Radiological Relapse Research Articles

Chronic Eosinophilic Pneumonia: A Long-term Follow-up of 12 Patients

Chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown etiology characterized by striking systemic and pulmonary manifestations such as fever, weight loss, blood eosinophilia, characteristic fluffy peripheral opacities on chest radiograph, and a prompt response to corticosteroid therapy. While the initial phase has been well documented, there is very limited information concerning the long-term natural history and treated course of this condition. We report the clinical and laboratory findings together with the long-term follow-up data on 12 patients with classic CEP who were followed up for a mean of 10.2 years (range, 4 to 13 years). The most striking feature of the long-term follow-up was the occurrence of relapses of CEP (often on multiple occasions) when corticosteroid therapy was discontinued or the dose was tapered. In those nine patients in whom steroid withdrawal was commenced, there was a clinical, hematologic, and radiologic relapse in seven (58 percent). However, prompt reinstitution of therapy led to a rapid resolution of symptoms. By contrast, two patients (17 percent) showed no evidence of relapse when steroid therapy was discontinued. A further three patients (25 percent) are maintained on a regimen of low-dose steroid therapy with no episodes of relapse. Reassuringly, all 12 patients are well at the end of a long period of follow-up. These data suggest that the long-term prognosis for patients with CEP is excellent but the majority will require long-term low-dose oral corticosteroid therapy in order to prevent relapse.

Long term follow-up of patients with Cushing's disease treated by interstitial irradiation.

The first 86 patients with Cushing's disease treated with interstitial irradiation (by needle implantation) as the sole therapy were reviewed. In the 82 patients who were reassessed 1 yr after treatment 63 (77%) achieved remission. This study comprises the outcome and complications in the 54 patients who had a remission and whom we were able to follow. The follow-up period ranged from 3-26 yr (mean, 10.5) from the time of remission. No instance of clinical or radiological relapse has occurred. Of these 54 patients, yttrium-90 alone was used in 32, of whom 12 (37%) required corticosteroid or T4 replacement therapy in a mean time of 3.5 months; in 7 of these 12 we elected to give an ablative dose. Gold-198 alone was used in 15 patients, of whom 7 (47%) developed hypopituitarism in a mean time of 76 months. Both isotopes were used in 7 patients. A diurnal serum cortisol rhythm was found in 28 of the 31 patients who were not receiving corticosteroid therapy. In 5 of the 7 patients with an initially abnormal pituitary fossa, serial radiological studies revealed remodelling in 3. There have been no complications in the last 17 years. Pituitary implantation with yttrium-90 is an effective alternative to transsphenoidal hypophysectomy, with a high remission rate, no recurrence (as yet), no operative complications, and avoidance of hormone replacement in the majority.

Longitudinal Observations of Serum Angiotensin-converting Enzyme Activity in Sarcoidosis With and Without Treatment

Serial measurements of serum angiotensin-converting enzyme activity were made to estimate its usefulness in following the course of 17 patients with sarcoidosis. In nine cases with spontaneous remissions, the enzyme levels decreased gradually, accompanied by improvements in chest radiologic findings. In eight patients given corticosteroids, the enzyme levels decreased rapidly preceding improvements in the chest roentgenograms. The levels returned to pretreatment values when there was radiologic relapse of disease. Reelevation of the enzyme level was also observed without determination of the chest radiologic findings in four of five patients who responded to therapy, but the elevated enzyme level remained lower than the pretreatment level. These observations suggest that the serum angiotensin-converting enzyme level reflects the activity of disease in untreated and corticosteroid-treated patients with sarcoidosis. However, a partial reelevation of the decreased enzyme activity in corticosteroid-treated patients does not necessarily indicate a relapse of the disease.

Failures after surgical treatment of patients with hiatus hernia and reflux symptoms. A pathophysiological study.

Patients treated surgically for hiatus hernia and reflux symptoms may still have reflux symptoms at follow-up examination, even though relapse of the hernia cannot be demonstrated on X ray. In an attempt to explain the causes of surgical failures, a group of 13 patients with persisting reflux symptoms after a modified Belsey MK IV repair for sliding hiatus hernia and reflux symptoms underwent intraluminal oesophageal manometry, acid clearing test, and 12-h continuous pH recording in the lower part of the oesophagus. None of the patients had radiological relapse of the hernia. The results of these tests, pre- and post-operatively, were compared with the results obtained in a group of successfully treated patients and with normal subjects. No differences of clinical importance could be demonstrated between the two patient groups with regard to the preoperative test results. Postoperatively, the 'failures' had low sphincter pressure, prolonged acid clearing, and pathological acid reflux. The tests seem of little value in the prediction of symptomatic failures, but do to some extent explain the symptoms of surgical 'failures'.

Diverting ileostomy for colonic Crohn's disease part 2: Radiological findings in the colon following diversion

In 14 patients, the radiological and clinical features preceding and following diverting ileostomy were evaluated. Clinical improvement was usually associated with disappearance of ulcers and nodules. There was either no change in length or width of the colon or only slight increases or decreases in length or width, in various combinations. Clinical relapses were all severe enough to warrant colectomy and were marked by severe narrowing or narrowing and shortening of the colon, or reappearance of ulcers or nodules. Asymptomatic radiographic relapses also occurred. Radiological follow-up is therefore essential, and intestinal continuity should not be re-established for some time after a radiological relapse has become evident.