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At least 19 recordsLinked to original sources

PubMed2000

[Osteonecrosis: natural course and conservative therapy].

The natural course of Osteonecrosis (ON) of the femoral head has yet not been evaluated sufficiently. Especially in the early forms of the disease (ARCO 0 to II) without collapse of the femoral head, useful information on the natural course could only be collected since the routine use of MR-imaging. The unspecific findings in ARCO stage I with negative radiographs are potential reversible. The "point of no return" already lies in the irreversible ARCO stage II in almost all cases. Prognosis for further progression for both early stages depends primarily on the extension and location of the lesion. Only the rare, small to medium sized lesions in the medial or central location may have a good prognostic course over a period of more than five years. The much more common large sized and lateral located lesions will have a probability of about 80% to progress to femoral head collapse within two years. Conservative therapy with single protected weight bearing has shown bad results not significantly different from the natural course of the disease. Pulsed electromagnetic fields are still discussed controversially. Until now there is no MRI controlled study available in early ON, showing superior results compared to the easy and cost-effective core decompression therapy. The extra corporal shock wave therapy has shown spontaneous pain relief in early ON. Midterm results of this new therapeutical concept are not available yet. Hyperbaric oxygen therapy has shown to stimulate the repair process in an animal experiment. The preliminary clinical results of this time and cost consuming therapy are not convincing. Vasoactive drugs in combination with limited weight bearing may play a role in the conservative management of early ON (ARCO I and part of ARCO II) in the future. For the conservative therapy in ON several other substance are currently in clinical testing. The benefit of conservative therapeutical concepts in ON in the future can only be evaluated with prospective MRI controlled clinical studies. The use of cytokines in combination with surgical debridement and bone grafting of the necrotic area may be a possible therapeutical concept for the future.

Disease Progression↗

PubMed1990

The use of the Markov process in describing the natural course of diabetic retinopathy.

The natural course of early diabetic retinopathy in young subjects with insulin-dependent diabetes mellitus was evaluated during 693 patient visits for 259 subjects during a mean of 2.4 years. Diabetic retinopathy is considered a progressive disease among people with insulin-dependent diabetes mellitus (type I). Improvement of early retinopathy has not been recognized as a part of the natural course. In our experience, 25% of observations in subjects with early diabetic retinopathy (grades 2 and 3) showed improvement. Thus, 28 of 174 observations of diabetic retinopathy improved from grade 2 to grade 1, and 34 of 79 observations improved from grade 3 to grades 2 or 1. Markov chains indicate that 25% of observations of diabetic retinopathy will change from grade 1 to grade 5 or 6 in 17.0 years and 25% will change from grade 2 to grade 5 or 6 in 16.0 years. Future studies of diabetic retinopathy should consider a matrix of estimated transition probabilities, depending on the population, to judge probabilities of transition between states of retinopathy.

Adolescent↗

PubMedDate not supplied

Natural course of lymphocytic infundibuloneurohypophysitis.

Natural course of lymphocytic infundibuloneurohypophysitis is poorly understood. A 49-year-old male had noticed being unnaturally thirsty since about two years previously. An enlargement of the pituitary stalk and pituitary gland was thus observed by MR at that time. However, no medical care had been given. Two years later, he was admitted to our hospital due to headache in addition to panhypopituitarism. The histologic features included T cell dominant lymphocytes infiltrating prominently the entire pituitary gland with a small amount of multinucleated giant cells, focal and small necrosis, cholesterin crystals and granuloma. Neither tuberculosis nor Langerhans histiocytosis were observed. In addition, the patient was found to have a unique massive well-encapusulated lesion in the sphenoid sinus, just below the pituitary fossa, consisting of serous fluid, normal columnar epithelium and submucosal fibrosis. This patient had a fairly typical clinical manifestation of lymphocytic infundibuloneurohypophysitis with invason of the posterior lobe and the stalk. The lesion became chronic and leaked to the sphenoid sinus. As a result, chronic hypophysitis with granuloma formation thus occurred. This case may show the course of this disease if not treated.

Adult↗

PubMed1990

Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage.

To clarify the natural course of degenerative spondylolisthesis, the mechanism and progression of disk slippage were studied clinically and radiographically in 40 patients. Progressive slippage was observed in 12 patients (30%). No progression of slippage was noted in patients who showed narrowing of the intervertebral disk, spur formation, subcartilaginous sclerosis, or ossification of ligaments. These suggest that the mechanisms of spinal restabilization prevent progression of the disease. General joint laxity was observed in many patients (65%), and this was believed to be involved in the pathogenic mechanism of this disease. There was no correlation between the clinical symptoms and progression of slippage. These findings suggest that careful consideration of the natural mechanisms of spinal restabilization as well as the natural course of the disease is important.

Female↗

PubMed1994

Autosomal recessive osteopetrosis: variability of findings at diagnosis and during the natural course.

OBJECTIVE: To determine the variability and the natural course of children suffering from autosomal recessive osteopetrosis to allow optimal counseling and decision making with respect to therapeutic intervention. DESIGN: Retrospective and longitudinal evaluation of clinical symptoms and natural course with emphasis on survival and sensoneurologic and hematologic findings. SETTING: Two large referral-based pediatric bone marrow transplantation units in Europe. PATIENTS: Thirty-three patients with autosomal recessive osteopetrosis admitted to units in Paris and Leiden between 1972 and 1988 were analyzed until last follow-up or the time at which bone marrow transplantation was performed. The great number of patients and unprecedented amount of data make this report one of the single largest clinical studies on autosomal recessive osteopetrosis. MAIN RESULTS: Ocular involvement occurring at a median age of 2 months was the symptom at initial examination in half of the patients. A striking variability between patients was found. Retinal degeneration was present in three patients and associated generalized neurodegeneration was present in two. The probability of survival until the age of 6 years was about 30% for the group as a whole. The cumulative risk of developing visual or hematologic impairment in the first year of life was about 75% and leveled off afterward. Patients with early hematologic impairment, ie, before 3 months of age, especially when combined with early visual impairment, had a very poor prognosis regarding life expectancy. CONCLUSIONS: Autosomal recessive osteopetrosis seems to be a variable disorder with a poor prognosis, especially in children with early visual and hematologic impairment. Allogenic bone marrow transplantation remains the only curative approach.

Bone Marrow Transplantation↗

PubMed2004

The natural course of cutaneous melanoma.

The natural course of cutaneous melanoma (CM) is determined by its metastatic spread and depends on tumor thickness, ulceration, gender, localization, and the histologic subtype of the primary tumor. CM metastasis develops via three main metastatic pathways and occurs as satellite or in-transit metastasis, as regional lymph node metastasis or as distant metastasis at the time of primary recurrence. About 50% of all CM patients with tumor progression firstly develop regional lymph node metastases. In the other 50% the first metastases are satellite or in-transit metastases (about 20%), or immediately distant metastases (about 30%). Development of distant metastasis appears to be an early event in metastatic spread and may in the majority of cases originate from the primary tumor, only few cases may develop secondarily to locoregional metastasis. Reporting of organ involvement in distant metastasis greatly differs between the results of imaging techniques and autopsy results in respect to the metastatic patterns detected, pointing out that there is a need of improved imaging systems. Proliferation, neovascularization, lymphangiogenesis, invasion, circulation, and embolism are important steps in the pathogenesis of CM metastasis, with tumor vascularity as an important independent significant prognostic factor. The expression of chemokine receptors in cancer cells associated with the expression of the respective chemokine receptor ligands in the target sites of the metastasis is an interesting observation which may stimulate the development of new therapeutic strategies.

Humans↗

PubMed1999

The natural course of atherosclerosis. Part I: incidence and progression.

The natural course of early atherogenesis is not well established. The current prospective survey was designed to monitor 5-year changes in carotid atherosclerosis in a large, stratified random sample of the general population using high-resolution duplex ultrasound (Bruneck Study). Incidence rates of carotid atherosclerosis ranged from near zero to 184 per 1000 person-years. Most atherosclerotic lesions developed at sites with enhanced wall thickness. Incidence of atherosclerosis in premenopausal women was less than half of that observed in men of equal age. The sex difference disappeared within 5 years after menopause and may possibly be attributed to sex variations in body iron stores. Preexisting atherosclerotic lesions may experience 1 of 2 different types of disease progression. 1) The first main type of plaque growth causing nonstenotic or diffuse dilative atherosclerosis was characterized by slow and continuous plaque extension, which usually affected several lesions simultaneously and did not primarily focus on the carotid bifurcation. This step-by-step process relied on a cumulative exposure to well-known risk factors such as hyper-lipidemia. Compensatory enlargement of the artery at the site of active atherosclerosis effectively preserved a (near) normal lumen. 2) The second main type of plaque growth was characterized by occasional prominent increases in lesion size. This process primarily occurred in the internal carotid artery and was mediated by procoagulant risk factors in a way that peak levels were relevant rather than cumulative exposure. As the main underlying pathomechanism, atherothrombosis may be hypothesized. Marked increases in plaque size and insufficient vascular remodeling acted synergistically in producing a significant compromise of the lumen. The current study provides novel insights into the natural course of early carotid atherosclerosis, thereby focusing on disease incidence and various types of spontaneous disease progression. Nonstenotic or diffuse dilating atherosclerosis and focal stenotic disease were found to constitute epidemiologically and etiologically distinct disease entities that develop and proceed independently of each other.

Adult↗

PubMed1991

[Influences of pregnancy on the natural course of chronic glomerulonephritis with impaired renal function].

In an attempt to clarify the influence of pregnancy on the natural course of the chronic glomerulonephritis with impaired renal function (glomerular filtration rate: GFR less than or equal to 70 ml/min), the courses of 14 pregnancies occurring in 10 patients (seven with IgA nephropathy, one with membranoproliferative glomerulonephritis, one with membranous nephropathy and one with hereditary nephropathy) were studied. In 8 patients GFR measured before pregnancies ranged from 46 to 70 ml/min and in the other two creatinine clearance estimated in the first trimester of pregnancies was 62 and 49 ml/min, respectively. The pregnancies resulted in 10 live births, one spontaneous abortion, one artificial abortion and 2 neonatal deaths. In 2 out of 10 live births fetal weight was less than 2500 g. In 3 of 11 pregnancies there was neither increase in urinary protein nor elevation of blood pressure during pregnancies, while seven (64%) had increased proteinuria during the third trimester, and 4 of them were also complicated with hypertension. In 6 of 10 patients, there was no decrease in GFR during pregnancies. In three patients GFR was decreased from 70 to 36 ml/min, 70 to 58 ml/min and 62 to 48 ml/min, respectively. However, these reductions were considered to go with the natural course of respective patients because the reduction slopes were almost the same or rather mild in comparison with those estimated before or after pregnancies. The other patient also had a transient increase in serum creatinine level during two pregnancies, but the reciprocals of serum creatinine concentration before and after the pregnanciesdeclined linearly with time. These data suggest that pregnancy might have little influence on the natural course of the chronic glomerulonephritis even if complicated with renal functional impairment defined as GFR of 70 ml/min or less.

Adolescent↗

PubMed2003

The risk and natural course of age-related maculopathy: follow-up at 6 1/2 years in the Rotterdam study.

OBJECTIVES: To evaluate the natural course of age-related maculopathy (ARM) and to assess the incidence and absolute risk of its final stage, age-related macular degeneration (AMD). METHODS: In a population-based prospective cohort study of 6418 persons 55 years and older, we studied the incidence and natural course of ARM. Subjects underwent identical examinations, including stereoscopic fundus photography, at baseline and at 2.0 and 6(1/2) years' follow-up. Age-related maculopathy was graded according to the International Classification and Grading System for ARM and AMD, and stratified into 5 exclusive stages. Incidence was expressed in rates and 5-year absolute risks. RESULTS: At follow-up, 47 new cases of AMD were identified, with a ratio of neovascular-atrophic AMD of 1.4:1. The 5-year risk of AMD increased with more severe stages to 28.0% for subjects 55 years and older with indistinct drusen and pigmentary irregularities (stage 3). Age, but not sex, independently increased this risk to a maximum of 42.0% for subjects with stage 3 ARM who were 80 years and older. Individual ARM fundus signs that predicted best the development of AMD were 10 or more large drusen (> or =125 microm) and 10% or more of the grid area covered by drusen. Subjects who developed atrophic AMD showed no significant (P =.25) differences in baseline fundus signs and natural course compared with subjects who developed neovascular AMD. CONCLUSIONS: We provided the absolute risk of AMD as a function of age and early ARM fundus signs, and showed that both are prominent independent risk factors. The progression of ARM stages follows, after the appearance of the first soft drusen, a distinct course at a gradual pace that accelerates with increasing age.

Age Factors↗

PubMed1995

Early gastric cancer: its surveillance and natural course.

The present status of screening for gastric cancer, and the natural course of the disease, are the concerns of this paper. The development of new diagnostic modalities has led to an increase in the percentage of early gastric cancers detected. Improvements in technology, and alterations in nutrient intake, are linked to the reduction in the mortality from gastric cancer that has taken place. Observation of the natural course of gastric cancer development shows that "early gastric cancer" is genuinely the early stage of gastric cancer, and not a term for a different disease phenomenon. A "malignant cycle" was shown to be implicated in the process of cancer development.

Endoscopy, Gastrointestinal↗

PubMed1985

[Natural course of Ebstein's anomaly].

The natural course of Ebstein's anomaly of the tricuspid valve was studied in 42 conservative patients, their age ranging from 1 day to 38 years at 1st examination (12.3 +/- 1.5 years). Twenty-seven of 42 patients reported for a follow-up check after 3 to 21 years, while the remaining 15 had died as a natural outcome of the defect, heart failure and rhythm disorders being the most common causes of death. The 27 survivors had reached the age of 7-54 years (33.8 +/- 4.2 years), all of them showing a deterioration of the condition and progressing cardiomegaly.

Adolescent↗

PubMed1994

[Natural course in idiopathic scoliosis].

We still do not know enough about the natural course of untreated idiopathic scoliosis although more knowledge would be desirable from the point of view of deciding on adequate conservative treatment or operative therapy. We present the natural course of 110 cases of marked scoliosis and 135 cases of slight, untreated scoliosis with respect to age, sex and localization of the curve. The results are compared to those of other authors.

Adolescent↗

PubMed1998

Follow-up of Helicobacter pylori positive gastritis and argyrophil cells pattern during the natural course of gastric ulcer.

BACKGROUND: A follow-up of argyrophil cell hyperplasia in Helicobacter pylori-positive corpus gastritis in gastric ulcer patients during the natural course of ulcer disease. METHODS: Endoscopic biopsies (4 specimens) were obtained step-wise from the posterior wall of the corpus mucosa in 55 gastric ulcer (GU) patients. The natural course of GU was followed up in 38 patients during more than 10 years (maximum 19 years), and altogether 115 endoscopic examinations were made: 20 patients were re-examined once, 14 twice, and 4 three times. A total of 364 biopsies from 307 biopsy sites were stained by Grimelius' silver, hematoxylin-eosin, and Giemsa method for the analysis of the argyrophil endocrine cells, chronic gastritis, and H. pylori colonization, respectively, according to the Sydney System. RESULTS: Of 307 biopsy sites, 153 (50%) showed some grade of ACH. Focal (linear/micronodular) hyperplasia was found in 118 (77%) of biopsy sites; it was detected in 78 (66%) cases of atrophic corpus mucosa, but was present in only 14 (12%) cases of gastritis without atrophy or in the normal mucosa. In the follow-up patients, ACH evolved in 17 and progressed in 6 cases, and a simultaneous development of atrophic corpus gastritis was found in 20 cases. CONCLUSION: This study demonstrates that ACH evolves during the natural course of GU, alongside the development of chronic atrophic gastritis.

Adult↗

PubMed2005

Prevalence, characteristics and natural course of inappropriate sinus tachycardia.

AIMS: To study the prevalence, characteristics and natural course of inappropriate sinus tachycardia (IST). METHODS AND RESULTS: The prevalence and characteristics of IST were evaluated in a random sample of 604 middle-aged subjects. Seven of the subjects (1.16%) fulfilled the contemporary diagnostic criteria of IST. The systolic (147+/-11 mmHg vs. 130+/-13 mmHg, P<0.001) and diastolic ambulatory blood pressures (92+/-7 mmHg vs. 81+/-8 mmHg, P<0.001) were higher among the subjects with IST than among the controls. The other laboratory, echocardiographic and personality measurements, with the exception of the hostility score (10+/-2 vs. 8+/-3, P<0.001), revealed no differences between the groups. The natural course and prognosis of the disorder was assessed among the subjects fulfilling the IST criteria and nine previously diagnosed IST patients. During a mean follow-up of 6.0+/-2.4 years, none of the subjects developed any clinical or echocardiographic evidence of structural heart disease despite ongoing palpitations, and there was no significant reduction in the 24-h average HR (9+/-2 bpm vs. 89+/-8 bpm, P=0.204). CONCLUSION: The prevalence of IST in a middle-aged population was higher than previously assumed. Despite the chronic nature of the disorder, the prognosis of IST was benign. The causal relationship between IST and hypertension and/or hostile personality type remains speculative.

Chi-Square Distribution↗

PubMed2004

The natural course of schizophrenia and psychopathological predictors of outcome. A community-based cohort study.

The natural course of schizophrenia is extremely heterogeneous and generally considered unpredictable. This prospective research investigated the natural course of schizophrenia in a community-based population linked to an Italian Mental Health Center, looking for the identification of psychopathological predictors of outcome. Forty schizophrenic patients were assessed at baseline in a stabilized phase of illness with clinical scales of psychopathology and social functioning and afterwards were followed up for 36 months. All of them were treated with antipsychotic drugs. According to their symptoms and function scores patients were empirically classified into three groups with a cluster analysis: a group characterized by low symptoms and good functioning, a group with high symptoms and poor functioning and an intermediate group. A crosstabs analysis revealed that the empirical classification correctly predicted long-term outcome. A survival analysis with comparison of distributions (Wilcoxon Gehan test) also revealed significant differences in terms of hospital admission and occurrence of alcohol-related diagnosis across groups. This study suggests that the long-term outcome in schizophrenic patients followed by a community-based mental health service is generally poor and multifaceted. However, outcome may be predicted on the basis of the psychopathological and social functioning profile assessed in a stabilized phase of illness defined with operational criteria.

Adult↗

PubMed2006

Endometrial endometrioid carcinoma: a glimpse at the natural course.

OBJECTIVE: This study was undertaken to assess the natural course of endometrial endometrioid carcinoma by identifying untreated patients and those with a prolonged (>6 months) treatment delay. STUDY DESIGN: A chart review of 252 patients with histologically confirmed endometrial endometrioid carcinoma was conducted and clinical data of untreated patients and those with a prolonged treatment delay were abstracted. RESULTS: Seven patients (3 untreated and 4 with prolonged treatment delay) were identified. Five had clinical stage I and 5 had well-differentiated tumors. The survival of the untreated patients ranged from 5 to 59 months. Of the patients with prolonged treatment delay, 2 died more than 5 years after diagnosis and 2 are alive more than 5 years after diagnosis. CONCLUSION: The lengthy survival of our patients seems to indicate that the natural progression course, even in untreated patients, may be very slow in endometrial endometrioid carcinoma with favorable prognostic factors.

Aged↗

PubMed1994

Natural course of human benign prostatic hyperplasia with relation to urinary disturbance.

To examine the natural course of human benign prostatic hyperplasia (BPH), cases in health care examination with or without slight urinary symptoms were examined by echography. In comparison with these cases, the size of the prostate was examined in patients who received prostatectomy. Prostatic sizes of health care cases varied widely along with increasing age, but could be divided into two groups: increasing or no-change. According to serial determinations of prostatic sizes in the increasing group, the annual growth rate of the prostate was calculated as 1.65 +/- 1.13 and 0.85 +/- 0.44 g in men < 65 years old and in men > or = 65 years old, respectively. Distribution of prostatic sizes as a function of age in health care cases was similar to that in operated patients, showing that the size was not correlated with urinary symptoms or surgical indication. Since uroflow rates decreased along with increasing age in the no-change group of operated patients, aging was a factor in deterioration of uroflow. Between the increasing and the no-change groups in health care cases, differences were found in total cholesterol and neutral fat in serum, in addition to gamma-seminoprotein; the latter may be due to differences in the size of the prostate. In conclusion, natural course of the prostatic hyperplasia is separated into two groups, increasing and no-change. Occurrence of urinary symptoms does not simply relate to an increase in prostatic weight but, at least in part, to the aging process.

Adult↗

PubMed2001

Does allergen immunotherapy alter the natural course of allergic disorders?

Allergy in patients with atopy is caused by clinical adverse reactions to environmental antigen, which is often associated with allergen-specific immunoglobulin (Ig)E production. Since allergy reflects an inappropriate immunological reaction, a therapeutic approach related to immunology is likely to actively alter the natural course of allergic disorders. Allergen immunotherapy, known at various times as desensitisation or hyposensitisation, is very recently defined by the World Health Organization as therapeutic vaccines for allergic diseases. At present, it has become a common clinical practice in selected patients for the treatment and prevention of the recurrence of allergic disorders caused by insect venoms and has proven to be effective in changing the course of allergic responses induced by grass and tree pollen, animal hair and dander, house dust mite and mold, as demonstrated by improvement in clinical symptoms, skin prick test and medication scores. Reported effects of allergen immunotherapy on the natural course of allergic disorders include (i) prevention of reaction following re-sting in insect venom allergy; (ii) prevention or decrease the rate of the natural progress of allergic rhinitis to asthma; and (iii) inhibition of new sensitisation in monosensitised children. Many aspects of the immune responses associated with allergic disorders, including antibody production, cytokine secretion, T cell activation and local inflammatory reactions, are found to be significantly altered during and/or after immunotherapy. Specifically, the ratio of allergen-specific IgG4 to IgG1 correlates well with positive clinical outcome caused by allergen immunotherapy in patients with pollen-allergy. Allergen immunotherapy affects the cytokine profile of allergen-specific T cells and switches T(H)2 type immune responses in patients with atopy towards T(H)0 or T(H)1 type responses. Although the changes in the absolute value of T(H)1 or T(H)2 cytokines appear quite variable, the increase in the ratio of T(H)1/T(H)2 cytokines is very consistent among published reports, especially in the late stage of treatment. Accumulating evidence indicates that appropriate immunotherapy prevents the onset of new sensitisation and prevents the progress of allergic rhinitis to asthma. Although the changes in B cell and T cell responses, especially IgG antibodies and T(H)1/T(H)2 cytokine production, may be the major mechanism underlying the clinical efficacy of allergen immunotherapy and the prevention of the development of allergic phenotypic changes, multiple mechanisms may be involved in the outcome of alteration of the natural course of allergic disorders.

Adult↗