scholarly journals Efficacy of Medical Therapy in Treatment of Chronic Rhinosinusitis

2012 ◽  
Vol 3 (1) ◽  
pp. ar.2012.3.0027 ◽  
Author(s):  
Lee C. Young ◽  
Nicholas W. Stow ◽  
Lifeng Zhou ◽  
Richard G. Douglas
Keyword(s):  
Chronic Rhinosinusitis ◽  
Clinical Features ◽  
Medical Therapy ◽  
Oral Prednisone ◽  
Treatment Regimens ◽  
Symptom Scores ◽  
Before And After ◽  
Long Term Follow Up

Uncomplicated chronic rhinosinusitis (CRS) is generally treated with medical therapy initially and surgery is contemplated only after medical therapy has failed. However, there is considerable variation in the medical treatment regimens used and studies defining their efficacy are few. The aim of this study was to determine the proportion of patients treated medically who responded sufficiently well so that surgery was not required. Subgroup analysis to identify clinical features that predicted a favorable response to medical therapy was also performed. Eighty patients referred to the Otorhinolaryngology Clinic at North Shore Hospital were treated with a standardized medical therapy protocol (oral prednisone for 3 weeks, oral antibiotics and ongoing saline lavage and intranasal budesonide spray). Symptom scores were collected before and after medical therapy. Clinical features such as presence of polyps, asthma, and aspirin hypersensitivity were recorded. Failure of medical therapy was defined as the persistence of significant CRS symptoms, and those patients who failed medical therapy were offered surgery. Follow-up data were available for 72 (90%) patients. Of this group, 52.5%, (95% CI, 42.7%, 62.2%) failed to respond adequately to medical therapy and were offered surgery. The remaining patients (37.5%) were successfully treated with medical therapy and did not require surgery at the time of follow-up. The premedical therapy symptom scores were significantly higher than the postmedical therapy symptom scores (p < 0.01). The symptom scores of those patients postmedical therapy who proceeded to have surgery were significantly higher than the group who responded well to maximum medical therapy (MMT) and did not require surgery (p < 0.0001). There were no significant differences in the proportion of patients with asthma, aspirin sensitivity, or polyps between the groups failing or not failing MMT. In approximately one-third of patients with CRS, medical therapy improved symptoms sufficiently so that surgical therapy was avoided. Patients with more severe symptoms tended not to respond as well as those with less severe symptoms. Long-term follow-up is required for the group of responders to determine how many will eventually relapse.

Maximum Bite Force of Edentulous Patients before and after Dental Implant Rehabilitation: Long-Term Follow-Up and Facial Type Influence

2016 ◽  
Vol 27 (6) ◽  
pp. 523-527 ◽  
Author(s):  
Ana Cláudia M. Melo ◽  
Ingrid M. Ledra ◽  
Rogéria A. Vieira ◽  
Edivaldo R. Coró ◽  
Ivete Aparecida de M. Sartori
Keyword(s):  
Dental Implant ◽  
Bite Force ◽  
Before And After ◽  
Long Term Follow Up ◽  
Edentulous Patients ◽  
Facial Type

scholarly journals Does immunological remission, defined as disappearance of autoantibodies, occur with current treatment strategies? A long-term follow-up study in rheumatoid arthritis patients who achieved sustained DMARD-free status

2019 ◽  
Vol 78 (11) ◽  
pp. 1497-1504 ◽  
Author(s):  
Debbie M Boeters ◽  
Leonie E Burgers ◽  
René EM Toes ◽  
Annette van der Helm-van Mil
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Current Treatment ◽  
Dmard Therapy ◽  
Before And After ◽  
Long Term Follow Up ◽  
Free Status

ObjectivesSustained disease-modifying antirheumatic drug (DMARD)-free status, the sustained absence of synovitis after cessation of DMARD therapy, is infrequent in autoantibody-positive rheumatoid arthritis (RA), but approximates cure (ie, disappearance of signs and symptoms). It was recently suggested that immunological remission, defined as disappearance of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor (RF), underlies this outcome. Therefore, this long-term observational study determined if autoantibodies disappear in RA patients who achieved sustained DMARD-free remission.MethodsWe studied 95 ACPA-positive and/or RF-positive RA patients who achieved DMARD-free remission after median 4.8 years and kept this status for the remaining follow-up (median 4.2 years). Additionally, 21 autoantibody-positive RA patients with a late flare, defined as recurrence of clinical synovitis after a DMARD-free status of ≥1 year, and 45 autoantibody-positive RA patients who were unable to stop DMARD therapy (during median 10 years) were studied. Anti-cyclic citrullinated peptide 2 (anti-CCP2) IgG, IgM and RF IgM levels were measured in 587 samples obtained at diagnosis, before and after achieving DMARD-free remission.Results13% of anti-CCP2 IgG-positive RA patients had seroreverted when achieving remission. In RA patients with a flare and persistent disease this was 8% and 6%, respectively (p=0.63). For anti-CCP2 IgM and RF IgM, similar results were observed. Evaluating the estimated slope of serially measured levels revealed that RF levels decreased more in patients with than without remission (p<0.001); the course of anti-CCP2 levels was not different (p=0.66).ConclusionsSustained DMARD-free status in autoantibody-positive RA was not paralleled by an increased frequency of reversion to autoantibody negativity. This form of immunological remission may therefore not be a treatment target in patients with classified RA.

Non-vascularized toe phalanx transfer for correction of severe clinodactyly of the thumb in Rubinstein–Taybi syndrome

2020 ◽  
Vol 45 (7) ◽  
pp. 715-721
Author(s):  
Marie Le Mapihan ◽  
Alina Badina ◽  
Stéphanie Pannier ◽  
Arielle Salon ◽  
Chrisophe Glorion ◽  
...  
Keyword(s):  
New Method ◽  
New Technique ◽  
Level Of Evidence ◽  
Before And After ◽  
Long Term Follow Up ◽  
Osteotomy Technique ◽  
Toe Transfer ◽  
Delta Phalanx

In Rubinstein–Taybi syndrome, patients may have a particularly severe clinodactyly of the thumb. We evaluated a new method for correction of these severe clinodactylies using non-vascularized toe phalanx transfer as a replacement for the abnormal delta phalanx. Results of the new technique are presented, together with those of an osteotomy technique. We retrospectively recorded the angle of the clinodactyly before and after surgery and at long-term follow-up of 11 osteotomies and five transfers in nine patients from 1990 to 2017. The pre-operative angle of clinodactyli was similar between the two groups with a mean of 59°. After surgery, the correction was equivalent (7° and 11°). At the last follow-up (7 and 18 years), the relapse of clinodactyly was 17° for osteotomies and 1° for phalanx transfers. We noticed growth of the transferred phalanx, resulting in an excellent thumb length. We conclude that non-vascularized toe transfer can be an effective correction of severe clinodactyly and may be more stable than osteotomy in the long-term. Level of evidence: IV

Anemia Before and After Roux-en-Y Gastric Bypass: Prevalence and Evolution on Long-Term Follow-up

2019 ◽  
Vol 29 (9) ◽  
pp. 2790-2794 ◽  
Author(s):  
Roberto de Cleva ◽  
Lilian Cardia ◽  
Daniel Riccioppo ◽  
Miwa Kawamoto ◽  
Newton Kanashiro ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Before And After ◽  
Long Term Follow Up

scholarly journals Management of Gastric Varices Unsuccessfully Treated by Balloon-Occluded Retrograde Transvenous Obliteration: Long-Term Follow-Up and Outcomes

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Fumio Uchiyama ◽  
Satoru Murata ◽  
Shiro Onozawa ◽  
Ken Nakazawa ◽  
Fumie Sugihara ◽  
...  
Keyword(s):  
Hepatic Function ◽  
Gastric Varices ◽  
Gastroesophageal Varices ◽  
Before And After ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
The Mean ◽  
Serum Ammonia

Our aim was to evaluate the long-term efficacy and safety of percutaneous transhepatic obliteration (PTO) alone and combined with balloon-occluded retrograde transvenous obliteration (BRTO) for gastroesophageal varices refractory to BRTO alone. Between July 1999 and December 2010, 13 patients with gastroesophageal varices refractory to BRTO were treated with PTO (n= 6) or a combination of PTO and BRTO (n= 7). We retrospectively investigated the rates of survival, recurrence, or worsening of the varices; hepatic function before and after the procedure; and complications. The procedure achieved complete obliteration or significant reduction of the varices in all 13 patients without major complications. During follow-up, the varices had recurred in 2 patients, of which one had hepatocellular carcinoma, and the other died suddenly from variceal rebleeding 7 years after PTO. The remaining 11 patients did not experience worsening of the varices and showed significant improvements in the serum ammonia levels and prothrombin time. The mean follow-up period was 90 months, and the cumulative survival rate at 1, 3, and 5 years was 92.9%, 85.7%, and 85.7%, respectively. Both PTO and combined PTO and BRTO seem as safe and effective procedures for the treatment of gastroesophageal varices refractory to BRTO alone.

Sign in / Sign up

Export Citation Format

Share Document