Six-month Follow-up Examination Research Articles

The effect of age on the change in deformity after radical resection and anterior arthrodesis for tuberculosis of the spine.

We compared the long-term changes in spinal deformity after a radical operation for tuberculosis of the spine in thirty-three children who were ten years old or younger at the time of the operation with those of seventy-one adult patients who were at least eighteen years old at the time of the operation. The spinal deformity was measured with use of the angles of kyphosis and deformity as assessed on lateral spinal radiographs made preoperatively and postoperatively at six months, one year, and five years and at the most recent follow-up evaluation (at a mean of fifteen years). We detected no significant difference in the mean angles of kyphosis and deformity between the children and the adults postoperatively at any follow-up evaluation; thus, we found that growth of the posterior portion of the spine does not contribute to the progression of deformity after a radical anterior procedure. The children who had tuberculosis of the thoracic spine had much better correction than the adults at the six-month follow-up examination. This correction was maintained. However, there were no such differences in the correction of the deformity between the adults and the children who had tuberculosis of the thoracolumbar or the lumbar spine. Our findings clearly show that a short anterior spinal arthrodesis done at an early age was not associated with progression of deformity during growth and development in our patients. The longitudinal pattern of changes in deformity was similar in the children and the adults, and there was no evidence of disproportionate posterior spinal growth contributing to the progression of deformity after anterior spinal arthrodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Restenosis after excimer laser angioplasty of coronary stenoses and chronic total occlusions

In an open clinical study, a xenon-chloride excimer laser was used for angioplasty of coronary stenoses (n = 48) and chronic total occlusions (n = 56) in 104 patients. Multifiber catheters (4.0F to 5.5F) transmitted 37 to 120 mjoules/mm 2 of fiber surface. Excimer laser angioplasty was successful in 43 patients with a stenosis (89%), followed by percutaneous transluminal coronary angioplasty in 21 patients (49%) to reduce the stenosis to less than 50% luminal narrowing. In 39 patients (70%) with a chronic occlusion (age 1 to 14 months), recanalization by means of excimer laser angioplasty was successful, with subsequent percutaneous transluminal coronary angioplasty performed in 23 patients. Major complications included one perforation, one acute occlusion, and two severe dissections. Six-month angiographic follow-up examinations after successful angioplasty were completed in 40 patients (98%) with stenoses and 34 (94%) with occlusions. Restenosis (> 20% decrease in luminal diameter) occurred in 13 patients (33%) with stenoses and in 16 patients (47%) after angioplasty of a chronic occlusion. These long-term results indicate that restenosis after excimer laser angioplasty of coronary stenoses and chronic total occlusions is similar to reported results of conventional balloon angioplasty.

Coronary Atherectomy: An Alternative to Balloon Angioplasty

To date, physicians at our hospital have performed coronary atherectomy on 15 patients. Of these patients, four needed open heart surgery. One patient needed surgery because a vessel was dissected during the procedure, and the three other patients had unsuccessful procedures. One patient died due to a cerebrovascular bleed related to the anticoagulation therapy required for the procedure. Of the remaining patients, three had no reocclusion and four had reocclusion at their six-month follow-up examinations. The remaining patients have not had a six-month follow-up examination. The restenosis rate at our institution is 25%. It is hoped that catheter-mediated atherectomy will be an effective, predictable transluminal treatment of single or multiple focal stenosis. Because of the small patient sampling and short duration follow-up, no trends have been established. A six-month follow-up with angiography will establish patency and restenosis rates.

Nodular hidradenoma: An eccrine sweat gland analog of pleomorphic adenomas of salivary gland origin

A tumor of eccrine sweat gland origin is described that bears a striking resemblance to pleomorphic adenomas of salivary gland. Upon closer examination, the tumor contained areas of apocrine decapitation secretory activity, primitive hair follicles, and melanin pigmentation, indicating cutaneous rather than mucosal origin. Six-month follow-up examination has revealed no evidence of recurrence.

Long-Term Results of Successful Vitrectomy With Silicone Oil for Advanced Proliferative Vitreoretinopathy

We have analyzed the six-month, one-year, and two-year follow-up examinations in 47 patients who had silicone oil injection in combination with revision of vitrectomy for intractable retinal detachment and advanced proliferative vitreoretinopathy. A visual acuity of 5/200 or better was attained in 22 eyes at six months (47%), 17 eyes at one year (36%), and 14 eyes at two years (30%). Of eyes that were completely attached posterior to the buckle at six months, 77% remained attached at two years. In those eyes that were attached at six months, corneal decompensation was the most frequent cause of a loss of vision between six months and two years. Silicone oil was removed in 22 eyes (47%).

Mycotic Endophthalmitis Caused by Penicillium sp. After Parenteral Drug Abuse

A 30-year-old man developed endophthalmitis three weeks after an intravenous injection of hydromorphone hydrochloride. Penicillium species was recovered from a vitreous aspirate. Treatment with amphotericin B and flucytosine resulted in documented sterilization of the vitreous. At a six-month follow-up examination, the visual acuity of the involved eye was still limited to light perception.

Language and thinking in psychosis. Is there an input abnormality?

We studied "formal thought disorder" in schizophrenics, schizoaffectives, and manics by examining syntax processing and perception of meaning, using the "embedded click" and "memory for gist tasks," two paradigms that were developed by psycholinguists. To control for generalized performance deficits, a matched-task design was used. Contrary to expectation, patients did worse on a matched memory for digits task than on sentence processing. At a six-month follow-up examination, schizophrenics' performance did not improve while other patients' did. We concluded that psychotic patients have no specific language perception deficit but do have a short-term memory deficit. This deficit tends to remit for manics and schizoaffectives, but not for schizophrenics.

‘Essential’ hypertension with hypokalemia

Primary aldosteronism is a potentially curable cause of hypertension; it occurs in about 1% of hypertensive patients. In the case reported here, persistent hypokalemia developed in a 72-year-old man who had been treated for 13 years for essential hypertension. Investigation revealed elevated aldosterone level and reduced plasma renin activity. Computed tomography and selective angiography showed a tumor in the right adrenal gland. Aldosterone-secreting adenoma of the adrenal gland was diagnosed, and right adrenalectomy was performed. At a six-month follow-up examination, the patient's blood pressure and potassium level were normal.

Congenital dislocation of the hip: Incidence, and treatment of a local population group

For a period of three months, the incidence of hip abnormality was determined in 450 consecutive deliveries at the Hornsby and Ku-ring-gai Hospital newborn nursery. Three children were found to have dislocatable hips, and received treatment with a von Rosen splint. In 60 babies, soft tissue clicks could be elicited but the joints were stable. These babies received no treatment, but were reassessed one and six weeks later. No hip abnormality was detected in any of them at the follow-up examination. A retrospective analysis of the records of the previous 450 newborn babies showed that nine had received treatment with double nappies; von Rosen splints had not been used. At the six-month follow-up examination, one of these nine babies had a dislocated hip. "Double nappies" as a treatment modality is still widely practised in Sydney, though neither the literature nor the results of our retrospective analysis support its efficacy.

Traumatic Chiasmal Syndrome Associated with Pneumocephalus and Sellar Fracture

A 50-year-old man sustained severe head injury, including a brief loss of consciousness, in an automobile accident. Skull X-ray films disclosed a fracture of the right superior orbit. Computed tomography demonstrated pneumocephalus and extension of the fracture into the sella turcica. Perimetric testing disclosed a bitemporal hemianopia along the vertical meridian. Visual acuity was 6/6 (20/20) in both eyes. Right macular sparing and left macular splitting were demonstrated by Amsler grid analysis as well as by the patient's description of target grids projected onto his maculas. Diplopia was attributed to direct grids projected onto his maculas. Diplopia was attributed to direct injury of the right superior rectus muscle and to the effect of bitemporal field loss. There was no evidence of pituitary dysfunction. No treatment of the patient's visual loss was undertaken. A six-month follow-up examination disclosed no change in the patient's visual field abnormalities.

The Lens Influence on Diabetic Vitrectomy Results

Fifty cases with clear lenses that were undergoing pars plana vitrectomy for diabetic retinopathy complications were randomly assigned to either retaining the lenses or to having lensectomy at the time of the vitrectomy. Management of the lens did not seem to have a major influence on the postoperative visual function. However, the aphakic cases had a higher incidence of elevated intraocular pressures and peripheral iris rubeosis at the six-month follow-up examination. The incidence of neovascular glaucoma was also higher in the aphakic group.

Effect of Surgery on Psychological and Social Functioning in Elderly Patients

Effects of elective surgery, mainly of ulcer and biliary tract types on intellectual and social functioning of 63 male patients with a mean age of 67 years, were determined and comparisons were made with a control group. Study variables included demographic, medical, neurological, psychometric, aphasic, and social adjustment measures. No significant differences were found between surgery and control groups before surgery or on any of four six-month follow-up examinations except for a favorable change on a personality measure of mood in the surgery group but not in the control group. The study supports the prevailing view of the desirability of elective surgery in aged patients. Significant differences between biliary tract and ulcer surgery patients in weight, blood pressures, and social adjustment scores suggested that these syndromes might best be studied as separate subgroups.