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Results for “Long term course”

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At least 19 recordsLinked to original sources

PubMed1998

Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course.

The long-term results after arthroscopic partial meniscectomy of 119 patients with a mean follow-up of 12 years are presented in this study. The same series of patients had an earlier follow-up 4 years postoperatively. Thus, an evaluation of the actual long-term course and not only a single result after partial meniscectomy is presented. Arthroscopic partial meniscectomy is shown to be the definitive means of therapy for meniscal lesion of the knee joint; 91.7% of patients had an excellent or good result 4 years after surgery, and 78.1% rated excellent or good 12 years after surgery. Full recovery regarding ability to work and sports activity level was achieved in a very high percentage of patients. Early results were mostly representative and did not change significantly during the long-term course for the isolated meniscal lesion. The factor with the highest impact on long-term results was damage to the articular cartilage, which did not influence knee function for several years after surgery but became increasingly symptomatic over time after 5 years and more. Only 62% of patients with additional cartilage damage rated excellent and good 12 years after surgery, in contrast with 94.8% good and excellent results in patients with isolated meniscal tears. Similar observations were made for the untreated rupture of the anterior cruciate ligament.

Adult↗

PubMed1991

Natural history of schizophrenia subtypes. II. Positive and negative symptoms and long-term course.

The natural history and long-term course of schizophrenia divided by pervasiveness of positive and negative symptoms was explored among 187 schizophrenic patients from the Chestnut Lodge follow-up study. Schizophrenia with many negative symptoms was associated with poor premorbid functioning, insidious onset, partial or no remissions during the first several years of illness, and in most cases a progressive course leading to permanent disability. Schizophrenia with few negative symptoms was associated with good premorbid functioning, acute onset, intermittent early course, and a better prognosis. Positive symptoms predicted future hospitalizations but were less powerful and specific as indicators of differential illness history, course, and long-term functional incapacity. As predictors of long-term outcome, negative symptoms were of greater value measured at index admission several years after illness onset than at first hospital admission. Multivariate analyses indicated that two negative symptoms (anhedonia and affective flattening) contribute significantly to outcome variance independent of their association with premorbid functioning or positive symptoms. Patients with the poorest long-term outcome tended to show an increase in negative symptoms during the early years of their illness. Progressive negative symptoms early in the course of schizophrenia may thus reflect or signal a process leading to long-term functional disability.

Age Factors↗

PubMed1989

[Antibiotic therapy and long-term course in spondylodiscitis].

Long-term outcome and therapy are reported in 29 patients with vertebral osteomyelitis. Antibiotics were administered for a mean period of 21 (6-102) weeks. In 13 patients surgery was additionally necessary. After a mean follow-up of 53 (10-136) months only one relapse had occurred. Radiographs and erythrocyte sedimentation rate were the best indicators of successful treatment.

Adult↗

PubMed1999

A decade of spontaneous long-term course of psychogenic impairment in a community population sample.

BACKGROUND: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. METHOD: Beginning in 1979 (nt1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (nt3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). RESULTS: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. CONCLUSION: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention.

Adult↗

PubMed2001

Mortality and long-term course in schizophrenia with a poor 2-year course: a study in a developing country.

BACKGROUND: The short-term course of schizophrenia is reported to be better in some developing country settings. The long-term course in such settings, however, has rarely been studied. AIMS: To examine the long-term course and mortality of schizophrenia in patients with a poor 2-year course. METHOD: The report is based on two incidence cohorts of first-contact patients in urban and rural Chandigarh, India, originally recruited for the World Health Organization Determinants of Outcome of Severe Mental Disorders study. Patients were assessed using standardised instruments at 2- and 15-year follow-ups. RESULTS: Ninety-two per cent of the patients with a poor 2-year course had a poor long-term course and 47% died - a nine times higher mortality rate than among patients with other 2-year course types. CONCLUSIONS: In this developing country setting, a poor 2-year course was strongly predictive of poor prognosis and high mortality, raising questions about the adequacy of care for such patients.

Adult↗

PubMed1978

[Acute purulent arthritis of the limbs in the infant and child. Long term course (author's transl)].

The authors study the long term course of 37 cases of purulent arthritis of the limbs in the child, for which complete radiological documents covering a period of more than a year were available. They describe in particular the sequelae observed in 25 cases, classifying them by joint and by increasing order of severity. They then attempt, in the light of their own findings and of other published series, to draw conclusions concerning the main factors in prognosis--the age at the time of onset of the arthritis, the treatment given and the joint involved. The prognosis is all the more gloomy when a newborn or young infant is involved, when there is a delay before treatment is started or in the absence of joint aspiration-drainage and when the hip is affected.

Acute Disease↗

PubMed1993

Supervised four-week heliotherapy alleviates the long-term course of psoriasis.

The long-term effects of psoriasis heliotherapy were studied in a randomized cross-over trial with a 2-year follow-up. We allocated 95 patients randomly to receive a 4-week heliotherapy course, either at the onset or in the middle of the follow-up period. After a highly significant immediate alleviation of psoriasis about 50% of the patients still had a reduction of psoriasis 6 months later and about 25% one year later. A favourable carry-over treatment effect was still observed during the second follow-up year. Taking advantage of the cross-over design, the effect of heliotherapy was calculated to be statistically significant during the first follow-up year, and the apparent long-term alleviation of psoriasis after the heliotherapy was reflected in a significant period effect. The alleviation of psoriasis was accompanied by a significant decrease in the use of antipsoriatic treatments.

Adult↗

PubMed2000

Chronic inflammatory demyelinating polyradiculoneuropathy: long-term course and treatment of 60 patients.

The objective of this study was to assess the long-term course and treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We evaluated, according to a predefined protocol, a series of 60 CIDP patients who received a long-term course of steroids and immunosuppressants. Eighteen of them also had monoclonal gammopathy of undetermined significance (MGUS). Mean follow-up was 4.4 years and was similar for CIDP and CIDP-MGUS patients. At the end of the follow-up, improvement was ascertained in 60% of patients (69% CIDP, 39% CIDP-MGUS). Complete remission was achieved in 13%. Out of 26 patients receiving steroids as a monotherapy, 19 improved (73%). The following variables were predictive of a better outcome: female gender, younger age at onset, relapsing-remitting course, and absence of axonal damage at neurophysiologic study. In the multivariate analysis, younger age at onset and demyelination without axonal damage still retained an independent positive value.

Adolescent↗

PubMed1986

The long-term course of primary generalized epilepsy with persisting absences.

The long-term course of primary generalized epilepsy with absences persisting after the age of 30 to 61 years was studied in 26 patients, each followed clinically and by EEG for 20 to 37 years. Whether treated or not, absences became less frequent, but only rarely ceased, and 92% of patients with persisting absences eventually developed generalized convulsions. EEG background activity did not deteriorate, and the classic spike and wave complexes remained typical in 84% of patients. In 36% of cases, almost all of them women, psychomotor slowing was observed, which did not affect job performance. It was not related solely to duration or severity of epilepsy, or to antiepileptic drugs, and some hormonal mechanism may be partly responsible.

Adult↗

PubMed1988

The heterogeneity of the long-term course of schizophrenia.

Research has demonstrated considerable heterogeneity in the long-term course of schizophrenia. In the period preceding the onset of frank psychosis (onset), patients vary relative to the rapidity of onset, the presence or absence of associality, and the presence or absence of semipsychotic symptoms. Following the onset of psychosis (middle course), patients may suffer from episodic or unremitting psychosis, and may or may not exhibit the deficit syndrome. In late adult life (late course), patients vary relative to the presence or absence of an improvement in psychosis and social capability. The usual approach to the study of putative course subtypes is to define a subtype by a number of features; they may include features of more than one epoch. In addition, the course of psychosis has not been distinguished from enduring personality impairments in these subtypes. Another approach to defining putative course subtypes would be based on dichotomizing patients according to the presence or absence of a particular feature of a single epoch. This second approach has important advantages: the availability of larger study populations and a diminished liability for confounding due to the correlates of features other than those under scrutiny.

Follow-Up Studies↗

PubMed1999

[The endoscopic diagnosis and therapy as well as the long-term course of Dieulafoy ulcer hemorrhage].

OBJECTIVE: To assess the effectiveness of endoscopic diagnosis and treatment as well as the long-term course in patients with bleeding from Dieulafoy's ulcer (DU). PATIENTS AND METHODS: Data were gathered on all cases coded "bleeding from Dieulafoy's ulcer" in an endoscopic data-bank. The following items were obtained from the case-notes: clinical symptoms, mean haemoglobin concentration, demand for infusion of erythrocyte concentrates and endoscopic procedures undertaken for diagnosis and treatment. There were 15 patients (mean age 64.8 years; 9 men and 6 women), seen between 1985 and 1998 with the diagnosis of DU. All lesions were located in the proximal stomach. The effectiveness of the various parameters was analysed. The long-term course was ascertained by telephone interviews with the patients and (or) their general practitioner. RESULTS: The suspected diagnosis of DU was confirmed by additional endoscopic means such as endoscopic Doppler sonography or endosonography. A combination of endoscopic techniques of stopping the bleeding (epinephrine injection and, if necessary, haemoclip application) was effective in 14 of the 15 patients, operative intervention being required in one. Three patients died during follow-up, none of bleeding. No recurrence of bleeding had occurred in the 10 patients followed for a mean of 20 (6-31) months. CONCLUSIONS: The endoscopic diagnosis of DU bleeding can be confirmed by endoscopic Doppler sonography or endosonography. It remains to be proven whether miniscope endosonography is of additional value. The combined method of stopping the bleeding has been effective in this patient collective, both during hospitalization and on long-term follow-up.

Adult↗

PubMed1997

Psychosocial factors and the long-term course of major depression.

Fifty-nine subjects participated in a telephone follow-up interview 6 years after being hospitalized with a severe major depressive episode and 5 years after completing a 12 month follow-up study. Patient information was used to provide a rating of symptom-free (n = 19), episodic (n = 30), or chronic (n = 10) that described each patient's long-term course of illness. Few variables from the acute stage were related to long-term course of illness; however, early patterns of global and family functioning, number of life events, and rapid reduction in depressive symptomatology were found to be of prognostic significance. For patients whose depression is severe enough to warrant hospitalization, the pattern of functioning in the first few months after discharge from hospital is a strong indicator of the future long-term course.

Adult↗

PubMed1995

Long-term course of obsessive-compulsive disorder treated in adolescence.

OBJECTIVE: To investigate the long-term course of obsessive-compulsive disorder treated in adolescence. METHOD: Fifteen young adults treated for the disorder in adolescence, mainly through not only by behavior therapy and family therapy, were followed up between 9 and 14 years later. RESULTS: Data were collected on 14 of the cases (93%, N = 15) from various sources including interview in person in 6 cases. Of the 14 cases, 6 were found to satisfy DSM-III-R criteria for obsessive-compulsive disorder at long-term follow-up, while 8 were not. These recovered participants were not currently taking medication, and long-lasting recovery was associated with good social adjustment. Chronic course was not attributable to lack of subsequent treatment. CONCLUSIONS: The recovery rate of 57% (N = 14) is similar to those found in other recent studies of outcome following vigorous treatment in adolescence. The findings are over the longest follow-up period so far reported for obsessive-compulsive disorder treated in adolescence. Positive response to treatment in adolescence can be followed by relapse after longer periods than have usually been studied.

Adjustment Disorders↗

PubMed1993

[Eradication therapy of Helicobacter pylori in gastroduodenal ulcer and its long-term course].

We investigated the efficacy of antimicrobial drugs, amoxicillin and clarithromycin that have the in vitro activity against H. pylori, and observed a long term course of ulcer after eradication. The eradication rate of combination therapy with PPI and amoxicillin showed best result (13/18: 72%). In eradicated cases, index of PAS positive substance and gastritis score in antral mucosa that is histological examination was improved, and ammonia concentration in gastric secretions decreased. The recurrent rate of ulcer in long term course after eradication was investigated, the recurrent rate of ulcer was significantly lower in H pylori eradicated cases than in H. pylori continuously positive cases. Results suggest that eradication of H. pylori may be controlled recurrence of H. pylori positive peptic ulcer.

Amoxicillin↗

PubMed2000

Reliability of the life chart schedule for assessment of the long-term course of schizophrenia.

We report on the inter-rater reliability of the Life Chart Schedule (LCS). The LCS is designed to assess the long-term course of schizophrenia in four key domains (symptoms, treatment, residence, and work) over two time periods (past two years, entire period of illness). The subjects were 27 consecutive admissions to a schizophrenia research unit. The LCS was filled out by pairs of raters, blinded to each others' ratings, using the same data (interview with subject and chart). Reliability was examined for 45 LCS ratings selected from all four domains and both time periods. Selected ratings pertained to the duration of specified experiences, the quality of these experiences, and the long-term time trend. The kappa statistic and the intra-class correlation coefficient (ICC) were used to determine inter-rater reliability for continuous and categorical ratings, respectively. LCS ratings proved reliable in all four key domains and both time periods. The reliability was fair to excellent for ratings of duration of experience (ICC ranged from 0.53 to 0.99), quality of experience (kappa ranged from 0.46 to 0. 92) and long-term time trends (kappa ranged from 0.66 to 0.94). The LCS can be used to obtain reliable ratings of the long-term course of schizophrenia in multiple domains.

Adolescent↗

PubMed2000

Psychosocial disability during the long-term course of unipolar major depressive disorder.

BACKGROUND: The goal of this study was to investigate psychosocial disability in relation to depressive symptom severity during the long-term course of unipolar major depressive disorder (MDD). METHODS: Monthly ratings of impairment in major life functions and social relationships were obtained during an average of 10 years' systematic follow-up of 371 patients with unipolar MDD in the National Institute of Mental Health Collaborative Depression Study. Random regression models were used to examine variations in psychosocial functioning associated with 3 levels of depressive symptom severity and the asymptomatic status. RESULTS: A progressive gradient of psychosocial impairment was associated with a parallel gradient in the level of depressive symptom severity, which ranges from asymptomatic to subthreshold depressive symptoms to symptoms at the minor depression/dysthymia level to symptoms at the MDD level. Significant increases in disability occurred with each stepwise increment in depressive symptom severity. CONCLUSIONS: During the long-term course, disability is pervasive and chronic but disappears when patients become asymptomatic. Depressive symptoms at levels of subthreshold depressive symptoms, minor depression/ dysthymia, and MDD represent a continuum of depressive symptom severity in unipolar MDD, each level of which is associated with a significant stepwise increment in psychosocial disability.

Adaptation, Psychological↗

PubMed1998

Predicting extreme patterns of long-term course of psychogenic impairment: a ten-year follow-up.

This longitudinal study identifies predictors of course and etiologically relevant factors of psychogenic disorders. Since 1979, the Mannheim Cohort Project on the Epidemiology of Psychogenic Disorders has investigated neurotic spectrum disorders, personality disorders, stress reactions, and somatoform disorders in the normal population. Using these data, a cohort of probands suffering from moderate psychogenic impairment (N = 240; 121 men, 119 women) based on a representative sample of the urban adult population (N = 600; with cohorts 1935, 1945, 1955; gender distribution 1:1) of Mannheim, an industrial and university town in Germany, was followed up for almost 10 years. The cohort was investigated three times by psychodynamically trained physicians and psychologists. Tests were performed by means of cluster analysis. Different types of course of psychogenic impairment were identified. Both extreme types--the probands with the most positive and the most negative spontaneous long-term course--were investigated with regard to potential course-determining variables. Personality variables and conditions of early childhood development considerably influenced the spontaneous long-term course.

Adult↗

PubMed1986

[Long-term course over three years in a patient with unstable angina pectoris].

The long-term follow up in 48 patients with unstable angina pectoris was analyzed retrospectively. All patients were hospitalized in a coronary care unit during the acute phase and responded favourably to a medical regimen consisting of nitrates in 45 patients, betablockers in 23, calcium channel blocking agents in 22 and i.v. nitroglycerin in 12. 30 patients (group 1) responded promptly to oral medication with one or a combination of two drugs, whereas in 18 patients a combination of at least three drugs or intravenous nitroglycerin were necessary. After 42 +/- 6 months 21 patients remained asymptomatic, with 8 still on antianginal therapy. In 27 patients (56%) complications had occurred. These complications were severe limiting angina pectoris in 16, of whom 11 were treated surgically after 3.5 +/- 3 months, and myocardial infarction in 11 patients after 16 +/- 9 months, of whom 4 patients died. Complications occurred in 10 of the 30 patients in group 1 and in 16 of the 18 patients in group 2 (33% vs. 89%, p less than 0.01). This study confirms that the long-term course in patients with unstable angina is often complicated by severe angina pectoris or myocardial infarction. The late response to initial therapy and the need for the combination of more than two antianginal drugs or of i.v. medications identifies a subgroup of patients with a high complication rate.

Adrenergic beta-Antagonists↗