Lung metastasectomy for osteosarcoma in children, adolescents, and young adults: proof of permanent cure

Introduction Surgical resection of pulmonary metastases has been associated with increased survival at 5 years for osteosarcoma, but limited information is available on long-term outcome, role of repeated metastasectomies, and surgical sequelae in a pediatric population. We analyzed a consecutive series of children, adolescents, and young adults (AYA) treated by repeated lung metastasectomies during a period >40 years to estimate the clinical benefit and potential cure rate of salvage surgery. Methods All patients who underwent lung metastasectomy for osteosarcoma at the IRCCS Istituto Ortopedico Rizzoli of Bologna, University of Modena, and IRCCS Istituto Nazionale Tumori of Milan from May 1973 to January 2014 were included. Overall survival (OS) at 20 years from the first metastasectomy was calculated. Results A total of 463 consecutive children and AYA were analyzed. Median age was 15.9 years (range 0.2–23.2 years) and median follow-up 18.6 years. The 5- and 20-year OS were 34.0% and 29.7% (95% CI 25.5–34.0%). Among the 138 (29.8%) alive patients, 42 (30.4%) had disease recurrence cured by repeated metastasectomies. Disease-free interval from primary tumor, number of metastases, and complete resection were the most relevant survival predictors at multivariable model analysis. Discussion The extended follow-up of this consecutive series shows that repeated lung metastasectomy can achieve a permanent cure when offered to properly selected patients with metastases from osteosarcoma.

Download Full-text

Pediatric endoscopic pilonidal sinus treatment (PEPSiT): what we learned after a 3-year experience in the pediatric population

Updates in Surgery ◽

10.1007/s13304-021-01094-4 ◽

2021 ◽

Author(s):

Ciro Esposito ◽

Ernesto Montaruli ◽

Giuseppe Autorino ◽

Mario Mendoza-Sagaon ◽

Maria Escolino

Keyword(s):

Patient Satisfaction ◽

Laser Therapy ◽

Pilonidal Sinus ◽

Pediatric Population ◽

Treatment Protocol ◽

Pilonidal Sinus Disease ◽

Term Outcome ◽

Long Term Outcome ◽

Clavien Grade

AbstractThis paper aimed to report a multi-institutional 3-year experience with pediatric endoscopic pilonidal sinus treatment (PEPSiT) and describe tips and tricks of the technique. We retrospectively reviewed all patients < 18 years, with primary or recurrent pilonidal sinus disease (PSD), undergoing PEPSiT in the period 2017–2020. All patients received pre-operative laser therapy, PEPSiT and post-operative dressing and laser therapy. Success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. A total of 152 patients (98 boys) were included. Median patient’s age was 17.1 years. Fifteen/152 patients (9.8%) presented a recurrent PSD. All patients resumed full daily activities 1 day after surgery. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10). Patient satisfaction was excellent (median score 4.8). The median follow-up was 12.8 months (range 1–36). Complete healing in 8 weeks was achieved in 145/152 (95.4%) and the median healing time was 24.6 days (range 16–31). We reported post-operatively immediate Clavien grade 2 complications (3 oedema, 2 burns) in 5/152 (3.3%) and delayed Clavien grade 2 complications (3 granulomas, 8 wound infections) in 11/152 (7.2%). Disease recurrence occurred in 7/152 (4.6%), who were re-operated using PEPSiT. PEPSiT should be considered the standard of care for surgical treatment of PSD in children and teenagers. PEPSiT is technically easy, with short and painless post-operative course and low recurrence rate (4.6%). Standardized treatment protocol, correct patient enrollment and information, and intensive follow-up are key points for the success of the procedure.

Download Full-text

Long term outcome of augmentation cystoplasty in pediatric population with refractory bladder dysfunction: 12 years follow up experience in a single center

European Urology Supplements ◽

10.1016/s1569-9056(17)30532-8 ◽

2017 ◽

Vol 16 (3) ◽

pp. e819

Author(s):

S. Mehmood ◽

S. Vallasciani ◽

A. Alshammari ◽

A. Almathami ◽

H. Alhazmi ◽

...

Keyword(s):

Bladder Dysfunction ◽

Pediatric Population ◽

Augmentation Cystoplasty ◽

Single Center ◽

Term Outcome ◽

Long Term Outcome

Download Full-text

Long-term outcome of social phobia treated by exposure

Psychological Medicine ◽

10.1017/s0033291701004020 ◽

2001 ◽

Vol 31 (5) ◽

pp. 899-905 ◽

Cited By ~ 39

Author(s):

G. A. FAVA ◽

S. GRANDI ◽

C. RAFANELLI ◽

C. RUINI ◽

S. CONTI ◽

...

Keyword(s):

Social Phobia ◽

Consecutive Series ◽

Term Outcome ◽

Long Term Outcome ◽

Concurrent Use ◽

Complete Treatment ◽

Long Term Follow Up ◽

Dsm Iv

Background. There is very little information on long-term follow-up of social phobia.Methods. A consecutive series of 70 patients satisfying the DSM-IV criteria for social phobia was treated in an out-patient clinic with behavioural methods based on exposure homework. Forty-five patients were judged to be remitted after eight individual sessions of psychotherapy. A 2 to 12 year (median = 6 years) follow-up was performed. Survival analysis was selected to characterize the clinical course of patients. Assessments were performed before treatment, at the end of therapy, after 1 year, and subsequently on a yearly basis, and utilized selected items of Paykel's Clinical Interview for Depression.Results. Six of the 45 patients (13%) had a relapse of social phobia at some time during follow-up. The estimated cumulative percentage of patients remaining in remission was 98 after 2 years, 85 after 5 years and 85 after 10 years. Such probabilities increased in the absence of a personality disorder, of residual social phobic avoidance after exposure, and of concurrent use of benzodiazepines.Conclusions. The findings suggest that, even though one patient out of three is unable to complete treatment or does not benefit sufficiently from it, exposure treatment can provide lasting effects to the majority of patients with social phobia. Disappearance of residual, subclinical social phobic avoidance appears to be the target of treatment.

Download Full-text

A Modified Capsular Shift for Atraumatic Anterior-Inferior Shoulder Instability

The American Journal of Sports Medicine ◽

10.1177/0363546504272685 ◽

2005 ◽

Vol 33 (7) ◽

pp. 1011-1015 ◽

Cited By ~ 17

Author(s):

Björn Marquardt ◽

Wolfgang Pötzl ◽

Kai-Axel Witt ◽

Jörn Steinbeck

Keyword(s):

Shoulder Instability ◽

Case Series ◽

Consecutive Series ◽

Study Group ◽

Level Of Evidence ◽

Term Outcome ◽

Long Term Outcome ◽

Capsular Shift ◽

Redislocation Rate

Purpose To evaluate the long-term outcome of a modified inferior capsular shift procedure in patients with atraumatic anterior-inferior shoulder instability by analyzing a consecutive series of patients who had undergone a modified inferior capsular shift for this specific type of shoulder instability. Study Design Case series; Level of evidence, 4. Methods Between 1992 and 1997, 38 shoulders of 35 patients with atraumatic anterior-inferior shoulder instability that were unresponsive to nonoperative management were operated on using a modified capsular shift procedure with longitudinal incision of the capsule medially and a bony fixation of the inferior flap to the glenoid and labrum in the 1 o'clock to 3 o'clock position. The patient study group consisted of 9 men and 26 women with a mean age of 25.4 years (range, 15-55 years) at the time of surgery. The mean follow-up was 7.4 years (range, 4.0-11.4 years); 1 patient was lost to follow-up directly after surgery. The study group was evaluated according to the Rowe score. Results After 7.4 years, 2 patients experienced a single redislocation or resubluxation, 1 patient had recurrent dislocations, and 1 patient had a positive apprehension sign, which is an overall redislocation rate of 10.5%. The average Rowe score increased to 90.6 (SD = 19.7) points from 36.2 (SD = 13.5) points before surgery. Seventy-two percent of the patients participating in sports returned to their preoperative level of competition. Conclusions Results in this series demonstrate the efficacy and durability of a modified capsular shift procedure for the treatment of atraumatic anterior-inferior shoulder instability.

Download Full-text

First episodes of psychosis in Afro-Caribbean and White people

The British Journal of Psychiatry ◽

10.1192/bjp.172.2.147 ◽

1998 ◽

Vol 172 (2) ◽

pp. 147-153 ◽

Cited By ~ 57

Author(s):

Noriyoshi Takei ◽

Rajendra Persaud ◽

Peter Woodruff ◽

Ian F. Brockington ◽

Robin M. Murray

Keyword(s):

Negative Symptoms ◽

Psychiatric Care ◽

Population Based ◽

Consecutive Series ◽

White People ◽

Term Outcome ◽

Long Term Outcome ◽

The Uk ◽

First Admission

BackgroundThere have been few prospective studies of the long-term outcome of psychosis in people of Afro-Caribbean origin in the UK.MethodWe followed-up a population-based, consecutive series of 34 Afro-Caribbean and 54 White people with psychosis who had been extensively investigated during their first admission in 1973/74. Diagnoses were made by direct interview using the Present State Examination at both first admission and follow-up.ResultsNinety-seven per cent of the original sample were traced. A slightly greater proportion of the Afro-Caribbean people were assigned to the S+ Catego class (schizophrenia), both on first assessment and at follow-up. No difference was found between the two groups in the consistency of diagnosis over the 18 years or in the proportion of patients considered psychotic but Afro-Caribbean people tended to have fewer negative symptoms at follow-up. There were striking differences between the two groups in their experience of psychiatric care; Afro-Caribbean people were more likely to have been readmitted, to have experienced longer hospitalisations, and to have undergone more involuntary admissions than their White counterparts.ConclusionsAfro-Caribbean people who met clinical and research criteria for schizophrenia had a less satisfactory experience of, and response to, psychiatric care over 18 years than their White counterparts.

Download Full-text

Effects of Therapy on Urine Neutrophil Gelatinase-Associated Lipocalin in Nondiabetic Glomerular Diseases with Proteinuria

International Journal of Nephrology ◽

10.1155/2016/4904502 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Amnuay Sirisopha ◽

Somlak Vanavanan ◽

Anchalee Chittamma ◽

Bunyong Phakdeekitcharoen ◽

Ammarin Thakkinstian ◽

...

Keyword(s):

Complete Remission ◽

Limited Information ◽

Urine Ngal ◽

Term Outcome ◽

Cross Sectional ◽

Glomerular Diseases ◽

Long Term Outcome ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

Urine neutrophil gelatinase-associated lipocalin (NGAL) is widely used as a biomarker for acute kidney injury. Cross-sectional studies have shown that NGAL may be elevated in glomerular diseases, but there is limited information on the value of NGAL in predicting treatment response or on the changes of NGAL levels after therapy. We prospectively evaluated the effects of therapy on NGAL in nondiabetic glomerular diseases. Urine NGAL was collected at biopsy and follow-up at 12 months. At baseline, NGAL in glomerular disease patients (n=43) correlated with proteinuria, but not with glomerular filtration rate (GFR). After therapy with renin-angiotensin blockers and/or immune modulating agents, change of NGAL correlated with change of proteinuria, but not with change of GFR. NGAL at baseline was not different between patients in complete remission (CR) at follow-up compared to those not in remission (NR). Compared to baseline, NGAL at follow-up decreased in CR (n=10), but not in NR. Change of NGAL was greater in CR than NR. In conclusion, the change of urine NGAL correlated with the change of proteinuria. Baseline NGAL was not a predictor of complete remission. Future studies will be necessary to determine the role of NGAL as a predictor of long term outcome in proteinuric glomerular diseases.

Download Full-text

Fragile States of Mind: Neuroticism, Vulnerability and the Long-Term Outcome of Depression

The British Journal of Psychiatry ◽

10.1192/bjp.169.3.338 ◽

1996 ◽

Vol 169 (3) ◽

pp. 338-347 ◽

Cited By ~ 51

Author(s):

P. G. Surtees ◽

N. W. J. Wainwright

Keyword(s):

Depressive Disorder ◽

Affective Disorder ◽

Prognostic Significance ◽

Consecutive Series ◽

Fragile States ◽

Term Outcome ◽

Long Term Outcome ◽

Self Confidence

BackgroundThis paper considers the extent to which vulnerability to the outcome of major affective disorder is conferred through personality deviance. Results are based upon a 12 year longitudinal follow-up study of 80 patients with a primary depressive disorder, originally selected from a consecutive series seeking care at a hospital in Scotland.MethodsThe study included detailed clinical course assessments in association with the formal application of diagnostic criteria. Assessments on recovery from the index episode included measures of self-confidence and of neuroticism. Experience of selected severe loss events over the study period was also determined.ResultsLimited self-confidence was strongly related, unlike neuroticism, to the subsequent first recurrence of affective disorder. Relationships between psychosocial, clinical and demographic factors and long-term outcome revealed psychosocial factors, in particular neuroticism and a lack of self-confidence, to have the greatest prognostic significance.ConclusionsThese results reveal the heightened risk over the long-term of a poor outcome for depressive disorder consequent upon measures of personality deviance and of exposure to adversity. While giving only limited support to narrowly defined psychosocial models of depression, they clarify the risk gradients involved and through this may provide a firmer basis than hitherto for relapse prevention.

Download Full-text

Future Imperfect: the Long-Term Outcome of Depression

The British Journal of Psychiatry ◽

10.1192/bjp.164.3.327 ◽

1994 ◽

Vol 164 (3) ◽

pp. 327-341 ◽

Cited By ~ 74

Author(s):

P. G. Surtees ◽

C. Barkley

Keyword(s):

Depressive Illness ◽

Consecutive Series ◽

Longitudinal Assessment ◽

Short Term ◽

Term Outcome ◽

Entire Study ◽

Long Term Outcome ◽

History Of

During 1976, 80 patients with a primary depressive illness were selected from a consecutive series of referrals to the Royal Edinburgh Hospital for a short-term follow-up study. This paper concerns the 12-year longitudinal assessment of the survivors. During the follow-up, mortality risk for the sample was almost doubled. Of the series, 35% had experienced a recurrence within 2 years of the initial interview, and just over 60% within the entire study time of 12 years. The risk of recurrence was enhanced for those aged over 45 years at index, for those with a history of depressive disorder and for those who had not engaged in parasuicidal behaviour during the index episode. The observed effect of previous episodes was largely accounted for by age. The chance of recurrence was not affected by whether the treatment of the index episode included ECT, or by whether diagnosis was ‘endogenous’ or ‘neurotic’. Application of the Lee-Murray outcome criteria showed that about one-third of the Edinburgh series experienced a very poor outcome. Results are presented concerning the prediction of long-term outcome as represented by the Depression Outcome Scale (DOS), a measure specially constructed for this study.

Download Full-text