scholarly journals Long-term outcome after implantation of the Prestige I disc in an end-stage indication: 4-year results from a pilot study

2004 ◽  
Vol 17 (3) ◽  
pp. 69-71 ◽  
Author(s):  
James T. Robertson ◽  
Newton H. Metcalf
Keyword(s):  
Outcome Measures ◽  
Long Term Results ◽  
Cervical Disc ◽  
Long Term Outcome ◽  
Term Function ◽  
Stage Disease ◽  
Sf 36 ◽  
End Stage ◽  
The Prestige

Object The long-term function of an artificial cervical disc device is critical to its clinical success. The Prestige I Cervical Disc System has been used clinically since June 1998, and long-term results can now begin to be assessed. The authors conducted clinical and radiographic examinations at 3 and 4 years postoperatively to evaluate the long-term performance of the Prestige I device. Methods A pilot trial was initiated in which the Prestige I disc was implanted in a cohort of patients with end-stage disease, who often had a history of multiple previous fusion procedures. All patients were followed according to a standardized clinical and radiographic protocol until 2 years postoperatively. Outcome measures included the Short Form–36 (SF-36) and Neck Disability Index (NDI) questionnaires, neurological status, and radiographic status. To evaluate the long-term function of the device, Ethics Committee approval was obtained to assess the patients at 3 and 4 years postoperatively. All patients were contacted, and after signing an additional informed consent document, were reevaluated according to the standardized protocol. Of the 17 patients in the original cohort, 13 were evaluated at 3 years and 14 were evaluated at 4 years postoperatively. Clinical outcome measures including the NDI and SF-36 showed good improvement, especially when the end-stage nature of the disease is considered. Radiographic analysis showed that the Prestige I disc maintained motion at the treated segment at 3 and 4 years postoperatively. Conclusions In this report the authors demonstrate the clinical viability of the Prestige I cervical disc system at long-term postoperative intervals, even in the more severe biomechanical environment of end-stage disease.

scholarly journals Long-Term Results of Neurological Outcome, Quality of Life, and Cosmetic Outcome After Cranioplastic Surgery: A Single Center Study of 202 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Henrik Giese ◽  
Jennifer Antritter ◽  
Andreas Unterberg ◽  
Christopher Beynon
Keyword(s):  
Quality Of Life ◽  
Regression Analysis ◽  
Neurological Outcome ◽  
Long Term Results ◽  
Complication Rates ◽  
Long Term Outcome ◽  
Sf 36

Objective: An increased interest in the surgical procedures of decompressive craniectomy (DC) and subsequent cranioplasty (CP) has emerged during the last decades with specific focus on mortality and complication rates. The aim of the present study was to evaluate long-term neurological and cosmetic outcomes as well as Quality of Life (QoL) after CP surgery.Methods: We retrospectively reviewed the medical records of CP patients treated at our institution between 2004 and 2014 and performed a follow-up examination, with evaluation of neurological outcome using the modified Rankin Scale (mRS) and the Glasgow outcome scale (GOS), QoL (SF-36 and EQ-5D-3L). Furthermore, the cosmetic results after CP were analyzed.Results: A total of 202 CP-patients were included in the present study. The main indications for DC and subsequent CP were space-occupying cerebral ischemia (32%), traumatic brain injury (TBI, 26%), intracerebral or subarachnoid hemorrhage (32%) and infection (10%). During a mean follow-up period of 91.9 months 46/42.6% of patients had a favorable neurological outcome (mRS ≤ 3/GOS ≥ 4). Patients with ischemia had a significant worse outcome (mRS 4.3 ± 1.5) compared with patients after TBI (3.1 ± 2.3) and infectious diseases requiring CP (2.4 ± 2.3). The QoL analysis showed that <1/3rd of patients (31.2%) had a good QoL (SF-36) with a mean EQ-5D-VAS of 59 ± 26. Statistical analysis confirmed a significant worse QoL of ischemia patients compared to other groups whereas multivariate regression analysis showed no other factors which may had an impact on the QoL. The majority (86.5%) of patients were satisfied with the cosmetic result after CP and regression analysis showed no significant factors associated with unfavorable outcomes.Conclusion: Long-term outcome and QoL after CP were significantly influenced by the medical condition requiring DC. Early detection and evaluation of QoL after CP may improve the patient's outcome due to an immediate initiation of targeted therapies (e.g., occupational- or physiotherapy).

scholarly journals Long-term outcome of the laparoscopic repair of hiatus hernia

2018 ◽  
Vol 9 (3) ◽  
pp. 26-33
Author(s):  
M. A. Burikov ◽  
I. V. Skazkin ◽  
O. V. Shulgin ◽  
A. I. Kinyakin ◽  
I. A. Sokirenko
Keyword(s):  
Surgical Treatment ◽  
Hiatus Hernia ◽  
Nissen Fundoplication ◽  
Life Quality ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Sf 36 ◽  
Basic Characteristics

Presently, the improvement in the quality of life of patients who underwent a laparoscopic surgical repair of hiatus hernia and the absence of the gastroesophageal reflux disease (GERD) recurrence are the basic characteristics of the surgical treatment. In this connection, further perfection of the tactics and techniques of the surgical GERD treatment becomes an important problem of modern surgery. Here, we present a comparative analysis of the remote results of the surgical treatment of 159 patients with GERD-complicated hiatus hernia. The patients were divided into two groups, depending on the technique of the performed endosurgical treatment. The first group consisted of patients operated via the standard laparoscopic Nissen fundoplication. In the second group, we included those patients who underwent surgical treatment using a modified procedure of Nissen fundoplication with the formation of a non-tension cuff (RF patent No. 2529415 of 27.09.2014). Evaluation of the results, based on the survey questionnaires Gerd-Q, GSRS, SF-36 and the data of instrumental research methods, was performed 1 to 5 years post-treatment. The treatment of the GERD-complicated hiatus hernia patients with application of the technique of forming a non-hanging fundoplication cuff shows the best long-term results: the incidence of the reflux syndrome and signs of hyperfunction of the fundoplication cuff is lower. The revealed differences coincide with the data of the Gerd-Q and GSRS questionnaires, as well as the life quality estimation by the SF-36 questionnaire. The developed techniques do not require application of sophisticated technical skills and re-equipment and may be recommended for the practical use in the everyday practice in surgical hospitals of all levels.

Surrogate Endpoints for Optimal Therapeutic Response to UDCA in Primary Biliary Cholangitis

2015 ◽  
Vol 33 (Suppl. 2) ◽  
pp. 118-124 ◽  
Author(s):  
Henk R. van Buuren ◽  
Willem J. Lammers ◽  
Maren H. Harms ◽  
Bettina E. Hansen
Keyword(s):  
Risk Score ◽  
Surrogate Endpoints ◽  
Primary Biliary Cholangitis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
C Statistic ◽  
Stage Disease ◽  
Comparable Performance ◽  
End Stage

Background: Ursodeoxycholic acid (UDCA) is the standard treatment for primary biliary cholangitis (PBC), as it can delay histological progression, improve long-term outcome and is extremely safe and well tolerated. However, UDCA is not always sufficient and the prognosis of patients inadequately responding to treatment is worse compared with the general population. Reliable identification of so-called non-responders is of key importance, not only for selecting patients who could benefit from additional, second-line therapy, but also for identifying those individuals who are at low risk of developing end-stage disease and in whom UDCA mono-therapy can be safely continued. Several laboratory surrogate endpoints for the long-term response to UDCA have been proposed, including the Barcelona, Paris, Toronto and Rotterdam criteria. All these criteria have limitations and the superiority of one over the other has not been firmly established. Key Messages: Recently the Global PBC Study Group developed a new prognostic tool by studying a large, representative and multinational cohort of 4,119 UDCA-treated patients. In a random sample of 2,488 cases, a risk score - the GLOBE score - was developed, predictive of transplantation-free survival. This risk score comprises age, and bilirubin, albumin, alkaline phosphatase and platelet count obtained after 1 year therapy, and has a performance (C statistic 0.81, 95% CI 0.79-0.83) that is markedly better than that of previously proposed response criteria. Comparable performance was found in an independent validation cohort of 1,631 cases (C statistic 0.82, 95% CI 0.79-0.84). A web app will allow the easy use of the score in clinical practice.

scholarly journals Functional Long-Term Outcome after Left- versus Right-Sided Intracerebral Hemorrhage

2017 ◽  
Vol 43 (3-4) ◽  
pp. 117-123 ◽  
Author(s):  
Vanessa D. Beuscher ◽  
Joji B. Kuramatsu ◽  
Stefan T. Gerner ◽  
Julia Köhn ◽  
Hannes Lücking ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Outcome Measures ◽  
A Priori ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Excellent Outcome ◽  
Confounding Variables ◽  
Baseline Characteristics

Background and Purpose: Hemispheric location might influence outcome after intracerebral hemorrhage (ICH). INTERACT suggested higher short-term mortality in right hemispheric ICH, yet statistical imbalances were not addressed. This study aimed at determining the differences in long-term functional outcome in patients with right- vs. left-sided ICH with a priori-defined sub-analysis of lobar vs. deep bleedings. Methods: Data from a prospective hospital registry were analyzed including patients with ICH admitted between January 2006 and August 2014. Data were retrieved from institutional databases. Outcome was assessed using the modified Rankin Scale (mRS) score. Outcome measures (long-term mortality and functional outcome at 12 months) were correlated with ICH location and hemisphere, and the imbalances of baseline characteristics were addressed by propensity score matching. Results: A total of 831 patients with supratentorial ICH (429 left and 402 right) were analyzed. Regarding clinical baseline characteristics in the unadjusted overall cohort, there were differences in disfavor of right-sided ICH (antiplatelets: 25.2% in left ICH vs. 34.3% in right ICH; p < 0.01; previous ischemic stroke: 14.7% in left ICH vs. 19.7% in right ICH; p = 0.057; and presence/extent of intraventricular hemorrhage: 45.0% in left ICH vs. 53.0% in right ICH; p = 0.021; Graeb-score: 0 [0-4] in left ICH vs. 1 [0-5] in right ICH; p = 0.017). While there were no differences in mortality and in the proportion of patients with favorable vs. unfavorable outcome (mRS 0-3: 142/375 [37.9%] in left ICH vs. 117/362 [32.3%] in right ICH; p = 0.115), patients with left-sided ICH showed excellent outcome more frequently (mRS 0-1: 64/375 [17.1%] in left ICH vs. 43/362 [11.9%] in right ICH; p = 0.046) in the unadjusted analysis. After adjusting for confounding variables, a well-balanced group of patients (n = 360/hemisphere) was compared showing no differences in long-term functional outcome (mRS 0-3: 36.4% in left ICH vs. 33.9% in right ICH; p = 0.51). Sub-analyses of patients with deep vs. lobar ICH revealed also no differences in outcome measures (mRS 0-3: 53/151 [35.1%] in left deep ICH vs. 53/165 [32.1%] in right deep ICH; p = 0.58). Conclusion: Previously described differences in clinical end points among patients with left- vs. right-hemispheric ICH may be driven by different baseline characteristics rather than by functional deficits emerging from different hemispheric functions affected. After statistical corrections for confounding variables, there was no impact of hemispheric location on functional outcome after ICH.

scholarly journals Long-Term Outcome after Successful Lower Extremity Free Flap Salvage

2018 ◽  
Vol 35 (04) ◽  
pp. 263-269 ◽  
Author(s):  
Amir Bigdeli ◽  
Emre Gazyakan ◽  
Volker Schmidt ◽  
Christoph Bauer ◽  
Günter Germann ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Free Flaps ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Component Score ◽  
Sf 36 ◽  
The Mean

Background Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. Methods A single-center retrospective study including long-term follow-up was approved by the local ethics committee. From January 1999 to December 2010, a total of 581 free flaps were performed for lower extremity reconstruction. Eighty-six flaps required emergency re-exploration, of which 65 could be salvaged. Fifteen salvaged flaps were excluded from the study because of secondary amputation. Of 50 patients, 29 (6 females and 23 males) were eligible for follow-up. The mean follow-up time was 54.5 ± 32.9 months. Health-related quality of life (Short Form 36 [SF-36]) and scar quality (Vancouver Scar Scale [VSS]) were analyzed. Results The overall flap survival rate was 94.7% and the total loss rate was 5.3%. The re-exploration rate was 14.8% (86 of 581 flaps). The salvage rate was 75.6% (65 of 86 flaps). Twenty-one free flaps were totally lost (24.4%). Partial flap loss occurred in 12 cases (14.0%); 67.5% of the vascular complications occurred during the first 24 hours, 20.9% between 24 and 72 hours, and 11.6% after more than 72 hours. The mean time from the first signs of impaired flap perfusion to re-exploration was 1.3 ± 0.4 hours, and from free tissue transfer to re-exploration was 16.2 ± 1.9 hours. The overall scar appearance was good with an average VSS score of 4.0 points. The average SF-36 physical component score was 54.4 ± 5.4 and the mental component score was 63.1 ± 10.7. Conclusion Careful monitoring and the opportunity for urgent re-exploration are the key to success for free flaps salvage. Following these principles, an acceptable long-term outcome can be achieved.

scholarly journals Long-term Results of an Anterior Discectomy without a Bone Graft for Treating a Cervical Disc Hernia : A Clinical Study

1994 ◽  
Vol 3 (1) ◽  
pp. 45-51 ◽  
Author(s):  
Takashi Yuasa ◽  
Yuji Nikaido ◽  
Kiyoshi Nagata ◽  
Yeohg-jin Kim ◽  
Kenta Fujimoto ◽  
...  
Keyword(s):  
Clinical Study ◽  
Bone Graft ◽  
Long Term Results ◽  
Cervical Disc ◽  
Disc Hernia ◽  
Anterior Discectomy

Fractures and Fracture Dislocations of the Midfoot: Occurrence, Causes and Long-term Results

2001 ◽  
Vol 22 (5) ◽  
pp. 392-398 ◽  
Author(s):  
Martinus Richter ◽  
Burkhard Wippermann ◽  
Christian Krettek ◽  
Hanns Eberhard Schratt ◽  
Tobias Hufner ◽  
...  
Keyword(s):  
Open Reduction ◽  
Traffic Accidents ◽  
Fracture Dislocation ◽  
Long Term Results ◽  
Treatment Optimization ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Fracture Dislocations

Etiology and outcome of 155 patients with midfoot fractures between 1972 and 1997 were analyzed to create a basis for treatment optimization. Cause of injuries were traffic accidents (72.2%), falls (11.6%), blunt injuries (7.7%) and others (5.8%). Isolated midfoot fractures (I) were found in 55 (35.5%) cases, Lisfranc fracture dislocations (L) in 49 (31.2%), Chopart-Lisfranc fracture dislocations (CL) in 26 (16.8%) and Chopart fracture dislocations (C) in 25 (16%). One hundred and forty eight (95%) of the midfoot fractures were treated operatively; 30 with closed reduction, 115 with open reduction, 3 patients had a primary amputation. Seven (5%) patients were treated non-operatively. Ninety seven (63%) patients had follow-up at an average of 9 (1.3–25, median 8.5) years. The average scores of the entire follow-up group were as follows: AOFAS – sum of all four sections (AOFAS-ET): 296, AOFAS-Midfoot (AOFAS-M): 71, Hannover Scoring System (HSS): 65, and Hannover Questionnaire (Q): 63. Regarding age, gender, cause, time from injury to treatment and method of treatment no score differences were noted (t-test: p > 0.05). L, C or I showed similar scores and CL significantly lower scores (AOFAS-ET, AOFAS-M, HSS, Q). The highest scores in all groups were achieved in those fractures treated with early open reduction and operative fixation. Midfoot fractures, particularly fracture dislocation injuries, effect the function of the entire foot in the long-term outcome. But even in these complex injuries, an early anatomic (open) reduction and stable (internal) fixation can minimize the percentage of long-term impairment.

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