis: In the case of relapse, surgery is again the only tool we have to control this type of tumor. We present two cases of paratesticular leiomyosarcoma, a tumor un common.

Topiramate treatment for nocturnal frontal lobe epilepsy

Aim of this study was to evaluate the efficacy and tolerability of the antiepileptic drug topiramate (TPM) in a sample of patients with nocturnal frontal lobe epilepsy (NFLE). A 24 patients with video-polysomnographically confirmed NFLE received topiramate as single or add-on therapy. They all completed diaries concerning the seizures frequency and complexity and underwent to periodic follow-up visits. We classified the patients as: seizure-free, responders or non-responders. 15 M; 9 F; mean age 29.3+/-10.4 years. The video-polysomnographic recordings showed a wide spectrum of seizures, ranging from repeated stereotypic brief motor attacks to prolonged attacks, with complex and bizarre behaviour; the recorded episodes occurred during non-REM sleep, both stage 2 and stage 3-4. The EEG during wakefulness was normal in all the patients, while seven of them showed epileptiform abnormalities during polysomnography. TPM was administered as single or add-on therapy from 50 to 300mg daily at bedtime. The follow-up duration ranged from 6 months to 6 years. The patients were classified as: seizure-free=6 (25%); responders (reduction of at least 50% of seizures)=15 (62.5%); non-responders=3 (12.5%). The adverse events were: weight loss (6 pts, 25%); paresthesias (3 pts, 12.5%); speech dysfunction (2 pts, 8.3%). All the adverse events disappeared within 3 months. In our experience, TPM seems to be effective in about 90% of patients with NFLE. Few of them experienced transitory adverse events. TPM could be included in the options for patients with this form of epilepsy.

Mastopatía diabética

Diabetic mastopathy is a complication of longstanding diabetes mellitus (DM). It consists of breast nodules that can mimic a malignant process. Imaging tests are nonspecific. Biopsy reveals dense fibrosis and lymphoid infiltrates without signs of malignant disease. There is no risk of malignant transformation of the lesions. A 32-year-old woman with DM type 1 presented with a 4-cm, hard, palpable mass in the subareolar region of the left breast. The nodule was mobile and irregularly shaped, without signs of inflammation. Diagnosis was based on percutaneous biopsy. Management was conservative through periodic follow-up visits and surgical resection was ruled out. In conclusion, although diabetic mastopathy can mimic cancer, it is always a benign process. Diagnosis must be made with core biopsy and treatment should avoid surgery.

Segmental Colitis Associated with Diverticula: A 7-Year Follow-Up Study

We performed a long-term follow-up study of patients with segmental colitis associated with diverticula, in order to clarify the natural history of this disease. We identified 15 patients who were diagnosed as having segmental colitis associated with diverticula during 1997. We assessed these patients by means of periodic follow-up visits from 1997 to 2004. Eight of the 15 patients had no clinical recurrence during follow-up. Five patients had sporadic recurrences that were clinically mild (on average, one in 5 years), which responded to topical therapy and often to self-medication. Only two patients were diagnosed during the follow-up period as having Crohn's disease; notably, these were the only patients who did not have hematochezia as the main symptom at onset. The course of this disease appears to be substantially benign.

Design of panel studies for disease progression with multiple stages.

A panel study consists of individuals who have data collected at periodic follow-up visits or pre-specified time points following entry into the study. The objective of this paper is to consider design issues in a panel study when the response variable is the stage of disease, and with focus on the transition intensities. Important design issues include the choice of the time interval between follow-up visits and sample size considerations. We study the effects of time intervals between follow-up visits on the precision of the transition intensities estimators. We also consider the power of statistical tests on the ratio of transition intensities. Discussion is extended to incorporate heterogeneity in the population in which frailty is introduced to describe subject-specific transition intensities.

Managing migraine headache.

Migraine, once regarded as an abstruse disorder, is now defined as an organic biochemical condition influenced by psycho-stressful events. This redefinition is the result of advances in cerebral blood flow studies and biochemistry and psychophysiology research.’ Accordingly, throughout international medical communities, interest in migraine has greatly increased. Yet the demands of migraine patients still exceed the supply of interested clinicians. The principles of successful migraine management differ little from those common to all medical disciplines, and include diagnostic specificity; knowledge of pain mechanisms; awareness of the patient's personality and physical condition; pharmacologic expertise; periodic follow-up visits; and patience.