Short-term Follow-up Of Patients Research Articles

The use of gastrocystoplasty in patients with bladder exstrophy

The authors report the use of a stomach segment vascularized via the right gastroepiploic artery in order to increased bladder capacity in 18 patients with bladder exstrophy. The morphological and functional results were good in 15 patients (83.4%); 13 (72.2%) continue to use intermittent catheterization to empty the bladder, while 5 (27.7%) have spontaneous voiding. Seven patients are completely continent, 8 partially continent (<3 h), and 2 are still incontinent. We encountered no metabolic complications and no patient complained of mucus production. Ten patients had a dysuria-hematuria syndrome, 8 only slight and 2 marked. We believe that even though gastrocystoplasty is a valid alternative compared with other tissues used to date for bladder augmentation, attention should be paid to this new pathological sequela, which has proved to occur quite frequently, as seen from the long- and short-term follow-up of patients who have had this operation.

Superior vena cava stent placement: results with the Wallstent endoprosthesis.

To assess the clinical success and short-term patency of the Wallstent endoprosthesis in the treatment of superior vena cava (SVC) syndrome. Twenty-one 14-mm-diameter endoprostheses were implanted in 15 patients (mean age, 60 years) treated for SVC syndrome due to malignant compression (n = 14) or postirradiation fibrotic stenosis (n = 1) of the SVC. Immediate technical success was achieved in all patients. Two early complications occurred: retroperitoneal hemorrhage due to venous iliac tear and early stent thrombosis. In the 14 patients without early stent occlusion, stent placement resulted in complete relief of SVC syndrome; clinical success was 93%. SVC syndrome did not recur from 1 to 14 months, until the patient died (n = 11) or until the end of the study (n = 3). Helical CT showed a patent stent in five patients, respectively, at 3, 6, 8, 10, and 11 months. SVC stent placement has good clinical results and a high patency rate at short-term follow-up in patients with SVC syndrome.

Peroperative Endoscopic Sphincterotomy

A major aim in the treatment of bile duct stones detected at the time of laparoscopic cholecystectomy should be to remove the stones during the same operation. In most instances, and for patients with small stones, this aim can be achieved using techniques through the cystic duct. In patients in whom these techniques failed, the role of a duodenal approach for removing the stones was evaluated by performing perendoscopic sphincterotomy (PES) and clearing the bile duct via this route. In an initial series of 13 patients, it was demonstrated that perendoscopic sphincterotomy and extraction of stones from the bile duct can be effectively performed in patients in the supine position with minimal interference to the laparoscopic cholecystectomy operation. The perendoscopic approach does not add to the complication rate of the operation, and short-term follow-up of patients indicates no significant postoperative sequalae. This approach adds to the various techniques being developed for the minimal-access approach to the treatment of bile duct stones.

Achalasia

Although concern about perforation has led physicians to perform pneumatic dilation for achalasia with routine contrast radiography immediately afterwards and with hospitalization, the need for these precautions has not been demonstrated. In contrast, we have routinely performed pneumatic dilations without contrast studies or hospitalization, and we hereby present our experience. During a recent six-year period, 110 pneumatic dilations were performed, and 71 of the last 73 were performed as outpatients with about 5-8 hr of clinical monitoring. Detailed review of 100 records showed that only 15 patients underwent contrast studies because of pain or fever. Perforation occurred in seven of the 15 patients, all of whom underwent surgery successfully. Short-term follow-up in patients who did not sustain perforation showed good or excellent results in 82%. Thus, it has been our experience that pneumatic dilation could be safely performed in achalasia without routine use of contrast studies or hospitalization.

A short-term follow-up of patients with mild scoliosis.

Thirty patients with mild idiopathic scoliosis were reviewed between 7 and 17 years after spinal maturity. These patients were not treated surgically because they were cosmetically acceptable, and unlikely to progress further. Standardised radiographs taken at spinal maturity and at review were comparable, so any change represented true progression in a fully mature spine. There was an increase of lateral curvature in 60 per cent of the patients; this was small and always under 10 degrees. No change was seen in rotation. Lateral curves over 30 degrees, with rotation of 25 degrees or more, were found to be almost twice as likely to progress. It is suggested that caution should be exercised in leaving these curves untreated, and follow-up into early adult life is advisable.

A short-term follow-up of patients with depressive disorder on entry into home dialysis training

Fifteen (18%) of 83 patients entering home hemodialysis training were found to suffer major depressive disorder diagnosed by rigorous clinical criteria. The diagnosis of depressive disorder was associated with a diagnosis of polycystic kidney disease. It was not, however, associated with past or family history of affective illness. Neither intellectual impairment nor chemical uremia were more pronounced in the patients with depressive disorder than in the patients without depressive disorder. Depressive symptoms almost invariably remitted during home dialysis training and had no apparent influence on outcome on the basis of a short-term (3-month) follow-up.

Coronary ectasia: Incidence and results of coronary bypass surgery

Coronary angiograms were performed in 1,660 patients between the ages of 27 and 84 years. Coronary ectasia was noted in 42 (2.5 per cent) patients. These 42 patients were compared with an equal number of patients with coronary artery disease, matched for age and sex. There were no significant differences in numbers of vessels involved with significant disease, coronary score, main left or left anterior descending artery disease, coronary calcification, hypertension, or abnormal glucose tolerance test in patients with or without ectasia. A family history of coronary artery disease, diabetes mellitus, and hypertension did not separate the groups, neither did serum cholesterol level. The serum level of triglyceride was higher in the coronary ectasia group (p < 0.025). The location of infarction by electrocardiogram or abnormal left ventricular contractility was similar in both groups. Of 64 ectatic vessels, 34 (53 per cent) occurred in the right coronary, 16 (25 per cent) in the left anterior descending, and 14 (22 per cent) in the left circumflex artery. Thirty patients with ectasia and 26 in the control group underwent bypass surgery. Nineteen of the ectasia group and 17 of the control group had post-bypass graft angiograms. In the ectasia group, two out of 47 and, in the control group, five out of 41 grafts were closed. The postoperative course was similar in both groups. An 18 month (mean) follow-up of the 42 patients with coronary ectasia revealed no late deaths, whereas one death occurred in a control patient who did not have surgery. In conclusion, coronary ectasia is more common in the right coronary artery. The presence of coronary ectasia does not indicate more severe or widespread coronary disease than in controls. Short term follow-up of patients with ectasia, with or without bypass surgery, does not differ from control patients.