Clinical Course of Different Types of Immune Reactions following Keratoplasty

2021 ◽  
Author(s):  
Philip Keye ◽  
Thabo Lapp ◽  
Daniel Böhringer ◽  
Sonja Heinzelmann ◽  
Philip Maier ◽  
...  
Keyword(s):  
Clinical Course ◽  
Corneal Graft ◽  
Long Term Outcomes ◽  
Immune Mediated ◽  
Corneal Graft Rejection ◽  
Different Types ◽  
Lost To Follow Up

Abstract Background Immune-mediated corneal graft rejection (IR) is a leading cause of corneal graft failure. The endothelium, stroma, epithelium, or a combination can be affected. Little is known about the long-term outcomes of different types of IR. Methods We reviewed the medical records of all keratoplasties that had been performed at our eye centre between 2003 and 2016 (n = 3934) for any kind of IR that occurred between the surgery and 2019. All patients with a definite diagnosis of IR and sufficient clinical data were included in the analysis. IRs were grouped according to the affected part of the graft (endothelial, stromal, epithelial, and mixed). We analysed the dynamics of recovery and the clinical outcomes. Results We identified a total of 319 patients with IR. Twenty-seven of those were lost to follow-up and were excluded from further analysis. Of the IRs, 89% affected the endothelium. Endothelial IR resulted more frequently in a considerable loss of endothelial cell density than other forms of IR. Stromal IR showed a lower relapse rate and a better visual recovery than other types of IR and resulted less often in a failure of the graft. Conclusions We herein report comprehensive data about the prognosis regarding functional recovery after different types of IR following keratoplasty. Our data underline that timely recognition and correct classification of IR are important because they determine the clinical course and prognosis.

A 25-year longitudinal, comparison study of the outcome of depression

2001 ◽  
Vol 31 (8) ◽  
pp. 1347-1359 ◽  
Author(s):  
H. BRODATY ◽  
G. LUSCOMBE ◽  
C. PEISAH ◽  
K. ANSTEY ◽  
G. ANDREWS
Keyword(s):  
Depressive Disorders ◽  
Endogenous Depression ◽  
Long Term Outcomes ◽  
Depressed Patients ◽  
Relative Paucity ◽  
Suicide Note ◽  
Longitudinal Comparison ◽  
Lost To Follow Up

Background. There is still a relative paucity of information about the long-term course of depression.Methods. Consecutive patients admitted to a teaching hospital psychiatry unit with symptoms of depression, previously assessed at 6 months and 2, 5 and 15 years after index admission, were reviewed at 25 years (N = 49, including eight informants of deceased probands, of an original 145 with major depression (DEPs)). Prospective psychiatric (N = 22) and retrospective surgical (N = 50) control groups assessed after 25 years were used for comparison.Results. A further decade of follow-up confirmed the chronicity of depression. Of depressed patients (DEPs) followed for the full 25-year-period only 12% of the 49 original DEPs recovered and remained continuously well, 84% experienced recurrences, 2% experienced an unremitting course and another 2% died by suicide. Note that in the first 15-year-period 6% (9/145 DEPs) committed suicide, a further 38 died and 32 were lost to follow-up. They experienced an average of three episodes of depression over the 25 years. In the decade since the 15-year follow-up, 27% improved in clinical outcome (including four of five previously chronically depressed patients), 55% remained unchanged and 18% worsened; and the number of episodes per year declined. Patients initially diagnosed with neurotic or endogenous depression had similar long-term outcomes. The criteria for a current DSM-III-R disorder were met by 37% of DEPs, including 11% with depression or dysthymia. On the global assessment of functioning scale 78% of the DEPs had some impairment compared to 62% of psychiatric controls and 40% of surgical controls.Conclusion. Even after 25 years, severe depressive disorders appear to have poor long-term outcomes. Patients with chronic outcomes over 15 years can improve when followed over longer periods.

Naturalistic Study on the Effects of Electroconvulsive Therapy (ECT) on Depressive Symptoms

2021 ◽  
pp. 070674372110640
Author(s):  
Sarah A. Goegan ◽  
Gary M. Hasey ◽  
Jelena P. King ◽  
Bruno J. Losier ◽  
Peter J. Bieling ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Rating Scales ◽  
Functional Disability ◽  
Remission Rate ◽  
Long Term Outcomes ◽  
Cognitive Assessments ◽  
Clinical Remission Rate ◽  
Lost To Follow Up

Objective The effectiveness of ECT under naturalistic conditions has not been well-studied. The current study aimed to 1) characterize a naturalistic sample of ECT patients; and 2) examine the long-term outcomes of ECT on depressive symptoms (Beck Depression Inventory-II; BDI-II) and functional disability symptoms (WHO Disability Assessment Schedule 2.0) in this sample. Methods Participants were adults who received ECT for a major depressive episode at an ambulatory ECT clinic between September 2010 and November 2020. Clinical and cognitive assessments were completed at baseline ( n = 100), mid-ECT ( n = 94), 2–4 weeks post-ECT ( n = 64), 6-months post-ECT ( n = 34), and 12-months post-ECT ( n = 19). Results At baseline, participants had severe levels of depressive symptoms (BDI-II: M = 41.0, SD = 9.4), and 62.9% screened positive for multiple psychiatric diagnoses on the MINI International Neuropsychiatric Interview. Depressive symptoms ( F(4,49.1) = 49.92, P  < 0.001) and disability symptoms ( F(3,40.72) = 12.30, P  < 0.001) improved significantly following ECT, and this was maintained at 12-months follow-up. Improvement in depressive symptoms trended towards significantly predicting reduction in disability symptoms from baseline to post-ECT, ( F(1,56) = 3.67, P  = 0.061). Although our clinical remission rate of 27% (BDI-II score [Formula: see text] 13 and [Formula: see text] 50% improvement) and overall response rate of 41.3% ([Formula: see text]50% improvement in BDI-II score) were lower than the rates reported in the extant RCT and community ECT literature, 36% of those treated with ECT were lost to follow-up and did not complete post-ECT rating scales. At baseline, remitters had significantly fewer psychiatric comorbidities, lower BDI-II scores, and lower disability symptoms than non-responders ( P < 0.05). Conclusions Participants were severely symptomatic and clinically complex. ECT was effective at reducing depressive symptoms and functional disability in this heterogeneous sample. Although a large amount of missing data may have distorted our calculated response/remission rates, it is also likely that clinical heterogeneity and severity contribute to lower-than-expected remission and response rates to ECT.

scholarly journals A case of recurrent thanatophoric dwarfism

2021 ◽  
Vol 10 (5) ◽  
pp. 2091
Author(s):  
L. Thulasi Devi ◽  
Athul R. S.
Keyword(s):  
Life Support ◽  
Clinical Course ◽  
Interesting Case ◽  
Comfort Care ◽  
Support Measures ◽  
Thanatophoric Dwarfism ◽  
Lost To Follow Up ◽  
Long Term Survivors

An interesting case of Recurrent Thanatophoric Dwarfism in a Multigravida; reporting to this hospital in second trimester which was terminated. It was confirmed on anomalies scan and was lethal. Genetic testing of the couple was advised; however, they refused and were lost to follow up. Long-term survivors are rare and require aggressive intervention for complications. In such cases couple should be informed of prognosis and extensively counselled for termination based on complications in long-term survivors as reported in literature. Management should be done after counselling and consultation regarding complications, clinical course, and prognosis of the condition. Due considerations may be given based on the parent’s desire for extreme life-support measures based on availability and affordability for provision of comfort care for the newborn. End of Life Support issues should be considered based on prevailing laws governing the nation.

Clinical Correlation of Multiple Sclerosis Immunopathologic Subtypes

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012782
Author(s):  
W. Oliver Tobin ◽  
Alicja Kalinowska-Lyszczarz ◽  
Stephen D. Weigand ◽  
Yong Guo ◽  
Nirubol Tosakulwong ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Progressive Disease ◽  
Clinical Course ◽  
Initial Attack ◽  
Long Term Outcomes ◽  
Common Pathway ◽  
Term Survival ◽  
Cns Demyelination

Objective:To compare clinical characteristics across immunopathological subtypes of patients with multiple sclerosis.Methods:Immunopathological subtyping was performed on specimens from 547 patients with biopsy and/or autopsy confirmed CNS demyelination.Results:The frequency of immunopathological subtypes were pattern I (23%), II (56%), and III (22%). Immunopatterns were similar in terms of age at autopsy/biopsy (median age 41 years, range 4-83 years, p=0.16) and proportion female (54%, p=0.71). Median follow-up after symptom onset was 2.3 years (range 0-38y). In addition to being overrepresented among autopsy cases (45% vs. 19% in biopsy cohort, p<0.001), index attack-related disability was higher in pattern III vs. pattern II (median EDSS 4 vs. 3, p=0.02). Monophasic clinical course was more common in patients with pattern III than pattern I or II (59% vs. 33% vs. 32%, p<0.001). Similarly, patients with pattern III pathology were likely to have progressive disease compared to patients with patterns I or II, when followed for ≥5 years (24% overall, p=0.49), with no differences in long-term survival, despite a more fulminant attack presentation.Conclusion:All three immunopatterns can be detected in active lesions, although they are found less frequently later into the disease due to the lower number of active lesions. Pattern III is associated with a more fulminant initial attack than either pattern I or II. Biopsied patients appear to have similar long-term outcomes irrespective of their immunopatterns. Progressive disease is less associated with the initial immunopattern and suggests convergence into a final common pathway related to the chronically denuded axon.

The Göteborg Cohort of Embolized Cerebral Arteriovenous Malformations: A 6-year Follow-up

Neurosurgery ◽  
2001 ◽  
Vol 49 (4) ◽  
pp. 779-806 ◽  
Author(s):  
Gunnar Wikholm ◽  
Christer Lundqvist ◽  
Pål Svendsen
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Course ◽  
Cerebral Arteriovenous Malformations ◽  
Stereotactic Irradiation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lost To Follow Up ◽  
Acrylic Glue

Abstract OBJECTIVE To present a follow-up of the results after endovascular treatment of cerebral arteriovenous malformations (AVMs) with acrylic glue. An initial follow-up was published in 1996. METHODS A cohort of 150 patients with cerebral AVMs underwent embolization between 1987 and 1993. Fifty-seven patients had supplemental stereotactic irradiation, and 13 had subsequent surgery. The follow-up was carried out clinically and radiologically. RESULTS The mean follow-up time was 6.2 years. Only four patients were lost to follow-up. If at least 90% of the AVM had been obliterated, the clinical course was stable and there were no new manifestations from the AVM. No recanalization occurred in any AVM that had been totally obliterated with glue. For patients in whom it was not possible to totally obliterate the AVM either with glue alone or glue supplemented with stereotactic irradiation or surgery, the long-term outcome was discouraging. CONCLUSION Obliteration of an AVM with acrylic glue seems to offer stability. If the AVM is totally obliterated, the patient had a stable clinical course. Patients with large AVMs with minor occlusion after embolization may have a worse clinical outcome than expected.

scholarly journals Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy

2022 ◽  
Vol 11 ◽  
Author(s):  
Gilda Cennamo ◽  
Daniela Montorio ◽  
Luca D’ Andrea ◽  
Antonio Farella ◽  
Elide Matano ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Uveal Melanoma ◽  
Tumor Control ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
The Mean ◽  
Lost To Follow Up ◽  
Plaque Brachytherapy

Uveal melanoma is the most common primary intraocular malignancy. The aim of this retrospective study was to report the results after ruthenium-106 (Ru-106) plaque brachytherapy for uveal melanoma in terms of tumor control, visual acuity, radiation-related complications, tumor recurrence, metastases, and patients’ survival rate during 4 years’ follow-up. A total of 355 eyes from 355 patients have been treated with Ru-106 plaque brachytherapy for uveal melanoma between February 2011 and March 2020. Five patients were lost to follow-up, and then 350 eyes of 350 patients (mean age 58 ± 11 years) were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination including echography and spectral domain–optical coherence tomography. The mean follow-up was 4 years (3 months to 9 years). After treatment, the mean tumor thickness was reduced to 1.75 ± 0.21 mm. Radiation complications were found in 63% of patients: 38% showed radiation maculopathy, 11% had optic neuropathy, and 14% developed cataracts. Cancer-free survival was 99%, 97%, and 85%, respectively, at 5, 7, and 9 years. Ru-106 plaque brachytherapy represents a reliable treatment of uveal melanoma. This technique is valid and safe with a low rate of ocular complications during a long-term follow-up.

Clinical course predicts long-term outcomes in bipolar disorder

2018 ◽  
Vol 49 (07) ◽  
pp. 1109-1117 ◽  
Author(s):  
Rudolf Uher ◽  
Sanna Pallaskorpi ◽  
Kirsi Suominen ◽  
Outi Mantere ◽  
Barbara Pavlova ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Hospital Admissions ◽  
Clinical Course ◽  
Bipolar Disorders ◽  
Long Term Outcomes ◽  
Course Characteristics ◽  
Manic Symptoms

AbstractBackgroundThe long-term outcomes of bipolar disorder range from lasting remission to chronic course or frequent recurrences requiring admissions. The distinction between bipolar I and II disorders has limited utility in outcome prediction. It is unclear to what extent the clinical course of bipolar disorder predicts long-term outcomes.MethodsA representative sample of 191 individuals diagnosed with bipolar I or II disorder was recruited and followed for up to 5 years using a life-chart method. We previously described the clinical course over the first 18 months with dimensional course characteristics and latent classes. Now we test if these course characteristics predict long-term outcomes, including time ill (time with any mood symptoms) and hospital admissions over a second non-overlapping follow-up period in 111 individuals with available data from both 18 months and 5 years follow-ups.ResultsDimensional course characteristics from the first 18 months prospectively predicted outcomes over the following 3.5 years. The proportion of time depressed, the severity of depressive symptoms and the proportion of time manic predicted more time ill. The proportion of time manic, the severity of manic symptoms and depression-to-mania switching predicted a greater likelihood of hospital admissions. All predictions remained significant after controlling for age, sex and bipolar I v. II disorder.ConclusionsDifferential associations with long-term outcomes suggest that course characteristics may facilitate care planning with greater predictive validity than established types of bipolar disorders. A clinical course dominated by depressive symptoms predicts a greater proportion of time ill. A clinical course characterized by manic episodes predicts hospital admissions.

Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽  
2013 ◽  
Vol 42 (4) ◽  
pp. 264-274
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Miroslav Lojík ◽  
Martina Mulačová ◽  
Martin Vališ
Keyword(s):  
Death Rate ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Angioplasty And Stenting ◽  
Aggressive Medical Management ◽  
Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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