scholarly journals Clinical Analysis of Transcatheter Embolotherapy for Congenital Pulmonary Arteriovenous Fistulas in Children

2020 ◽  
Vol 5 (2) ◽  
pp. 109-116
Author(s):  
Xue Zhou ◽  
Ang Li ◽  
Dan Yin ◽  
Xu-pei Huang ◽  
Jie Tian ◽  
...  
Keyword(s):  
Remission Rate ◽  
Clinical Manifestations ◽  
Specific Effect ◽  
Clinical Analysis ◽  
Therapeutic Effects ◽  
Full Potential ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Pulmonary Arteriovenous Fistulas

Objective: To summarize the clinical features and therapeutic effects of transcatheter embolotherapy for congenital pulmonary arteriovenous fistulas (PAVFs) in children, and to explore the method and therapeutic principle of transcatheter embolotherapy for congenital PAVFs in children.Method: We retrospectively reviewed nine patients with PAVF who underwent transcatheter embolotherapy in the Children’s Hospital of Chongqing Medical University from July 2004 to July 2019, including the demographic characteristics, clinical manifestations, efficiency of closure, and follow-up.Results: Transcatheter embolotherapy was successful in all cases, and the symptom remission rate was 100% during the follow-up. No residual shunts or other complications occurred during the follow-up period. Compared with before embolotherapy, there were significant changes in the percentage of saturated oxyhemoglobin and total hemoglobin level at the last follow-up (t=10.06, P=0.000; t=3.055, P=0.0076). No significant difference was observed in pulmonary artery pressure before and after embolotherapy (t=0.13, P=0.90).Conclusions: Transcatheter embolotherapy offers the advantages of safety, with a decreased risk of trauma and a specific effect of treatment, and therefore is recommended as the first-line treatment for congenital PAVFs in children. However, continued research is necessary to understand the full potential of transcatheter embolotherapy.

scholarly journals Analysis of Approaches in the Microsurgical Treatment of 102 Cases of Petroclival Meningioma in a Single Center

2021 ◽  
Vol 12 ◽  
Author(s):  
Yazhou Lin ◽  
Qiang Gao ◽  
Huiping Jin ◽  
Nana Wang ◽  
Dingkang Xu ◽  
...  
Keyword(s):  
Attachment Site ◽  
Petrous Apex ◽  
Surgical Approaches ◽  
Karnofsky Performance Scale ◽  
Therapeutic Effects ◽  
Single Center ◽  
Petroclival Meningioma ◽  
Tumor Subtypes ◽  
Significant Difference

Objectives: We identified the optimal approaches for treating the diverse tumor subtypes of petroclival meningioma (PM) by analyzing the clinical benefits of various surgical approaches adopted for each subtype.Methods: Tumors in 102 PM patients from a single center who underwent surgical treatment were classified as upper clivus (UC), cavernous sinus (CS), tentorium (TE), or petrous apex (PA) types based on the attachment site of the tumor base and the displacement of the trigeminal nerve. The therapeutic effects of different surgical approaches among the subtypes were evaluated according to the patient outcomes.Results: The subtemporal (33.33%), retrosigmoid (16.67%), and Kawase approaches (50%) were used for the UC type. Simpson I/II resection was achieved in 46.66% of patients with the Kawase approach. Significant differences were found between the other two approaches (P = 0.044) and in the follow-up Karnofsky performance scale (KPS) scores (P = 0.008). The subtemporal (60%) and Kawase approaches (40%) were used for the CS type; neither approach achieved Simpson I/II resection. The retrosigmoid (25.81%) and Kawase approaches (74.19%) were used for the TE type. The Simpson I/II resection rates of the two approaches were 55.55 and 86.95%, respectively, and a significant difference was observed between them (P = 0.039). The retrosigmoid (43.75%) and Kawase approaches (56.25%) were used for the PA type. The Simpson I/II resection rates of the two approaches were 31.25 and 50%, respectively. The resection degrees of the two approaches and the KPS scores at follow-up were significantly different (P = 0.034).Conclusion: The individual microsurgical approaches adopted for the various PM tumor subtypes can provide maximal safe resection and good KPS scores. The Kawase approach is more suitable for PM, especially for UC- and PA-type PM tumors.

P1321PLASMATIC OSTEOPONTIN: A PREDICTOR OF VASCULAR ACCESS DYSFUNCTION IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nirvana Sadaghianloo ◽  
CONTENTI Julie ◽  
Vido Sandor ◽  
Carboni Joseph ◽  
Bonnet Sophie ◽  
...  
Keyword(s):  
Biological Marker ◽  
Duplex Ultrasound ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Strongly Correlated ◽  
Arteriovenous Fistulas ◽  
Significant Difference ◽  
Patients At Risk ◽  
Elisa Technique

Abstract Background and Aims Despite recommendations for a close follow-up of arteriovenous fistulas (AVF), thombosis rate reaches 10% each year. Conventional follow-up modalities remain a burden for hemodialysis patients. We tested the hypothesis that osteopontin (OPN), a pro-inflammatory molecule related to intimal hyperplasia, could be a biological marker of stenosis, and could thereby allow a screening of patients at risk for AVF dysfunction. Method Our prospective study (NCT03270358) compared the rate of plasmatic OPN between patients with a good-functioning AVF (control group, N= 39) and patients who required surgical or endovascular revision of their AVF because of a stenosis (stenosis group, N= 37). Blood samples were taken in the AVF, at the time of AVF cannulation in control patients, and at the time of AVF revision in stenosis patients. For each patient, blood from the contralateral arm was also analyzed as a between-subject control (paired t test). Cardiovascular risk factors, ongoing medications, and OPN rates (ELISA technique) were compared among the groups (uni- and multivariate analysis). The ROC curve determined sensitivity and specificity of the marker for the detection of stenosis. Results Patients' characteristics were similar between the 2 groups (mean age, 70 years; men, 63%; AVF duration; 39 months), apart from diabetes (control group, 33%; stenosis group, 57%; p=0.04). The rate of OPN was similar between the AVF arm and the contralateral arm (p=0.11), but significantly increased in the stenosis group compared to the control group (655 vs. 452 ng/mL, respectively, p=0.02). There was no statistically significant difference in OPN rate for diabetics and non diabetics (two-way ANOVA, p= 0.50). Sensitivity was 89% for a threshold >293ng/mL and specificity was 80% for a threshold >567ng/mL (AUC: 0.70; 95%CI: 0.57-0.81; p=0.004). Patients with an OPN rate ≥293ng/mL and those with an OPN rate ≥567ng/mL had respectively 8.87 and 15.62 higher odds to have a stenosis than patients with an OPN rate <293ng/mL (binomial regression, p<0.01). Conclusion Plasmatic OPN rate in hemodialysis patients can be measured simply, in a blood sample taken at the time of AVF cannulation, and is strongly correlated to the presence of a symptomatic AVF stenosis. This biomarker could help the physician choose which patient need a comprehensive examination of his/her AVF with duplex ultrasound or fistulogram.

Efficacy of anterior cervical decompression and fusion procedures for monomelic amyotrophy treatment: a prospective randomized controlled trial

2013 ◽  
Vol 19 (4) ◽  
pp. 412-419 ◽  
Author(s):  
Feizhou Lu ◽  
Hongli Wang ◽  
Jianyuan Jiang ◽  
Wenjun Chen ◽  
Xin Ma ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Iliac Crest ◽  
Plate Fixation ◽  
Cervical Collar ◽  
Therapeutic Effects ◽  
Iliac Crest Bone Grafting ◽  
Anterior Cervical Decompression ◽  
Significant Difference ◽  
Internal Plate Fixation

Object Monomelic amyotrophy (MMA) is a benign, self-limiting lower motor neuron disease. Optimal surgical strategies—discectomy decompression and fusion (DDF) or corpectomy decompression and fusion (CDF)—for patients with aggravated symptoms (within 6 months of presentation) are controversial, particularly in those who are ineligible for conventional treatment. These 2 methods of anterior cervical decompression and fusion for MMA in patients unwilling or unable to wear a conventional cervical collar long term were evaluated. Methods Anterior cervical decompression and fusion were performed in 48 male patients with MMA between September 2007 and September 2010. Patients were randomly treated with anterior cervical discectomy decompression with autologous iliac crest bone grafting and internal plate fixation (DDF group: 24 patients) or anterior cervical corpectomy, posterior longitudinal ligament resection, autologous iliac crest bone grafting, and internal plate fixation (CDF group: 24 patients). Subjective symptom assessments and electromyography (EMG) examinations were conducted both preoperatively and postoperatively. Results Subjective assessments and EMG studies (mean follow-up duration 25.9 months) indicated improvement in 64.6% and 60% of patients, respectively. No significant correlations between the effectiveness of surgery and age at symptom onset, preoperative symptom duration, or postoperative follow-up time were found. Conclusions The lack of a significant difference in effectiveness between DDF and CDF favors DDF as more clinically applicable because of its lower procedural risks. As a second-line alternative to cervical collar treatment, surgical anterior cervical decompression and fusion via DDF or CDF may prevent further deterioration and produce good short-term therapeutic effects in patients with MMA; however, cervical collar treatment is recommended for eligible patients because of its lower associated risks.

The Addition of Gemtuzumab Ozogamicin to Induction Chemotherapy for AML Improves Disease Free Survival without Extra Toxicity: Preliminary Analysis of 1115 Patients in the MRC AML15 Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 13-13 ◽  
Author(s):  
Alan K. Burnett ◽  
William J. Kell ◽  
Anthony H. Goldstone ◽  
Donald Milligan ◽  
Ann Hunter ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Preliminary Analysis ◽  
De Novo ◽  
Remission Rate ◽  
Pilot Trial ◽  
Disease Free Survival ◽  
Gemtuzumab Ozogamicin ◽  
Significant Difference ◽  
The Impact

Abstract The MRC AML15 Trial is primarily for patients with any form of AML who are under 60 years. One of the questions addressed was whether the addition of the immunoconjugate, Gemtuzumab Ozogamicin (GO) to induction (course 1) and/or consolidation (course 3) is beneficial. In induction patients are randomised to receive either DA (Daunorubicin/Ara-C) or ADE (Ara-C/Daunorubicin/Etoposide) or FLAG-Ida (Fludarabine/Ara-C/Idarubicin/G-CSF) and in consolidation either MACE (Amsacrine/Etoposide) or HD Ara-C (3.0g/m2 or 1.5g/m2 per dose). Our prior pilot trial had shown that GO 3mgs/m2 could be safely added to day 1 of each of these treatments (Kell et al Blood102, 4277–4283). Here we report the preliminary results of the effect of combining GO with induction chemotherapy. This randomisation achieved its recruitment target and was closed on 30 June 2006. All other comparisons in the trial, including GO in consolidation, remain open. Patients: A total of 1115 patients were randomised between July 2002 and June 2006. The median age was 49 (range 0–71) years: 53% of patients were male: 92% (n=1027) had de novo disease: 95% had WHO performance score of <2: 43% received DA, 43% FLAG-Ida, and 14% ADE. (Recruitment to ADE+GO opened in June 2005). Patients with WBC > 30 x 109/l and LFT’s > normal were initially excluded but admitted from March 2004. APL patients were not eligible for entry. 15% of patients with data had favourable 71% intermediate, and 14% adverse cytogenetics. Over 83% were CD33 positive. Results: The overall remission rate was 85% with no differences between the arms for GO vs no GO in CR (85% vs 85%) induction death (8% vs 7%) or resistant disease (7% vs 8%). There was a modest increase in mucositis on the GO arm in course 1 only (p=0.04) and increased AST and Alt toxicity in C1 (p=.002; p=.03) but no difference in bilirubin grades. GO patients used more platelets (19 vs 14; p<0.0001), but not red cells, and had more days on IV antibiotics (20.6 vs 18.6 p=0.001). The haemopoietic recovery and days in hospital were similar. With a median follow-up of 15 months (range 0–45), there is no significant difference in deaths in CR (GO vs no GO): 36 vs 45 (HR 0.75; CI.49–1.16 p=0.2), but relapse was reduced: 37% vs 52% at 3 years (HR 0.70 (0.52–0.92) p=0.01) resulting in an improved DFS: 51% vs 40% at 3 years (HR 0.72 (0.56–0.91) p=0.008). There is so far no significant difference in OS (53% vs 46% at 3 years; HR 0.91(0.73–1.14) p=0.4). Conclusion: This preliminary analysis of 1115 randomised patients indicates that the addition of GO to induction chemotherapy can reduce the relapse risk without adding significant extra toxicity and this has significantly improved the DFS in the GO arm. Longer follow up is required to determine the impact on survival.

scholarly journals Clinical Features and Remission Rate of Pediatric Graves’ Hyperthyroidism Treated With Antithyroid Drug

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A710-A711
Author(s):  
Kyusang You ◽  
Goo Lyeon Kim ◽  
Jeesuk Yu
Keyword(s):  
Children And Adolescents ◽  
Clinical Features ◽  
Remission Rate ◽  
Antithyroid Drug ◽  
Tsh Receptor ◽  
Receptor Antibody ◽  
Tsh Receptor Antibody ◽  
Tertiary Center ◽  
Significant Difference

Abstract Introduction: Pediatric Graves’ hyperthyroidism needs long-term therapy and there is no specific guideline. Antithyroid medication is used as the first line of treatment, among antithyroid medication, radioiodine therapy, and surgery. The study was designed to investigate the clinical features and remission rate and the factors associated with the remission of Graves’ hyperthyroidism treated with antithyroid drug in children and adolescents. Methods: Initially, 114 children and adolescents who have been managed with thyrotoxicosis in a single tertiary center were included in the study. Retrospective review of medical records was performed on the demographic data, clinical information, and laboratory results. Ten patients with Hashitoxicosis, 36 patients who were followed less than 1 year, and 19 patients with no available initial results of thyroid function test were excluded from the study. We analyzed the clinical features and remission rate between the group with remission and the group without remission. Chi-square, Fisher’s exact test, and t-test were used for statistics. Results: A total of 49 patients were included in the study (M:F 11:38). Mean age at diagnosis was 12.6±3.7 years old and the follow up duration was 4.9±2.5 years. Goiter was visible in 47 patients (96%) and exophthalmos was found in 12 patients (24%). Thirteen patients (27%) showed treatment-related hypothyroidism during follow up. Twenty-seven patients (55%) could discontinue the medication for more than 1 month. Among those, eleven patients showed recurrence and 6 out of 11 patients reached remission again. As a result, 22 patients (45%, male 7) maintained the remission state. Average time till remission was 4.2±2.4 years. Remission rate was 2%, 8%, 12%, 35%, and 45% during the treatment of 1, 2, 3, 4, and 5 years, respectively. Mean follow up duration was significantly longer in the group with remission (5.7±2.2 years), compared with the group without remission (4.3±2.6 years) (p<0.05). There was no significant difference in the presence of goiter or exophthalmos between two groups (goiter 95.5% vs 96.3%; exophthalmos 18% vs. 30%). Incidence rate of hypothyroidism during treatment was also not statistically different between the groups (36% vs. 19%). Age at onset, recent age, initial levels of T3, free T4 or TSH, and the presence of anti-thyroglobulin antibody or anti-thyroid peroxidase antibody were not significantly different between the groups. In contrast, initial levels of TSH receptor antibody was significantly lower in the group with remission (15.6±9.7 IU/L vs. 26.2±14.7 IU/L, p=0.004). Conclusion: This study showed that the remission rate was 45% during the treatment duration of 5 years. Initial titer of TSH receptor antibody was the most important factor associated with the remission in the pediatric Graves’ hyperthyroidism.

scholarly journals Clinical Analysis of Chronic Active EBV Infection with Coronary Artery Dilatation and Matched Case-control Study

2020 ◽  
Author(s):  
Ang Wei ◽  
Honghao Ma ◽  
Liping Zhang ◽  
Zhigang Li ◽  
Yitong Guan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Serum Ferritin ◽  
Clinical Manifestations ◽  
Control Group ◽  
Hematopoietic Stem ◽  
Ebv Infection ◽  
Coronary Artery Dilatation ◽  
Tnf Α ◽  
Significant Difference

Abstract Objective To investigate the clinical characteristics, treatment, prognosis, and risk factors of chronic active EBV infection (CAEBV) associated with coronary artery dilatation (CAD) in children.Methods Children with CAEBV associated with CAD hospitalized in Beijing Children’s Hospital, Capital Medical University, from March 2016 to December 2019 were analyzed. At the same time, children with CAEBV without CAD were selected as the control group, matched by sex, age, treatment and admission time. The clinical manifestations, laboratory and ultrasonic examinations, treatment and prognosis of the children were collected in both groups.Results There were 10 children with CAEBV combined with CAD, accounting for 8.9% (10/112) of CAEBV patients at the same period, which including 6 males and 4 females, with onset age of 6.05 (2.8-14.3) years. The median follow-up time was 20 (6-48) months. All the patients had high copies of EBV-DNA in whole blood 1.18x107（1.90x105-3.96x107）copies/mL and plasma 1.81x104（1.54x103-1.76x106）copies/mL, and the Epstein-Barr virus encoded small RNA in biopsy was all positive. Among the 10 children, 8 had bilateral CAD, with 2 patients unilateral. After diagnosis, 7 children were treated with L-DEP chemotherapy in our hospital. After chemotherapy, four patients accepted allo-genetic Hematopoietic Stem Cell Transplantation (HSCT). The others were waiting for HSCT. By the end of the follow-up, CAD had returned to normal in 3 patients, and the time from diagnosis of CAD to recovery was 21 (18-68) d. The level of LDH, serum ferritin, TNF-α and IL-10 had statistically significant difference between the two groups (P=0.009, 0.008, 0.026 and 0.030). There were no significant differences in survival rate between the two groups (P=0.416).Conclusion The incidence of CAEBV with CAD was low. CAEBV with CAD did not influence the prognosis. Patients with CAEBV had high LDH, serum ferritin, TNF-α and IL-10 in the early onset were prone to have CAD.

scholarly journals Follow-up of percutaneous transcatheter closure of pulmonary arteriovenous fistulas

2019 ◽  
Vol 132 (8) ◽  
pp. 980-983 ◽  
Author(s):  
Shi-Bing Xi ◽  
Yu-Mei Xie ◽  
Ming-Yang Qian ◽  
Ji-Jun Shi ◽  
Yi-Fan Li ◽  
...  
Keyword(s):  
Transcatheter Closure ◽  
Arteriovenous Fistulas ◽  
Pulmonary Arteriovenous Fistulas

scholarly journals Evaluation of factors influencing tick bites and tick-borne infections: a longitudinal study

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Bo Bødker Jensen ◽  
Mie Topholm Bruun ◽  
Per Moestrup Jensen ◽  
Andreas Kristian Pedersen ◽  
Pierre-Edouard Fournier ◽  
...  
Keyword(s):  
Blood Donors ◽  
Seroconversion Rate ◽  
Clinical Manifestations ◽  
Weather Conditions ◽  
Igg Antibodies ◽  
Tick Bites ◽  
Significant Difference ◽  
Study Population ◽  
June July

Abstract Background Various tick-borne infections like borreliosis and rickettsiosis pose a health risk to humans in many parts of the world. We investigated seroprevalence of and seroconversion to Borrelia burgdorferi and Rickettsia spp. and relation to tick-bites, weather and clinical manifestations in Denmark. Methods Blood donors were enrolled at the Hospital of Southern Jutland in June–July with follow-up November–February of 2018 and 2019. Blood samples were collected, and a questionnaire regarding tick bites, potential exposures and symptoms was completed at each visit. Samples were tested for presence of IgM and IgG antibodies directed against B. burgdorferi and Rickettsia spp. using R. helvetica and R. felis as antigens. Data were examined for correlation between tick bites, serological results, potential exposures and symptoms. Results Two-hundred and fourteen (93 follow-ups) and 130 (38 follow-ups) blood donors were included in 2018 and 2019, respectively. The total borrelia seroconversion rate was 6.3% (CI 2.1–10.5), while the prevalence of IgM and IgG antibodies was 7.8% (CI 4.9–10.6) and 6.7% (CI 4–9.3), respectively. Seroconversion to Rickettsia spp. was detected in one participant. Tick bites and seroconversion were not significantly associated with the reported unspecific symptoms, but unspecific symptoms were common in the study population. There was no significant difference in number of tick bites or seroconversion/prevalence between seasons with highly alternating weather. Conclusions Results suggest that weather conditions in an individual year have a limited impact. Anti-Borrelia-antibodies do not seem to persist in serum for several years. Rickettsiosis is of limited concern in Denmark. Graphic abstract

scholarly journals A study of effectiveness of nutritional interventions on children with severe acute malnutrition admitted in nutrition rehabilitation centers of Bhopal, Madhya Pradesh

2018 ◽  
Vol 5 (6) ◽  
pp. 2590
Author(s):  
D. M. Saxena ◽  
Akshat Pathak ◽  
Ganga Ram Mahor ◽  
Ramniwas Mahor ◽  
Anil Agarwal
Keyword(s):  
Severe Acute Malnutrition ◽  
Madhya Pradesh ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Average Weight ◽  
Full Potential ◽  
Health Issues ◽  
Significant Difference ◽  
Nutrition Rehabilitation

Background: The prevalence of under-nutrition among under-five children is high and varies widely. Children with severe acute malnutrition require immediate attention along with proper nutritional rehabilitation not only to decrease mortality but also to achieve full potential after recovery. Nutrition rehabilitation centres (NRCs) were started to control severe malnutrition and decrease the prevalence of severe malnourished children to less than 1% among children aged 1–5 years.Methods: The present study was conducted from July 2016 to June 2017; 500 children admitted to five different NRCs in Bhopal district of Madhya Pradesh were observed during their stay at NRCs and children were followed up during a period of 6 months after discharge from NRCs. Mothers of the children were interviewed on various health issues of children and feeding practices at the NRCs using a predesigned and pretested interview schedule.Results: The study group consisted of 252 boys and 248 girls; 51.20% were between 13 and 36 months of age. All 500 children were analysed for anthropometric indicators. A statistically significant difference was obtained between the weight of children at admission, discharge and follow up (ANOVA=106.2, p<0.001); difference of mid upper arm circumference (MUAC) at admission, discharge and follow up was also statistically significant (ANOVA=24.02, p<0.001). The average weight gain during the stay at the centers was 8.95±3.59 g/kg/day. The mothers of the children lacked adequate information on health issues and composition and preparation of nutrient rich diets for their children.Conclusions: The NRCs were effective in improving the condition of admitted children, but the effects were not well sustained following discharge due to lack of adequate parental awareness and action. 

Long-term outcomes of transsphenoidal surgery for management of growth hormone–secreting adenomas: single-center results

2020 ◽  
Vol 133 (5) ◽  
pp. 1360-1370 ◽  
Author(s):  
Mohammed J. Asha ◽  
Hirokazu Takami ◽  
Carlos Velasquez ◽  
Selfy Oswari ◽  
Joao Paulo Almeida ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Recurrence Rate ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Repeat Surgery ◽  
Significant Difference ◽  
Remission Rates ◽  
Biochemical Remission

OBJECTIVETranssphenoidal surgery is advocated as the first-line management of growth hormone (GH)–secreting adenomas. Although disease control is defined by strict criteria for biochemical remission, the length of follow-up needed is not well defined in literature. In this report, the authors present their long-term remission rate and identify various predictive factors that might influence the clinical outcome.METHODSThe authors conducted a single-institute retrospective analysis of all transsphenoidal procedures for GH-secreting adenomas performed from January 2000 to June 2016. The primary outcome was defined as biochemical remission according to the 2010 consensus criteria and measured at the 1-year postoperative mark as well as on the last recorded follow-up appointment.Secondary variables included recurrence rate, patterns of clinical presentation, and outcome of adjuvant therapy (including repeat surgery). Subgroup analysis was performed for patients who had biochemical or radiological “discordance”—patients who achieved biochemical remission but with incongruent insulin-like growth factor 1 (IGF-1)/GH or residual tumor on MRI. Recurrence-free survival analysis was conducted for patients who achieved remission at 1 year after surgery.RESULTSEighty-one patients (45 female and 36 male) with confirmed acromegaly treated with transsphenoidal surgery were included. In 62 cases the patients were treated with a pure endoscopic approach and in 19 cases an endoscopically assisted microscopic approach was used.Primary biochemical remission after surgery was achieved in 59 cases (73%) at 1 year after surgery. However, only 41 patients (51%) remained in primary surgical remission (without any adjuvant treatment) at their last follow-up appointment, indicating a recurrence rate of 31% (18 of 59 patients) over the duration of follow-up (mean 100 ± 61 months). Long-term remission rates for pure endoscopic and endoscopically assisted cases were not significantly different (48% vs 52%, p = 0.6). Similarly, no significant difference in long-term remission was detected between primary surgery and repeat surgery (54% vs 33%, p = 0.22).Long-term remission was significantly influenced by extent of resection, cavernous sinus invasion (radiologically as well as surgically reported), and preoperative and early postoperative GH and IGF-1 levels (within 24–48 hours after surgery) as well as by clinical grade, with lower remission rates in patients with dysmorphic features and/or medical comorbidities (grade 2–3) compared to minimally symptomatic or silent cases (grade 1).CONCLUSIONSThe long-term surgical remission rate appears to be significantly less than “early” remission rates and is highly dependent on the extent of tumor resection. The authors advocate a long-term follow-up regimen and propose a clinical grading system that may aid in predicting long-term outcome in addition to the previously reported anatomical factors. The role of repeat surgery is highlighted.

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