Miren la: Miren%20la | Spanish Translator

miren la – Translation into English – examples Spanish

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mirar la
miren
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These examples may contain rude words based on your search.

These examples may contain colloquial words based on your search.

look at the

look to the

look at that

watch the

behold the

Si esto no es posible, por favor, miren la siguiente síntesis.

It this is not possible, please look at the following synthesis.

Diles a tus amigos que miren la hora antes de venir.

Ask your friends to look at the time before showing up.

No tiene pulso, miren la herida en la cabeza.

There’s no heartbeat, look at the head wound.

Quiero decir, miren la forma en que de pronto se dispara.

I mean, look at the way he suddenly goes off.

Para ver cada diseño, miren la última foto publicada.

To see each design, look at the last picture posted.

Ahora miren la segunda imagen con los carillones y compárenla.

Now look at the second picture with the carillons and compare.

Dé tiempo para que los niños miren la foto.

Allow time for children to look at the picture.

Y miren la emoción que está en el aire.

And look at the excitement in the air.

Por favor miren la fotografía adjunta a este número.

Please look at the picture enclosed in this issue.

Y, mientras me detengo unos segundos, miren la pantalla.

And as I pause for a few seconds, have a look at the screen.

Pero, sólo por un momento, miren la cruz simplemente como una imagen.

But, just for a moment, look at the cross simply as an image.

Ahora miren la línea justo abajo de ella.

Now look at the one right below that.

Vamos, amigos, miren la hora.

Come on, guys, look at the time.

Sólo miren la miseria en esta villa empobrecida.

Just look at the misery in this impoverished village.

Finalmente, miren la vida del hombre.

Finally, look at the life of the man.

Así que miren la foto de nuevo.

So look at the photo again.

Quiero decir, miren la vista, sin embargo.

I mean, look at the view, though.

Hijos mío, miren la niebla a vuestro alrededor.

My sons, look at the mist all around us.

Quiero decir, miren la forma en como hablan.

I mean, look at the way they talk.

Por favor miren la última foto que se muestra con el color de la galjanoplastia chart.

Please look at the last photo that is displayed with the color plating chart.

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Miren la cara que pone! in English with examples

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miren la cara que pone!

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Spanish

miren la

English

look at the

Last Update: 2014-08-26

Usage Frequency: 1
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Spanish

miren la .

English

look in the .

Last Update: 2016-02-24

Usage Frequency: 1
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Spanish

«¡miren la casa!

English

“look at this house.

Last Update: 2018-02-13

Usage Frequency: 1
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Spanish

la cara que puso,

English

that face,

Last Update: 2018-02-13

Usage Frequency: 1
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Spanish

“miren la luna.

English

“look at the moon.

Last Update: 2018-02-13

Usage Frequency: 2
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Spanish

he puts it on the face,

Last Update: 2016-02-24

Usage Frequency: 1
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ahora miren la línea justo abajo de ella.

English

now look at the one right below that.

Last Update: 2015-10-13

Usage Frequency: 1
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Spanish

anormalidades de la cabeza y la cara, que incluyen:

English

abnormalities of the head and face, including:

Last Update: 2018-02-13

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We answer 8 questions about the Mirena coil that you were embarrassed to ask

Women who want a stable and reliable contraceptive effect without any extra effort often choose intrauterine devices (IUDs). They range from inert constructions that are considered obsolete and practically not used, to modern hormonal coils, such as Mirena.

Mirena is an intrauterine device coated with the hormone levonorgestrel. Unlike metal-containing spirals of the previous generation, which acted due to local inflammation of the cervix, it has a complex contraceptive effect:

● thickens the mucus in the cervical canal, preventing the penetration of spermatozoa;

● stimulates the production of uterine glycoprotein glycodelin A, which starts the process of death of a small part of the spermatozoa that enter the uterus;

● causes changes in the inner layer of the uterine wall to prevent implantation of the egg in those very rare cases when fertilization does take place.

Triple action ensures the high reliability of Mirena for the prevention of unwanted pregnancies. The Pearl Index – the main indicator of the effectiveness of contraception, is 0.1-0.3, which is a very good value, second only to surgical sterilization. Moreover, the effectiveness of contraception is the same for women of different age groups. And that’s not all the benefits: in addition to the contraceptive effect, Mirena has a therapeutic effect in case of heavy menstruation and a number of other pathologies that require hormone therapy.

Thanks to reliable contraception and a beneficial effect on the female body, Mirena deservedly occupies a leading position in the ranking of intrauterine devices used in Russia. However, despite its popularity, many women have questions about the use of Mirena, and patients do not always dare to talk about a sensitive topic with a doctor. Therefore, today we have prepared answers to typical questions that concern women who want to try intrauterine contraception.

№1 — how to prepare for the spiral setting?

It must be understood that any intrauterine devices have a number of contraindications for use. First of all, these are acute gynecological diseases, bleeding from the genital tract, congenital or acquired deformities of the uterus, malignant neoplasms of the genital organs and mammary glands. Therefore, before the procedure, the doctor conducts a standard examination on the gynecological chair and prescribes a number of tests: a cytological smear from the cervix to exclude cancerous and precancerous changes, a smear and blood tests for sexually transmitted infections (STIs).

#2 – how long can the coil be used?

The recommended period for wearing a spiral is 5 years. After this period, the spent IUD is removed from the uterus, and if necessary, it can be replaced with a new spiral to continue contraception. Many patients use intrauterine contraception for many years without any health problems, if you follow the regular visits to the doctor and take into account all contraindications.

№3 – Does the coil protect against venereal infections?

No, none of the IUD options provide protection against STIs. The only reliable method of preventing these infections is barrier contraception – male and female condoms, as well as latex wipes during oral sex. Therefore, for women who often change sexual partners, it is recommended to additionally use a condom or choose barrier contraception as the only method.

№4 – does Mirena affect the possibility of getting pregnant in the future?

The spiral does not cause irreversible inhibition of ovarian function, therefore, after its removal, the woman’s reproductive function is restored. In 96% of patients, conception becomes possible in the first 12 months after stopping contraception. It should be borne in mind that a small percentage of women experience complications that can still lead to infertility and miscarriage.

№5 – can Mirena increase the risk of gynecological diseases?

The hormonal coil has fewer adverse reactions than copper-based IUDs, but complications are not excluded. One of the most common are inflammatory and infectious diseases of the genital organs, the risk of which increases with prolonged use of the spiral. Wearing an IUD increases the likelihood of an ectopic pregnancy and, in rare cases, can cause uterine perforation.

However, due to the content of levonorgestrel, the spiral has a number of therapeutic effects:

● reduces the amount of menstrual bleeding in women with polymenorrhea;

● prevents the development of iron deficiency anemia with heavy menstrual bleeding;

● prevents hyperplastic processes in the endometrium in women in late reproductive age and premenopause;

● has a beneficial effect on the course of uterine fibroids, adenomyosis, premenstrual syndrome.

No. 6 – can Mirena fall out?

Any intrauterine device can change its position: fall out into the vagina or move deeper into the uterine cavity. In both cases, Mirena loses its contraceptive effect. In addition, such a complication is fraught with damage and even perforation of the wall of the affected organ.

The reasons for the fallout are:

● small size of the uterine cavity and increased tone of the myometrium, due to which the IUD is pushed into the vagina;

● incorrect installation of the contraceptive and the lack of ultrasound control a week after the procedure;

● incorrect selection of the spiral without taking into account the anatomical features of the female genital tract;

● Intense physical activity.

Displacement of the contraceptive can occur when using large sex toys, traumatic intercourse, inaccurate insertion of a tampon into the vagina. If a woman feels a foreign body in the vagina, notices an elongation of the spiral threads, suffers from pain in the lower abdomen and other symptoms, you should immediately contact a gynecologist who will check the condition of the spiral.

№7 – Does Mirena interfere with sex?

The spiral is located inside the uterus, only 2 thin threads enter the vagina, which are needed to control the correct position of the IUD. They are not felt by a woman either in everyday life or during intimacy. A man also cannot feel the threads from the spiral during sexual intercourse, so this type of contraception is considered comfortable for both partners. If discomfort occurs, this indicates a displacement of the spiral.

№8 — what to do if the coil fell out during intercourse?

If sexual intercourse ends with ejaculation, a woman has a small risk of becoming pregnant. This can be avoided by immediately contacting a gynecologist and consulting him about emergency contraception.

And finally, we want to remind you that gynecologists at ID-Clinic receive patients and give online consultations where you can discuss exciting questions about contraception. You can ask our doctors the most delicate questions and be sure that you will receive a detailed and ethical answer, and that all the information you provide will remain confidential. To make an appointment for a consultation, it is enough to leave a request in the online form.

Contraceptive and therapeutic benefits of the intrauterine levonorgestrel-releasing system Mirena® | Gevorkyan M.A., Manukhin I.B.

In the second half of the last century there was a serious revision of the role of women in society and the family. Not only the lifestyle of the woman has changed, but also the reproductive history. A woman of the 21st century is socially active, engaged in business and politics. This leads to a delay in the implementation of the generative function, and consequently, to the need for long-term use of various methods of contraception. Therefore, the answer to the question of what a modern woman wants is unequivocal – reliable and safe contraception.

In addition, it is known that the incidence of fibroids and/or endometriosis also increases after the age of 30, which affects not only reproductive health, but also the quality of life of young women. It is known that taking hormonal contraceptives is an effective prevention of uterine fibroids and endometriosis. The most popular methods of contraception include combined oral contraceptives (COCs), the latest generation of which contain minimal doses of estrogens and metabolically inert progestogens with antiandrogenic effects. However, many women have contraindications to estrogens, prompting researchers to search for effective progestogen-containing contraceptives. Unfortunately, tablet preparations require special care in adhering to the regimen and therefore are not very reliable. The deposited forms of progestogenic contraceptives have not found wide application: women refuse them due to constant acyclic spotting.
The most popular method of contraception in our country in the last century was intrauterine contraception (IUD). Adherence to IUD was mainly due to the convenience of the method and a negative attitude towards taking hormonal drugs. At the same time, inert and copper-containing intrauterine “spirals” (IUDs) were used. Currently, these IUDs are used much less frequently due to the high risk of pelvic inflammatory disease (PID), infertility, menorrhagia, and ectopic pregnancy.
Today, a fundamentally new IUD is widely used in the world – the intrauterine hormone releasing system Mirena®, which releases 20 μg of levonorgestrel per day (Bayer Schering Pharma). Mirena® is a flexible polyethylene T-shaped system, on the vertical rod of which is a reservoir containing levonorgestrel.
“Father of the idea” of the intrauterine releasing system – Dr. Tapani Lukkanen (Finland). Mirena® has been studied for a total of 20 years with 10,000 women. At 1990 Mirena® first went on sale in Finland. The creation of an intrauterine levonorgestrel-releasing system can be considered a breakthrough in the development of progestogen-containing contraceptives.
The mechanism of contraceptive action is based on a decrease in the proliferation of the endometrium, thickening of the cervical mucus, which prevents the penetration of spermatozoa, and a decrease in their mobility in the uterine cavity. Such a mechanism of action, fundamentally different from copper-containing IUDs, explains the presence of qualitatively new properties in Mirena. For example, Mirena® reduces the risk of PID, provides menstrual comfort, and has some therapeutic options. Mirena® does not affect ovarian function, does not suppress ovulation. Therefore, in the first 3-6 months, functional ovarian cysts may occur, which does not require additional medical intervention. In most cases, these formations regress on their own within 3 months.
The mechanisms of the therapeutic action of Mirena are implemented locally at the level of the endometrium, where the highest concentration of levonorgestrel (LNG) (468–1568 ng / g) is noted. At the same time, the content of LNG in the blood plasma is thousands of times less than in the endometrium (0.15–0.2 ng/g). This can explain the minimum side effects characteristic of Mirena and their predominant appearance in the first months after the introduction of the system – during the adaptation period.
Mirena® meets all modern requirements for contraceptives:
• efficiency and reliability – Pearl index 0. 01, comparable to that of sterilization;
• convenience – contraceptive protection for 5 years, no need for daily pills;
• no weight gain – minimum and short duration of side effects;
• rapid recovery of menstrual function – after 1-3 months. after removal;
• acceptability – after the first year of use, 93% of women continue to use the method.
The minimum examinations before the introduction of Mirena are well known to all doctors: history, gynecological examination, smear for flora and oncocytology, complete blood count, RW, HIV, hepatitis, ultrasound of the pelvic organs.
Contraindications to the introduction of Mirena are practically the same as for other IUDs:
• acute PID,
• infections of the lower genital tract;
• postpartum endometritis;
• cervicitis;
• infected abortion within the last 3 months;
• cervical dysplasia;
• malignant tumors of the uterus and cervix;
• malformations of the uterus.
All changes in the menstrual cycle (acyclic spotting in the first 3-6 months, further impoverishment of menstruation or amenorrhea) are reversible. Amenorrhea (uterine form), which develops against the background of the use of the Mirena® system, is due to the local effect of the hormone on the endometrium. Many women consider the presence of menstrual bleeding an integral part of femininity. In this regard, proper counseling is necessary, a conversation with a woman before the introduction of Mirena® with an explanation that the gonadotropic and ovarian function is not impaired.
By the way, about the expediency of menstrual bleeding. At the beginning of the 21st century, a group of famous scientists and doctors published the concept that monthly ovulation and menstruation are not mandatory, and in certain cases, due to significant fluctuations in hormone levels, pose a health risk, provoking the development and exacerbation of diseases such as anemia, arthritis, bronchial asthma, dysmenorrhea, endometriosis, uterine fibroids, premenstrual syndrome (PMS). “Disorders associated with menstruation are one of the leading causes of gynecological morbidity in the world” [12]. It is possible to reduce the number of menstruation and reduce the risks of dyshormonal gynecological diseases by prescribing COCs in a prolonged regimen. Many practitioners already know what a prolonged regimen of COC use is: 63 days of daily COC use, followed by a 7-day break. With this mode, not only the number of menstruation is reduced, but also the suppression of ovulation is more stable, which increases the effectiveness of the treatment of PMS, androgen-dependent dermatopathies, stimulates ovulation in patients with polycystic ovary syndrome (PCOS) (rebound effect), reduces the risk of recurrence of external genital endometriosis, stabilizes growth uterine fibroids. This trend in COC use has a pathophysiological basis. It is known that retrograde menstruation plays an important role in the pathogenesis of external genital endometriosis. It is obvious that by minimizing the number of periods, the risk of developing external genital endometriosis decreases. In addition, the consequence of taking COCs are atrophic processes in the endometrium. Accordingly, the invasive activity of such an endometrium is minimal, taking into account many other factors in the pathogenesis of external genital endometriosis [1]. On the issue of the pathogenesis of uterine fibroids, numerous studies have shown that under the influence of progesterone in the II phase of the cycle, the activity of apoptosis inhibitors and many oncogenic and mitogenic factors that promote tumor growth increase. During menstrual bleeding, contractions of the myometrium contribute to ischemia and activation of the proliferative potential of muscle cells, that is, the risk of developing fibroids increases [4,6].
From the above current trends in contraception, it becomes obvious that the uterine form of amenorrhea (reversible!) Is the prevention of hormone-dependent diseases of the pelvic organs. Practitioners have already guessed what will be discussed next. If we compare the oral intake of COCs in a prolonged mode and the intrauterine releasing system, in which there is no primary passage of the hormone through the hepatobiliary tract with a minimum concentration of levonorgestrel in the blood (with its maximum content in the endometrium), not only contraceptive, but also therapeutic and prophylactic advantages of Mirena become apparent. ®. Thus, the uterine form of amenorrhea and oligomenorrhea, which occur in women on the background of Mirena®, can be attributed to the desired therapeutic and prophylactic effects. Indeed, for women suffering from menorrhagia, Mirena® is the optimal method of contraception, which provides additional therapeutic effects.
Worldwide, this method of contraception is becoming a leader. Unfortunately, in Russia, the negative attitude towards the IUD, instilled over the years by practicing physicians, causes restraint not only among women, but also among doctors, and hinders the wider use of a fundamentally new IUD – the Mirena® hormonal releasing system [2]. The hormonal releasing system is designed for 5 years, which is very convenient – “set it and forget it!”.
In terms of non-contraceptive, therapeutic effects, the commitment of women and doctors in our country to Mirena® is higher. Mirena® is effective in the treatment of idiopathic menorrhagia, as well as those caused by internal endometriosis, small uterine fibroids. Menorrhagia affects up to 20% of women of reproductive age [3]. 5 to 20% of patients aged 30–49years of age refer to specialists for excessive menstrual bleeding [5]; 10% of healthy women have menorrhagia, which is diagnosed with menstrual blood loss of more than 80 ml during each menstruation [3];
Mirena® is effective in the prevention of recurrent endometrial polyps, endometrial hyperplasia (stage II after pathogenetic therapy), with dysfunctional uterine bleeding in the perimenopausal period.
In many European countries, Mirena® is successfully used to protect the endometrium from proliferative processes in postmenopausal women taking hormone replacement therapy (HRT) with estrogens. In our country, this aspect of the use of Mirena® has not yet been widely used. We hope that this is a matter of time and improvement of the qualifications of practicing doctors.
Let us dwell in more detail on the therapeutic aspects of the use of Mirena®.
Menorrhagia – menstrual bleeding with a regular cycle, but with more blood loss (? 80 ml), which causes:
• chronic anemia,
• psychological discomfort.
Causes of menorrhagia:
• idiopathic (no apparent cause),
• uterine fibroids,
• internal endometriosis (adenomyosis),
• genital infections,
• endometrial polyps,
• endometrial hyperplasia,
• thrombophilia.
The causes of idiopathic forms of menorrhagia are not fully understood, but seem to be genetically determined and occur in 9–13% of cases [11].
Uterine fibroids and/or internal
endometriosis
Mirena® effectively reduces the volume and duration of menstrual bleeding in menorrhagia associated with uterine myoma and adenomyosis (Scheme 1). However, according to our experience, in patients with this pathology, the introduction of Mirena® I stage is impractical, since in adenomyosis it is often in the first 3-6 months. observed acyclic bleeding. In this regard, many women have a negative attitude towards Mirena®, which requires additional detailed counseling of patients. Therefore, at stage I, we recommend therapy aimed at “impoverishment” of menstruation: aGnRH – 4-6 injections (medicated menopause) or Jeanine® in a cyclic regimen for 6-8 months. (against the background of the prolonged regimen, a high frequency of breakthrough bleeding was noted). Stage II – without waiting for the restoration of the menstrual cycle, after aGnRH or on the 5th day of the cycle after the abolition of Jeanine® – the introduction of Mirena®. This tactic is explained by the fact that both uterine fibroids and internal endometriosis are organic (anatomical) diseases and, therefore, by introducing Mirena® we are treating not a pathology, but a symptom – menorrhagia. Of the two proposed options for stage I, preference should be given to GnRH a (pronounced antigonadotropic effect), since in the next 3-6 months. the risk of functional cysts and, accordingly, acyclic spotting against the background of Mirena® is minimal. In addition, myoma nodes less than 2.5–3 cm in diameter undergo regression, which, with the subsequent administration of Mirena®, is more effective for stabilizing the growth of fibroids [4,6]. Once again, I would like to emphasize that Mirena® does not cure the patient of either internal endometriosis or uterine fibroids, but is very effective in regressing symptoms and preventing the progression of the disease [7]. Therefore, after the removal of Mirena® after 5 years, a relapse is possible, about which the patient must be warned. Re-introduction of Mirena® will solve this problem and prolong the period of remission.
Relapse Prevention
hyperplastic processes
endometrium
In many scientific papers, reports at congresses, practitioners are advised to prescribe Mirena® as a treatment for patients with endometrial hyperplastic processes. Taking into account the age of the patient, it is impossible to unequivocally follow such recommendations, since the causes of the development of endometrial hyperplasia are multifactorial. So, in women of reproductive age, the main pathogenetic mechanisms for the development of endometrial hyperplasia are due to impaired gonadotropic function and, as a result, anovulation with relative or absolute hyperestrogenism. These patients have an increase in gonadotropic activity. As you know, Mirena® does not have an antigonadotropic effect. It is logical that at the first stage it is advisable to recommend pathogenetic therapy aimed at suppressing the gonadotropic function of the pituitary gland and, as a result, ovarian folliculosteroidogenesis, resulting in endometrial atrophy (aGnRH, COC in a prolonged mode, etc. 6 months). Stage II recommended the introduction of Mirena® to prevent the recurrence of HPE (Scheme 2).
In patients with HPE in peri- and postmenopause against the background of physiological involutive processes in the reproductive system, characterized by a decrease in estrogen levels, it is possible to recommend the introduction of Mirena® as a stage I treatment [8–10]. In the presence of symptoms of CS, it is optimal to prescribe transdermal estrogens against the background of reliable protection of the endometrium by Mirena®.
In recent years, the incidence of recurrent endometrial polyps has increased. It is known that the genesis of polyps is multifactorial: hormone-dependent – more often in reproductive age, in postmenopause, estrogen-deficient endometritis plays an important role as the cause of polyp recurrence. The most debatable issue is the hormone therapy of fibrous polyps against the background of atrophic endometrium in postmenopausal patients. Traditional hormone therapy included 4-6 months. taking progestogens. Based on our experience with or without hormone therapy, postmenopausal polyp recurrence is equally common. Therefore, the most optimal prevention of recurrent polyps in postmenopausal women is the introduction of Mirena® for 5 years.
Mirena® and HRT
Perhaps this aspect of the use of Mirena® deserves the most attention. Recall that almost every third woman entering peri- and postmenopause has concomitant gynecological and somatic pathology. It is in this contingent of women (history of fibroids, endometriosis, menorrhagia, recurrent endometrial hyperplastic processes, metabolic syndrome, NIDDM, etc.) that menopause is accompanied by severe symptoms of menopausal syndrome (CS) and at the same time contraindications to hormone therapy. Patients with menorrhagia due to the above gynecological diseases on the background of traditional cyclic HRT have a higher incidence of breakthrough bleeding, which prompts the doctor and the patient to cancel treatment. And as a result, the symptoms of CS reduce the social activity and quality of life of a woman. Today, we can offer such patients an effective and safe therapy for the symptoms of CS – a combination of intrauterine use of Mirena® and transdermal administration of estrogen (Climara).
In conclusion, we can present the main advantages of Mirena®, which can significantly expand its use for various categories of women:
• Mirena® is the most optimal method for postpartum contraception, since there is no negative effect on lactation and, most importantly, it is convenient for a woman, since it is almost impossible to adhere to the regimen of taking progestin-only contraceptive pills.
• Mirena® is well tolerated by nulliparous women. The traditionally prevailing opinion about the negative impact on the reproductive health of IUDs (PID, menorrhagia, infertility) not only among women, but also among practitioners refers to copper-containing spirals and does not apply to Mirena®. For example, no IUD has a curative effect on menorrhagia, dysmenorrhea, PMS, etc. Mirena® has these capabilities and reduces the risk of PID.
• Mirena® is the contraceptive method of choice in late reproductive age, when there is the highest frequency of hormone-dependent diseases of the endo- and myometrium and contraindications to estrogen-containing COCs. Mirena® is the most reliable protection of the endometrium from hyperplastic processes, recurrent endometrial polyps, when using estrogen-replacement therapy in peri- and postmenopause. Mirena® is a prevention of recurrence of endometrioid cysts, stabilization of the growth of fibroids.
• Mirena® – ideal contraception + treatment.

Literature
1. Gevorkyan M.A., Manukhin I.B. et al. Prevention of recurrence of external genital endometriosis. reproduction problems. 2008. No. 1.S. 78–80.
2. Manukhin I.B., Tumilovich L.G., Gevorkyan M.A. Clinical lectures on gynecological endocrinology. M. Geotar-media. 2006.
3. Prilepskaya V.N., Bostanjyan L.L. Gynecology, v.09/N 2/2007
4. Tikhomirov A.L., Lubnin D.M. Contraception in patients with uterine myoma. Rus. honey. Magazine. 2002. Volume 10. No. 4. pp. 212–215.
5. Oehler, M. K. & Rees, M. C. P. Acta Obst Gyn Scand 2003: 82(5), 405–422.
6. Magalha J, Aldrighi JM, de Lima GR, Contraception 75 (2007), 193–198.
7. Aristides M. Bragheto. Effectiveness of the levonorgestrel–releasing intrauterine system in the treatment of adenomyosis was diagnosed and monitored by magnetic resonance imaging. Contraception 76 (2007) 195–199.
8. Sitruk–Ware R. The levonorgestrel intrauterine system for use in peri– and postmenopausal women.Contraception. 2007 Jun;75(6 Suppl):S155–60.
9. G. Scarselli, C. Tantani and M. Colafranceschi, Levonorgestrel–Nova–T and precancerous lesions of the endometrium, Eur J Gynecol Oncol 9 (1988), pp. 284–286.
10. Wildemeersch D et al. Management of patients with non-atypical and atypical endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: Long-term follow-up.