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Sample records for early puerperal complications

  1. CT and MR imaging findings of systemic complications occurring during pregnancy and puerperal period, adversely affected by natural changes

    PubMed Central

    Himoto, Yuki; Kido, Aki; Moribata, Yusaku; Yamaoka, Toshihide; Okumura, Ryosuke; Togashi, Kaori

    2015-01-01

    Dynamic physiological and anatomical changes for delivery may adversely induce various specific non-obstetric complications during pregnancy and puerperal period. These complications can be fatal to both the mother and the fetus, thus a precise and early diagnosis ensued by an early treatment is essential. Along with ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) have assumed an increasing role in the diagnosis. This article aims to discuss the pathophysiology of these complications, the indications for CT and MRI, and the imaging findings.

  2. [Puerperal infection].

    PubMed

    Barz, M S

    1986-01-01

    Puerperal infections are of great importance also under the conditions of modern obstetrics. There is a close connection with the problematic nature of hospitalism. The prospective study from 1,409 patients shows a puerperal fever at a percentage of 32.1%. Only 19.0% of the patients meet the criteria of a "standard puerperal morbidity". Within the complications occurring during the childbed period subinvolutio uteri holds the first place with 16.3%. The incidence of puerperal infections is influenced by predisposing factors dominated by the mode of accouchement. Ampicillin and chloramphenicol are the most used antibiotics. The preventive and therapeutic application of antibiotics is discussed. In the experimental part of the study the settlement of the vagina, the cervix, and the amniotic fluid is analysed. The evidence of causative organism for oxybiontic pathogenes partly also for anoxybiontic pathogenes and fungi is made. The fight against puerperal infections is particularly based on preventive measures. There must be mentioned a strict consideration of the antisepsis and asepsis as well as the restriction of predisposing factors. Under this precondition the wellaimed and indicated application of a therapy based on antibiotics will be successful. PMID:3518291

  3. [Puerperal mastitis].

    PubMed

    Noack, H

    1977-05-26

    The puerperal mastitis is a staphylococcal infection of the lactating mamma cumulating during the third and fourth week after delivery. It is seen three times as often after hospital than after house delivery, and it is also more frequent with primiparae than with multiparae. The infection is caused by bacterial hospitalism. Most commonly mamilla and milkducts are infected via the child's nasopharynx. Mastitis rarely occurs in non-nursing women. Early diagnosis before the appearance of all classical inflammatory symptoms is important, to start the treatment with antibiotics before abscess formation takes place. We mentioned Fucidine, Oleandomycin and Oxacillin as staphylococcal-effective, penicillinase-resistent antibiotics. Additionally low-dose X-ray radiation may be given. In case of abscess formation local antibiotic-instillation combined with oral antibiotic treatment should be tried before incision. It is best to incise an abscess only after is complete breakdown. Complications to be looked for are maternal sepsis and staphylococcal infection of the newborn. PMID:873413

  4. Early complications. Chylothorax.

    PubMed

    Vallires, E; Karmy-Jones, R; Wood, D E

    1999-08-01

    Postpneumonectomy chylothorax is a very common but serious complication. Drainage of the pneumonectomy space, metabolic and nutritional support with TPN, and absolute enteral rest may lead to control of the leak. Failure of these measures to obtain a rapid resolution of the chyle losses should be followed by early surgical intervention in most instances in an effort to alleviate the chronic metabolic, nutritional, and immunological consequences of prolonged chyle losses. PMID:10459431

  5. Early respiratory complications after liver transplantation

    PubMed Central

    Feltracco, Paolo; Carollo, Cristiana; Barbieri, Stefania; Pettenuzzo, Tommaso; Ori, Carlo

    2013-01-01

    The poor clinical conditions associated with end-stage cirrhosis, pre-existing pulmonary abnormalities, and high comorbidity rates in patients with high Model for End-Stage Liver Disease scores are all well-recognized factors that increase the risk of pulmonary complications after orthotopic liver transplantation (OLT) surgery. Many intraoperative and postoperative events, such as fluid overload, massive transfusion of blood products, hemodynamic instability, unexpected coagulation abnormalities, renal dysfunction, and serious adverse effects of reperfusion syndrome, are other factors that predispose an individual to postoperative respiratory disorders. Despite advances in surgical techniques and anesthesiological management, the lung may still suffer throughout the perioperative period from various types of injury and ventilatory impairment, with different clinical outcomes. Pulmonary complications after OLT can be classified as infectious or non-infectious. Pleural effusion, atelectasis, pulmonary edema, respiratory distress syndrome, and pneumonia may contribute considerably to early morbidity and mortality in liver transplant patients. It is of paramount importance to accurately identify lung disorders because infectious pulmonary complications warrant speedy and aggressive treatment to prevent diffuse lung injury and the risk of evolution into multisystem organ failure. This review discusses the most common perioperative factors that predispose an individual to postoperative pulmonary complications and these complications’ early clinical manifestations after OLT and influence on patient outcome. PMID:24409054

  6. Early Complications Following Cemented Modular Hip Hemiarthroplasty

    PubMed Central

    Sullivan, Niall P.T; Hughes, Andrew W; Halliday, Ruth L; Ward, Abigail L; Chesser, Tim J.S

    2015-01-01

    Introduction : Hemiarthroplasty is the recommended treatment for displaced, intracapsular, femoral neck fractures. This study aimed to evaluate the early complications following insertion of the JRI Furlong cemented hemiarthroplasty, a contemporary, modular, double tapered, polished prosthesis. Method : A series of 459 consecutive patients (May 2006 - June 2009) treated with a JRI hemiarthroplasty with a minimum of one-year (1-4years) follow-up were evaluated. Data collected retrospectively from clinical records and hospital databases included patient demographics, mortality, deep infection, dislocation, periprosthetic fracture, and any requirement for revision or complications related to the prosthesis. Results : Full data were available for 429 of 459 (93%), partial data for 30 (7%). Average age was 83 years (52-100), 76% were female. One-year mortality was 24%. Intraoperative fractures occurred in 17 patients (3.7%). There were two intraoperative deaths. There were nine early deep wound infections (2%). There were two revisions to total hip replacement (THR), four patients required conversion to THR and one underwent an excision arthroplasty procedure. Discussion : Early surgical outcomes for the JRI hemiarthroplasty prosthesis are equivalent or superior to other major hemiarthroplasty prostheses previously reported however, there was a high intraoperative fracture rate of 3.7%. We recommend using a stem one size smaller than the final broach in fragile, osteoporotic bone. No patients re-presented with aseptic loosening or stem failure. PMID:25685248

  7. Carbapenem Resistant Organisms: An Unusual Aetiology for Puerperal Sepsis

    PubMed Central

    Vijayaselvi, Reeta; Balaji, V; Benjamin, Santosh J.; Sahni, Rani Diana

    2015-01-01

    Puerperal infection is a common complication of labour. It occurs universally and is usually responsive to first line antibiotics. However, resistance to first line antibiotics and even second line antibiotics is becoming more wide spread. We report a case of puerperal infection caused by carbapenem resistant organisms leading to prolonged fever and hospitalisation. A 28-year-old primigravida, following caesarean section done elsewhere, for elevated blood pressure presented with high grade fever. The patient was treated with antibiotic to which she failed to respond. She underwent laparotomy twice and only improved after Colistin was combined with Meropenam, based on urine and pus culture reports. PMID:26393170

  8. [Radiotelemetric studies on uterine motility in cows during the 3d period of labor and the early puerperal period].

    PubMed

    Kostov, I; Bodurov, N

    1979-01-01

    The outside appearance of a one-channel radiotelemetric system is presented and a short description of supplementary devices for the study of uterine motility in cows is given. The radiotube consisting of an inductive converter and a two-transistor sound generator is described in short. The tube is placed directly in the uterine cavity through the cervical canal. The numerical values of contractile uterine activity in hours post delivery up to the 120 hour are presented in one table and a graph. Original registering of normal uterine activity and of reflectory inhibition of the same are shown as well as registerings of other functions of the organism through the uterus such as urination, defecation, lowing and belching. The contractile activity of the uterus during a normal course of the third stage of labour and the early puerperium is most strongly expressed during the first day post calving. The duration of this activity in the following days is directly dependent on the individual characteristics of the organism. PMID:545847

  9. Early Diagnosis of a Large Vesical Calculus Complicating Pregnancy

    PubMed Central

    Pricilla, Ruby Angeline; David, Kirubah Vasandhi; Venkatesan, Sankarapandian; Benjamin, Santosh Joseph

    2013-01-01

    Vesical calculus-complicating pregnancy is rare. This is a case report of a large vesical calculus-complicating pregnancy. The early diagnosis and appropriate surgical management of the large vesical calculus prevented complications like recurrent urinary tract infections and obstructed labor. It enabled the mother to have an uneventful vaginal delivery. PMID:24479053

  10. Puerperal uterine inversion managed by the uterine balloon tamponade

    PubMed Central

    Thiam, Mariétou; Niang, Mouhamadou Mansour; Gueye, Lamine; Sarr, Fatou Rachel; Dieme, Marie Edouard Faye; Cisse, Mamadou Lamine

    2015-01-01

    The uterine inversion is a rare and severe puerperal complication. Uncontrolled cord traction and uterine expression are the common causes described. We report a case of uterine inversion stage III caused by poor management of the third stage of labor. It was about a 20 years old primigravida referred in our unit for postpartum hemorrhage due to uterine atony. After manual reduction of the uterus, the use of intra uterine balloon tamponade helped to stop the hemorrhage. The uterine inversion is a rare complication that may cause maternel death. The diagnosis is clinical and its management must be immediate to avoid maternal complications. PMID:26977239

  11. [Puerperal uterine inversion].

    PubMed

    Slaoui, M A; Bouchikhi, C; Banani, A

    2010-09-01

    The uterine inversion defines itself anatomically as the invagination of the uterine bottom "finger of glove" until be able to at most express itself in the vulva. It is a dramatic accident of the delivery and a sporadic occurrence in countries with low medical entity, this rarity which can mislead the practitioner, the delay of the diagnosis ends in redoubtable complications even the maternal death. Through a retrospective study concerning six case reports brought together within CHU Hassan II of Fez spreading out over eight years and review of literature, we try to describe different aspects epidemiological, etiologic, therapeutic and prognosis of this rather particular entity. PMID:21086583

  12. Early Complications of Hyperleukocytosis and Leukapheresis in Childhood Acute Leukemias.

    PubMed

    Abla, Oussama; Angelini, Paola; Di Giuseppe, Giancarlo; Kanani, Mohamed F; Lau, Wendy; Hitzler, Johann; Sung, Lillian; Naqvi, Ahmed

    2016-03-01

    Hyperleukocytosis in children with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) is associated with early morbidity and mortality. The benefit from leukapheresis is controversial, and its complications are not well defined. We analyzed the frequency of early complications in children with ALL and AML presenting with white blood cell (WBC) count >10010/L, and the type and frequency of complications related to leukapheresis. During a 12-year period, 84 of 634 (13%) ALL and 18 of 143 (12.5%) AML patients presented with hyperleukocytosis. Leukapheresis was performed in 18 ALL and 12 AML patients. The median initial WBC was 47410/L in the leukapheresis group compared with 17510/L in the nonleukapheresis group. Neurological leukostasis occurred in 6 ALL (7.1%) and 4 AML (22.2%) patients. Pulmonary leukostasis occurred in 16 ALL (19%) and 4 AML patients (22.2%). Neurological symptoms improved in few patients after leukapheresis, except in patients with very high WBC (>65010/L in ALL and >40010/L in AML). Leukapheresis improved respiratory symptoms in some patients but caused worsening symptoms in others. Early death was associated with neurological complications, AML diagnosis, and coagulopathy. Leukapheresis did not delay initiation of chemotherapy, nor did it impact early response to chemotherapy or long-term survival. Complications included femoral vein thrombosis, electrolyte imbalances, and hemodynamic instability, which were all reversible. The role of leukapheresis as a cytoreductive procedure in childhood hyperleukocytic leukemia remains to be well defined. PMID:26794706

  13. [Puerperal infections. From Semmelweis to current problems].

    PubMed

    Bjro, K

    1993-12-10

    Maternity hospitals began to be established in the middle of the 18th century to relieve the distress of the poor. As the number of lying-in hospitals increased, so did the cases of puerperal sepsis. The death rate from puerperal sepsis in Norway was high and remained so until 1934. Semmelweis studied the maternal mortality rates in two obstetric clinics in Vienna for the years 1841-46. He declared that puerperal fever was transmitted by the doctors who taught in the dissecting room and went straight from there into the labour wards. I 1847 he instructed all doctors or students to scrub their hands in a solution of chloride of lime before they delivered, examined or touched any patient. The haemolytic streptococcus was finally proved to be the cause of puerperal sepsis by Louis Pasteur in 1879. There was a significant drop in mortality rates in maternity hospitals after the introduction of antiseptic and aseptic techniques around 1880. Deaths from puerperal fever paralleled deaths from erysipelas, and both conditions declined after 1934. Puerperal fever and pelvic inflammation is still a clinical problem. The author discusses sexually transmitted diseases and multibacterial causes. PMID:8278957

  14. Early complications after interventions in patients with acute pancreatitis

    PubMed Central

    Wei, Ai-Lin; Guo, Qiang; Wang, Ming-Jun; Hu, Wei-Ming; Zhang, Zhao-Da

    2016-01-01

    AIM: To identify the possible predictors of early complications after the initial intervention in acute necrotizing pancreatitis. METHODS: We collected the medical records of 334 patients with acute necrotizing pancreatitis who received initial intervention in our center. Complications associated with predictors were analyzed. RESULTS: The postoperative mortality rate was 16% (53/334). Up to 31% of patients were successfully treated with percutaneous catheter drainage alone. The rates of intra-abdominal bleeding, colonic fistula, and progressive infection were 15% (50/334), 20% (68/334), and 26% (87/334), respectively. Multivariate analysis indicated that Marshall score upon admission, multiple organ failure, preoperative respiratory infection, and sepsis were the predictors of postoperative progressive infection (P < 0.05). Single organ failure, systemic inflammatory response syndrome upon admission, and C-reactive protein level upon admission were the risk factors of postoperative colonic fistula (P < 0.05). Moreover, preoperative Marshall score, organ failure, sepsis, and preoperative systemic inflammatory response syndrome were the risk factors of postoperative intra-abdominal bleeding (P < 0.05). CONCLUSION: Marshall score, organ failures, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome, and C-reactive protein level upon admission are associated with postoperative complications. PMID:26973421

  15. Central nervous system infectious complications early after liver transplantation.

    PubMed

    Feltracco, P; Barbieri, S; Furnari, M; Milevoj, M; Rizzi, S; Galligioni, H; Salvaterra, F; Zanus, G; Cillo, U; Ori, C

    2010-05-01

    Infectious complications contribute to significant patient morbidity and mortality in orthotopic liver transplant (OLT) recipients. Early central nervous system (CNS) involvement (within the first month after OLT) by infectious disease is essentially set off by aggressive surgical procedures, severe morbid conditions of the pretransplant period, initial graft dysfunction, permanence of intravascular catheters, and prolonged mechanical ventilation. The type and severity of CNS infection may be determined by many factors, such as posttransplant adverse events; prolonged or repeated surgery with massive intraoperative transfusions, net state of immunosuppression, recurrence of infections by immunomodulating viruses, and retransplantation. Bacteria, viruses, and fungi can spread to the CNS just as they affect the abdomen, blood stream, respiratory tract, urine, drainages, etc. Because immunosuppressive drugs may modify the clinical presentation of CNS infections, it is very important to maintain vigilance and attend to minor neurologic symptoms. Special attention should therefore be given to cerebral investigation in patients with prolonged pulmonary contamination, unresponsive fever, and heavy corticosteroid therapy, primarily when they became disoriented, develop seizures, or exhibit focal neurologic signs. Clinical response to medical therapy may sometimes be poor because of chronic encapsulation of the pathogen, development of resistance, and/or catastrophic hemorrhagic complications. PMID:20534265

  16. Puerperal sepsis in the 21st century: progress, new challenges and the situation worldwide.

    PubMed

    Buddeberg, Bigna S; Aveling, Wynne

    2015-10-01

    Puerperal sepsis is one of the five leading causes of maternal mortality worldwide, and accounts for 15% of all maternal deaths. The WHO defined puerperal sepsis in 1992 as an infection of the genital tract occurring at any time between the rupture of membranes or labour and the 42nd day post partum; in which, two or more of the following are present: pelvic pain, fever, abnormal vaginal discharge and delay in the reduction of the size of the uterus. At the same time, the WHO introduced the term puerperal infections, which also include non-genital infections in the obstetric population. Recent epidemiological data shows that puerperal sepsis and non-genital tract infections are a major area of concern. In puerperal sepsis, group A streptococcus (GAS) is the most feared pathogen. Up to 30% of the population are asymptomatic carriers of GAS. GAS commonly causes throat infections. Women who died from GAS-positive sepsis all had signs of a throat infection themselves or one of their family members suffered from a throat infection. The pathway of infection is from the hands of the pregnant women or the mother to her perineum. In non-genital tract infections, influenza viruses and the HIV pandemic in the developing part of the world are responsible for many maternal deaths, and demand our attention. The physiological changes of pregnancy and the puerperium can obscure the signs and symptoms of sepsis in the obstetric population. A high level of suspicion is, therefore, needed in the care for the sick pregnant patient. If sepsis is suspected, timely administration of antibiotics, sepsis care bundles, multidisciplinary discussion and early involvement of senior staff members are important to improve outcome. PMID:26310266

  17. EARLY SURGICAL COMPLICATIONS AFTER GASTRIC BY-PASS: A LITERATURE REVIEW

    PubMed Central

    ACQUAFRESCA, Pablo A.; PALERMO, Mariano; ROGULA, Tomasz; DUZA, Guillermo E.; SERRA, Edgardo

    2015-01-01

    Introduction Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones. Method Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. Results There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction. Conclusions Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention. PMID:25861076

  18. The Effect of Neoadjuvant Therapy on Early Complications of Esophageal Cancer Surgery

    PubMed Central

    Rajabi Mashhadi, Mohammadtaghi; Bagheri, Reza; Abdollahi, Abbas; Ghamari, Mohammad Javad; Shahidsales, Soudabeh; Salehi, Maryam; Shahkaram, Reza; Majidi, Mohamad Reza; Sheibani, Shima

    2015-01-01

    Introduction: Early diagnosis and appropriate treatment is required in esophageal cancer due to its invasive nature. The aim of this study was to evaluate early post-esophagectomy complications in patients with esophageal cancer who received neoadjuvant chemoradiotherapy (NACR). Materials and Methods: This randomized clinical trial was carried out between 2009 and 2011. Patients with lower-third esophageal cancer were randomly assigned to one of two groups. The first group consisted of 50 patients receiving standard chemoradiotherapy (Group A) and then undergoing surgery, and the second group consisted of 50 patients undergoing surgery only (Group B). Patients were evaluated with respect to age, gender, clinical symptoms, type of pathology, time of surgery, perioperative blood loss, and number of lymph nodes resected as well as early post-operative complicate including leakage at the anastomosis site, chylothorax and pulmonary complications, hospitalization period, and mortality rate within the first 30 days after surgery. Results: The mean age of patients was 55 years. Seventy-two patients had squamous cell carcinoma (SCC) and 28 patients had adenocarcinoma (ACC). There was no significant difference between the two groups with respect to age, gender, time of surgery, complications including anastomotic leakage, chylothorax, pulmonary complications, cardiac complications, deep venous thrombosis (DVT), or mortality. However, there was a significant difference between the two groups regarding hospital stay, time of surgery, perioperative blood loss, and number of lymph nodes resected. Conclusion: The use of NACR did not increase early post-operative complications or mortality among patients with esophageal cancer. PMID:26788476

  19. The Association of Birth Complications and Externalizing Behavior in Early Adolescents: Direct and Mediating Effects

    PubMed Central

    Liu, Jianghong; Raine, Adrian; Wuerker, Anne; Venables, Peter H.; Mednick, Sarnoff

    2012-01-01

    Prior studies have shown that birth complications interact with psychosocial risk factors in predisposing to increased externalizing behavior in childhood and criminal behavior in adulthood. However, little is known about the direct relationship between birth complications and externalizing behavior. Furthermore, the mechanism by which the birth complications predispose to externalizing behavior is not well explored. This study aims to assess whether birth complications predispose to early adolescent externalizing behavior and to test whether Intelligence Quotient (IQ) mediates relationships between predictor and outcome variables. We used data from a prospective, longitudinal birth cohort of 1,795 3-year-old boys and girls from Mauritius to test hypotheses. Birth complications were assessed from hospital record data, malnutrition from a pediatric exam at age 3 years, psychosocial adversity from parental interviews at age 3 years, and externalizing behavior problems from parental ratings at age 11 years. We found that babies with birth complications are more likely to develop externalizing behavior problems at age 11. Low IQ was associated with birth complications and was found to mediate the link between early predictors and later externalizing behavior. These prospective, longitudinal findings have potential clinical implications for the identification of early adolescent externalizing behavior and for public health attempts to prevent the occurrence of child externalizing behavior problems. PMID:22485069

  20. Early complications after instrumentation of the lumbar spine using cortical bone trajectory technique.

    PubMed

    Patel, Shalin S; Cheng, Wayne K; Danisa, Olumide A

    2016-02-01

    This retrospective chart review aimed to identify and report on a series of early complications that resulted from instrumentation of the lumbar spine using the cortical bone trajectory (CBT) technique. CBT technique is a novel method for fixation of the lumbar spine. Since it was first described in 2009 this technique has gained significant popularity. Here we report a series of early complications that have developed in patients who had lumbar spine fusion using the CBT technique. A retrospective chart review was performed in which all cases utilizing the CBT technique for instrumentation of the lumbar spine by two fellowship trained spine surgeons at our institution between July 2012 and May 2014 were reviewed. Medical records were reviewed to determine the number of patients who went on to develop an early complication after instrumentation with this technique. An early complication was defined as any of the following occurring within 3months of surgery: (1) early screw loosening confirmed by post-operative CT scan, (2) evidence of fracture development confirmed by post-operative CT scan, (3) intra-operatively identified durotomy, (4) superficial or deep post-operative infection and (5) neurological injury. A total of 22 cases using the CBT technique were performed in our department. Of these cases two patients went onto develop early screw loosening, one developed an intra-operative pars fracture, one developed a dural tear and lastly, one patient developed both a pedicle fracture and early screw loosening. At our institution a total of five patients thus far have developed early complications after undergoing instrumentation of the lumbar spine using the CBT technique between 2012-2014. PMID:26482459

  1. Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair

    PubMed Central

    Bastos Gonçalves, F; Baderkhan, H; Verhagen, H J M; Wanhainen, A; Björck, M; Stolker, R J; Hoeks, S E; Mani, K

    2014-01-01

    Background Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance. Methods Patients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6–18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks. Results Some 597 EVARs (71·1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47·6 per cent), moderate shrinkage (5–9 mm) in 142 (23·8 per cent) and major shrinkage (at least 10 mm) in 171 patients (28·6 per cent). Four years after the index imaging, the rate of freedom from complications was 84·3 (95 per cent confidence interval 78·7 to 89·8), 88·1 (80·6 to 95·5) and 94·4 (90·1 to 98·7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3·11; P < 0·001). Moderate compared with major shrinkage (HR 2·10; P = 0·022), early postoperative complications (HR 3·34; P < 0·001) and increasing abdominal aortic aneurysm baseline diameter (HR 1·02; P = 0·001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage. Conclusion Early change in aneurysm sac diameter is a strong predictor of late complications after EVAR. Patients with major sac shrinkage have a very low risk of complications for up to 5 years. This parameter may be used to tailor postoperative surveillance. PMID:24752772

  2. Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis

    PubMed Central

    Chaudhary, Poras; Nabi, Ishaq; Ranjan, Gyan; Tiwari, Alok Kumar; Kumar, Sanjay; Kapur, Arun; Arora, Mohinder P.

    2015-01-01

    Background To determine the indications, nature, and rate of early complications of temporary loop ileostomy created in emergency for benign diseases, their management, and to find out the associated risk factors. Methods A total of 630 patients undergoing temporary loop ileostomy for benign diseases were studied prospectively over a period of 6 years. Stoma-related early complications occurring within 6-8 weeks were analyzed. Only emergency cases were included in this study. Descriptive statistics were used to summarize the data and statistical significance was evaluated by applying the Pearson’s chi-square test. Results Typhoid perforation (n=402) was the most commonpathology, followed by tuberculosis (n=106); trauma (n=81); and intestinal obstruction with gangrenous bowel (n=41). 299 patients had no stoma-related complications. Skin excoriation was the most commonstoma-related complication. Age more than 50 years; shock at presentation; delay in presentation; delay in surgery; presence of comorbidities; and surgery done out of working hours, were associated with increased complications. Conclusion Temporary loop ileostomy for perforation peritonitis due to benign systemic diseases like typhoid fever and tuberculosis confers a very high morbidity. PMID:25609137

  3. Drug resistance and molecular epidemiology of aerobic bacteria isolated from puerperal infections in Bangladesh.

    PubMed

    Ahmed, Salma; Kawaguchiya, Mitsuyo; Ghosh, Souvik; Paul, Shyamal Kumar; Urushibara, Noriko; Mahmud, Chand; Nahar, Kamrun; Hossain, Mohammad Akram; Kobayashi, Nobumichi

    2015-06-01

    Puerperal infection is a common complication during postnatal period in developing countries. Bacterial species, drug resistance, and genetic characteristics were investigated for a total of 470 isolates from puerperal infections in Bangladesh for a 2-year period (2010-2012). The most common species was Escherichia coli (n=98), followed by Enterococcus faecalis (n=54), Staphylococcus haemolyticus (n=33), Proteus mirabilis (n=32), Staphylococcus aureus (n=27), Klebsiella pneumoniae (n=22), and Enterobacter cloacae (n=21). S. aureus and Acinetobacter baumannii were isolated at a higher frequency from wound infections after cesarean section, while E. coli, E. cloacae, and K. pneumoniae were isolated from community-acquired endometritis and urinary tract infections. Resistance to third-generation cephalosporins was frequent for Enterobacteriacae, and was mainly mediated by blaCTX-M-1 group beta-lactamases. The CTX-M gene in E. coli from the four phylogroups was identified as blaCTX-M-15, and phylogroup B2 isolates with blaCTX-M-15 were classified into ST131 with O25b allele, harboring aac(6')-Ib-cr and various virulence factors. Carbapenemase genes blaNDM-1 and blaNDM-7 were identified in one isolate each of phylogroup A E. coli. Methicillin-resistant S. aureus isolates had type IV or V SCCmec, including isolates of ST361 (CC672), which is related to an emerging ST672 clone in the Indian subcontinent. This study revealed the recent epidemiological status of aerobic bacteria causing puerperal infections in Bangladesh, providing useful information to improve clinical practice and infection control. PMID:25555043

  4. Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial

    PubMed Central

    Abdollahi, Ali Akbar; Mehranfard, Shahzad; Behnampour, Nasser; Kordnejad, Abdol Mohamad

    2015-01-01

    Introduction: After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. Methods: In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol), early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS) of pain and Kristin Swain's check list was applied to evaluate the severity of bleeding and hematoma. Results:None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference. Conclusion: Based on the findings of this study, changing patients' position can be safe and they can be ambulated early after angiography. PMID:26171374

  5. Familial liability, obstetric complications and childhood development abnormalities in early onset schizophrenia: a case control study

    PubMed Central

    2011-01-01

    Background Genetic and environmental risk factors and gene-environment interactions are linked to higher likelihood of developing schizophrenia in accordance with the neurodevelopmental model of disease; little is known about risk factors and early development in early-onset schizophrenia (EOS) and very early-onset schizophrenia (VEOS). Methods We present a case-control study of a sample of 21 patients with EOS/VEOS and a control group of 21 patients with migraine, recruited from the Child Neuropsychiatry Unit, Department of Neurologic and Psychiatric Science, University of Bari, Italy. The aim was to assess the statistical association between VEOS/EOS and family history for psychiatric disorders, obstetric complications and childhood developmental abnormalities using 2 × 2 tables and a Chi Squared or Fisher test. Results The results show a statistical association between EOS/VEOS and schizophrenia and related disorders (P = 0.02) and personality disorders (P = 0.003) in relatives, and between EOS/VEOS and developmental abnormalities of early relational skills (P = 0.008) and learning (P = 0.04); there is not a statistically relevant difference between cases and controls (P > 0.05) for any obstetric complications (pre, peri and postpartum). Conclusions This study confirms the significant role of familial liability but not of obstetric complications in the pathogenesis of VEOS/EOS; the association between childhood developmental abnormalities and EOS/VEOS supports the neurodevelopmental model of disease. PMID:21492438

  6. Neonatal infected subgaleal hematoma: an unusual complication of early-onset E. coli sepsis.

    PubMed

    Chang, Hung-Yang; Cheng, Kun-Shan; Liu, Yu-Peng; Hung, Hsiao-Fang; Fu, Hua-Wen

    2015-04-01

    Subgaleal hematoma (SGH) is an uncommon but potentially lethal medical emergency in newborns. Delay in diagnosis may lead to mortality and morbidity. Infection of an SGH is extremely rare. We report an infected SGH with abscess formation as a complication of early-onset Escherichia coli sepsis in a term neonate. The patient was discovered to have SGH soon after birth. Early-onset E. coli sepsis developed on Day 3 of life. The SGH became infected, with abscess formation 1 week later. The infected SGH was probably due to direct hematogenous spreading of sepsis. The patient was successfully treated without complications. Clinicians should be aware that SGH is a potential site of infection and infection may be caused either by direct hematogenous extension or from traumatic scalp lesions. Appropriate antibiotic treatment and surgical debridement are necessary when an infected SGH occurs. PMID:23597516

  7. [Clinical examinations of gilts with puerperal septicemia and toxemia].

    PubMed

    Bostedt, H; Maier, G; Herfen, K; Hospes, R

    1998-11-01

    In a clinical examination on 78 gilts suffering from feverish puerperal illness the signs were documented. 42 gilts without puerperal disturbances out of the same farms (n = 22) were used as a control. Data for statistics were recorded in minute-books, listing 38 parameters, partly divided in three or four subunits. Within the first 24 hours after parturition 60% of the probands were registered, the other gilts up to the 72nd hour after parturition. 42.3% of the patients beared for the first or second time. Duration of partus averaged more than six hours in 85.9% of patients with consequent puerperal illness, whereas probands of the same age in the control group finished parturition in less than three hours (78.8%; p < or = 0.01). Frequency of obstetrical intervention measured 27% in the group of patients, in the group of probands 9.5% (p < or = 0.05). Gilts with following puerperal illness delivered 1.1 piglets more than healthy individuals (p < or = 0.05) and showed an increased stillbirth rate (p < or = 0.01). Signs of clinical interest in puerperal illness were increase of body temperature (p < or = 0.01), cardiac rate (p < or = 0.01) and respiratory frequency (p < or = 0.01). Approximately 75% of the patients showed anorexia, 66% abnormal faecal consistency. 24.4% of the diseased animals showed exclusively signs of mastitis, in 29.5% there was a combination of mastitis and inflammatory affection of the genital system to be diagnosed, in 46.1% of the cases a solitary infection of the reproductive tract was to be stated. Predominantly E. coli, followed by Staphylococcus spp. and Streptococcus spp. were isolated from the genital tract. The results of this study emphasize the clinical necessity to differentiate between isolated mastitis and puerperal septicaemia respectively toxaemia in cases of feverish puerperal illness. Puerperal septicaemia and toxaemia can, but do not have to be associated with mastitis in gilts. PMID:9857412

  8. [Role of local lymphatic stimulation in the prevention of early complications after stomach surgeries].

    PubMed

    Dzhumbaev, E S

    1993-12-01

    Experiments were conducted on 120 albino rats and 16 dogs with the use of scanning and electron microscopy as well as the radionuclide method of microcirculation study to substantiate the method of regional lymphostimulation after operations on the stomach for the prevention of early postoperative complications. Some lymphagogues (lidase, heparin, procaine hydrochloride) were infused in the early postoperative period through a catheter introduced into the hepatoduodenal ligament. This zone is represented by a large group of lymph nodes receiving lymph from the stomach and the adjacent organs and the intercellular space of the hepatoduodenal ligament. The study showed that lymphostimulation improves the circulation of lymph and blood which are disturbed as the result of the operation and improves the local homeokinesis in the wall of the stomach after its resection and vagotomy. Lymphostimulation increases the resorption and transport activity of the lymphatic system and improves drainage of the edema fluid and the products of disturbed metabolism from the interstitium of the gastric mucosa. The results of using the method of regional lymphostimulation in 441 patients after various operations on the stomach for peptic ulcer showed the possibility of reducing the number of early postoperative complications, such as inadequacy of the sutures of the gastroduodeno--entero--anastomosis, anastomositis, infectious-inflammatory complications, and others. PMID:8158953

  9. Early Enteral Feeding After Living Donor Liver Transplantation Prevents Infectious Complications: A Prospective Pilot Study.

    PubMed

    Kim, Jong Man; Joh, Jae-Won; Kim, Hyun Jung; Kim, Sung-Hye; Rha, Miyong; Sinn, Dong Hyun; Choi, Gyu-Seong; Kwon, Choon Hyuck David; Cho, Young Yun; Suh, Jeong-Meen; Lee, Suk-Koo

    2015-11-01

    Infectious complications, including bacteria, virus, and fungus, often occur after liver transplantation and are the most frequent causes of in-hospital mortality. The current study prospectively analyze the effect of early enteral feeding in patients after living donor liver transplantation (LDLT)Between January 2013 and August 2013, 36 patients underwent LDLT. These patients were randomly assigned to receive enteral formula via nasointestinal feeding tubes [enteral feeding (EN) group, n?=?17] or maintenance on intravenous fluid until oral diets were initiated (control group, n?=?19). All patients completed the study.The pretransplant and perioperative characteristics of patients did not differ between the 2 groups. The incidence of bacterial infection was significantly lower in the EN group (29.4%) than in the control group (63.2%) (P?=?0.043). In addition, the incidence of bile duct complications in the EN group was lower than in the control group (5.9% versus 31.6%, P?=?0.041). Multivariate analysis showed that early enteral feeding was closely associated with bacterial infections (odds ratio, 0.178; P?=?0.041). There was no statistically significant difference in nutritional status between the 2 groups. There were no cases of in-hospital mortality.Early enteral feeding after LDLT prevents posttransplant bacterial infection, suggesting the possibility of a reduction of in-hospital mortality as a result of decreased infectious complications. PMID:26554774

  10. Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures

    PubMed Central

    Foroulis, Christophoros N.; Kleontas, Athanasios; Karatzopoulos, Avgerinos; Nana, Chryssoula; Tagarakis, George; Tossios, Paschalis; Anastasiadis, Kyriakos

    2014-01-01

    Objective To detect the rate and predisposing factors for the development of postoperative complications requiring re-operation for their control in the immediate postoperative period. Methods During the time period 2009-2012, 719 patients (male: 71.62%, mean age: 5419 years) who underwent a wide range of general thoracic surgery procedures, were retrospectively collected. Data of patients who underwent early re-operation for the management of postoperative complications were assessed for identification of the responsible causative factors. Results Overall, 33/719 patients (4.6%) underwent early re-operation to control postoperative complications. Early re-operation was obviated by the need to control bleeding or to drain clotted hemothoraces in nine cases (27.3%), to manage a prolonged air leak in six cases (18.2%), to drain a post-thoracotomy empyema in five cases (15.2%), to revise the thoracotomy incision or an ischemic musculocutaneous flap in five cases (15.2%), to manage a bronchopleural fistula in four cases (12.1%), to manage persistent atelectasis of the remaining lung in two cases (6.1%), to cease a chyle leak in one case (3%) and to plicate the right hemidiaphragm in another one case (3%). The factors responsible for the development of complications requiring reopening of the chest for their management were technical in 17 cases (51.5%), initial surgery for lung or pleural infections in 9 (27.3%), the recent antiplatelet drug administration in 4 (12.1%) and advanced lung emphysema in 3 (9.1%). Mortality of re-operations was 6.1% (2/33) and it was associated with the need to proceed with completion pneumonectomy in the two cases with persistent atelectasis of the remaining lung and permanent parenchymal damage. The majority of complications requiring reoperation were observed after lung parenchyma resection (17 out of the 228 procedures/7.4%) or pleurectomy (7 out of the 106 procedures/6.5%). Reoperations after video-assisted thoracic surgery (VATS) were uncommon (2 out of the 99 procedures/2%). Conclusions The rate of complications requiring reoperation after general thoracic surgery procedures is low and it is mainly related to technical issues from the initial surgery, the recent administration of antiplatelet drugs, the presence of advanced emphysema and surgery for infectious diseases. The need to proceed with completion pneumonectomy has serious risk for fatal outcome. PMID:24672696

  11. Presentation, diagnosis, and management of early hepatic venous outflow complications in whole cadaveric liver transplant.

    PubMed

    Khorsandi, Shirin Elizabeth; Athale, Anuja; Vilca-Melendez, Hector; Jassem, Wayel; Prachalias, Andreas; Srinivasan, Parthi; Rela, Mohamed; Heaton, Nigel

    2015-07-01

    Early hepatic venous outflow obstruction (HVOO) can be a devastating complication leading to graft loss after liver transplantation (LT). A retrospective study on 777 adult LT recipients over a 5-year period (August 2007 to August 2012) was undertaken to determine the incidence of early HVOO presenting within 3 months of transplant, its clinical features and management, and potential technical risk factors related to the implanting technique. Cases of early HVOO were screened for by identifying recipients with problematic ascites within 3 months of transplant. Definitive diagnosis for HVOO was based on a wedge pressure of >12 mm Hg. Considering only whole livers, the incidence of early problematic ascites was 3% (20/695) of which more than one-third (35%, 7/20) were then confirmed to have HVOO. Overall, the incidence of early HVOO was 1% (7/695). Two hepatic veins (HVs) with extension piggybacks (PBs; n?=?423) were the dominant implanting technique in the time period of study rather than the 3 HV PB (n?=?182) and caval replacement techniques (n?=?82). Considering the implantation technique, all cases of HVOO occurred after 2 HVs when extension PBs had been used with an incidence of 1.7% (7/423). Institutionally, early HVOO was mainly managed surgically by either cavoplasty within a month of transplant (n?=?4) or retransplant (n?=?1), and the remainder (n?=?2) were medically managed with diuretics. In conclusion, early HVOO is rare, and there is no evidence from this study that a given implantation technique is at a higher risk of developing HVOO (2 HV with extension versus 3 HV and caval replacement; P?=?0.11). However, early revisional surgery for HVOO can preserve graft function with retransplantation being reserved for when surgical cavoplasty or radiological stenting is technically not possible. PMID:25907399

  12. Acute gastric remnant dilatation, a rare early complication of laparoscopic mini-gastric bypass.

    PubMed

    Almulaifi, Abdullah M; Ser, Kong-Han; Lee, Wei-Jei

    2014-05-01

    Several thousands of laparoscopic mini-gastric bypass have been performed globally by a number of surgeons. There is growing evidence that mini-gastric bypass is a safe and effective procedure. We report a rare case of massive gastric remnant dilation in a 45-year-old man after laparoscopic mini-gastric bypass. Acute gastric dilatation is a surgical emergency. In our case, a triad of clinical suspicion, laboratory profile, and emergency radiologic investigation were essential for early diagnosis and management. Image-guided gastrostomy tube placement provides an effective decompression of the gastric remnant. A literature review revealed no previous reports of similar complications in mini-gastric bypass. PMID:24754886

  13. Dendrobium officinale Prevents Early Complications in Streptozotocin-Induced Diabetic Rats

    PubMed Central

    Hou, Shao-zhen; Liang, Chu-yan; Liu, Hua-zhen; Zhu, Dong-mei; Wu, Ya-yun; Liang, Jian; Zhao, Ya; Guo, Jian-ru; Huang, Song; Lai, Xiao-Ping

    2016-01-01

    Background. Dendrobium officinale (DO) Kimura et Migo is a precious Chinese herb that is considered beneficial for health due to its antioxidant and antidiabetes properties, and so on. In this research, we try to determine the preventive effect of DO on the early complications of STZ-induced diabetic rats. Methods. Type 1 diabetic rats were produced with a single intraperitoneal injection of STZ (50 mg/kg). DO (1 g/kg/day) was then orally administered for 5 weeks. Blood glucose, TC, TG, BUN, CREA, and GSH-PX levels were determined, and electroretinographic activity and hypoalgesia were investigated. Pathological sections of the eyes, hearts, aortas, kidneys, and livers were analyzed. Results. Treatment with DO significantly attenuated the serum levels of TC, TG, BUN, and CREA, markedly increased the amplitudes of ERG a- and b-waves and Ops, and reduced the hypoalgesia and histopathological changes of vital organs induced by hyperglycemia. The protective effect of DO in diabetic rats may be associated with its antioxidant activity, as evidenced by the marked increase in the serum level of glutathione peroxidase. However, DO had no significant effect on blood glucose levels and bodyweight of diabetic rats. Conclusions. DO supplementation is an effective treatment to prevent STZ-induced diabetic complications.

  14. Early and Late Complications Related to Central Venous Catheters in Hematological Malignancies: a Retrospective Analysis of 1102 Patients

    PubMed Central

    Morano, Salvatore Giacomo; Coppola, Lorenzo; Latagliata, Roberto; Berneschi, Paola; Chistolini, Antonio; Micozzi, Alessandra; Girmenia, Corrado; Breccia, Massimo; Brunetti, Gregorio; Massaro, Fulvio; Rosa, Giovanni; Guerrisi, Pietro; Mandelli, Franco; Fo, Roberto; Alimena, Giuliana

    2014-01-01

    Several severe complications may be associated with the use of central venous catheters (CVC). We retrospectively evaluated on a large cohort of patients the incidence of CVC-related early and late complications. From 7/99 to 12/2005, 1102 CVC have been implanted at our Institution in 881 patients with hematological malignancies (142,202 total day number of implanted CVC). Early mechanic complications were 79 (7.2% - 0.55/1,000 days/CVC). Thirty-nine episodes of early infective complications (<1 week from CVC implant) occurred (3.5% - 0.3/1000 days/CVC): furthermore, 187 episodes of CVC-related sepsis (17% - 1.3/1000 days/CVC) were recorded. There were 29 episodes (2.6%) of symptomatic CVC-related thrombotic complications, with a median interval from CVC implant of 60 days (range 7 395). The rate of CVC withdrawal due to CVC-related complications was 26%. The incidence of CVC-related complications in our series is in the range reported in the literature notwithstanding cytopenia often coexisting in hematological patients. PMID:24678388

  15. Early and late complications related to central venous catheters in hematological malignancies: a retrospective analysis of 1102 patients.

    PubMed

    Morano, Salvatore Giacomo; Coppola, Lorenzo; Latagliata, Roberto; Berneschi, Paola; Chistolini, Antonio; Micozzi, Alessandra; Girmenia, Corrado; Breccia, Massimo; Brunetti, Gregorio; Massaro, Fulvio; Rosa, Giovanni; Guerrisi, Pietro; Mandelli, Franco; Fo, Roberto; Alimena, Giuliana

    2014-01-01

    Several severe complications may be associated with the use of central venous catheters (CVC). We retrospectively evaluated on a large cohort of patients the incidence of CVC-related early and late complications. From 7/99 to 12/2005, 1102 CVC have been implanted at our Institution in 881 patients with hematological malignancies (142,202 total day number of implanted CVC). Early mechanic complications were 79 (7.2% - 0.55/1,000 days/CVC). Thirty-nine episodes of early infective complications (<1 week from CVC implant) occurred (3.5% - 0.3/1000 days/CVC): furthermore, 187 episodes of CVC-related sepsis (17% - 1.3/1000 days/CVC) were recorded. There were 29 episodes (2.6%) of symptomatic CVC-related thrombotic complications, with a median interval from CVC implant of 60 days (range 7 - 395). The rate of CVC withdrawal due to CVC-related complications was 26%. The incidence of CVC-related complications in our series is in the range reported in the literature notwithstanding cytopenia often coexisting in hematological patients. PMID:24678388

  16. Intraoperative and early postoperative flap-related complications of laser in situ keratomileusis using two types of Moria microkeratomes.

    PubMed

    Karabela, Yunus; Muftuoglu, Orkun; Gulkilik, Ibrahim Gokhan; Kocabora, Mehmet Selim; Ozsutcu, Mustafa

    2014-10-01

    The purpose of this study is to describe the incidence, management, and visual outcomes of intraoperative and early postoperative flap-related complications of laser in situ keratomileusis (LASIK) surgery using two types of Moria M2 microkeratomes. This retrospective analysis was performed on 806 primary LASIK cases. The intraoperative and early postoperative flap-related complications were identified and categorized according to type of Moria microkeratome. There were 52 intraoperative and early postoperative complications--one case of partial flap (0.124 %), one case of free flap (0.124 %), one case of small flap (0.124 %), 13 cases of epithelial defect (1.61 %), 12 cases of flap striae (1.49 %), 10 cases of diffuse lamellar keratitis (1.24 %), 10 cases of interface debris (1.24 %), three cases of epithelial ingrowth (0.37 %), and one case of microbial infection (0.124 %). The overall incidence of flap complications was 6.45 %. There were 27 right eye (6.73 %) and 25 left eye (6.17 %) complications. The incidence of complications with the Moria automated metallic head 130 microkeratome was 4.22 % and with the Moria single-use head 90 microkeratome was 2.23 %. We observed one culture-negative interface abscess which was cured with surgical cleaning and intensive medical treatment. The most common complication encountered was epithelial defects, followed by flap striae. Our study showed that LASIK with a microkeratome has a relatively low incidence of intraoperative and early postoperative flap complications. The authors have no financial interest in any of the issues contained in this article and have no proprietary interest in the development of marketing of or materials used in this study. PMID:24531872

  17. Early diagnosis of diabetic vascular complications: impairment of red blood cell deformability

    NASA Astrophysics Data System (ADS)

    Shin, Sehyun; Ku, Yunhee; Park, Cheol-Woo; Suh, Jang-Soo

    2006-02-01

    Reduced deformability of red blood cells (RBCs) may play an important role on the pathogenesis of chronic vascular complications of diabetes mellitus. However, available techniques for measuring RBC deformability often require washing process after each measurement, which is not optimal for day-to-day clinical use at point of care. The objectives of the present study are to develop a device and to delineate the correlation of impaired RBC deformability with diabetic nephropathy. We developed a disposable ektacytometry to measure RBC deformability, which adopted a laser diffraction technique and slit rheometry. The essential features of this design are its simplicity (ease of operation and no moving parts) and a disposable element which is in contact with the blood sample. We studied adult diabetic patients divided into three groups according to diabetic complications. Group I comprised 57 diabetic patients with normal renal function. Group II comprised 26 diabetic patients with chronic renal failure (CRF). Group III consisted of 30 diabetic subjects with end-stage renal disease (ESRD) on hemodialysis. According to the renal function for the diabetic groups, matched non-diabetic groups were served as control. We found substantially impaired red blood cell deformability in those with normal renal function (group I) compared to non-diabetic control (P = 0.0005). As renal function decreases, an increased impairment in RBC deformability was found. Diabetic patients with chronic renal failure (group II) when compared to non-diabetic controls (CRF) had an apparently greater impairment in RBC deformability (P = 0.07). The non-diabetic cohort (CRF), on the other hand, manifested significant impairment in red blood cell deformability compared to healthy control (P = 0.0001). The newly developed slit ektacytometer can measure the RBC deformability with ease and accuracy. In addition, progressive impairment in cell deformability is associated with renal function loss in all patients regardless of the presence or absence of diabetes. In diabetic patients, early impairment in RBC deformability appears in patients with normal renal function.

  18. Hypertensive phase and early complications after Ahmed glaucoma valve implantation with intraoperative subtenon triamcinolone acetonide

    PubMed Central

    Turalba, Angela V; Pasquale, Louis R

    2014-01-01

    Objective To evaluate intraoperative subtenon triamcinolone acetonide (TA) as an adjunct to Ahmed glaucoma valve (AGV) implantation. Design Retrospective comparative case series. Participants Forty-two consecutive cases of uncontrolled glaucoma undergoing AGV implantation: 19 eyes receiving intraoperative subtenon TA and 23 eyes that did not receive TA. Methods A retrospective chart review was performed on consecutive pseudophakic adult patients with uncontrolled glaucoma undergoing AGV with and without intraoperative subtenon TA injection by a single surgeon. Clinical data were collected from 42 eyes and analyzed for the first 6 months after surgery. Main outcome measures Primary outcomes included intraocular pressure (IOP) and number of glaucoma medications prior to and after AGV implantation. The hypertensive phase (HP) was defined as an IOP measurement of greater than 21 mmHg (with or without medications) during the 6-month postoperative period that was not a result of tube obstruction, retraction, or malfunction. Postoperative complications and visual acuity were analyzed as secondary outcome measures. Results Five out of 19 (26%) TA cases and 12 out of 23 (52%) non-TA cases developed the HP (P=0.027). Mean IOP (14.24.6 in TA cases versus [vs] 14.75.0 mmHg in non-TA cases; P=0.78), and number of glaucoma medications needed (1.81.3 in TA cases vs 1.61.1 in the comparison group; P=0.65) were similar between both groups at 6 months. Although rates of serious complications did not differ between the groups (13% in the TA group vs 16% in the non-TA group), early tube erosion (n=1) and bacterial endophthalmitis (n=1) were noted with TA but not in the non-TA group. Conclusions Subtenon TA injection during AGV implantation may decrease the occurrence of the HP but does not alter the ultimate IOP outcome and may pose increased risk of serious complications within the first 6 months of surgery. PMID:25050061

  19. Post-cesarean section puerperal morbidity. The incidence and risk factors at Srinagarind Hospital.

    PubMed

    Pothinam, S; Chanpoo, T; Lumbiganon, P

    1992-03-01

    We found that the incidence of post-cesarean puerperal morbidity at Srinagarind Hospital, Khon Kaen University was 5.5 per cent, which is very low compared to other reports. Statistically significant risk factors for post-cesarean puerperal morbidity included having less than 4 antenatal care visits, duration of labour longer than 12 hours and absence of prophylactic antibiotics. PMID:1506796

  20. Perioperative complications and early follow-up with 100 TVT-SECUR procedures.

    PubMed

    Neuman, Menahem

    2008-01-01

    Our objective was to evaluate the complications and early follow-up of the tension-free vaginal tape (TVT)-SECUR, a new minimally invasive anti-incontinence operative procedure. A prospective, observational, and consecutive patient series was conducted. Perioperative and 12-month postoperative data were prospectively collected for the first 50 patients against the next consecutive 50 patients, among which TVT-SECUR specific surgical measurements were adopted (Canadian Task Force classification 2). In private hospital operative theatres, the TVT-SECUR operation was performed. Patients with urodynamically proved stress urinary incontinence were enrolled in this study after detailed informed consent was given. The TVT-SECUR, in the hammock shape to mimic the TVT-obturator placement, yet with no skin incisions, required neither bladder catheterization nor intraoperative diagnostic cystoscopy. The clinical and surgical data of 100 consecutive patients with TVT-SECUR were collected prospectively. Two patients had urinary obstructions and needed surgical tape-tension relief. One patient had a 50 mL paravesical self-remitting hematoma. At the first-month postoperative follow-up appointment, the objective therapeutic failure rate for the TVT-SECUR procedure among the 50 patients was 20.0% (10 patients). But when the tape was placed close to the urethra with no space allowed in between, the failure rate in the second patient group went down to 8.0% (4 patients); yet no further postoperative bladder outlet obstruction was diagnosed. Four (8.0%) patients in the first group had vaginal wall penetration with the inserters, requiring withdrawal, reinsertion, and vaginal wall repair. This was avoided with the second patient group by facilitating the inserters' introduction by widening the submucosal tunnel to 12 mm. Six (12.0%) other patients in the first group needed postoperative trimming of a vaginally extruded tape segment, performed in the office with satisfactory results. This problem was addressed later by making the submucosal dissection deeper to avoid intimate proximity of the tape with the vaginal mucosa. Consequently the tape protrusion rate was reduced to 8% (4 patients). Five (10.0%) patients in the first group had unintended tape removal at the time of inserter removal, necessitating the use of a second TVT-SECUR. This was addressed by meticulous detachment of the inserter before its withdrawal, after which no further unintended tape displacements were recorded. No clinical signs for bowel, bladder, or urethral injuries; intraoperative bleeding; or postoperative infections were evident. Telephone interview at the end of 12 months postoperatively was completed with 44 (88.0%) of the first patient group and 46 (92%) of the second patient group. In all, 39 (88.6%) and 43 (93.5%) of the telephone-interviewed patients of the first and second groups, respectively, reported objective urinary continence. The TVT-SECUR, a new midurethral sling, was associated with early safety and efficacy problems. These were identified and rectified, to make the TVT-SECUR a safe and effective anti-incontinence procedure. Operative complications associated with the TVT, such as bladder penetration and postoperative outlet obstruction, and TVT-obturator complications, such as postoperative thigh pain and bladder outlet obstruction, may be reduced with the TVT-SECUR. The first 100 operations' cumulative data analysis yielded some insights, including the necessity of meticulous and proper dissection before placement of the tape and the need for applying minimal extra tension to the tape. However, long-term comparative data collection will be required to draw solid conclusions regarding the appropriate position of this operative technique within the spectrum of anti-incontinence operations. PMID:18539095

  1. The Association of Birth Complications and Externalizing Behavior in Early Adolescents: Direct and Mediating Effects

    ERIC Educational Resources Information Center

    Liu, Jianghong; Raine, Adrian; Wuerker, Anne; Venables, Peter H.; Mednick, Sarnoff

    2009-01-01

    Prior studies have shown that birth complications interact with psychosocial risk factors in predisposing to increased externalizing behavior in childhood and criminal behavior in adulthood. However, little is known about the direct relationship between birth complications and externalizing behavior. Furthermore, the mechanism by which the birth

  2. The Association of Birth Complications and Externalizing Behavior in Early Adolescents: Direct and Mediating Effects

    ERIC Educational Resources Information Center

    Liu, Jianghong; Raine, Adrian; Wuerker, Anne; Venables, Peter H.; Mednick, Sarnoff

    2009-01-01

    Prior studies have shown that birth complications interact with psychosocial risk factors in predisposing to increased externalizing behavior in childhood and criminal behavior in adulthood. However, little is known about the direct relationship between birth complications and externalizing behavior. Furthermore, the mechanism by which the birth…

  3. Early and late residual renal function and surgical complications in living donors: a 15-year experience at a single institution.

    PubMed

    Sansalone, C V; Maione, G; Aseni, P; Rossetti, O; Mangoni, I; Soldano, S; De Roberto, A; Minetti, M E; Perrino, M L; Civati, G

    2006-05-01

    Living donation in the field of renal transplantation has increased over time as well as the use of laparoscopic nephrectomy. We present a 15-year experience on 162 living donors (105 women, 57 men; mean age, 46.7 years; range, 31-74 years) who underwent nephrectomy using different surgical approaches as open lombotomic nephrectomy (OLN), open transperitoneal nephrectomy (OTN), and laparoscopic hand-assisted nephrectomy (LHAN). We collected data on residual donor and recipient renal function, as well as early versus late medical and surgical complications. With a mean follow-up of about 8 years, we observed normal residual renal function in all donors and similar results of early and late graft function independent of the surgical procedure. Long-term incidence of hypertension and noninsulin-dependent diabetes in living donors was similar to the general population. OLN and OTN donors showed higher incidences of early and late complications, readmissions, and reoperations than LHAN donors. Our results confirmed that living donor nephrectomy is a safe procedure without serious side effects in terms of renal function and long-term quality of life. LHAN should be the preferred technique because of a lower incidence of early and late complications. PMID:16757241

  4. [Woman's participation in the decision process of the pregnancy and puerperal cycle: nursing care integrative review].

    PubMed

    Busanello, Josefine; Lunardi Filho, Wilson Danilo; Kerber, Nal Pereira da Costa; Lunardi, Valria Lerch; dos Santos, Silvana Sidnei

    2011-12-01

    This is an integrative review that aims to identify the contribution of nursing care for woman's participation in the decision process of the pregnancy and puerperal cycle, as described in Brazilian scientific publications. The scientific productions were retrieved in May, 2010, from the Virtual Library of Health (Biblioteca Virtual em Sade) database. From the eight articles reviewed, two themes stood out: Contributions of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle; and Limitations of nursing care to the woman's participation in the decision process of the pregnancy and puerperal cycle. The following review supports the production of knowledge in nursing, by identifying a gap in what nurses know and do about this issue, as shown by the lack of nursing researches that concern, specifically, the participation of the woman in the decision process during the pregnancy and puerperal cycle and the possible contributions of nursing care to ensure women of this right. PMID:22299285

  5. Treatment of Acute Puerperal Mastitis and Breast Abscess

    PubMed Central

    Cantlie, Helene Bertrand

    1988-01-01

    Mastitis is a benign infection of the breast if it is treated early. If two days elapse before treatment is started, it can lead to serious complications such as chronic or recurrent mastitis or breast abscess. Treatment consists in frequent nursing and massaging or stripping the breast to keep it empty of milk or pus, and appropriate antibiotics. Incision and drainage of a breast abscess can be done in the office under local anesthesia, and the drainage continued at home by the mother. PMID:21253250

  6. Pregnancy Complications

    MedlinePLUS

    ... of— Preeclampsia. Early delivery. Cesarean birth . Having a big baby, which can complicate delivery. Having a baby ... health prevention with improved sources of maternal health data, and methods for measuring and studying the data. ...

  7. Early treatment revisions by addition or switch for type 2 diabetes: impact on glycemic control, diabetic complications, and healthcare costs

    PubMed Central

    Schwab, Phil; Saundankar, Vishal; Bouchard, Jonathan; Wintfeld, Neil; Suehs, Brandon; Moretz, Chad; Allen, Elsie; DeLuzio, Antonio

    2016-01-01

    Background The study examined the prevalence of early treatment revisions after glycosylated hemoglobin (HbA1c) ≥9.0% (75 mmol/mol) and estimated the impact of early treatment revisions on glycemic control, diabetic complications, and costs. Research design and methods A retrospective cohort study of administrative claims data of plan members with type 2 diabetes and HbA1c ≥9.0% (75 mmol/mol) was completed. Treatment revision was identified as treatment addition or switch. Glycemic control was measured as HbA1c during 6–12 months following the first qualifying HbA1c ≥9.0% (75 mmol/mol) laboratory result. Complications severity (via Diabetes Complication Severity Index (DCSI)) and costs were measured after 12, 24, and 36 months. Unadjusted comparisons and multivariable models were used to examine the relationship between early treatment revision (within 90 days of HbA1c) and outcomes after controlling for potentially confounding factors measured during a 12-month baseline period. Results 8463 participants were included with a mean baseline HbA1c of 10.2% (75 mmol/mol). Early treatment revision was associated with greater reduction in HbA1c at 6–12 months (−2.10% vs −1.87%; p<0.001). No significant relationship was observed between early treatment revision and DCSI at 12, 24, or 36 months (p=0.931, p=0.332, and p=0.418). Total costs, medical costs, and pharmacy costs at 12, 24, or 36 months were greater for the early treatment revision group compared with the delayed treatment revision group (all p<0.05). Conclusions The findings suggest that in patients with type 2 diabetes mellitus, treatment revision within 90 days of finding an HbA1c ≥9.0% is associated with a greater level of near-term glycemic control and higher cost. The impact on end points such as diabetic complications may not be realized over relatively short time frames. PMID:26925237

  8. Medical Complications of the Critically Ill Newborn: A Review for Early Intervention Professionals.

    ERIC Educational Resources Information Center

    McNab, Theresa C.; Blackman, James A.

    1998-01-01

    Provides early-intervention professionals with a basic familiarity and understanding of some of the newest technologies employed in the neonatal intensive care units for neonates with respiratory distress syndrome, persistent fetal circulation, retinopathy of prematurity, intraventricular hemorrhage, and periventricular leukomalacia. Early

  9. Early, intermediate and late infectious complications after transcatheter or surgical aortic-valve replacement: a prospective cohort study.

    PubMed

    Falcone, M; Russo, A; Mancone, M; Carriero, G; Mazzesi, G; Miraldi, F; Pennacchi, M; Pugliese, F; Tritapepe, L; Vullo, V; Fedele, F; Sardella, G; Venditti, M

    2014-08-01

    Transcatheter aortic valve implantation (TAVI) has been proposed to treat older surgical high-risk patients with severe symptomatic aortic stenosis. There are no data regarding short-term and long-term infectious complications in these patients. The objective of this study was to define the incidence, aetiology and outcome of early and late infectious complications following TAVI compared with patients >65years old undergoing traditional surgical aortic replacement (SAR). This was a prospective observational study evaluating all consecutive patients who underwent TAVI or SAR. Follow up was performed up to 1year after the procedure of valve implantation. Fifty-one patients underwent TAVI and were compared with 102 patients who underwent SAR. Compared with SAR patients, those who underwent TAVI had lower incidence of early post-operative (11.7% vs 26.4%, p0.04), intermediate (5.9% vs 17.6%, p0.01) and late (7.8% vs 11.7%, p0.03) infections. Among SAR patients the most common infections were bloodstream infections, pneumonias, urinary tract infections and sternal wound infections. Patients who underwent TAVI had a longer survival without infection (358days vs 312.9, p0.006). There were no significant differences in 12-month crude survival between the two study populations. Despite a high frequency of coexisting illnesses, patients undergoing TAVI develop few infectious complications. TAVI appears to be a reasonable and safe option in high-risk patients with severe symptomatic aortic stenosis. PMID:24267878

  10. [Portal thrombosis: early complication of azygo-portal disconnection in the treatment of bleeding esophageal varices].

    PubMed

    Chaib, E; Pugliesi, V; Capacci, M de L; D'Albuquerque, L C; Widman, A; Bernardini, A P; Silva, A de O; Saad, W A; Machado, M C; Pinotti, H W

    1990-01-01

    The authors studied 30 patients with bleeding from esophageal varices due to portal hypertension. They underwent the disconnection of portal and azygos veins and splenectomy. The immediate postoperative complications were: portal thrombosis in four patients (13.3%); subphrenic abscess in two (6.6%); pulmonary embolism in one (3.3%) and esophageal perforation in one (3.3%). The manifestations of portal thrombosis were ascites, and fever (without leukocytosis). One patient with portal thrombosis who had intractable ascite was submitted to peritoneovenous shunting. PMID:2133172

  11. Use of Inflated Foley Catheters to Prevent Early Empty Pelvis Complications Following Pelvic Exenteration.

    PubMed

    Bacalbasa, Nicolae; Tomescu, Dana; Balescu, Irina

    2015-10-01

    For most patients with bulky pelvic tumors, pelvic exenteration remains the only curative option. Although initially reported as a palliative procedure, nowadays it is rather performed with curative intent. Once the resectional phase is ended, a large defect will remain at the level of the pelvic diaphragm, predisposing to severe complications which are generically included under the name of empty pelvis syndrome. It has been widely demonstrated that this type of complication is associated with severe mortality, even if the patient is free of any pelvic recurrence. We present the case of a 56-year-old patient submitted to total pelvic exenteration for locally invasive previously chemo-irradiated cervical cancer who presented six months after surgery with a severe enteroperineal fistula. We decided to reoperate on the patient; intraoperatively we found recurrence on both pelvic walls and an enteroperineal fistula caused by tumoral invasion. We performed an intestinal resection with enteroenteral anastomosis. In order to isolate the intestinal loops from the unresectable pelvic recurrence, in the pelvis we placed three Foley catheters inflated with 60 ml of saline each, in order to hold the intestinal loops away from the pelvic wall. The postoperative course was uneventful. The urinary cathethers were removed after six weeks. PMID:26408723

  12. Doctor's role in early detection of diabetic retinopathy and prevention of blindness from its complications.

    PubMed

    Subedi, S; Subedi, K U; Badhu, B P

    2005-01-01

    Diabetic retinopathy (DR) is a microangiopathy, which is caused by chronic hyperglycemia, affecting the retinal arterioles, capillaries and venules, complications of which lead to incurable blindness. Approximately 10% of the diabetic population has type I diabetes mellitus (DM) which is diagnosed before the age of 30 years and rest is type II which is diagnosed after the age of 30 years. In UK 2% general population is affected by DM. In developed countries, diabetic retinopathy is an important and leading cause of blindness in working age group where as in developing western countries this figure occupy 12% of the blindness. In developing countries like Nepal, cataract still remains a main cause of blindness and diabetes is not considered as a major problem. However due to a rapid urbanization and modernization of population, diabetes mellitus is becoming an endemic disease and bringing a new challenge in blindness reduction program. PMID:16152680

  13. Early detection of myocardial contusion and its complications in patients with blunt trauma.

    PubMed

    Norton, M J; Stanford, G G; Weigelt, J A

    1990-12-01

    Myocardial contusion remains an elusive clinical entity, which consumes a disproportionate amount of scarce and expensive critical care resources for the purpose of cardiac monitoring. This study attempts to define a group of patients at high risk who can be identified from the available data present at the time of admission. All patients admitted with the suspicion of a myocardial contusion over a 3-year period were retrospectively studied. The records were examined for history, physical findings, electrocardiographic (ECG) results, creatine kinase levels, Injury Severity Score (ISS), and echocardiographic findings. A diagnosis of a myocardial contusion was made if patients had an ECG consistent with acute injury, increased creatine kinase-MB, or an abnormal echocardiogram consistent with acute injury. Patients were stratified into two groups: Group 1 patients satisfied the criteria for a myocardial contusion and Group 2 patients lacked sufficient evidence to substantiate this diagnosis. The records were then examined for the presence of factors available in the emergency room that might be predictive of a myocardial contusion or its complications. A total of 88 patients were evaluated; 27 of these were found to have a myocardial contusion (Group 1) with 61 patients placed in Group 2 (no myocardial contusion). Group 1 patients had an abnormal admission ECG (p less than 0.05), and an ISS greater than or equal to 10 (p less than 0.05). Multivariate analysis identified two factors predictive of a myocardial contusion: an abnormal ECG and an ISS greater than 10. When these two predictors were absent, the probability of a myocardial contusion was 1%. No predictors of a complication of a myocardial contusion were identified. These data suggest that a combination of easily obtained variables in the emergency department can be used to select a patient population at high risk for myocardial contusion. Prospective evaluation of these variables is necessary. PMID:2252116

  14. Radiation pneumonitis: a complication resulting from combined radiation and chemotherapy for early breast cancer

    SciTech Connect

    Gez, E.; Sulkes, A.; Isacson, R.; Catane, R.; Weshler, Z.

    1985-10-01

    Described is a patient with early breast carcinoma who developed clinical radiation pneumonitis during primary radiation therapy and concomitant chemotherapy that included prednisone. This syndrome developed three days following abrupt steroid withdrawal. Retrieval of steroids brought complete resolution of the clinical and radiological findings. Although this syndrome is rare, it is recommended that steroid therapy in a patient previously irradiated to the chest be avoided.

  15. The role of FDG-PET/CT imaging in early detection of extra-cardiac complications of infective endocarditis.

    PubMed

    Orvin, K; Goldberg, E; Bernstine, H; Groshar, D; Sagie, A; Kornowski, R; Bishara, J

    2015-01-01

    The exact incidence of extra-cardiac complications (ECC) in patients with infective endocarditis (IE) is unknown but presumed to be high. These patients, although mostly asymptomatic, may require a more aggressive therapeutic approach. (18)fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used for the diagnosis of infections, but its role in the early diagnosis of IE complications is still unclear. This study aimed to evaluate the role of FDG-PET/CT in the early diagnosis of ECC in IE and its implications for medical management. We prospectively studied 40 consecutive patients with a confirmed diagnosis of IE (according to the modified Duke criteria) who underwent a whole body FDG-PET/CT study within 14 days from diagnosis. The FDG-PET/CT demonstrated ECC in 17 (42.5%) patients, while 8 (38.1%) of them were asymptomatic. The most frequent embolic sites were musculoskeletal and splenic. Owing to the FDG-PET/CT findings, treatment planning was modified in 14 (35%) patients. This included antibiotic treatment prolongation (27.5%), referral to surgical procedures (15%) and, most substantially, prevention of unnecessary device extraction (17.7%). According to our experiences, FDG-PET/CT imaging was useful in the detection of embolic and metastatic infections in IE. This clinical information had a significant diagnostic and therapeutic impact in managing IE disease. PMID:25636930

  16. Helical CT in renal transplantation: normal findings and early and late complications.

    PubMed

    Sebasti, C; Quiroga, S; Boy, R; Cantarell, C; Fernandez-Planas, M; Alvarez, A

    2001-01-01

    Over a 5-year period, 346 helical computed tomographic (CT) studies were performed in renal transplant recipients. Helical CT proved useful in this context by depicting parenchymal, perirenal, renal sinus, pyeloureteral, and vascular complications in great detail. CT often delineates fluid collections and their anatomic relationship to adjacent structures better than ultrasonography (US), particularly in obese patients. CT-guided puncture and drainage can be performed in cases in which US is deemed inadequate. CT angiography can depict arterial diseases such as stenosis, thrombosis, arteriovenous fistulas, aneurysms, and pseudoaneurysms in the graft artery and in the recipient iliac arterial system, thereby obviating conventional angiography in some cases. Helical CT with three-dimensional image reformatting allows accurate imaging of the entire course of ureteral and periureteral diseases (eg, hydronephrosis, ureteral leak and stricture, pyeloureteral obstruction). CT can be used in the confirmation and staging of malignancies of the renal parenchyma and urothelium. It is also helpful in evaluating associated disease in the native kidneys, acute and chronic rejection, graft embolization, and end-stage disease. Although US and nuclear medicine examination are the imaging modalities of choice in renal transplantation, helical CT is a valuable alternative when these techniques are inconclusive. PMID:11553819

  17. Early Percutaneous Cholecystostomy in Severe Acute Cholecystitis Reduces the Complication Rate and Duration of Hospital Stay

    PubMed Central

    Chou, Chung-Kai; Lee, Kuei-Chuan; Chan, Che-Chang; Perng, Chin-Lin; Chen, Chun-Ku; Fang, Wen-Liang; Lin, Han-Chieh

    2015-01-01

    Abstract The optimal timing of percutaneous cholecystostomy for severe acute cholecystitis is unclear. The aim of this study was to investigate the timing of percutaneous cholecystostomy and its relationship to clinical outcomes in patients with inoperable acute severe cholecystitis. From 2008 to 2010, 209 consecutive patients who were admitted to our hospital due to acute cholecystitis and were treated by percutaneous cholecystostomy were retrospectively reviewed. The time periods from symptom onset to when percutaneous cholecystostomy was performed and when patients were discharged were recorded. In the 209 patients, the median time period between symptom onset and percutaneous cholecystostomy was 23?hours (range, 395?hours). The early intervention group (?24?hours, n?=?109) had a significantly lower procedure-related bleeding rate (0.0% vs 5.0%, P?=?0.018) and shorter hospital stay (15.8??12.9 vs 21.0??17.5 days) as compared with the late intervention group (>24?hours, n?=?100). Delayed percutaneous cholecystostomy was a significant independent factor for a longer hospital stay (odds ratio 3.03, P?=?0.001). In inoperable patients with acute severe cholecystitis, early percutaneous cholecystostomy reduced hospital stay and procedure-related bleeding without increasing the mortality rate. PMID:26166097

  18. A comparison between early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparous vaginal delivery

    PubMed Central

    Shahraki, Azar Danesh; Aram, Shahnaz; Pourkabirian, Soodabeh; Khodaee, Sepideh; Choupannejad, Shekofeh

    2011-01-01

    BACKGROUND: Routine episiotomy is a controversial issue among gynecologists. The aim of this study was to compare early maternal and neonatal complications of restrictive episiotomy and routine episiotomy in primiparus vaginal delivery. METHODS: In this descriptive cross-sectional study, two groups of primiparus normal vaginal delivery (NVD) cases with routine and restrictive episiotomy were studied. Immediately and in the first 24 and 48 hours after delivery, specific charts were used to compare the two groups in terms of perineal laceration size, neonatal Apgar score and post-delivery. For data analysis, SPSS was used to conduct student t-test and Kruskal-Wallis test. A p-value < 0.05 was considered significant. RESULTS: Forty primiparus pregnant women were studied in each group. Episiotomy was performed in 7.5% of the restrictive group. Perineal laceration was measured as 3.68 0.47 cm and 1.21 1.1 in routine and restrictive episiotomy groups, respectively (p < 0.05). Intact perineum or first-degree laceration was seen in 80% of the restrictive group. However, second- and third-degree laceration were respectively observed in 75% and 15% of the routine episiotomy group (p < 0.05). Pain relief (immediately, 24 and 48 hours after delivery) was significantly higher in the restrictive group (p < 0.05). On the contrary, no significant difference in Apgar scores at the first and fifth minutes after birth was found between the two groups (p > 0.05). CONCLUSIONS: Restrictive episiotomy results in low maternal complications. Therefore, avoiding routine episiotomy in unnecessary conditions would increase the rate of intact perineal and minor perineal trauma and reduce postpartum delivery pain with no adverse effects neither on maternal nor neonatal morbidities. PMID:22973367

  19. [Prevention of diabetes mellitus complications and improvement of early diagnosis at a population level, through the implementation of integrated disease management in the Modena region].

    PubMed

    Caroli, Giuseppe; Paganelli, Angela; Fattori, Giuseppe; Daghio, Maria Monica; Guidetti, Patrizia; Borsari, Silvana; Guerzoni, Andrea; Petropulacos, Kyriakoula; Daya, Ghassan; Ciardullo, Anna Vittoria

    2008-04-01

    We evaluated the effectiveness of diabetes mellitus disease management, implemented in Modena province since ten years, on the prevention of complications and early diagnoses at a population level. Time trends show that diabetic patients had significantly decreasing values over time of age, diabetes duration, and glycated haemoglobin; and increasing percentage over time of new-onset diabetes and optimal glycaemic control. That indicates an improved ability of early diagnosis and care of diabetes mellitus. It indicates at a population level that the Local Health Unit, as health system, promoted diabetes prevention and its complications. PMID:18595633

  20. Dose-Volume Histogram Predictors of Chronic Gastrointestinal Complications After Radical Hysterectomy and Postoperative Concurrent Nedaplatin-Based Chemoradiation Therapy for Early-Stage Cervical Cancer

    SciTech Connect

    Isohashi, Fumiaki; Yoshioka, Yasuo; Mabuchi, Seiji; Konishi, Koji; Koizumi, Masahiko; Takahashi, Yutaka; Ogata, Toshiyuki; Division of Medical Physics, Oncology Center, Osaka University Hospital, Suita, Osaka ; Maruoka, Shintaroh; Kimura, Tadashi; Ogawa, Kazuhiko

    2013-03-01

    Purpose: The purpose of this study was to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in cervical cancer patients who underwent radical hysterectomy and postoperative concurrent nedaplatin-based chemoradiation therapy. Methods and Materials: This study analyzed 97 patients who underwent postoperative concurrent chemoradiation therapy. The organs at risk that were contoured were the small bowel loops, large bowel loop, and peritoneal cavity. DVH parameters subjected to analysis included the volumes of these organs receiving more than 15, 30, 40, and 45 Gy (V15-V45) and their mean dose. Associations between DVH parameters or clinical factors and the incidence of grade 2 or higher chronic GI complications were evaluated. Results: Of the clinical factors, smoking and low body mass index (BMI) (<22) were significantly associated with grade 2 or higher chronic GI complications. Also, patients with chronic GI complications had significantly greater V15-V45 volumes and higher mean dose of the small bowel loops compared with those without GI complications. In contrast, no parameters for the large bowel loop or peritoneal cavity were significantly associated with GI complications. Results of the receiver operating characteristics (ROC) curve analysis led to the conclusion that V15-V45 of the small bowel loops has high accuracy for prediction of GI complications. Among these parameters, V40 gave the highest area under the ROC curve. Finally, multivariate analysis was performed with V40 of the small bowel loops and 2 other clinical parameters that were judged to be potential risk factors for chronic GI complications: BMI and smoking. Of these 3 parameters, V40 of the small bowel loops and smoking emerged as independent predictors of chronic GI complications. Conclusions: DVH parameters of the small bowel loops may serve as predictors of grade 2 or higher chronic GI complications after postoperative concurrent nedaplatin-based chemoradiation therapy for early-stage cervical cancer.

  1. Postoperative Infectious Complications in Our Early Experience With Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

    PubMed Central

    Tanaka, Kazushi; Haraguchi, Takahiro; Yamamichi, Fukashi; Muramaki, Mototsugu; Miyake, Hideaki; Fujisawa, Masato

    2013-01-01

    Purpose The objective of this study was to retrospectively investigate postoperative infectious complications (PICs) in our early experience with holmium laser enucleation of the prostate (HoLEP) followed by mechanical morcellation for symptomatic benign prostatic hyperplasia. Materials and Methods A retrospective review was performed of the clinical data for 90 consecutive patients who underwent HoLEP at our institution between February 2008 and March 2011. All patients were evaluated for the emergence of PICs, including prophylactic antibiotic administration (PAA) and the influence of the kind or duration of PAA on PIC. The details of cases with PICs were also examined. Results The patients' mean age was 71 years (range, 50 to 95 years), and their mean prostate volume was 60 mL (range, 2 to 250 mL). There were 7 cases (7.78%) with PICs; in detail, 3 patients were diagnosed with prostatitis, 2 with pyelonephritis, and 2 with epididymitis. Three patients had positive urine cultures: 1 had Serratia marcescens/Proteus mirabilis, 1 had S. marcescens, and 1 had Klebsiella pneumonia; only one case had urological sepsis. Our statistical data showed no significant differences between 2 or fewer days and 3 or more days of PAA and PIC occurrence. There was also no significant effect on PIC occurrence of sulbactam/ampicillin compared with other antibiotics. Conclusions The results of this retrospective study showed that PIC occurrence did not depend on the duration or the kind of PAA. Further prospective study is necessary for the evaluation and establishment of prophylactic measures for PICs. PMID:23526729

  2. Taxonomic map of the schizophrenias, with special reference to puerperal psychosis.

    PubMed Central

    Hays, P

    1978-01-01

    Data collected by a single observer on 147 schizophrenic patients were subjected to clustering analysis. The results produced the hypothesis that schizophrenic illnesses directly after childbirth are a separate disease entity. This hypothesis was not disproved by experimental testing. Several disease entities may be included in the term schizophrenia. If this is so, the methods used in generating and testing the hypothesis that puerperal schizophrenia is a separate disease may provide a systematic method of classifying the various illnesses. PMID:698707

  3. Residual fibrous tissue floating in the right atrium after percutaneous pacemaker lead extraction: an unusual complication early detected by intracardiac echocardiography.

    PubMed

    Rizzello, Vittoria; Dello Russo, Antonio; Casella, Michela; Biddau, Roberto

    2008-07-01

    Extraction of pacemaker leads represents the optimal therapy in patients with endocarditis involving the pacemaker leads. The percutaneous approach is becoming popular. However, complications of percutaneous extraction are not rare and incomplete removal of the vegetations with embolization in the pulmonary arteries has been described. This case report describes for the first time a case of incomplete removal of the fibrous sheath covering the lead, with residual tissue floating in the right atrium after pacemaker/ICD extraction. ICE monitoring was essential for early detection and correct diagnosis of this complication. PMID:17588687

  4. Protein Z G79A polymorphism and puerperal cerebral venous thrombosis.

    PubMed

    Yadav, Dharmendrasinh Dhansingh; De, Tanima; Nagaraja, Dindagur; Christopher, Rita

    2015-11-01

    Protein Z (PZ), a cofactor for PZ-dependent protease inhibitor, is known to play an important role in inhibiting the coagulation cascade. The aim of the study was to investigate whether PZ G79A polymorphism is a risk factor for puerperal cerebral venous thrombosis (CVT). A total of 71 patients with puerperal CVT and 98 healthy controls were genotyped for PZ 79GA polymorphism by polymerase chain reaction-restriction fragment length polymorphism method. In patients, the genotype distribution for GG, GA, and AA genotypes was 22.5%, 43.7%, and 33.8%, and in controls, 25.5%, 40.8%, and 33.7%, respectively. The risk associated with carrying the mutant genotype (GA and AA) versus the wild GG genotype was found to be 1.11 (95% confidence interval: 0.52-2.35; P = .909). There was no significant difference in the clinical features of the patients with and without the polymorphism. We therefore conclude that PZ G79A polymorphism is not a risk factor for puerperal CVT in Indian women. PMID:24907135

  5. Mixed epithelial and stromal tumor of the kidney in a puerperal woman.

    PubMed

    Sharma, Jai Bhagwan; Aruna, Janaki; Mittal, Suneeta; Sharma, Meher Chand

    2007-08-01

    Puerperal pyrexia is still rampant, especially in third world countries, and is usually due to puerperal sepsis, urinary tract infections, upper respiratory infection, and breast infection. Rarely, in third world countries like India, it may be due to tuberculosis, malaria, typhoid, and so on, which are also rampant in the general population. Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently recognized subset of renal tumors composed mainly of smooth muscle cells in which epithelial structures are embedded. It usually occurs in middle aged and older women. In the present case report, a 36-year-old woman presented with puerperal pyrexia, possibly due to tuberculosis and with an incidental mixed epithelial and stromal tumor of the kidney causing complex ascitis and fever, which required nephrectomy that was followed by full recovery. This case report highlights the importance of keeping MESTK in mind even in younger women with asymptomatic renal mass. It also highlights the importance of keeping renal tumors in mind as a possibility and to perform proper investigations for adequate treatment and recovery. PMID:17688634

  6. Pregnancy outcome after operative correction of puerperal uterine inversion.

    PubMed

    Tank Parikshit, D; Mayadeo Niranjan, M; Nandanwar, Y S

    2004-03-01

    Uterine inversion is an uncommon but life-threatening obstetric emergency. A review of the approaches to correct uterine inversion is presented. In cases where time has elapsed between delivery and presentation, the inversion ring may have become too tight to allow manual reposition of the fundus. In such cases, it has to be divided by a vertical incision. In subsequent pregnancy, antenatal care should include placental localization and planning for an elective Caesarean Section. The outcome of future pregnancies may be complicated by placenta accreta and massive haemorrhage. PMID:13680263

  7. Intraoperative custom press-fit and standard press-fit femoral components in total hip arthroplasty. A comparison of surgery, charges, and early complications.

    PubMed

    Mathur, S K; Mont, M A; McCutchen, J W

    1996-07-01

    A consecutive group of 60 patients who had intraoperative custom press-fit total hip arthroplasties (67 hips; Identifit, Thackray, London, United Kingdom) was compared with a similar group of 60 patients who had standard press-fit arthroplasties (66 hips; McCutchen, Wright Medical Technologies, Arlington, Tennessee) to determine if there were differences in operative time and charges, as well as early complications and early radiographic results. The unilateral intraoperative custom group had an average anesthesia time of 3 hours, 39 minutes, an operating time of 2 hours and 26 minutes, and a blood loss of 725 mL. The averages for the standard group included an anesthesia time of 2 hours, 19 minutes, a surgical time of 1 hour, 25 minutes, and a blood loss of 480 mL. By 6 months after surgery, 49 (73%) in the custom group had subsidence of 2 mm or more, compared with 10 hips (15%) in the standard group. The custom group had 17 early postoperative complications versus 3 in the standard group. The charge for the hospital stay averaged $19,950 for the custom group and $14,322 for the standard group. At the present time, the high incidence of complications and the increased charges make the intraoperative custom hip replacement an unlikely first choice of recommendation. PMID:8831891

  8. Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review

    PubMed Central

    Lee, Bryan S.; Vadera, Sumeet; Gonzalez-Martinez, Jorge A.

    2014-01-01

    Introduction The role of shunt placement is to divert cerebrospinal fluid from within the ventricles to an alternative location in the setting of hydrocephalus. One of the rare shunt complications is distal catheter migration, and various body sites have been reported, including the scrotum. Although cases of scrotal migration of distal catheter have been reported in pediatric patients, cases in adult patients are rare due to obliterated processus vaginalis. Furthermore, there has not been a case reported for scrotal migration in an adult at an early onset. Presentation of case 65-year-old male underwent shunt placement for normal-pressure hydrocephalus-like symptoms. On post-operative day seven patient developed right testicular edema, for which ultrasound was performed, revealing hydrocele along with the presence of distal catheter in the scrotum. On post-operative day nine patient underwent distal catheter trimming via laparoscopic approach with general surgery, with post-operative imaging showing satisfactory location of distal catheter in the peritoneal cavity. Discussion/Conclusion Early onset of distal catheter migration into scrotum in an adult male is a unique case, as most cases are reported in pediatric patients, and it is the first case reported in the English literature to have occurrence at an early onset during the peri-operative period. As our case demonstrates, early occurrence and detection of scrotal migration of the distal catheter prevent shunt malfunction. Prompt surgical management of catheter repositioning is therefore recommended to avoid the risk of further complications. PMID:25553524

  9. Different rebound rise in plasma prolactin during the postdopamine infusion phase in puerperal women and patients with pathological hyperprolactinemia.

    PubMed

    Genazzani, A R; Cavagnini, F; Picotti, G B; Ghigo, E; De Leo, V; Galva, M D; Maraschini, C; Muller, E E

    1983-12-01

    Dopamine infused at a rate of 4 micrograms/kg . min for 120 min induced at the end of the infusion period a clear-cut and similar suppression of circulating PRL levels in normal and puerperal women as well as in patients with hyperprolactinemia either due to a tumor or of unknown etiology. At the discontinuation of the infusion there was a marked PRL rebound above baseline levels in normal subjects and a rapid return to basal levels in subjects with pathological hyperprolactinemia. In contrast, there was no increase in plasma PRL in puerperal women, in whom PRL levels remained suppressed during the whole postinfusion period. The reason(s) for this pattern in puerperal women is presently unknown, although previous estrogen loading of the lactotropes during pregnancy may be involved. PMID:6630411

  10. Comparison of Propofol and Ketamine versus Propofol and Fentanyl for Puerperal Sterilization, A Randomized Clinical Trial

    PubMed Central

    Cherian, Anusha; Balachander, Hemavathi; Kumar C, Yashavantha

    2014-01-01

    Background: Puerperal sterilization requires a rapid recovery of the mother so that she can take care of her child. Propofol with fentanyl (PF) is an option, but is associated with intraoperative hypotension, respiratory depression and an unsatisfactory postoperative recovery profile. Propofol with ketamine (PK) appears to be an alternative in terms of haemodynamic stability and analgesia. Materials and Methods: This randomized clinical trial involved 60 patients who were scheduled to undergo puerperal sterilization, who belonged to American society of anaesthesiologists (ASA) physical status 1. Patients were randomly allocated to receive either ketamine – propofol infusion in a concentration of 8mg/ml each (group PK) or fentanyl 2μg/kg intravenously, followed by an infusion of propofol in a concentration of 8mg/ml (group PF). In both the groups, the infusion was started at 300ml/hr till patient lost consciousness. Subsequently, the rate was set at 1.5ml/kg/hr for group PF and at 0.75ml/kg/hr for group PK. After the initial 10 minutes, the infusion rate was reduced to 1ml/kg/hr for group PF and to 0.5ml/kg/hr for group PK. Blood pressure and saturation were the primary outcomes which were measured. Results: Patients from group PF recorded a significant drop in the systolic blood pressure from the 5th minute, in diastolic pressure from the 10th minute and transient oxygen desaturation, as compared to group PK. Patients in group PK had adequate surgical conditions and better recovery profiles in terms of pain and sedation. Conclusion: The combination of ketamine and propofol is a safe and possibly superior alternative to propofol – fentanyl combination in patients who undergo puerperal sterilization, in terms of haemodynamic stability and respiratory depression. PMID:24995191

  11. Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder 'in situ'.

    PubMed Central

    Escourrou, J; Cordova, J A; Lazorthes, F; Frexinos, J; Ribet, A

    1984-01-01

    Endoscopic sphincterotomy has gained wide acceptance in the treatment of biliary lithiasis. We attempted endoscopic sphincterotomy in 443 patients and were successful in 407 (92%). Sphincterotomy was carried out with the gall bladder in situ in 234 cases (57%) of advanced age or high surgical risk. Immediate complications occurred in 7%, of which haemorrhage was the most frequent. The mortality rate was 1.5%. Three hundred and sixteen endoscopic sphincterotomies were performed more than six months before writing and follow up was available for 226 (72%) from six to 78 months. Late complications were observed in 16 patients with gall bladder 'in situ' (12%); the most frequent was cholecystitis in 6%. In five patients of the group without gall bladder, four had cholangitis related to retained or recurrent stones, and one restenosed . No episodes of cholangitis were observed in patients without stones despite reflux of barium up the biliary tree as observed during a barium meal examination. PMID:6735245

  12. Critical analysis of Strattice performance in complex abdominal wall reconstruction: intermediate-risk patients and early complications.

    PubMed

    Patel, Ketan M; Albino, Frank P; Nahabedian, Maurice Y; Bhanot, Parag

    2013-01-01

    The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m(2)). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1-24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice. PMID:24229027

  13. Patient-related independent clinical risk factors for early complications following Nd: YAG laser resection of lung cancer

    PubMed Central

    Perin, Branislav; Zaric, Bojan; Jovanovic, Svetlana; Matijasevic, Jovan; Stanic, Jelena; Kopitovic, Ivan; Zvezdin, Biljana; Antonic, Milan

    2012-01-01

    INTRODUCTION: Neodymium:yttrium aluminum garnet (Nd:YAG) laser resection is one of the most established interventional pulmonology techniques for immediate debulking of malignant central airway obstruction (CAO). The major aim of this study was to investigate the complication rate and identify clinical risk factors for complications in patients with advanced lung cancer. METHODS: In the period from January 2006 to January 2011, data sufficient for analysis were identified in 464 patients. Nd:YAG laser resection due to malignant CAO was performed in all patients. The procedure was carried out in general anesthesia. Complications after laser resection were defined as severe hypoxemia, global respiratory failure, arrhythmia requiring treatment, hemoptysis, pneumothorax, pneumomediastinum, pulmonary edema, tracheoesophageal fistulae, and death. Risk factors were defined as acute myocardial infarction within 6 months before treatment, hypertension, chronic arrhythmia, chronic obstructive pulmonary disease (COPD), stabilized cardiomyopathy, previous external beam radiotherapy, previous chemotherapy, and previous interventional pulmonology treatment. RESULTS: There was 76.1% male and 23.9% female patients in the study, 76.5% were current smokers, 17.2% former smokers, and 6.3% of nonsmokers. The majority of patients had squamous cell lung cancer (70%), small cell lung cancer was identified in 18.3%, adenocarcinoma in 3.4%, and metastases from lung primary in 8.2%. The overall complication rate was 8.4%. Statistically significant risk factors were age (P = 0.001), current smoking status (P = 0.012), arterial hypertension (P < 0.0001), chronic arrhythmia (P = 0.034), COPD (P < 0.0001), and stabilized cardiomyopathy (P < 0.0001). Independent clinical risk factors were age over 60 years (P = 0.026), arterial hypertension (P < 0.0001), and COPD (P < 0.0001). CONCLUSION: Closer monitoring of patients with identified risk factors is advisable prior and immediately after laser resection. In order to avoid or minimize complications, special attention should be directed toward patients who are current smokers, over 60 years of age, with arterial hypertension or COPD. PMID:23189101

  14. Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus.

    PubMed

    Easmin, S; Chowdhury, T A; Islam, M R; Beg, A; Jahan, M K; Latif, T; Dhar, S; Alam, M N; Akhter, M

    2015-07-01

    Obstetric outcome in early onset and late onset GDM was compared in a prospective study conducted at the Department of Obstetrics & Gynecology in BIRDEM, Dhaka, Bangladesh. A total 120 pregnant women were recruited purposively for the study in which 60 were early onset GDM and 60 were late onset GDM during study period of January 2008 to December 2009. Patients were followed up in different periods of gestation, during delivery and early postpartum period & findings were compared between two groups. BMI & family history of diabetes were significantly higher in early GDM group (p<0.05). Evidence of increased glycaemia was observed in early GDM group & difference of glycaemic status was statistically significant (p<0.05). Insulin was needed in 85% of early onset GDM and 55% in late onset GDM. There was also significant difference (p<0.05). In this study, 23.3% of early onset GDM group developed pre-eclampsia while in late onset GDM it was 10% and was statistically significant (p<0.05). Regarding intrapartum & postpartum complications - perineal tear, PPH wound infection, puerperal sepsis were more in early onset than late onset GDM group with no significant difference. Regarding foetal outcome, 8.3% early GDM group delivered asphyxiated baby in comparison to 3.3% in late GDM group. Twenty percent (20%) of early onset GDM group had to admit their babies in neonatal unit while in late onset group it was 5%. There was significant difference between two groups (p<0.05). Neonatal hypoglycaemia was also statistically significantly (p<0.05) higher in early GDM group. Neonatal hyper-bilirubinaemia, RDS, perinatal death was more in early onset GDM subjects. Early onset GDM subjects are high risk subgroup & have significant deleterious effect on maternal and perinatal outcome than late GDM groups. PMID:26329938

  15. Diphtheria Complications

    MedlinePLUS

    ... Materials Publications Related Links World Health Organization (WHO) Immunization Action Coalition (IAC) Diphtheria and the Alaskan Iditarod Complications Recommend on Facebook Tweet Share Compartir Complications from ...

  16. A Complex Solution to a Complicated Problem? Early Messages from the National Evaluation of the Children's Fund Prevention Programme

    ERIC Educational Resources Information Center

    Mason, Paul; Morris, Kate; Smith, Penny

    2005-01-01

    This paper is concerned with exploring the research and policy base that underpinned the development of the Children's Fund Prevention Programme. It discusses how the initiative developed, how it is being evaluated and how it is now contributing to the new policy agenda around prevention services. Early findings are discussed highlighting some of

  17. Clinical aspects of intraoperative radiotherapy in early breast cancer: short-term complications after IORT in women treated with low energy x-rays

    PubMed Central

    2013-01-01

    Background To assess postoperative complications, clinical outcome and histological findings in patients undergoing intraoperative radiotherapy with low energy x-rays for early breast cancer. Methods We retrospectively analysed data of 208 women who underwent intraoperative irradiation during breast conserving surgery (BCS) between 2002 and 2007. Demographic, clinical and surgical parameters as well as short-term complications within the first postoperative week and histological findings were evaluated. Toxicities were assessed using the CTC/EORTC Score. Results Postoperative complications were rare and the immediate toxicity low, without any grade 3/4 acute toxicity. The most frequent postoperative side effects were suggillation (24%) and palpable seroma (17.3%). In 78.6% of the axillary seroma and in 25% of the breast seroma a needle aspiration was inevitable. Erythema grade I-II of the breast was found in 27 women (13%); whereas in 7 patients (3.4%), mastitis was confirmed. In 57.7% of the cases, the pathological assessment revealed ductal invasive breast cancer and tumour size ranged between 0.1 and 4.5 cm (mean = 1.6 cm). Conclusion IORT using Intrabeam® during BCS is safe, although it is associated with postoperative adverse events such as seroma. These should be mentioned and explained to women in detail during the preoperative discussion. This explicitly clinical description is useful for daily clinical practice; especially for giving a detailed analysis of the postoperative side effects during preoperative counselling. PMID:23607703

  18. Breast ductal carcinoma in situ presenting as recurrent non-puerperal mastitis: case report and literature review.

    PubMed

    Liong, Yee Vonne; Hong, Ga Sze; Teo, Jennifer Gek Choo; Lim, Geok Hoon

    2013-01-01

    Breast ductal carcinoma in situ (DCIS) is a preinvasive form of breast cancer. It typically presents as microcalcifications which are picked up on screening mammogram. We report an atypical case of breast DCIS presenting with recurrent non-puerperal mastitis with a normal mammogram and perform a literature review. PMID:23924035

  19. Determination of ceftiofur derivatives in serum, endometrial tissue, and lochia in puerperal dairy cows with fever or acute puerperal metritis after subcutaneous administration of ceftiofur crystalline free acid.

    PubMed

    von Krueger, X; Scherpenisse, P; Roiger, S; Heuwieser, W

    2013-02-01

    Acute puerperal metritis (APM) is one of the most common diseases during the puerperal period. Systemic administration of ceftiofur for 5 consecutive days has been shown to be effective for treatment of APM. The objective of this study was to determine concentrations of ceftiofur derivatives in serum, endometrial tissue, and lochia of cows with fever postpartum or APM 4 to 6d after treatment with a single subcutaneous dose of 6.6 mg of ceftiofur crystalline free acid (CCFA)/kg of estimated BW at the base of the ear. In the first experiment, samples from CCFA-treated cows with fever postpartum or APM (n=42) were taken on d 4, 5, or 6 after treatment. Concentrations of ceftiofur derivatives were quantified using an HPLC assay. Concentrations of active ceftiofur metabolite desfuroylceftiofuracetamide (DCA) were greatest at d 4 after treatment with CCFA in all samples, but they were considerably lower than the concentrations of DCA in healthy postpartum cows treated with the same dose of CCFA. The concentrations of DCA in serum, endometrial tissue, and lochia were affected by odor of vaginal discharge before treatment with CCFA. Mean concentrations of DCA could be detected above the reported minimal drug concentrations (minimum inhibitory concentrations, MIC) required to inhibit relevant pathogens such as Escherichia coli and Arcanobacterium pyogenes in serum on all days and in endometrial tissue and lochia only on d 4 in CCFA-treated cows with fetid vaginal discharge before treatment. In the second experiment, samples from CCFA-treated cows with APM (n=8) were taken on d 0 (before treatment) and d 4, 5, and 6 after treatment. Mean concentrations of DCA in serum and lochia were similar on d 4 to 6 in both laboratories. Furthermore, determined concentrations of DCA from both laboratories were correlated for serum and lochia. Mean concentrations of DCA could be detected above the reported MIC in serum and lochia only on d 4. Our 2 experiments demonstrated that in postpartum cows with fever postpartum or APM concentrations above the MIC for relevant bacteria (>0.5 μg/mL or >0.5 μg/g) of DCA could be sustained only for 4 (serum: 15/17; endometrial tissue: 2/17; lochia: 1/16) to 5d (serum: 10/13; endometrial tissue: 1/13; lochia: 2/12) after a single treatment with CCFA only in a certain proportion of cows. Overall, our data provide first pharmacological evidence that a single subcutaneous administration of 6.6g of CCFA/kg of BW might not be sufficient to efficaciously treat APM in postpartum dairy cows. PMID:23261383

  20. [Acute respiratory distress syndrome complicating an acute chest syndrome: potential benefit of early combination of exchange transfusion and prone positioning].

    PubMed

    Dusacre, J-A; Pons, B; Piednoir, P; Soubirou, J-F; Thiery, G

    2014-12-01

    We report the case of an 8-year-old sickle cell anemia child admitted for acute respiratory failure complicating acute chest syndrome. Because of threatening respiratory failure, tracheal intubation was performed immediately after ICU admission. The patient met the criteria for ARDS with a PaO2/FiO2 ratio of 94mmHg. An exchange transfusion was performed immediately after admission. HbS fraction failed from 69 % to 30 %. Fluid resuscitation with crystalloids and continuous norepinephrine infusion was needed because of arterial hypotension. Due to persistent severe hypoxemia with PaO2/FiO2 ratio below 100, the patient was placed in prone positioning 16hours after admission, for a total duration of 14hours. A second 12-hour session of prone positioning was performed 41h after admission and PaO2/FiO2 ratio reached 300mmHg after. Treatment also included transfusion of two red-cell pack on day 1 and 2 after admission in order to maintain hemoglobin level above 8g/dL, and a daily folic acid supplementation. The control of hyperthermia was achieved by a systematic parenteral administration of paracetamol. Cefotaxime and erythromycine were continued until day 7 despite the negative results of all bacteriological samples. The outcome was favorable from day 3 and the patient met the criteria for extubation on day 5. A first attempt of extubation was performed on day 5, but re-intubation was required because of laryngeal edema. Steroids were given for 48h and the patient was successfully extubated on day 7. She was discharged from the ICU on day 8, and from the hospital on day 12. We discuss the various treatments available for the management of acute chest syndrome and their actual relevance in acute respiratory distress syndrome in the absence of strong evidence-based guidelines in pediatric ARDS. PMID:25458459

  1. Foot Complications

    MedlinePLUS

    ... by Mail Close www.diabetes.org > Living With Diabetes > Complications > Foot Complications Share: Print Page Text Size: A A A Listen En Español Foot Complications People with diabetes can develop many different foot problems. Even ordinary problems can get worse and ...

  2. Semmelweis and the aetiology of puerperal sepsis 160 years on: an historical review

    PubMed Central

    NOAKES, T. D.; BORRESEN, J.; HEW-BUTLER, T.; LAMBERT, M. I.; JORDAAN, E.

    2008-01-01

    SUMMARY It is generally accepted that Professor Ignaz Semmelweis was the first to identify the mode of transmission of puerperal sepsis. However no appropriate statistical analysis of Semmelweis's data supporting his theory has been reported. Mean annual percent maternal mortality rates for the Allgemeines Krankenhaus and Dublin Maternity Hospitals (1784–1858) were analysed. The introduction of pathological anatomy at the Allgemeines Krankenhaus in 1823 was associated with increased mortality. After 1840 maternal mortality was higher in Clinic 1 which was staffed by male obstetricians and medical students who, unlike the midwives in Clinic 2, attended autopsies. The introduction of chlorine washing of the male clinicians’ hands in Clinic 1 by Semmelweis in 1847 reduced mortality, whereas the cessation of handwashing after Semmelweis left Vienna in 1850 was associated with increased mortality. This statistical analysis supports Semmelweis's hypothesis that ‘the cadaveric particles adhering to the hand had … caused the preponderant mortality in the first Clinic’. PMID:17553179

  3. Difference in the rate of rectal complications following prostate brachytherapy based on the prostate-rectum distance and the prostate longitudinal length among early prostate cancer patients

    PubMed Central

    Kang, Moon Hyung; Yu, Young Dong; Shin, Hyun Soo; Oh, Jong Jin

    2015-01-01

    Purpose To investigate the difference in rectal complications rate following prostate low dose rate (LDR) brachytherapy based on prostate-rectum distance and prostate longitudinal length among early prostate cancer patients. Materials and Methods From March 2008 to February 2013, 245 prostate cancer patients with a Gleason score ?7 were treated with 125-I LDR brachytherapy. Among them, 178 patients with prostate volume 20-35 mL and a follow-up period ?6 months were evaluated for radiation proctitis. Magnetic resonance imaging (MRI) was performed for a prebrachytherapy evaluation, and prostate-rectum distance and prostate longitudinal length were measured. The radiation proctitis was confirmed and graded via colonoscopy based on the radiation therapy oncology group (RTOG) toxicity criteria. Results Twenty-three patients received a colonoscopy for proctitis evaluation, and 12 were identified as grade 1 on the RTOG scale. Nine patients were diagnosed as grade 2 and 2 patients were grade 3. No patient developed grade 4 proctitis. The rectal-complication group had a mean prostate-rectum distance of 2.510.16 mm, while non-rectal-complication control group had 3.320.31 mm. The grade 1 proctitis patients had a mean prostate-rectum distance of 2.800.15 mm, which was significantly longer than 2.120.31 mm of grades 2 and 3 patient groups (p=0.045). All 11 patients of grades 2 and 3 had a prostate longitudinal length of 35.222.50 mm, which was longer than group 1, but the difference was not statistically significant (p=0.214). Conclusions As the prostate-rectum distance increased, fewer postimplantation rectal symptoms were observed. Patients with a shorter prostate-rectum distance in MRI should receive modified implantation techniques or radical prostatectomy. PMID:26366276

  4. Early Postoperative Results and Complications of using the EX-PRESS Shunt in uncontrolled Uveitic Glaucoma: A Case Series of Preliminary Results

    PubMed Central

    Chan, Jonathan CH; Qing, Li; Lai, Jimmy SM

    2014-01-01

    ABSTRACT Purpose: The purpose of this case series is to describe the efficacy of the EX-PRESS shunt in uveitic glaucoma. Methods: This prospective case series sequentially recruited uveitic glaucoma subjects with intraocular pressure (IOP) > 21 mm Hg despite maximal topical antiglaucoma medications from July 2012 to July 2013 in Hong Kong. All subjects received a trabeculectomy with mitomycin C (MMC) and EX-PRESS shunt implantation. The primary outcome measures included preope-rative IOP and postoperative IOP on day 1, 1 week, 1 month, and every 3 months thereafter. The secondary outcome measures included postoperative complications and follow-up procedures, pre- and postoperative Snellen best corrected visual acuity and cup-disc ratio, as well as the number of antiglaucoma medication required. Results: In a case series of five subjects with uncontrolled uveitic glaucoma, two had inactive anterior uveitis, and three had active panuveitis. The mean preoperative IOP was 35.4 ± 12.6 mm Hg on 3.8 ± 0.5 antiglaucoma eye drops. The mean day 1, 1 week and 1 month IOP's were 6.6 ± 3.7 mm Hg, 7.2 ± 3.2 mm Hg, and 12.6 ± 8.2 mm Hg, respectively. One case required subconjunctival MMC injections postoperatively; two required conjunctival resuture for leakage; and two had early postoperative hypotony that resolved after oral prednisolone. At 6 months, the mean IOP was 13.2 ± 4.6 mm Hg. Four out of five subjects had IOP < 21 mm Hg without medication, and all had IOP < 21 mm Hg with antiglaucoma medication. Conclusion: The EX-PRESS shunt demonstrates good IOP control with a propensity for hypotony in the early postoperative period in this small uveitic glaucoma series. How to cite this article: Lee JWY, Chan JCH, Qing L, Lai JSM. Early Postoperative Results and Complications of using the EXPRESS Shunt in uncontrolled Uveitic Glaucoma: A Case Series of Preliminary Results. J Current Glau Prac 2014;8(1):20-24.

  5. [Diagnosis and therapy of retained fetal membranes, puerperal metritis and clinical endometritis in cattle: Results of the Online-survey among Swiss practitioners. II. Puerperal metritis and clinical endometritis].

    PubMed

    Hehenberger, E M; Doherr, M G; Bodmer, M; Steiner, A; Hirsbrunner, G

    2015-09-01

    The aim of the study was to obtain the diagnostic and therapeutic approach among Swiss practitioners in cows with puerperal metritis and clinical endometritis (part 2). All members of the Association for ruminant health were contacted per email via the newsletter. The survey was completed by 128 veterinarians, partially responded by 140 veterinarians. The following main symptoms of puerperal metritis were stated by the practitioners: purulent vaginal discharge, fever and reduced appetite. A vaginal and rectal examination was performed to diagnose the disease. Usually, an intrauterine treatment with tetracycline or cefapirin was done. Parenteral administration of tetracycline or penicillin was often combined with PGF(2?), NSAIDS or cortisone. Clinical endometritis was also diagnosed by vaginal and rectal examination and the main symptom indicated was purulent vaginal discharge. The therapy consisted of the administration of PGF(2?), uterine infusions predominantly with cefapirin, and rarely with parenteral administration of antibiotics. Further diagnostic tools were not used and normally cows were not rechecked. The success of the therapy of puerperal metritis and clinical endometritis was judged to be satisfactory to excellent. PMID:26757591

  6. Complications of nephrotic syndrome.

    PubMed

    Park, Se Jin; Shin, Jae Il

    2011-08-01

    Nephrotic syndrome (NS) is one of the most common glomerular diseases that affect children. Renal histology reveals the presence of minimal change nephrotic syndrome (MCNS) in more than 80% of these patients. Most patients with MCNS have favorable outcomes without complications. However, a few of these children have lesions of focal segmental glomerulosclerosis, suffer from severe and prolonged proteinuria, and are at high risk for complications. Complications of NS are divided into two categories: disease-associated and drug-related complications. Disease-associated complications include infections (e.g., peritonitis, sepsis, cellulitis, and chicken pox), thromboembolism (e.g., venous thromboembolism and pulmonary embolism), hypovolemic crisis (e.g., abdominal pain, tachycardia, and hypotension), cardiovascular problems (e.g., hyperlipidemia), acute renal failure, anemia, and others (e.g., hypothyroidism, hypocalcemia, bone disease, and intussusception). The main pathomechanism of disease-associated complications originates from the large loss of plasma proteins in the urine of nephrotic children. The majority of children with MCNS who respond to treatment with corticosteroids or cytotoxic agents have smaller and milder complications than those with steroid-resistant NS. Corticosteroids, alkylating agents, cyclosporin A, and mycophenolate mofetil have often been used to treat NS, and these drugs have treatment-related complications. Early detection and appropriate treatment of these complications will improve outcomes for patients with NS. PMID:22087198

  7. Complications of auricular correction

    PubMed Central

    Staindl, Otto; Siedek, Vanessa

    2008-01-01

    The risk of complications of auricular correction is underestimated. There is around a 5% risk of early complications (haematoma, infection, fistulae caused by stitches and granulomae, allergic reactions, pressure ulcers, feelings of pain and asymmetry in side comparison) and a 20% risk of late complications (recurrences, telehone ear, excessive edge formation, auricle fitting too closely, narrowing of the auditory canal, keloids and complete collapse of the ear). Deformities are evaluated less critically by patients than by the surgeons, providing they do not concern how the ear is positioned. The causes of complications and deformities are, in the vast majority of cases, incorrect diagnosis and wrong choice of operating procedure. The choice of operating procedure must be adapted to suit the individual ear morphology. Bandaging technique and inspections and, if necessary, early revision are of great importance for the occurence and progress of early complications, in addition to operation techniques. In cases of late complications such as keloids and auricles that are too closely fitting, unfixed full-thickness skin flaps have proved to be the most successful. Large deformities can often only be corrected to a limited degree of satisfaction. PMID:22073079

  8. Early-switch/early-discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections: proof of concept in the United Arab Emirates

    PubMed Central

    El Houfi, Ashraf; Javed, Nadeem; Solem, Caitlyn T; Macahilig, Cynthia; Stephens, Jennifer M; Raghubir, Nirvana; Chambers, Richard; Li, Jim Z; Haider, Seema

    2015-01-01

    Objectives To describe real-world treatment patterns and health care resource use and to estimate opportunities for early-switch (ES) from intravenous (IV) to oral (PO) antibiotics and early-discharge (ED) for patients hospitalized in the United Arab Emirates (UAE) with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections. Methods This retrospective observational medical chart review study enrolled physicians from four UAE sites to collect data for 24 patients with documented MRSA complicated skin and soft tissue infections, hospitalized between July 2010 and June 2011, and discharged alive by July 2011. Data include clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and PO antibiotic use, and ES and ED eligibility using literature-based and expert-validated criteria. Results Five included patients (20.8%) were switched from IV to PO antibiotics while being inpatients. Actual length of MRSA-active treatment was 10.8±7.0 days, with 9.8±6.6 days of IV therapy. Patients were hospitalized for a mean 13.9±9.3 days. The most frequent initial MRSA-active therapies used were vancomycin (37.5%), linezolid (16.7%), and clindamycin (16.7%). Eight patients were discharged with MRSA-active antibiotics, with linezolid prescribed most frequently (n=3; 37.5%). Fifteen patients (62.5%) met ES criteria and potentially could have discontinued IV therapy 8.3±6.0 days sooner, and eight (33.3%) met ED criteria and potentially could have been discharged 10.9±5.8 days earlier. Conclusion While approximately one-fifth of patients were switched from IV to PO antibiotics in the UAE, there were clear opportunities for further optimization of health care resource use. Over half of UAE patients hospitalized for MRSA complicated skin and soft tissue infections could be eligible for ES, with one-third eligible for ED opportunities, resulting in substantial potential for reductions in IV days and bed days. PMID:26124673

  9. HHV-6 encephalitis may complicate the early phase after allogeneic hematopoietic stem cell transplantation: Detection by qualitative multiplex PCR and subsequent quantitative real-time PCR.

    PubMed

    Inazawa, Natsuko; Hori, Tsukasa; Yamamoto, Masaki; Hatakeyama, Naoki; Yoto, Yuko; Nojima, Masanori; Yasui, Hiroshi; Suzuki, Nobuhiro; Shimizu, Norio; Tsutsumi, Hiroyuki

    2016-02-01

    Viral reactivation following hematopoietic stem cell transplantation (HSCT) can cause various complications especially viral encephalitis. In this prospective study, we investigated the correlation of post-HSCT viral reactivation in blood with CNS dysfunction. We employed a multiplex PCR that detects 13 kinds of viruses as a first-line screening test and real-time PCR for subsequent quantitative evaluation. Five hundred ninety-one whole blood samples were collected from 105 patients from before until 42 days after HSCT. Seven patients developed CNS dysfunction such as altered consciousness. In six of the seven, the multiplex PCR test detected HHV-6 DNA in at least one sample. In contrast, DNA from other viruses, such as CMV, EBV, HHV-7, adenovirus, and HBV was never detected in any of the seven patients throughout the study period. Quantitative measurement of whole blood HHV-6 DNA levels demonstrated four of the six HHV-6 DNA loads were elevated at successive time points during the CNS dysfunction. In addition, the virus DNA peaks were temporally associated with the development of CNS dysfunction. CSF was tested in two of the four patients and high HHV-6 DNA levels comparable to those in whole blood were confirmed in both. These four patients were, thus, suspected to have developed HHV-6 encephalitis, a rate of 3.8% in the study population. Our results suggest that early diagnosis of probable HHV-6 encephalitis can be improved by confirming high HHV-6 DNA load in blood. J. Med. Virol. 88:319-323, 2016. 2015 Wiley Periodicals, Inc. PMID:26241219

  10. Ocular complications of diabetes mellitus

    PubMed Central

    Sayin, Nihat; Kara, Necip; Pekel, Gökhan

    2015-01-01

    Diabetes mellitus (DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and is becoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world’s most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases. PMID:25685281

  11. Effect of puerperal metritis on reproductive and productive performance in dairy cows in Argentina.

    PubMed

    Piccardi, M; Romero, G; Veneranda, G; Castello, E; Romero, D; Balzarini, M; Bó, G A

    2016-03-15

    The objectives of this study were to evaluate the reproductive and productive performance of dairy cows with and without puerperal metritis and to evaluate the effectiveness of using a long-acting ceftiofur preparation. Dairy cows in one dairy farm, calving from July 2009 to January 2010, were examined between 3 and 14 days postpartum and classified on the basis of vaginal discharge into three groups: cows with normal discharge (control; C); cows with a bloody mucus purulent or pathologic nonfetid discharge (PnFD), and cows with bloody mucopurulent or purulent fetid discharge (PFD). Cows in C and PnFD groups were not treated, whereas those in the PFD group were randomly allocated to receive 2.2 mg/kg of ceftiofur subcutaneously behind the ear (PFD-T) or remain untreated (PFD-No T). From the 640 cows examined, 58.2% formed the C group, 13.4% formed the PnFD group, and 28.4% formed the PFD group. Survival curves differed between cows in the C group and PFD-No T group (P = 0.0013) and between PFD-No T versus PFD-T group (P = 0.0006). Survival curves of PnFD were intermediate and did not differ from those in the C group (P = 0.2) and PFD-T group (P = 0.1) but tended to be different from the PFD-No T group (P = 0.056). The postpartum interval to achieve a 25% pregnancy rate was 72 days for cows in the C group, 73 days for the PFD-T group, 83 days for PnFD group, and 95 days for the PFD-No T group. The chance of pregnancy in a cow in the C group was 1.98 times higher (95% confidence interval = 1.33, 3.08) and in cows in the PFD-T group was 2.16 times higher (95% confidence interval = 1.37, 3.50) than that in the PFD-No T group. Finally, the chance of pregnancy in cows in the PnFD group tended to be higher (P = 0.08) than that in the PFD-No T group but did not differ from the other two groups. Cumulative 305-day milk production was higher (P < 0.0001) in C group than those with vaginal discharge, regardless of fetidness and regardless of treatment. It is concluded that puerperal metritis affects the reproductive and productive performance of dairy cows and the treatment with ceftiofur was effective in reducing the adverse effects on reproductive performance but not on milk production. PMID:26643603

  12. Puerperal and parental experiences alter rat preferences for pup odors via changes in the oxytocin system.

    PubMed

    Munetomo, Arisa; Ishii, Hirotaka; Miyamoto, Takenori; Sakuma, Yasuo; Kondo, Yasuhiko

    2016-02-20

    In the rat, induction of maternal behavior depends on the parity of the female. For example, nulliparous (NP) females need longer exposure to pups than multiparous (MP) or lactating (L) females to exhibit similar maternal behavior. In this study, we investigated the role of brain oxytocin in the approaching behavior of these female rats. Olfactory preferences for pup odors were examined for 8 consecutive days. Each preference test was followed by direct overnight exposure to pups. On the 8th day, MP and L, but not NP females showed robust pup-odor preferences. After the behavioral test, half of the females were exposed to pups for 2 h, whereas the other half were not. The females were then sacrificed to analyze brain oxytocin (OXT) and vasopressin (AVP) activities by cFos immunohistochemistry and to quantify their receptor mRNA expression using real-time PCR. In the paraventricular nucleus (PVN), the percentage of cFos-positive OXT neurons was significantly larger in MP and L females than in NP females after pup exposure. No significant differences were found in cFos expression in OXT neurons of the supraoptic nucleus (SON) or in AVP neurons of either the PVN or SON. Expression of OXT receptor mRNA in the medial preoptic area and amygdala of the control groups was also higher in MP females than in NP females. Finally, we demonstrated that infusion of OXT into the lateral ventricle of NP females promoted preferences for pup odors. These results indicate that puerperal and parental experiences enhance the responsiveness of OXT neurons in the PVN to pup stimuli and establish olfactory preferences for these odors in a parity-dependent manner. PMID:26460689

  13. Puerperal and parental experiences alter rat preferences for pup odors via changes in the oxytocin system

    PubMed Central

    MUNETOMO, Arisa; ISHII, Hirotaka; MIYAMOTO, Takenori; SAKUMA, Yasuo; KONDO, Yasuhiko

    2015-01-01

    In the rat, induction of maternal behavior depends on the parity of the female. For example, nulliparous (NP) females need longer exposure to pups than multiparous (MP) or lactating (L) females to exhibit similar maternal behavior. In this study, we investigated the role of brain oxytocin in the approaching behavior of these female rats. Olfactory preferences for pup odors were examined for 8 consecutive days. Each preference test was followed by direct overnight exposure to pups. On the 8th day, MP and L, but not NP females showed robust pup-odor preferences. After the behavioral test, half of the females were exposed to pups for 2 h, whereas the other half were not. The females were then sacrificed to analyze brain oxytocin (OXT) and vasopressin (AVP) activities by cFos immunohistochemistry and to quantify their receptor mRNA expression using real-time PCR. In the paraventricular nucleus (PVN), the percentage of cFos-positive OXT neurons was significantly larger in MP and L females than in NP females after pup exposure. No significant differences were found in cFos expression in OXT neurons of the supraoptic nucleus (SON) or in AVP neurons of either the PVN or SON. Expression of OXT receptor mRNA in the medial preoptic area and amygdala of the control groups was also higher in MP females than in NP females. Finally, we demonstrated that infusion of OXT into the lateral ventricle of NP females promoted preferences for pup odors. These results indicate that puerperal and parental experiences enhance the responsiveness of OXT neurons in the PVN to pup stimuli and establish olfactory preferences for these odors in a parity-dependent manner. PMID:26460689

  14. [Surgical complications in renal transplantation].

    PubMed

    Boffo, V; Cortese, F; Baroni, B; Pisani, F; Utzeri, G; Casciani, C U

    1993-11-01

    Technical complications in kidney transplantation are unusual but with a high incidence of graft loss and mortality. The authors report their experience with 89 kidney transplants with an overall incidence of 16.8%. Only early and aggressive surgical procedures can resolve certain of the complications. PMID:8152568

  15. Aneurysm Complications

    MedlinePLUS

    ... Sign-Up Contact Us Understanding Brain Aneurysm Basics Warning Signs/Symptoms Brain Aneurysm Statistics and Facts Seeking Medical Attention Pediatric Aneurysms Brain Aneurysm Causes and Risk Factors Family History Early Detection and Screening Unruptured Brain Aneurysms Subarachnoid Hemorrhage ...

  16. Early continuous veno-venous haemofiltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years' experience

    PubMed Central

    2012-01-01

    Background Conservative treatment of patients with severe acute pancreatitis (SAP) may be associated with development of intra-abdominal hypertension (IAH), deterioration of visceral perfusion and increased risk of multiple organ dysfunction. Fluid balance is essential for maintenance of adequate organ perfusion and control of the third space. Timely application of continuous veno-venous haemofiltration (CVVH) may help in balancing fluid replacement and removal of cytokines from the blood and tissue compartments. The aim of the present study was to determine whether CVVH can be recommended as a constituent of conservative treatment in patients with SAP who suffer IAH. Methods A retrospective analysis of 10 years' experience with low-flow CVVH application in patients with SAP who develop IAH was. In all patients, measurement of the intra-abdominal pressure (IAP) was done indirectly through the urinary bladder. Sequential organ failure assessment (SOFA) score was calculated for severity assessment, and necrotizing forms were verified by contrast-enhanced computed tomography. Dynamics of IAP were analysed in parallel with signs of systemic inflammation, dynamics of C-reactive protein and cumulative fluid balance. All variables, complication rate and outcomes were analysed in the whole group and in patients with IAH (CVVH and no-CVVH groups). Results From the total of 130 patients, 75 were treated with application of CVVH and 55 without CVVH. Late hospitalization was associated with application of CVVH. Infection was observed in 28.5% of cases regardless of the type of treatment received, with a similar necessity for surgical intervention. IAH was observed in 68.5% of patients, and they had significantly higher SOFA scores compared to patients with normal IAP. CVVH treatment resulted in negative cumulative fluid balance starting from day 5 in patients with IAH, whereas without this treatment, fluid balance remained increasingly positive after a week. Finally, application of CVVH resulted in a lower infection rate and shorter hospital stay, 26.7% vs. 37.9%, and a median of 32 (interquartile range (IQR) = 60 to 12) days vs. 24 (IQR = 34 to 4) days, p = 0.05, comparing CVVH vs. no-CVVH group. Mortality rate reached 11.7% in the CVVH group and 13.8% in the no-CVVH group. Conclusions Early application of CVVH facilitates negative fluid balance and reduction of IAH in patients with SAP; it is not associated with increased infection or mortality rate and may reduce hospital stay. PMID:23281603

  17. Comparative Microbial Analysis of Paired Amniotic Fluid and Cord Blood from Pregnancies Complicated by Preterm Birth and Early-Onset Neonatal Sepsis

    PubMed Central

    Wang, Xiaowei; Buhimschi, Catalin S.; Temoin, Stephanie; Bhandari, Vineet; Han, Yiping W.; Buhimschi, Irina A.

    2013-01-01

    Background 16S rRNA-based genomic analyses have revolutionized our understanding of infectious diseases. Many cases which were recognized as “idiopathic” are now known to have an infectious etiology. Here, we present a proof-of-concept study to examine the microbial link between intra-amniotic infection (IAI) and early-onset neonatal sepsis (EONS). Results Using culture independent methods, we analyzed paired amniotic fluid (AF) and cord blood (CB) samples from 36 singleton pregnancies complicated by preterm birth (PTB), IAI, and/or EONS. PTB cases were grouped as 1) Group 1– neonatal blood culture-positive EONS (n = 6). 2) Group 2– neonatal blood culture-negative presumed EONS with positive IAI (n = 16). 3) Group 3– neonatal blood culture-negative presumed EONS with no IAI (n = 7); 4) Group 4– no EONS or IAI (n = 7). In addition, samples from term healthy deliveries (n = 8) served as technical controls. A total of 31 species (15 non-redundant) were identified in AF, of which only 1/3 were cultivated. Significantly fewer microorganisms were detected in CB, with a total of 18 species (7 non-redundant) identified, of which only 2 (Escherichia coli, Streptococcus agalactiae) were cultivated. Of those, Bergeyella, Fusobacterium nucleatum, and Sneathia sanguinegens had not been detected in EONS before. The novel species identified in AF by PCR include Peptoniphilus harei and Lachnospiraceae sp. The majority (72%) of CB species were also detected in the matching AF, with E. coli and F. nucleatum as the most prevalent. The 16S rRNA sequences of paired AF and CB were 99.9–100% identical, while no identical sequences were found between different pregnancies. Conclusions Previously unrecognized, uncultivated or difficult-to-cultivate species are implicated in EONS. Microbial species in paired AF and CB likely share the same infectious origin. Given its prevalence in EONS, F. nucleatum should be placed on the same importance scale as E. coli. PMID:23437088

  18. Early Urinary Markers of Diabetic Kidney Disease: A Nested Case-Control Study From the Diabetes Control and Complications Trial (DCCT)

    PubMed Central

    Kern, Elizabeth O; Erhard, Penny; Sun, Wanjie; Genuth, Saul; Weiss, Miriam F

    2010-01-01

    Background Urinary markers were tested as predictors of macroalbuminuria or microalbuminuria in type 1 diabetes. Study Design Nested case:control of participants in the Diabetes Control and Complications Trial (DCCT) Setting & Participants Eighty-seven cases of microalbuminuria were matched to 174 controls in a 1:2 ratio, while 4 cases were matched to 4 controls in a 1:1 ratio, resulting in 91 cases and 178 controls for microalbuminuria. Fifty-five cases of macroalbuminuria were matched to 110 controls in a 1:2 ratio. Controls were free of micro/macroalbuminuria when their matching case first developed micro/macroalbuminuria. Predictors Urinary N-acetyl-?-D-glucosaminidase, pentosidine, AGE fluorescence, albumin excretion rate (AER) Outcomes Incident microalbuminuria (two consecutive annual AER > 40 but <= 300 mg/day), or macroalbuminuria (AER > 300 mg/day) Measurements Stored urine samples from DCCT entry, and 19 years later when macroalbuminuria or microalbuminuria occurred, were measured for the lysosomal enzyme, N-acetyl-?-D-glucosaminidase, and the advanced glycosylation end-products (AGEs) pentosidine and AGE-fluorescence. AER and adjustor variables were obtained from the DCCT. Results Sub-microalbuminuric levels of AER at baseline independently predicted microalbuminuria (adjusted OR 1.83; p<.001) and macroalbuminuria (adjusted OR 1.82; p<.001). Baseline N-acetyl-?-D-glucosaminidase independently predicted macroalbuminuria (adjusted OR 2.26; p<.001), and microalbuminuria (adjusted OR 1.86; p<.001). Baseline pentosidine predicted macroalbuminuria (adjusted OR 6.89; p=.002). Baseline AGE fluorescence predicted microalbuminuria (adjusted OR 1.68; p=.02). However, adjusted for N-acetyl-?-D-glucosaminidase, pentosidine and AGE-fluorescence lost predictive association with macroalbuminuria and microalbuminuria, respectively. Limitations Use of angiotensin converting-enzyme inhibitors was not directly ascertained, although their use was proscribed during the DCCT. Conclusions Early in type 1 diabetes, repeated measurements of AER and urinary NAG may identify individuals susceptible to future diabetic nephropathy. Combining the two markers may yield a better predictive model than either one alone. Renal tubule stress may be more severe, reflecting abnormal renal tubule processing of AGE-modified proteins, among individuals susceptible to diabetic nephropathy. PMID:20138413

  19. [Orbital complications of sinusitis].

    PubMed

    ucha?, M; Hor?k, M; Kaliarik, L; Krempask, S; Kotialov, T; Kova?, J

    2014-12-01

    Orbital complications categorised by Chandler are emergency. They need early diagnosis and agresive treatment. Stage and origin of orbital complications are identified by rhinoendoscopy, ophtalmologic examination and CT of orbite and paranasal sinuses. Periorbital cellulitis and early stage of orbital cellulitis can be treated conservatively with i. v. antibiotics. Monitoring of laboratory parameters and ophtalmologic symptoms is mandatory. Lack of improvement or worsening of symptoms within 24-48 hours and advanced stages of orbital complications are indicated for surgery. The purpose of the study is to evaluate epidemiology, clinical features and management of sinogenic orbital complications. Retrospective data of 8 patients with suspicion of orbital complication admited to hospital from 2008 to 2013 were evaluated. Patients were analyzed in terms of gender, age, CT findings, microbiology, clinical features, stage and treatment. Male and female were afected in rate 1,66:1. Most of patients were young adult in 3rd. and 4th. decade of life (62,5 %). Acute and chronic sinusitis were cause of orbital complication in the same rate. The most common origin of orbital complication was ethmoiditis (62,5 %), than maxillary (25 %) and frontal (12,5 %) sinusitis. Polysinusitis with affection of ethmoidal, maxillary and frontal sinuses (75 %) was usual CT finding. Staphylococcus epidermidis and Staphylococcus aureus were etiological agens in half of cases. Periorbital oedema (100 %), proptosis, chemosis (50 %), diplopia and glaucoma (12,5 %) were observed. Based on examinations, diagnosis of periorbital oedema/preseptal cellulitis was made in 3 (37,5 %), orbital cellulitis in 3 (37,5 %) and subperiosteal abscess in 2 cases (25 %). All patients underwent combined therapy - i. v. antibiotics and surgery within 24 hours. Eradication of disease from ostiomeatal complex (OMC), drainage of affected sinuses and drainage of subperiosteal abscess were done via fuctional endonasal endoscopic surgery (FEES). In case of superior subperiosteal abscess, combined endonasal and external approach (external orbitotomy) was needed. Combined therapy facilitated quick improvement of local and systematic symptoms. Average time of hospitalisation was 7 days. Early diagnosis and agresive combined therapy prevent loss of vision and life threatening complications. PMID:25640234

  20. Complications of antiobesity surgery.

    PubMed

    Nguyen, Ninh T; Wilson, Samuel E

    2007-03-01

    Bariatric surgery is an effective long-term treatment for patients who suffer from morbid obesity, the incidence of which is increasing in North America. Laparoscopic gastric bypass and laparoscopic adjustable gastric band placement are the two commonly performed bariatric procedures. This article discusses the indications for bariatric surgery and the early and late complications associated with these two procedures. Laparoscopic biliopancreatic diversion and laparoscopic sleeve gastrectomy are also briefly discussed. PMID:17339851

  1. Thrombophilia and Pregnancy Complications.

    PubMed

    Simcox, Louise E; Ormesher, Laura; Tower, Clare; Greer, Ian A

    2015-01-01

    There is a paucity of strong evidence associated with adverse pregnancy outcomes and thrombophilia in pregnancy. These problems include both early (recurrent miscarriage) and late placental vascular-mediated problems (fetal loss, pre-eclampsia, placental abruption and intra-uterine growth restriction). Due to poor quality case-control and cohort study designs, there is often an increase in the relative risk of these complications associated with thrombophilia, particularly recurrent early pregnancy loss, late fetal loss and pre-eclampsia, but the absolute risk remains very small. It appears that low-molecular weight heparin has other benefits on the placental vascular system besides its anticoagulant properties. Its use is in the context of antiphospholipid syndrome and recurrent pregnancy loss and also in women with implantation failure to improve live birth rates. There is currently no role for low-molecular weight heparin to prevent late placental-mediated complications in patients with inherited thrombophilia and this may be due to small patient numbers in the studies involved in summarising the evidence. There is potential for low-molecular weight heparin to improve pregnancy outcomes in women with prior severe vascular complications of pregnancy such as early-onset intra-uterine growth restriction and pre-eclampsia but further high quality randomised controlled trials are required to answer this question. PMID:26633369

  2. Thrombophilia and Pregnancy Complications

    PubMed Central

    Simcox, Louise E.; Ormesher, Laura; Tower, Clare; Greer, Ian A.

    2015-01-01

    There is a paucity of strong evidence associated with adverse pregnancy outcomes and thrombophilia in pregnancy. These problems include both early (recurrent miscarriage) and late placental vascular-mediated problems (fetal loss, pre-eclampsia, placental abruption and intra-uterine growth restriction). Due to poor quality case-control and cohort study designs, there is often an increase in the relative risk of these complications associated with thrombophilia, particularly recurrent early pregnancy loss, late fetal loss and pre-eclampsia, but the absolute risk remains very small. It appears that low-molecular weight heparin has other benefits on the placental vascular system besides its anticoagulant properties. Its use is in the context of antiphospholipid syndrome and recurrent pregnancy loss and also in women with implantation failure to improve live birth rates. There is currently no role for low-molecular weight heparin to prevent late placental-mediated complications in patients with inherited thrombophilia and this may be due to small patient numbers in the studies involved in summarising the evidence. There is potential for low-molecular weight heparin to improve pregnancy outcomes in women with prior severe vascular complications of pregnancy such as early-onset intra-uterine growth restriction and pre-eclampsia but further high quality randomised controlled trials are required to answer this question. PMID:26633369

  3. Cabergoline for suppression of puerperal lactation in a prevention of mother-to-child HIV-transmission programme in rural Malawi.

    PubMed

    Buhendwa, L; Zachariah, R; Teck, R; Massaquoi, M; Kazima, J; Firmenich, P; Harries, A D

    2008-01-01

    This study shows that cabergoline (single oral-dose) is an acceptable, safe and effective drug for suppressing puerperal lactation. It could be of operational benefit not only for artificial feeding, but also for weaning in those that breast-feed within preventive mother-to-child HIV transmission programmes in resource-limited settings. PMID:18302861

  4. [Esophageal stenting complications].

    PubMed

    Smoliar, A N; Radchenko, Iu A; Nefedova, G A; Abakumov, M M

    2014-01-01

    The aim of the study was to analyze esophageal stenting complications in case of cancer and benign diseases. It was investigated complications in 8 patients in terms from 7 days to 1 year after intervention. In 4 patients esophageal stenting was performed for constrictive esophageal cancer and compression with pulmonary cancer metastases into mediastinal lymphatic nodes. 2 patients had esophageal stenting for post-tracheostomy tracheo-esophageal fistula, 1 patient - for spontaneous esophageal rupture, 1 patient - for post-burn scar narrowing of esophagus and output part of the stomach. Severe patients' condition with tumor was determined by intensive esophageal bleeding in 2 cases, bilateral abscessed aspiration pneumonia, tumor bleeding, blood aspiration (1 case), posterior mediastinitis (1 case). Severe patients' condition with benign disease was associated with decompensated esophageal narrowing about proximal part of stent (1 case), increase of tracheo-esophageal fistula size complicated by aspiration pneumonia (1 case), stent migration into stomach with recurrence of esophago-mediastino-pleural fistula and pleural empyema (1 case), decompensated narrowing of esophagus and output part of the stomach (1 case). Patients with cancer died. And patients with benign diseases underwent multi-stage surgical treatment and recovered. Stenting is palliative method for patients with esophageal cancer. Patients after stenting should be under outpatient observation for early diagnosis of possible complications. Esophageal stenting in patients with benign diseases should be performed only by life-saving indications, in case of inability of other treatment and for the minimum necessary period. PMID:25589315

  5. Hypoglycemia: The neglected complication

    PubMed Central

    Kalra, Sanjay; Mukherjee, Jagat Jyoti; Venkataraman, Subramanium; Bantwal, Ganapathi; Shaikh, Shehla; Saboo, Banshi; Das, Ashok Kumar; Ramachandran, Ambady

    2013-01-01

    Hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes mellitus. Attempts made at intensive glycemic control invariably increases the risk of hypoglycemia. A six-fold increase in deaths due to diabetes has been attributed to patients experiencing severe hypoglycemia in comparison to those not experiencing severe hypoglycemia Repeated episodes of hypoglycemia can lead to impairment of the counter-regulatory system with the potential for development of hypoglycemia unawareness. The short- and long-term complications of diabetes related hypoglycemia include precipitation of acute cerebrovascular disease, myocardial infarction, neurocognitive dysfunction, retinal cell death and loss of vision in addition to health-related quality of life issues pertaining to sleep, driving, employment, recreational activities involving exercise and travel. There is an urgent need to examine the clinical spectrum and burden of hypoglycemia so that adequate control measures can be implemented against this neglected life-threatening complication. Early recognition of hypoglycemia risk factors, self-monitoring of blood glucose, selection of appropriate treatment regimens with minimal or no risk of hypoglycemia and appropriate educational programs for healthcare professionals and patients with diabetes are the major ways forward to maintain good glycemic control, minimize the risk of hypoglycemia and thereby prevent long-term complications. PMID:24083163

  6. Cardiovascular Complications of Pregnancy

    PubMed Central

    Gongora, Maria Carolina; Wenger, Nanette K.

    2015-01-01

    Pregnancy causes significant metabolic and hemodynamic changes in a woman’s physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up. PMID:26473833

  7. Benzoyl-L-arginine methyl ester (BAME)-esterase activity in human plasma during the gravidic-puerperal cycle.

    PubMed

    Salles Meirelles, R

    1977-01-01

    Benzoyl-L-arginine methyl ester (BAME)-esterase activity of plasma was measured in women going through the gravidic-puerperal cycle and compared with plasma of non-pregnant women. Plasma from women in the 36th to 40th week of pregnancy hydrolyzes BAME two times more rapidly than that from non-pregnant women. During pregnancy, BAME-esterase activity in plasma increases progressively up to the 40th week, decreases during labor, and after delivery reaches the same level as in non-pregnant women. The BAME-esterase activity of plasma was affected by the storage temperature, with differences demonstrable between -20 and -4 C and between pregnant and non-pregnant women. PMID:754510

  8. Puerperal Mastitis: a Reproductive Event of Importance Affecting Anti-Mucin Antibody Levels and Ovarian Cancer Risk

    PubMed Central

    Cramer, Daniel W.; Williams, Kristina; Vitonis, Allison F.; Yamamoto, Hidemi S.; Stuebe, Alison; Welch, William R.; Titus, Linda; Fichorova, Raina N.

    2013-01-01

    Purpose Test the hypothesis that puerperal mastitis may alter immunity related to the mucin (MUC) family of glycoproteins and lower risk for ovarian cancer. Methods In two case-control studies conducted in New England between 19982008, we examined the association between self-reported mastitis and ovarian cancer in 1,483 women with epithelial ovarian cancer and 1,578 controls. IgG1 antibodies against (MUC1) CA15.3 and (MUC16) CA125 were measured using electrochemiluminescence assays in a subset of controls (n=200). Preoperative CA125 was recorded in 649 cases. The association between ovarian cancer and mastitis was assessed using unconditional logistic regression to calculate adjusted odds ratios, OR, and 95% confidence intervals (CI). Associations between mastitis and anti-CA15.3 and anti-CA125 antibodies and preoperative CA125 levels were evaluated using adjusted linear regression models. Results Prior mastitis was associated with a significantly lower risk for ovarian cancer: OR (and 95% CI) of 0.67 (0.48, 0.94) adjusted for parity, breastfeeding, and other potential confounders. The association was strongest with 2 or more episodes of mastitis; and risk declined progressively with increasing number of children and episodes of mastitis. Among controls, prior mastitis was associated with significantly higher anti-CA15.3 and anti-CA125 antibody levels and, among cases, with significantly lower preoperative CA125 levels. Conclusion Puerperal that mastitis may produce long-lasting anti-mucin antibodies that may lower the risk for ovarian cancer, plausibly through enhanced immune surveillance. Studying immune reactions related to MUC1 and MUC16 in the 1020% of breastfeeding women who develop mastitis may suggest ways to duplicate its effects through vaccines based on both antigens. PMID:23925696

  9. Orbital Complications of Sinusitis

    PubMed Central

    Radovani, Pjerin; Vasili, Dritan; Xhelili, Mirela; Dervishi, Julian

    2013-01-01

    Background: Despite the modern antibiotherapies applied in the practice of otorhinolaryngology, the orbital complications of sinusitis are still considered a serious threat to essential functions of the eye, including loss of vision, and at worst, life threatening symptoms. Aims: The goal of this study is to consider and analyse patients who were treated for these complications in the last decade in our hospital, which is the only tertiary hospital in our country. Study Design: Retrospective analysis of cases. Methods: In our practice, cases treated in the hospital are rhinosinusitis cases where surgical intervention is necessary, or those with a suspicion of complications. Between the years 1999 and 2009 there were 177 cases, the clinical charts of which were reviewed. The cases that are omitted from this study are those involving soft tissues, bone, and intracranial complications. The diagnoses were determined based on anamnesis, anterior rhinoscopy, x-rays of the sinuses with the Water’s projection or where there was a suspicion of a complication, and CT scans with coronal and axial projections. In all cases, intensive treatment was initiated with a combination of cefalosporines, aminoglycosides and Proetz manoeuvre. When an improvement in the conditions did not occur within 24–48 hours, we intervened with a surgical procedure, preferably the Lynch-Patterson external frontoethmoidectomy. Results: In our study, we encountered 35 cases (19.8%) of orbital complications with an average age of 25 (range: 3–75); Palpebral inflammatory oedema (15), orbital cellulitis (10), subperiosteal abscess (6), orbital abscess (3), and cavernous sinus thrombosis (1 patient). The average time that patients remained in hospital was 4.6 days; for those with orbital complications this was 7 days. Conclusion: Orbital complications of sinusitis are considered to be severe pathologies. The appearance of oedema in the corner of the eye should be evaluated immediately and the means to exclude acute sinusitis should be taken under serious consideration. Early diagnosis and aggressive treatment are key to the reduction of these unwanted manifestations. PMID:25207092

  10. Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systematic review and meta-analysis of weight results, diabetes resolution and early complications in single-centre comparisons.

    PubMed

    Hedberg, J; Sundstrm, J; Sundbom, M

    2014-07-01

    Long-term weight loss after Roux-en-Y gastric bypass (RYGB) in super-obese patients has not been ideal. Biliopancreatic diversion with duodenal switch (DS) is argued to be better; however, additional side effects are feared. The aim of the present study was to determine differences in results after DS and RYGB in publications from single-centre comparisons. A systematic review of studies containing DS and RYGB performed at the same centre was performed. Outcome data were weight results, resolution of comorbid conditions, perioperative results and complications. Main outcome was difference in weight loss after DS and RYGB. Secondary outcomes were difference in resolution of comorbidities, perioperative results and complications. The final analysis included 16 studies with in total 874 DS and 1,149 RYGB operations. When comparing weight results at the longest follow-up of each study, DS yielded 6.2 (95% confidence interval 5.0-7.5) body mass index units additional weight loss compared with RYGB, P < 0.001. Operative time and length of stay were significantly longer after DS, as well as the risk for post-operative leaks, P < 0.05. DS is more effective than RYGB as a weight-reducing procedure. However, this comes at the price of more early complications and might also yield slightly higher perioperative mortality. PMID:24666623

  11. Lateral Lumbar Interbody Fusion for the Correction of Spondylolisthesis and Adult Degenerative Scoliosis in High-Risk Patients: Early Radiographic Results and Complications

    PubMed Central

    Waddell, Brad; Briski, David; Qadir, Rabah; Godoy, Gustavo; Houston, Allison Howard; Rudman, Ernest; Zavatsky, Joseph

    2014-01-01

    Background Lateral lumbar interbody fusion (LLIF) is not associated with many of the complications seen in other interbody fusion techniques. This study used computed tomography (CT) scans, the radiographic gold standard, to assess interbody fusion rates achieved utilizing the LLIF technique in high-risk patients. Methods We performed a retrospective review of patients who underwent LLIF between January 2008 and July 2013. Forty-nine patients underwent nonstaged or staged LLIF on 119 levels with posterior correction and augmentation. Per protocol, patients received CT scans at their 1-year follow-up. Of the 49 patients, 21 patients with LLIF intervention on 54 levels met inclusion criteria. Two board-certified musculoskeletal radiologists and the senior surgeon (JZ) assessed fusion. Results Of the 21 patients, 6 patients had had previous lumbar surgery, and the cohort's comorbidities included osteoporosis, diabetes, obesity, and smoking, among others. Postoperative complications occurred in 12 (57.1%) patients and included anterior thigh pain and weakness in 6 patients, all of which resolved by 6 months. Two cases of proximal junctional kyphosis occurred, along with 1 case of hardware pullout. Two cases of abdominal atonia occurred. By CT scan assessment, each radiologist found fusion was achieved in 53 of 54 levels (98%). The radiologists' findings were in agreement with the senior surgeon. Conclusion Several studies have evaluated LLIF fusion and reported fusion rates between 88%-96%. Our results demonstrate high fusion rates using this technique, despite multiple comorbidities in the patient population. Spanning the ring apophysis with large LLIF cages along with supplemental posterior pedicle screw augmentation can enhance stability of the fusion segment and increase fusion rates. PMID:24688329

  12. Early Complication in Sickle Cell Anemia Children due to A(TA)nTAA Polymorphism at the Promoter of UGT1A1 Gene

    PubMed Central

    Chaouch, Leila; Talbi, Emna; Moumni, Imen; Ben Chaabene, Arij; Kalai, Miniar; Chaouachi, Dorra; Mallouli, Fethi; Ghanem, Abderraouf; Abbes, Salem

    2013-01-01

    Aim. To determine the implication of the polymorphism, namely, A(TA)nTAA of UGT1A1 in lithogenesis for the first time in Tunisia among sickle cell anemia (SCA) children patients. Material and Methods. Our study was performed in 2010 and it involved 76 subjects chosen as control group characterized with normal hemoglobin status and presence of cholelithiasis and 102 SCA pediatric patients among whom 52 have cholelithiasis. We analyzed the polymorphism A(TA)nTAA at the UGT1A1 promoter and the relationships between the various A(TA)nTAA genotypes and alleles and bilirubin levels and occurrence of cholelithiasis. Results and Discussion. The repartition of genotypes found according to serum bilirubin level shows a significant association between genotypes carrying variant (TA)7 and hyperbilirubinemia (P < 0.05). We demonstrated the association of two genotypes with gallstones formation among SCA children patients: (TA)7/(TA)7 and (TA)7/(TA)8 with P = 8.1 × 10−8 and P = 0.01, respectively. (TA)7 and (TA)8 allele variants act as a risk factor for early gallstones formation in SCA patients with P = 5.8 × 10−9 and P = 0.01, respectively. As for the control group only the genotype (TA)7/(TA)7 presented a risk factor for gallstones formation. Conclusion. The novelty of this report is that it is the first time that a similar study was made on the Tunisian children sickle cell population and that the results show a clear association of (TA)7 variant in early gallstones formation in Tunisian SCA children. Interestingly our findings highlighted the association of (TA)8 variant as well, which was not found in previous studies. PMID:24167350

  13. Radiotherapy alone for oropharyngeal carcinomas: the role of fraction size (2 Gy vs 2.5 Gy) on local control and early and late complications.

    PubMed

    Thomas, F; Ozanne, F; Mamelle, G; Wibault, P; Eschwege, F

    1988-11-01

    This retrospective study involved 150 patients treated for oropharyngeal carcinoma by external radiotherapy alone at the Institut Gustave-Roussy. The midplane tumor dose was 70 Gy delivered in 7 weeks. During 1981, 63 patients were treated with 5 fractions (5 F) of 2 Gy per week. The following year, 87 patients, were treated with 4 fractions (4 F) of 2.5 Gy per week. Prognostic factors were equally distributed in both groups. The locoregional tumor control was 83% for the 4 F patients and 83% for the 5 F patients. Degree and incidence of acute reactions with both fractionation regimens were similar. Necrosis of the oropharyngeal mucosa and trismus were significantly more severe and more frequent in the 4 F group (23% and 20% respectively) than in the 5 F group (10% and 5% respectively) (p = 0.03 and p = 0.01). Other late effects such as skin necrosis (6% in the 4 F group versus 0% in the 5 F group) and severe cervical sclerosis (12 vs 5%) were also more frequent in the 4 F group than in the 5 F group but the difference was not significant. The results suggest a greater sensitivity of late compared to early normal tissue effects and of tumor response to an increase in dose per fraction (from 2 Gy to 2.5 Gy) in oropharyngeal carcinoma. PMID:3182341

  14. Complications of Endovascular Repair of Abdominal Aortic Aneurysms: A Review

    SciTech Connect

    Katzen, Barry T. MacLean, Alexandra A.

    2006-12-15

    The endovascular procedure for repair of abdominal aortic aneurysms has had an enormous impact on the treatment of this challenging disease. Complications, however, do occur and it is important to have a thorough understanding of the array of complications and appropriate management strategies. In this review of endovascular complications, we describe early and late complications paying particular attention to preventive, treatment and surveillance strategies.

  15. Complications of open reduction and internal fixation of ankle fractures.

    PubMed

    Leyes, Manuel; Torres, Raúl; Guillén, Pedro

    2003-03-01

    This article discusses the complications after open reduction and internal fixation of ankle fractures. Complications are classified as perioperative (malreduction, inadequate fixation, and intra-articular penetration of hardware), early postoperative (wound edge dehiscence, necrosis, infection and compartment syndrome), and late (stiffness, distal tibiofibular synostosis, degenerative osteoarthritis, and hardware related complications). Emphasis is placed on preventive measures to avoid such complications. PMID:12760580

  16. Imaging after cesarean delivery: acute and chronic complications.

    PubMed

    Rodgers, Shuchi K; Kirby, Cheryl L; Smith, Ryan J; Horrow, Mindy M

    2012-10-01

    Cesarean delivery is a commonly performed operation and accounts for nearly one-third of all births in the United States. Although it is a safe procedure, cesarean delivery has a variety of acute and chronic complications that prompt imaging with ultrasonography (US), computed tomography, and magnetic resonance imaging. Acute complications include hematomas in specific locations that are unique to the procedure, as well as a variety of infections. A bladder flap hematoma occurs in the space between the bladder and the lower uterine segment, whereas a subfascial hematoma is an extraperitoneal collection located in the prevesical space posterior to the rectus muscles and anterior to the peritoneum. Puerperal infections after cesarean delivery include abscesses, wound infections and dehiscence, uterine dehiscence and rupture, and pelvic thrombophlebitis. The prevalence of chronic complications related to the healed cesarean delivery scar is unknown, but the scar may result in technical limitations for pelvic US due to the adhesions between the anterior lower uterine segment and the anterior abdominal wall. The cesarean delivery scar also leaves the patient susceptible to several unique diagnoses. A cesarean scar "niche" is a tethering of the endometrium that can serve as a reservoir for intermenstrual blood and fluid. Intrauterine devices can be malpositioned in the cesarean delivery scar, and endometrial implants can develop in the abdominal wall years after surgery. These patients are also at increased risk for implantation abnormalities including cesarean scar ectopic pregnancy, retained products of conception, and placenta accreta. Familiarity with the normal postoperative findings following cesarean delivery is necessary to recognize acute and chronic complications, which are being encountered with increasing frequency. PMID:23065165

  17. Complications Following Anorectal Surgery.

    PubMed

    Kunitake, Hiroko; Poylin, Vitaliy

    2016-03-01

    Anorectal surgery is well tolerated. Rates of minor complications are relatively high, but major postoperative complications are uncommon. Prompt identification of postoperative complications is necessary to avoid significant patient morbidity. The most common acute complications include bleeding, infection, and urinary retention. Pelvic sepsis, while may result in dramatic morbidity and even mortality, is relatively rare. The most feared long-term complications include fecal incontinence, anal stenosis, and chronic pelvic pain. PMID:26929747

  18. The effect of puerperal uterine disease on histopathologic findings and mRNA expression of proinflammatory cytokines of the endometrium in dairy cows.

    PubMed

    Heppelmann, M; Weinert, M; Ulbrich, S E; Brömmling, A; Piechotta, M; Merbach, S; Schoon, H-A; Hoedemaker, M; Bollwein, H

    2016-04-15

    The aim of this study was to investigate the effect of puerperal uterine disease on histopathologic findings and gene expression of proinflammatory cytokines in the endometrium of postpuerperal dairy cows; 49 lactating Holstein-Friesian cows were divided into two groups, one without (UD-; n = 29) and one with uterine disease (UD+; n = 21), defined as retained fetal membranes and/or clinical metritis. General clinical examination, vaginoscopy, transrectal palpation, and transrectal B-mode sonography were conducted on days 8, 11, 18, and 25 and then every 10 days until Day 65 (Day 0 = day of calving). The first endometrial sampling (ES1; swab and biopsy) was done during estrus around Day 42 and the second endometrial sampling (ES2) during the estrus after synchronization (cloprostenol between days 55 and 60 and GnRH 2 days later). The prevalence of histopathologic evidence of endometritis, according to the categories used here, and positive bacteriologic cultures was not affected by group (P > 0.05), but cows with uterine disease had a higher prevalence of chronic purulent endometritis (ES1; P = 0.07) and angiosclerosis (ES2; P ≤ 0.05) than healthy cows. Endometrial gene expression of IL1α (ES2), IL1β (ES2), and TNFα (ES1 and ES2) was higher (P ≤ 0.05) in the UD+ group than in the UD- group. In conclusion, puerperal uterine disease had an effect on histopathologic parameters and on gene expression of proinflammatory cytokines in the endometrium of postpuerperal cows, indicating impaired clearance of uterine inflammation in cows with puerperal uterine disease. PMID:26810831

  19. Does uterine gauze packing increase the risk of puerperal morbidity in the management of postpartum hemorrhage during caesarean section: a retrospective cohort study

    PubMed Central

    Guo, Yu-Na; Ma, Jue; Wang, Xiao-Jin; Wang, Bing-Shun

    2015-01-01

    Background: To compare the outcomes especially the puerperal morbidity of uterine gauze packing (UGP) with those of uterine balloon tamponade (UBT) in the management of postpartum hemorrhage (PPH) during caesarean section (c-section). Methods: It was considered success as no requirement for either a further therapy or hysterectomy for PPH. The postpartum infection risk was pragmatically measured as puerperal morbidity. Results: The identified PPH subjects were subdivided into two groups for comparison, in which UGP or UBT was used as second-line therapy for women undergoing c-sections between January 2010 and September 2014. Of the 318 c-section subjects initially treated by basic managements for expected PPH, 99 cases underwent UGP and 66 UBT as the second-line therapies to stop persistent bleeding. The success rates of the UGP and UBT groups were 90.91 and 87.88%, respectively. Only one patient in UBT group resorted to hysterectomy. The respective rates of puerperal morbidity were 10.10 and 13.64%, with risk ratio of 0.74 (95% CI: 0.32, 1.72). There were no significant differences between the two groups even after the adjustment for potential confounding factors. Conclusion: UGP appears to be effective in treating PPH during c-section without an observed increase in the risk of potential postpartum infection when compared with UBT. UGP could be recommended as routine for patients who are not responding to conventional basic therapies in addressing PPH, along with the provision of appropriate training. PMID:26550320

  20. Central line complications

    PubMed Central

    Kornbau, Craig; Lee, Kathryn C; Hughes, Gwendolyn D; Firstenberg, Michael S

    2015-01-01

    Central venous access is a common procedure performed in many clinical settings for a variety of indications. Central lines are not without risk, and there are a multitude of complications that are associated with their placement. Complications can present in an immediate or delayed fashion and vary based on type of central venous access. Significant morbidity and mortality can result from complications related to central venous access. These complications can cause a significant healthcare burden in cost, hospital days, and patient quality of life. Advances in imaging, access technique, and medical devices have reduced and altered the types of complications encountered in clinical practice; but most complications still center around vascular injury, infection, and misplacement. Recognition and management of central line complications is important when caring for patients with vascular access, but prevention is the ultimate goal. This article discusses common and rare complications associated with central venous access, as well as techniques to recognize, manage, and prevent complications. PMID:26557487

  1. Severe complications of herpes zoster.

    PubMed

    Volpi, Antonio

    2007-09-01

    The usual presentation of herpes zoster is as a self-limiting vesicular rash, often accompanied by post-herpetic neuralgia (PHN), its most common complication. However, herpes zoster can give rise to other complications, many of which have unusual presentations and serious sequelae. The incidence and burden of many of these less common complications are poorly understood. Ocular complications of ophthalmic zoster are relatively frequent but, with early antiviral therapy, need not be sight-threatening. Delayed contralateral hemiparesis is a rare complication of ophthalmic zoster that may present as stroke, temporally remote from the zoster episode. Ramsay Hunt syndrome is caused by reactivation of varicella zoster virus (VZV) involving the facial nerve; facial paralysis, ear pain and vesicles in the ear are diagnostic. Facial paralysis in the absence of vesicles may indicate zoster sine herpete, which can be mistaken for Bell's palsy. Herpetic facial palsies may respond to combination therapy with an antiviral plus steroid, but further research is needed to determine the benefit of such treatments. PMID:17939894

  2. [Postoperative complications of heart and pericardial injuries].

    PubMed

    Radchenko, Iu A; Abakumov, M M; Vladimirova, E S; Danielian, Sh N; Nikitina, O V; Belozerov, G E

    2013-01-01

    The 31-year experience of 839 cases of heart and pericardial injuries was analyzed. The complicated course was registered in 36%. Such factors as patient's age, blood loss, severity of injury and patient's condition on admission, defined the possibility of complications. No less important were the characteristics of postoperative treatment and early diagnostics of the injury. The thorough analysis of reasons of the complications' development allowed to work out some prophylactic measures and to decrease the frequency of postoperative lethality from 13.8 to 6.8%, whereas the complications rate was decreased from 43.8 to 32.3%. PMID:23715389

  3. ESCAPS study protocol: a feasibility randomised controlled trial of ‘Early electrical stimulation to the wrist extensors and wrist flexors to prevent the post-stroke complications of pain and contractures in the paretic arm’

    PubMed Central

    Fletcher-Smith, Joanna C; Walker, Dawn-Marie; Sprigg, Nikola; James, Marilyn; Walker, Marion F; Allatt, Kate; Mehta, Rajnikant; Pandyan, Anand D

    2016-01-01

    Introduction Approximately 70% of patients with stroke experience impaired arm function, which is persistent and disabling for an estimated 40%. Loss of function reduces independence in daily activities and impacts on quality of life. Muscles in those who do not recover functional movement in the stroke affected arm are at risk of atrophy and contractures, which can be established as early as 6 weeks following stroke. Pain is also common. This study aims to evaluate the feasibility of a randomised controlled trial to test the efficacy and cost-effectiveness of delivering early intensive electrical stimulation (ES) to prevent post-stroke complications in the paretic upper limb. Methods and analysis This is a feasibility randomised controlled trial (n=40) with embedded qualitative studies (patient/carer interviews and therapist focus groups) and feasibility economic evaluation. Patients will be recruited from the Stroke Unit at the Nottingham University Hospitals National Health Service (NHS) Trust within 72 h after stroke. Participants will be randomised to receive usual care or usual care and early ES to the wrist flexors and extensors for 30 min twice a day, 5 days a week for 3 months. The initial treatment(s) will be delivered by an occupational therapist or physiotherapist who will then train the patient and/or their nominated carer to self-manage subsequent treatments. Ethics and dissemination This study has been granted ethical approval by the National Research Ethics Service, East Midlands Nottingham1 Research Ethics Committee (ref: 15/EM/0006). To our knowledge, this is the first study of its kind of the early application (within 72 h post-stroke) of ES to both the wrist extensors and wrist flexors of stroke survivors with upper limb impairment. The results will inform the design of a definitive randomised controlled trial. Dissemination will include 2 peer-reviewed journal publications and presentations at national conferences. Trial registration number ISRCTN1648908; Pre-results. Clinicaltrials.gov ID: NCT02324634. PMID:26729394

  4. Pregnancy Complications: Preexisting Diabetes

    MedlinePLUS

    ... Home > Complications & Loss > Pregnancy complications > Preexisting diabetes Preexisting diabetes Now playing: E-mail to a friend Please ... to help prevent problems like these. Can preexisting diabetes cause problems during pregnancy? Yes. If it’s not ...

  5. Neurological Complications of AIDS

    MedlinePLUS

    ... Find People About NINDS NINDS Neurological Complications of AIDS Information Page Feature Federal domestic HIV/AIDS information ... resources from MedlinePlus What are Neurological Complications of AIDS? AIDS is primarily an immune system disorder caused ...

  6. Pregnancy Complications: Genital Herpes

    MedlinePLUS

    ... Loss > Pregnancy complications > Genital herpes and pregnancy Genital herpes and pregnancy Now playing: E-mail to a ... the United States has genital herpes. Can genital herpes cause complications during pregnancy? Yes. Genital herpes can ...

  7. Perioperative complications in infant cleft repair

    PubMed Central

    Fillies, Thomas; Homann, Christoph; Meyer, Ulrich; Reich, Alexander; Joos, Ulrich; Werkmeister, Richard

    2007-01-01

    Background Cleft surgery in infants includes special risks due to the kind of the malformation. These risks can be attributed in part to the age and the weight of the patient. Whereas a lot of studies investigated the long-term facial outcome of cleft surgery depending on the age at operation, less is known about the complications arising during a cleft surgery in early infancy. Methods We investigated the incidence and severity of perioperative complications in 174 infants undergoing primary cleft surgery. The severity and the complications were recorded during the intraoperative and the early postoperative period according to the classification by Cohen. Results Our study revealed that minor complications occurred in 50 patients. Severe complications were observed during 13 operations. There was no fatal complication in the perioperative period. The risk of complications was found to be directly correlated to the body weight at the time of the surgery. Most of the problems appeared intraoperatively, but they were also followed by complications immediately after the extubation. Conclusion In conclusion, cleft surgery in infancy is accompanied by frequent and sometimes severe perioperative complications that may be attributed to this special surgical field. PMID:17280602

  8. Complications of skin biopsy

    PubMed Central

    Abhishek, Kumar; Khunger, Niti

    2015-01-01

    Skin biopsy is the most commonly performed procedure by the dermatologist. Though it is a safe and easy procedure yet complications may arise. Post operative complications like wound infection and bleeding may occur. It is essential to keep the potential complications of skin biopsy in mind and be meticulous in the technique, for better patient outcomes. PMID:26865792

  9. From Folklore to Scientific Evidence: Breast-Feeding and Wet-Nursing in Islam and the Case of Non-Puerperal Lactation

    PubMed Central

    Moran, Lia; Gilad, Jacob

    2007-01-01

    Breast-feeding practice has an important medical and socio-cultural role. It has many anthropological aspects concerning the power structures that find their expression in breast-feeding and the practices that formed around it, both socially, scientifically, and legally-speaking. Breast-feeding has been given much attention by religions and taboos, folklore, and misconception abound around it making it a topic of genuine curiosity. This paper aims at expanding the spectrum of folklore associated with breast-feeding. The paper deals with historical, religious, and folkloristic aspects of breast-feeding, especially wet-nursing, in Islam and focuses on an intriguing Islamic tale on breast-feeding - lactation by non-pregnant women (or non-puerperal lactation). Apparently, accounts of non-puerperal lactation are not restricted to Islam but have been documented in various societies and religions throughout centuries. Two medical situations - hyperprolactinemia and induced lactation, appear as possible explanations for this phenomenon. This serves as an excellent example for the value of utilizing contemporary scientific knowledge in order to elucidate the origin, anthropology and evolvement of ancient myth and superstition. PMID:23675050

  10. Periprocedural complications in endovascular stroke treatment.

    PubMed

    Akpinar, Suha H; Yilmaz, Guliz

    2016-01-01

    Endovascular stroke treatment is a neurointerventional emergency where the main goal is the early recanalization of the occlusion within the critical time window, as safely as possible. Although the time window and rate of complications for endovascular stroke treatment differ with anterior and posterior circulation strokes, awareness of potential periprocedural complications is important, as they affect patient morbidity and mortality. Periprocedural complications are classified as haemorrhagic complications, procedure-/device-related, puncture site complications, and late-onset events including vascular stenosis. We present the digital subtraction angiography and CT imaging findings related to these complications in a study of 56 stroke patients, as they relate to previous findings in the literature. PMID:26529228

  11. Transoesophageal Echocardiography Related Complications

    PubMed Central

    Mathur, S K; Singh, Pooja

    2009-01-01

    Summary The application of transesophageal echocardiography (TEE) has been continuously increasing over past several decades. It is usually considered a very safe diagnostic and monitoring device. Though the complications are rare, but these complications must be known to the operators performing TEE. The goal of this article is to encapsulate the potential complications associated with TEE. The complications are primarily related to gastrointestinal, cardiovascular and respiratory systems along with some miscellaneous problems related to probe insertion, drugs and inexperience of the operator. Strategies for the prevention of these complications are also analyzed in order to avoid the risk. PMID:20640107

  12. Chronic complications of spinal cord injury

    PubMed Central

    Sezer, Nebahat; Akkuş, Selami; Uğurlu, Fatma Gülçin

    2015-01-01

    Spinal cord injury (SCI) is a serious medical condition that causes functional, psychological and socioeconomic disorder. Therefore, patients with SCI experience significant impairments in various aspects of their life. The goals of rehabilitation and other treatment approaches in SCI are to improve functional level, decrease secondary morbidity and enhance health-related quality of life. Acute and long-term secondary medical complications are common in patients with SCI. However, chronic complications especially further negatively impact on patients’ functional independence and quality of life. Therefore, prevention, early diagnosis and treatment of chronic secondary complications in patients with SCI is critical for limiting these complications, improving survival, community participation and health-related quality of life. The management of secondary chronic complications of SCI is also important for SCI specialists, families and caregivers as well as patients. In this paper, we review data about common secondary long-term complications after SCI, including respiratory complications, cardiovascular complications, urinary and bowel complications, spasticity, pain syndromes, pressure ulcers, osteoporosis and bone fractures. The purpose of this review is to provide an overview of risk factors, signs, symptoms, prevention and treatment approaches for secondary long-term complications in patients with SCI. PMID:25621208

  13. Facial Filler Complications.

    PubMed

    Woodward, Julie; Khan, Tanya; Martin, John

    2015-11-01

    The use of facial fillers has greatly expanded over the past several years. Along with increased use comes a rise in documented complications, ranging from poor cosmetic result to nodules, granulomas, necrosis, and blindness. Awareness of the potential types of complications and options for management, in addition to the underlying facial anatomy, are imperative to delivering the best patient care. This article defines the complications and how to treat them and provides suggestions to avoid serious adverse outcomes. PMID:26505541

  14. Complications of Elbow Trauma.

    PubMed

    Cheung, Emilie V; Sarkissian, Eric J

    2015-11-01

    The elbow is a highly congruent trochoginglymoid joint allowing motion in both flexion-extension and pronosupination across 3 articulations. Therefore, treatment of fractures of the elbow can be technically challenging to manage, even after initial surgery. The posttraumatic elbow is prone to complications such as stiffness associated with heterotopic ossification, instability or subluxation (posterolateral rotatory instability and varus posteromedial instability patterns), and wound complications. This article discusses the pathoanatomy, prevention, and treatment of these complications. PMID:26498555

  15. Cavernous sinus thrombophlebitis complicating sinusitis

    PubMed Central

    Berdai, Adnane Mohamed; Shimi, Abdelkarim; Khatouf, Mohammed

    2013-01-01

    Background Thrombophlebitis of the cavernous sinus is a rare but serious disease that most often affects young adults and children. It is associated with significant morbidity or mortality and is often related to local infections of the head. The diagnosis is based on clinical findings and is confirmed by imaging. Case Report: We report the case of a 17-year-old male with a history of recurrent sinusitis, who presented general signs of infection, orbital symptoms, and meningeal involvement. CT and MRI showed thrombosis of the cavernous sinus associated with cerebral ischemic damage. The therapeutic management included empiric antibiotic therapy, drainage of an orbital collection, and anticoagulation. The patient died later secondary to septic shock. Conclusions: Although thrombophlebitis of the cavernous sinus is increasingly rare, it remains a lethal complication of sinusitis, and mortality is still high. The course of this disease can be dramatic due to infectious or vascular neurological complications. Early diagnosis and appropriate treatment are crucial. PMID:23826444

  16. Neurologic Complications in Pregnancy.

    PubMed

    Cuero, Mauricio Ruiz; Varelas, Panayiotis N

    2016-01-01

    Pregnant women are subject to the same complications as the general population, as well to specific neurologic complications associated with pregnancy, such as preeclampsia or eclampsia. The hormonal and physiologic changes during pregnancy lead to altered incidences of these complications, which usually present during the late period of pregnancy, labor, or the puerperium. In addition, the treatment of these conditions is different from that of nonpregnant women, because special attention is paid to avoid any abnormalities or death of the fetus. This article discusses the most common of these neurologic complications. PMID:26600443

  17. [Complications in thyroid surgery].

    PubMed

    Lombardi, C P; Raffaelli, M; De Crea, C; Traini, E; Oragano, L; Sollazzi, L; Bellantone, R

    2007-10-01

    Thyroidectomy is one of the most frequently performed surgical procedure worldwide, even if the risks of lethal postoperative complications prevented its evolution and diffusion until the beginning of the XX century. At that time, T. Kocher described his meticulous technique, reporting excellent results in terms of mortality and morbidity. At present, mortality for this procedure approaches 0% and overall complication rate is less than 3%. Nonetheless, major complications of thyroidectomy (i.e. compressive hematoma, recurrent laryngeal nerve palsy and hypoparathyroidism) are still fearful complications and account for a significant percentage of medico-legal claims. Patients volume and surgical skill play an important role in reducing the risk of complications. Accurate knowledge of anatomy and pathophysiology, complications incidence and pathogenesis and a careful surgical performance are essential. In this review, post-thyroidectomy complications basing on literature analysis and personal experience are described. The main anatomical, technical and pathophysiological factors that help preventing post-thyroidectomy complications are analyzed, taking into proper account new technologies and the minimally invasive surgical procedures that influenced thyroid surgery during the last decade. PMID:17947950

  18. COMPLICATIONS IN HIP ARTHROSCOPY

    PubMed Central

    Contreras, Marcos Emílio Kuschnaroff; Hoffmann, Rafael Barreiros; de Araújo, Lúcio Cappelli Toledo; Dani, William Sotau; José Berral, Francisco

    2015-01-01

    Objectives: To determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the sample through a learning curve; and to recognize the causes of complications in arthroscopic hip operations. Method: 150 consecutive cases that underwent hip arthroscopy between May 2004 and December 2008 were evaluated. The complications encountered were classified in three ways: organic system affected, severity and groups of 50 consecutive cases. The data were analyzed by means of descriptive statistics and Fisher's exact test. Results: We observed 15 complications in this study (10%): ten were neurological, two were osteoarticular, one was vascular-ischemic and two were cutaneous. In the classification of severity, three were classified as major, 12 as intermediate and none as minor. The incidence of complications over the course of the learning curve did not present any statistically significant difference (p = 0.16). Conclusions: Hip arthroscopy is a surgical procedure that involves low morbidity, but which presents complications in some cases. These complications are frequently neurological and transitory, and mainly occur because of joint traction. The complication rate did not decrease with progression of our sample.

  19. Neuromuscular complications of statins.

    PubMed

    Ahn, Sung C

    2008-02-01

    Statins, 3-hydroxy-3-methlglutaryl coenzyme A reductase inhibitors, are commonly prescribed for patients who have hyperlipidemia. Statins were first approved in 1987. Statin therapy is well documented to reduce serum low-density lipoprotein levels, incidence of cardiovascular events, and mortality. Although statin therapy is well tolerated, serious adverse affects have been reported, including neuromuscular and hepatic complications. Myopathy is particularly concerning because of the potential for rhabdomyolysis and death. Recently, peripheral neuropathy also has been identified as a possible complication. The incidence of neuromuscular complications is expected to increase with the increased number of people using statin therapy. Clinicians should be aware of the potential neuromuscular complications. This article reviews epidemiology, possible mechanisms, risk factors, and management of statin-associated neuromuscular complications. PMID:18194749

  20. An uncommon complication of acute stroke thrombolysis

    PubMed Central

    Allan, Morven; Zachariah, George; Kordzadeh, Ali; Umachandran, Velaitham

    2014-01-01

    Thrombolysis with tissue plasminogen activator is a well-established treatment for acute ischaemic stroke. We report a case of an 87-year-old woman who developed an acute ischaemic limb, on the background of stroke thrombolysis, and underwent an embolectomy. A rare but serious complication, there are few reports of similar thromboembolic events, particularly in patients with known atrial fibrillation as presented in this case. Early recognition of this rare complication may prevent long-term, and at times fatal, complications. PMID:24473425

  1. Subcutaneous Immunization with Inactivated Bacterial Components and Purified Protein of Escherichia coli, Fusobacterium necrophorum and Trueperella pyogenes Prevents Puerperal Metritis in Holstein Dairy Cows

    PubMed Central

    Machado, Vinícius Silva; Bicalho, Marcela Luccas de Souza; Meira Junior, Enoch Brandão de Souza; Rossi, Rodolfo; Ribeiro, Bruno Leonardo; Lima, Svetlana; Santos, Thiago; Kussler, Arieli; Foditsch, Carla; Ganda, Erika Korzune; Oikonomou, Georgios; Cheong, Soon Hon; Gilbert, Robert Owen; Bicalho, Rodrigo Carvalho

    2014-01-01

    In this study we evaluate the efficacy of five vaccine formulations containing different combinations of proteins (FimH; leukotoxin, LKT; and pyolysin, PLO) and/or inactivated whole cells (Escherichia coli, Fusobacterium necrophorum, and Trueperella pyogenes) in preventing postpartum uterine diseases. Inactivated whole cells were produced using two genetically distinct strains of each bacterial species (E. coli, F. necrophorum, and T. pyogenes). FimH and PLO subunits were produced using recombinant protein expression, and LKT was recovered from culturing a wild F. necrophorum strain. Three subcutaneous vaccines were formulated: Vaccine 1 was composed of inactivated bacterial whole cells and proteins; Vaccine 2 was composed of proteins only; and Vaccine 3 was composed of inactivated bacterial whole cells only. Two intravaginal vaccines were formulated: Vaccine 4 was composed of inactivated bacterial whole cells and proteins; and Vaccine 5 was composed of PLO and LKT. To evaluate vaccine efficacy, a randomized clinical trial was conducted at a commercial dairy farm; 371 spring heifers were allocated randomly into one of six different treatments groups: control, Vaccine 1, Vaccine 2, Vaccine 3, Vaccine 4 and Vaccine 5. Late pregnant heifers assigned to one of the vaccine groups were each vaccinated twice: at 230 and 260 days of pregnancy. When vaccines were evaluated grouped as subcutaneous and intravaginal, the subcutaneous ones were found to significantly reduce the incidence of puerperal metritis. Additionally, subcutaneous vaccination significantly reduced rectal temperature at 6±1 days in milk. Reproduction was improved for cows that received subcutaneous vaccines. In general, vaccination induced a significant increase in serum IgG titers against all antigens, with subcutaneous vaccination again being more effective. In conclusion, subcutaneous vaccination with inactivated bacterial components and/or protein subunits of E. coli, F. necrophorum and T. pyogenes can prevent puerperal metritis during the first lactation of dairy cows, leading to improved reproduction. PMID:24638139

  2. Complications of glioma surgery.

    PubMed

    Jackson, Christina; Westphal, Manfred; Quiñones-Hinojosa, Alfredo

    2016-01-01

    Even with current advances in adjunctive therapies, including radiation, chemotherapy, and various clinical trials of gene therapy and immunotherapy, surgical resection remains one of the most effective treatment for intra-axial gliomas. Survival in these patients has been shown to be related to the extent of resection. In some cases, it can provide cures of long-term remission; in others, it can provide disease control when combined with the above adjunctive treatments. However, surgical resection carries its own risks and complications. These complications can be broadly divided into neurologic, regional, and systemic, including direct cortical and vascular injury, surgical wound complications, and postsurgical medical complications. Certain patient characteristics, including Karnofsky performance status score (KPS) and pathology of the tumor, have been shown to have an impact on the risk of postsurgical complications. Advancement in preoperative and intraoperative adjunct technology such as cortical mapping and navigation has improved the surgeon's ability to safely and maximally resect the tumors. It is therefore important to understand the perioperative complications after craniotomy and tumor resection and factors affecting morbidity and mortality in order for surgeons to optimally select and counsel patients who will benefit the most from surgical resection. This chapter will focus on the complications associated with craniotomy for intrinsic glioma and ways of avoiding these events. PMID:26948356

  3. Gastrointestinal complications of diabetes mellitus

    PubMed Central

    Krishnan, Babu; Babu, Shithu; Walker, Jessica; Walker, Adrian B; Pappachan, Joseph M

    2013-01-01

    Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease, and other co-morbidities. Gastrointestinal (GI) involvement can present with esophageal dysmotility, gastro-esophageal reflux disease (GERD), gastroparesis, enteropathy, non alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy. Severity of GERD is inversely related to glycemic control and management is with prokinetics and proton pump inhibitors. Diabetic gastroparesis manifests as early satiety, bloating, vomiting, abdominal pain and erratic glycemic control. Gastric emptying scintigraphy is considered the gold standard test for diagnosis. Management includes dietary modifications, maintaining euglycemia, prokinetics, endoscopic and surgical treatments. Diabetic enteropathy is also common and management involves glycemic control and symptomatic measures. NAFLD is considered a hepatic manifestation of metabolic syndrome and treatment is mainly lifestyle measures, with diabetes and dyslipidemia management when coexistent. Glycogenic hepatopathy is a manifestation of poorly controlled type 1 diabetes and is managed by prompt insulin treatment. Though GI complications of diabetes are relatively common, awareness about its manifestations and treatment options are low among physicians. Optimal management of GI complications is important for appropriate metabolic control of diabetes and improvement in quality of life of the patient. This review is an update on the GI complications of diabetes, their pathophysiology, diagnostic evaluation and management. PMID:23772273

  4. Management of complicated duodenal diverticula.

    PubMed

    Oukachbi, N; Brouzes, S

    2013-06-01

    The duodenum is the second most common location of intestinal diverticula after the colon. Duodenal diverticulum (DD) is usually located in the second portion of the duodenum (D2), close to the papilla. Most duodenal diverticula are extraluminal and acquired rather than congenital; more rare is the congenital, intraluminal diverticulum. DD is usually asymptomatic and discovered incidentally, but can become symptomatic in 1% to 5% of cases when complicated by gastroduodenal, biliary and/or pancreatic obstruction, by perforation or by hemorrhage. Endoscopic treatment is the most common first-line treatment for biliopancreatic complications caused by juxtapapillary diverticula and also for bleeding. Conservative treatment of perforated DD based on fasting and broad-spectrum antibiotics may be offered in some selected cases when diagnosis is made early in stable patients, or in elderly patients with comorbidities who are poor operative candidates. Surgical treatment is currently reserved for failure of endoscopic or conservative treatment. The main postoperative complication of diverticulectomy is duodenal leak or fistula, which carries up to a 30% mortality rate. PMID:23810155

  5. Late complications after Hodgkin's disease.

    PubMed

    Henry-Amar, M; Joly, F

    1996-01-01

    Hodgkin's disease is considered a curable disease. The use of appropriate staging techniques and treatment methods has resulted in long-term survival rates as high as 90% in early stages, 75% or greater in advanced stages. Long-surviving Hodgkin's disease patients, however, face new problems which have become apparent as greater numbers of successfully treated patients are followed for longer periods of time. They concern mostly chronic medical as well as psychosocial complications which can interfere with survivors quality of life. Hodgkin's disease therapy may result in severe infections, thyroid, cardiovascular, pulmonary, digestive or gonadal dysfunction. It may also result in secondary malignancy which is considered the most serious complication. This review focuses on the variety of medical problems considering subsequent nonmalignant complications, secondary malignancies, long-term patient quality of life and causes of death. Because the vast majority of patients who achieve remission remain symptom-free and enjoy a normal life, an attempt is made to provide estimated risk for individuals based on available data. PMID:8836422

  6. Dengue-associated neuromuscular complications.

    PubMed

    Garg, Ravindra Kumar; Malhotra, Hardeep Singh; Jain, Amita; Malhotra, Kiran Preet

    2015-01-01

    Dengue is associated with many neurological dysfunctions. Up to 4% of dengue patients may develop neuromuscular complications. Muscle involvement can manifest with myalgias, myositis, rhabdomyolysis and hypokalemic paralysis. Diffuse myalgia is the most characteristic neurological symptom of dengue fever. Dengue-associated myositis can be of varying severity ranging from self-limiting muscle involvement to severe dengue myositis. Dengue-associated hypokalemic paralysis often has a rapidly evolving course; benign nature; excellent response to potassium; and, often leads to diagnostic confusion with other dengue-associated neuromuscular disorders. Rhabdomyolysis is the most severe form of muscle involvement and may be life-threatening. Guillain-Barrι syndrome is another frequent neuromuscular dengue-associated complication. Dengue-associated Guillain-Barrι syndrome responds very well to intravenous immunoglobulins. Predominant spinal gray matter involvement has been reported in a patient presenting with areflexic paraparesis. Mononeuropathies often manifest with paralysis of the diaphragm due to phrenic nerve dysfunction. Brachial plexopathy, in the form of neuralgic amyotrophy, has been described much more frequently than lumbo-sacral plexopathy. Early recognition of these neuromuscular complications is needed for successful treatment and to prevent further disabilities. PMID:26238884

  7. Complications Following Radical Nephroureterectomy.

    PubMed

    Raman, Jay D; Jafri, Syed M

    2016-05-01

    Radical nephroureterectomy (RNU) is the gold standard treatment strategy for bulky, high-grade, or muscle-invasive upper tract urothelial carcinoma (UTUC). Many patients with UTUC who require RNU are elderly, comorbid, and at risk for perioperative complications. Recognition of likelihood and extent of such complications guides preoperative counseling, decision-making process for major surgery, and perioperative care. A critical review of such data is essential, given the inevitable impact of complications on hospital duration, need for readmission, resource utilization, and costs associated with management. PMID:26968416

  8. Complications of Pathologic Myopia.

    PubMed

    Cho, Bum-Joo; Shin, Joo Young; Yu, Hyeong Gon

    2016-01-01

    Pathologic myopia (PM) is one of the leading causes of visual impairment worldwide. The pathophysiology of PM is not fully understood, but the axial elongation of the eye followed by chorioretinal thinning is suggested as a key mechanism. Pathologic myopia may lead to many complications such as chorioretinal atrophy, foveoschisis, choroidal neovascularization, rhegmatogenous retinal detachment, cataract, and glaucoma. Some complications affect visual acuity significantly, showing poor visual prognosis. This article aims to review the types, pathophysiology, treatment, and visual outcome of the complications of PM. PMID:26649982

  9. HIV and the Risk of Direct Obstetric Complications: A Systematic Review and Meta-Analysis

    PubMed Central

    Calvert, Clara; Ronsmans, Carine

    2013-01-01

    Background Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications. Methods and findings Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00–5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42–13.97). For other obstetric complications the evidence was weak and inconsistent. Conclusions The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women. PMID:24124458

  10. Tetanus: Symptoms and Complications

    MedlinePLUS

    ... of the muscles of the jaw, or "lockjaw". Tetanus symptoms include: Headache Jaw cramping Sudden, involuntary muscle ... sweating High blood pressure and fast heart rate Tetanus complications include: Uncontrolled/involuntary muscular contraction of the ...

  11. Dental Implant Complications.

    PubMed

    Liaw, Kevin; Delfini, Ronald H; Abrahams, James J

    2015-10-01

    Dental implants have increased in the last few decades thus increasing the number of complications. Since many of these complications are easily diagnosed on postsurgical images, it is important for radiologists to be familiar with them and to be able to recognize and diagnose them. Radiologists should also have a basic understanding of their treatment. In a pictorial fashion, this article will present the basic complications of dental implants which we have divided into three general categories: biomechanical overload, infection or inflammation, and other causes. Examples of implant fracture, loosening, infection, inflammation from subgingival cement, failure of bone and soft tissue preservation, injury to surround structures, and other complications will be discussed as well as their common imaging appearances and treatment. Lastly, we will review pertinent dental anatomy and important structures that are vital for radiologists to evaluate in postoperative oral cavity imaging. PMID:26589696

  12. Extraintestinal Complications: Kidney Disorders

    MedlinePLUS

    ... most commonly encountered kidney complications of IBD—particularly oxalate stones. Kidney stones are more common in Crohn's ... of fat malabsorption. Fat binds to calcium, leaving oxalate (a type of salt) free to be absorbed ...

  13. Management of medical complications.

    PubMed

    Dohle, Carolin I; Reding, Michael J

    2011-06-01

    Medical comorbidities and complications are expected following stroke, traumatic brain injury, and spinal cord injury. The neurorehabilitation physician's role is to manage these comorbidities, prevent complications, and serve as a medical and neurologic resource for the patient, family, and neurorehabilitation team. The most common comorbidities are similar to those found in the general population, namely hypertension, dyslipidemia, diabetes mellitus, and ischemic heart disease. Frequent complications encountered in the neurorehabilitation unit relate to medication side effects, medical comorbidities, and the direct effect of the neurologic injury. They include orthostatic hypotension; syncope or presyncope; cardiac arrhythmia; bowel and bladder dysfunction; seizures; pressure sores; dysphagia-related pneumonia, dehydration, and malnutrition; venous thromboembolism; falls; and sexual dysfunction. This article discusses strategies for managing comorbidities and avoiding complications. PMID:22810865

  14. Infection and Other Complications

    MedlinePLUS

    ... Stage 3 Infection and Other Complications NLN Position Papers Lymphedema Awareness Campaign Education Kits Educational Videos What ... Patients (8) LymphLink Articles (175) FAQ's (6) Position Papers (9) LSAP Perspective (9) Become a member now » ...

  15. Chickenpox (Varicella) Complications

    MedlinePLUS

    ... Search The CDC Cancel Submit Search The CDC Chickenpox (Varicella) Note: Javascript is disabled or is not ... message, please visit this page: About CDC.gov . Chickenpox Home About Chickenpox Overview Signs & Symptoms Complications Transmission ...

  16. Postoperative surgical complications of lymphadenohysterocolpectomy

    PubMed Central

    Marin, F; Ple?ca, M; Bordea, CI; Voinea, SC; Burl?nescu, I; Ichim, E; Jianu, CG; Nicol?escu, RR; Teodosie, MP; Maher, K; Blidaru, A

    2014-01-01

    Rationale The current standard surgical treatment for the cervix and uterine cancer is the radical hysterectomy (lymphadenohysterocolpectomy). This has the risk of intraoperative accidents and postoperative associated morbidity. Objective The purpose of this article is the evaluation and quantification of the associated complications in comparison to the postoperative morbidity which resulted after different types of radical hysterectomy. Methods and results Patients were divided according to the type of surgery performed as follows: for cervical cancer group A- 37 classic radical hysterectomies Class III Piver - Rutledge -Smith ( PRS ), group B -208 modified radical hysterectomies Class II PRS and for uterine cancer- group C -79 extended hysterectomies with pelvic lymphadenectomy from which 17 patients with paraaortic lymphnode biopsy . All patients performed preoperative radiotherapy and 88 of them associated radiosensitization. Discussion Early complications were intra-abdominal bleeding ( 2.7% Class III PRS vs 0.48% Class II PRS), supra-aponeurotic hematoma ( 5.4% III vs 2.4% II) , dynamic ileus (2.7% III vs 0.96% II) and uro - genital fistulas (5.4% III vs 0.96% II).The late complications were the bladder dysfunction (21.6% III vs 16.35% II) , lower limb lymphedema (13.5% III vs 11.5% II), urethral strictures (10.8% III vs 4.8% II) , incisional hernias ( 8.1% III vs 7.2% II), persistent pelvic pain (18.91% III vs 7.7% II), bowel obstruction (5.4% III vs 1.4% II) and deterioration of sexual function (83.3% III vs 53.8% II). PRS class II radical hysterectomy is associated with fewer complications than PRS class III radical hysterectomy , except for the complications of lymphadenectomy . A new method that might reduce these complications is a selective lymphadenectomy represented by sentinel node biopsy . In conclusion PRS class II radical hysterectomy associated with neoadjuvant radiotherapy is a therapeutic option for the incipient stages of cervical cancer. Abbreviations: PRS- Piver Rutledge-Smith, II- class II, III- class III PMID:24653760

  17. Complications of Radical Cystectomy and Orthotopic Reconstruction

    PubMed Central

    Tan, Wei Shen; Lamb, Benjamin W.; Kelly, John D.

    2015-01-01

    Radical cystectomy and orthotopic reconstruction significant morbidity and mortality despite advances in minimal invasive and robotic technology. In this review, we will discuss early and late complications, as well as describe efforts to minimize morbidity and mortality, with a focus on ileal orthotopic bladder substitute (OBS). We summarise efforts to minimize morbidity and mortality including enhanced recovery as well as early and late complications seen after radical cystectomy and OBS. Centralisation of complex cancer services in the UK has led to a fall in mortality and high volume institutions have a significantly lower rate of 30-day mortality compared to low volume institutions. Enhanced recovery pathways have resulted in shorter length of hospital stay and potentially a reduction in morbidity. Early complications of radical cystectomy occur as a direct result of the surgery itself while late complications, which can occur even after 10 years after surgery, are due to urinary diversion. OBS represents the ideal urinary diversion for patients without contraindications. However, all patients with OBS should have regular long term follow-up for oncological surveillance and to identify complications should they arise. PMID:26697063

  18. Treating Complicated Grief

    PubMed Central

    Simon, Naomi M.

    2015-01-01

    IMPORTANCE The death of a loved one is one of lifes greatest, universal stressors to which most bereaved individuals successfully adapt without clinical intervention. For a minority of bereaved individuals, grief is complicated by superimposed problems and healing does not occur. The resulting syndrome of complicated grief causes substantial distress and functional impairment even years after a loss, yet knowing when and how to intervene can be a challenge. OBJECTIVE To discuss the differential diagnosis, risk factors for and management of complicated grief based on available evidence and clinical observations. EVIDENCE REVIEW MEDLINE was searched from January 1990 to October 2012. Additional citations were procured from references of select research and review articles. Available treatment studies targeting complicated grief were included. RESULTS A strong research literature led to inclusion of complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (termed persistent complex bereavement disorder as a subtype of other specified trauma and stressor-related disorders), although it is a condition for which more research is formally recommended, and there is still ongoing discussion about the optimal name and diagnostic criteria for the disorder. Reliable screening instruments are available, and the estimated prevalence rate is 7% of bereaved people. Randomized controlled data support the efficacy of a targeted psychotherapy including elements that foster resolution of complicating problems and facilitate the natural healing process. Preliminary studies suggest antidepressant medications may be helpful. CONCLUSION AND RELEVANCE Individuals with complicated grief have greater risk of adverse health outcomes, should be diagnosed and assessed for suicide risk and comorbid conditions such as depression and posttraumatic stress disorder, and should be considered for treatment. PMID:23917292

  19. [Myocarditis and complicated dengue: a case report].

    PubMed

    Pereda, María Gracia; López, Maríanelly; Mariluz, Melissa

    2015-04-01

    Hemorragic dengue fever is a prevalent infection in many countries around the world. Myocarditis is a severe manifestation of dengue virus infection. With prompt intervention and an early diagnosis, the outcome of this condition can be improve. We report a adult patient with complicated dengue, myocarditis, cardiac and respiratory insufficiency with acute renal injury. PMID:26065460

  20. Coeliac disease: symptoms, complications and patient support.

    PubMed

    Holmes, Susan

    Coeliac disease is an autoimmune inflammatory disease of the small intestine precipitated by ingestion of gluten in genetically susceptible individuals. Simply defined as 'gluten-sensitive enteropathy', it is a lifelong disease, which, if untreated, is associated with significant morbidity and mortality. Early diagnosis and management are important to minimise complications. PMID:20509383

  1. Metabolomics in diabetic complications.

    PubMed

    Filla, Laura A; Edwards, James L

    2016-04-22

    With a global prevalence of 9%, diabetes is the direct cause of millions of deaths each year and is quickly becoming a health crisis. Major long-term complications of diabetes arise from persistent oxidative stress and dysfunction in multiple metabolic pathways. The most serious complications involve vascular damage and include cardiovascular disease as well as microvascular disorders such as nephropathy, neuropathy, and retinopathy. Current clinical analyses like glycated hemoglobin and plasma glucose measurements hold some value as prognostic indicators of the severity of complications, but investigations into the underlying pathophysiology are still lacking. Advancements in biotechnology hold the key to uncovering new pathways and establishing therapeutic targets. Metabolomics, the study of small endogenous molecules, is a powerful toolset for studying pathophysiological processes and has been used to elucidate metabolic signatures of diabetes in various biological systems. Current challenges in the field involve correlating these biomarkers to specific complications to provide a better prediction of future risk and disease progression. This review will highlight the progress that has been made in the field of metabolomics including technological advancements, the identification of potential biomarkers, and metabolic pathways relevant to macro- and microvascular diabetic complications. PMID:26891794

  2. Complications of diverticular disease: surgical laparoscopic treatment.

    PubMed

    Anania, G; Vedana, L; Santini, M; Scagliarini, L; Giaccari, S; Resta, G; Cavallesco, G

    2014-01-01

    Surgical treatment of complicated colonic diverticular disease is still debatable. The aim of our study was to evaluate the outcome of laparoscopic colon resection in patients with diverticulitis and with complications like colon-vescical fistula, peridiverticular abscess, perforation or stricture. All patients underwent laparoscopic colectomy within 8 years period. Main data recorded were age, sex, return of bowel function, operation time, duration of hospital stay, ASA score, body mass index (BMI), early and late complications. During the study period, 33 colon resections were performed for diverticulitis and complications of diverticulitis. We performed 5 associated procedures. We had 2 postoperative complications; 1 of these required a redo operation with laparotomy for anastomotic leak and 3 patients required conversion from laparoscopic to open colectomy. The most common reasons for conversion were related to the inflammatory process with a severe adhesion syndrome. Mean operative time was 229 minutes, and average postoperative hospital stay was 9,8 days. Laparoscopic surgery for complications of diverticular disease is safe, effective and feasible. Laparoscopic colectomy has replaced open resection as standard surgery for recurrent and complicated diverticulitis in our institution. PMID:24979103

  3. Perinatal Complications and Aging Indicators by Midlife

    PubMed Central

    Caspi, Avshalom; Ambler, Antony; Belsky, Daniel W.; Chapple, Simon; Cohen, Harvey Jay; Israel, Salomon; Poulton, Richie; Ramrakha, Sandhya; Rivera, Christine D.; Sugden, Karen; Williams, Benjamin; Wolke, Dieter; Moffitt, Terrie E.

    2014-01-01

    BACKGROUND: Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife. METHODS: Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age. RESULTS: Perinatal complications predicted both leukocyte TL (β = −0.101; 95% confidence interval, −0.169 to −0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators. CONCLUSIONS: Our findings provide support for early-life developmental programming by linking newborns’ perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging “inside,” as measured by leukocyte TL, an indicator of cellular aging, and “outside,” as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed. PMID:25349321

  4. Osteoarticular complications of brucellosis.

    PubMed Central

    Colmenero, J D; Reguera, J M; Fernndez-Nebro, A; Cabrera-Franquelo, F

    1991-01-01

    Two hundred and sixty three patients with a diagnosis of brucellosis between January 1984 and December 1987 were studied prospectively. Sixty five patients (25%) developed osteoarticular complications. These patients had a more prolonged course than those with no complications. Spondylitis in 38 (58%) and sacroiliitis in 29 (45%) were the most prevalent. There were no significant laboratory, serological, or bacteriological differences between patients with and without osteoarticular complications. At diagnosis 47 patients (72%) showed radiographic abnormalities, commonly in axial sites but rarely in peripheral sites. Radionuclide bone scan was positive with no radiographic abnormalities in 17 (26%) of cases. Fifty seven patients received medical treatment alone, 51 (89%) being cured with a single course of treatment. Treatment failed or there was a relapse in six patients (11%), of whom five had spondylitis. Eight of the 65 patients (12%), all of whom had spondylitis and paravertebral or epidural abscesses, also required surgical treatment. Images PMID:1994863

  5. Fatal complications of tracheotomy.

    PubMed

    Stemmer, E A; Oliver, C; Carey, J P; Connolly, J E

    1976-03-01

    Thirty-six of 403 deaths after tracheotomy were direct complications of that procedure. Arterial hemorrhage caused three deaths, venous bleeding, seven. Airway obstruction resulted in six fatalities. Tracheoesophageal fistula caused five deaths. Eight deaths were due to infection and sepsis. Tension pneumothorax developed in one patient and the remaining six deaths were due to cardiopulmonary collapse. Many of the complications of tracheotomy can be avoided with accurate knowledge of anatomic variations, ideal operating conditions, proper technic, careful arterial and venous hemostasis, routine postoperative chest x-ray films, sterile suction technic, proper use of soft cuffed tracheotomy tubes, adequate humidification, and careful postoperative blood gas monitoring. PMID:769582

  6. Anesthetic Complications in Pregnancy.

    PubMed

    Hoefnagel, Amie; Yu, Albert; Kaminski, Anna

    2016-01-01

    Anesthesia complications in the parturient can be divided into 2 categories: those related to airway manipulation and those related to neuraxial anesthesia. Physiologic changes of pregnancy can lead to challenging intubating conditions in a patient at risk of aspiration. Neuraxial techniques are used to provide analgesia for labor and anesthesia for surgical delivery. Therefore, complications associated with neuraxial techniques are often seen in this population. In the event of maternal cardiac arrest, modification to advanced cardiac life support algorithms must be made to accommodate the gravid uterus and to deliver the fetus if return of maternal circulation is not prompt. PMID:26600441

  7. Osteoporosis and its complications.

    PubMed

    Varacallo, Matthew A; Fox, Ed J

    2014-07-01

    This article provides an overview of the current burden of osteoporosis and its complications in today's health care system. The impact of osteoporosis on patients' quality of life and direct financial consequences to the entire health care system are emphasized to highlight the need for increased knowledge and awareness of its complications if left untreated or treated incorrectly. Special attention is given to hip fracture and vertebral compression fracture, stressing the importance of diagnosing osteoporosis before fragility fractures occur. Models for improved care of fragility fractures during follow-up in the outpatient setting and the use of pharmacologic agents are discussed. PMID:24994054

  8. Orthopedic complications in diabetes.

    PubMed

    Gehling, Daniel J; Lecka-Czernik, Beata; Ebraheim, Nabil A

    2016-01-01

    Diabetes is associated with a number of lower extremity orthopedic conditions and complications including fractures, Charcot neuroarthropathy, plantar ulcers, and infection. These complications are of significant clinical concern in terms of morbidity, mortality, and socioeconomic costs. A review of each condition is discussed, with particular emphasis on the clinical importance, diagnostic considerations, and orthopedic treatment recommendations. The goal of the article is to provide a clinical picture of the challenges that orthopedic surgeons confront, and highlight the need for specific clinical guidelines in diabetic patients. PMID:26211990

  9. Neurological Complications of Lyme Disease

    MedlinePLUS

    ... Find People About NINDS NINDS Neurological Complications of Lyme Disease Information Page Synonym(s): Lyme Disease - Neurological Complications Table ... resources from MedlinePlus What are Neurological Complications of Lyme Disease? Lyme disease is caused by a bacterial organism ...

  10. Neurological Complications of Transplantation

    PubMed Central

    Pruitt, Amy A.; Graus, Francesc; Rosenfeld, Myrna R.

    2013-01-01

    Hematopoietic cell transplantation (HCT) is the preferred treatment for an expanding range of neoplastic and nonmalignant conditions. Increasing numbers of solid organ transplantations (SOTs) add an additional population of immunosuppressed patients with multiple potential neurological problems. While the spectrum of neurological complications varies with conditioning procedure and hematopoietic cell or solid organ source, major neurological complications occur with all transplantation procedures. This 2 part review emphasizes a practical consultative approach to central and peripheral nervous system problems related to HCT or SOT with clinical and neuroimaging examples from the authors’ institutional experience with the following conditions: the diversity of manifestations of common infections such as varicella zoster virus, Aspergillus, and progressive multifocal leukoencephalopathy (PML), drug therapy-related complications, stroke mechanisms, the spectrum of graft versus host disease (GVHD), and neurologically important syndromes of immune reconstitution inflammatory syndrome (IRIS), posterior reversible encephalopathy syndrome (PRES), and posttransplantation lymphoproliferative disorder (PTLD). These complications preferentially occur at specific intervals after HCT and SOT, and neurological consultants must recognize an extensive spectrum of syndromes in order to effect timely diagnosis and expedite appropriate treatment. PMID:23983885

  11. Complicating Visual Culture

    ERIC Educational Resources Information Center

    Daiello, Vicki; Hathaway, Kevin; Rhoades, Mindi; Walker, Sydney

    2006-01-01

    Arguing for complicating the study of visual culture, as advocated by James Elkins, this article explicates and explores Lacanian psychoanalytic theory and pedagogy in view of its implications for art education practice. Subjectivity, a concept of import for addressing student identity and the visual, steers the discussion informed by pedagogical

  12. Interpreting Dream Complications.

    ERIC Educational Resources Information Center

    Gollub, Dan

    1984-01-01

    Explains different complications, i.e., emotional behavior, speech, and symbolism, suggesting that emotional behavior in dreams is either genuine or opposite from emotional reality. Dream speech delineates boundaries between the conscious and unconscious. Symbolism in dreams presents abstract concepts visually. (BH)

  13. Complications of Mumps

    MedlinePLUS

    ... Articles Outbreak Articles Related Links World Health Organization Medline Plus Complications of Mumps Language: English Español (Spanish) ... www.vaccineinformation.org). Related Links World Health Organization Medline Plus Language: English Español (Spanish) File Formats Help: ...

  14. Pertussis (Whooping Cough) Complications

    MedlinePLUS

    ... and adults with pertussis needed care in the hospital. Pneumonia (lung infection) was diagnosed in 1 out of 50 (2%) of those patients. The most common complications in another study were: Weight loss in 1 out of 3 (33%) adults Loss of bladder control in 1 out of 3 (28%) adults Passing ...

  15. Treatment of complicated grief

    PubMed Central

    Rosner, Rita; Pfoh, Gabriele; Kotoučová, Michaela

    2011-01-01

    Following the death of a loved one, a small group of grievers develop an abnormal grieving style, termed complicated or prolonged grief. In the effort to establish complicated grief as a disorder in DSM and ICD, several attempts have been made over the past two decades to establish symptom criteria for this form of grieving. Complicated grief is different from depression and PTSD yet often comorbid with other psychological disorders. Meta-analyses of grief interventions show small to medium effect sizes, with only few studies yielding large effect sizes. In this article, an integrative cognitive behavioral treatment manual for complicated grief disorder (CG-CBT) of 25 individual sessions is described. Three treatment phases, each entailing several treatment strategies, allow patients to stabilize, explore, and confront the most painful aspects of the loss, and finally to integrate and transform their grief. Core aspects are cognitive restructuring and confrontation. Special attention is given to practical exercises. This article includes the case report of a woman whose daughter committed suicide. PMID:22893810

  16. Neurologic complications of influenza.

    PubMed

    Shah, Snehal; Keil, Anthony; Gara, Kieren; Nagarajan, Lakshmi

    2014-09-01

    We report on a child with mild encephalopathy with reversible splenial lesion (MERS) associated with influenza infection and present a case series of neurological complications associated with influenza infections in children who presented to a tertiary children's hospital in Australia over a period of one year. PMID:24072018

  17. Obstetric complications of twin pregnancies.

    PubMed

    Rao, Anita; Sairam, Shanthi; Shehata, Hassan

    2004-08-01

    Advances in assisted reproductive technology and increases in the proportion of maternities in older women have both contributed to the steep increase in the incidence of twin pregnancies since the 1980s. Maternal and perinatal complications are higher in twins than in singleton pregnancies. A significant proportion of perinatal mortality and morbidity among twins is due to the high incidence of preterm delivery and the added complication of twin-to-twin transfusion syndrome (TTTS) in monochorionic twins. Monochorionic twins also have a much higher rate of perinatal mortality than dichorionic twins, the greatest risk being before fetal viability (<24 weeks gestation). Early diagnosis of twins and their chorionicity, close fetal surveillance, particularly of monochorionic twins, and prompt therapeutic intervention in TTS are necessary to reduce perinatal mortality. Intrapartum management in the hospital setting with anaesthetic and neonatal facilities, as well as critical assessment of mode of delivery, have led to better outcomes. Ultrasonography is a valuable tool in the management of twin pregnancy. This chapter briefly summarises these topics, with a particular focus on recent literature. PMID:15279817

  18. [Complications of silicone oil tamponade].

    PubMed

    Baillif, S; Gastaud, P

    2014-03-01

    Silicone oil tamponade is used for the management of complicated retinal detachment. Patients should be closely monitored as many complications may occur with intraocular silicone oil. Short-term complications include temporarily increased intraocular pressure and anterior segment inflammation. Long-term complications include cataract, emulsification, ocular hyper- or hypotension, keratopathy and retinal redetachment associated with proliferative vitreoretinopathy. PMID:24559527

  19. Bereavement and Complicated Grief

    PubMed Central

    Ghesquiere, Angela; Glickman, Kim

    2013-01-01

    Bereavement is a common experience in adults age 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with everyday activities and find interest or pleasure. About 7% of bereaved older adults, however, will develop the mental health condition of Complicated Grief (CG). In CG, the movement from acute to integrated grief is derailed, and grief symptoms remain severe and impairing. This article reviews recent publications on the diagnosis of CG, risk factors for the condition, and evidenced-based treatments for CG. Greater attention to complicated grief detection and treatment in older adults is needed. PMID:24068457

  20. Surgical complications of ascariasis.

    PubMed

    Ochoa, B

    1991-01-01

    Over the past 25 years (1963-1988), a total of 311 children under 12 years of age were admitted to the Pediatric Surgical Service of the San Vicente de Pal University Hospital, Medelln, Colombia, with complications resulting from infection with Entamoeba histolytica or Ascaris lumbricoides. In this group, the abdominal complications produced by ascariasis numbered 145, and included intestinal obstruction (n = 107), perforation of the appendix (n = 10), and migration of the parasite to the biliary tree or to the peritoneal cavity (n = 28). Evaluation of the living conditions of a significant subgroup of our patients confirms that intestinal parasitism is an endemic condition prevailing in nations that exhibit deep social and economic imbalance, where large sectors of the population remain deprived of the basic services of education, health, housing, and recreation. Massive infestation in children may give rise to grave complications that demand expert surgical care. Third World surgeons practicing in general hospitals that take care of patients of low economic capacity are usually familiar with the diagnosis and management of this pathology; surgeons who practice in the industrialized nations will only occasionally face such problems. The greater mobility of today's societies and the rather massive migrations that take place in current times have resulted in an increasing incidence of these entities in the hospital populations of the large urban centers of these nations. It is for the surgeons practicing in such centers that the information presented herein may be of greater value. PMID:2031358

  1. Pleuropulmonary complications of pancreatitis

    PubMed Central

    Kaye, Michael D.

    1968-01-01

    Pancreatitis, in common with many other upper abdominal diseases, often leads to pleuropulmonary complications. Radiological evidence of pleuropulmonary abnormality was found in 55% of 58 cases examined retrospectively. The majority of such abnormalities are not specific for pancreatitis; but a particular category of pleural effusions, rich in pancreatic enzymes, is a notable exception. A patient with this type of effusion, complicated by a spontaneous bronchopleural fistula and then by an empyema, is reported. The literature relating to pancreatic enzyme-rich pleural effusions (pathognomonic of pancreatitis) is reviewed. Of several possible mechanisms involved in pathogenesis, transdiaphragmatic lymphatic transfer of pancreatic enzymes, intrapleural rupture of mediastinal extensions of pseudocysts, and diaphragmatic perforation are the most important. The measurement of pleural fluid amylase, at present little employed in this country, has considerable diagnostic value. Enzyme-rich effusions are more commonly left-sided, are often blood-stained, are frequently associated with pancreatic pseudocysts, and—if long standing—may be complicated by a bronchopleural fistula. Images PMID:4872925

  2. Technical note: Intraobserver, interobserver, and test-retest reliabilities of an assessment of vaginal discharge from cows with and without acute puerperal metritis.

    PubMed

    Sannmann, I; Heuwieser, W

    2015-08-01

    Acute puerperal metritis (APM) in dairy cows is a common disease occurring in the first 10 d after calving. According to a widely accepted definition, the diagnosis is primarily based on body temperature and sensorial assessment of vaginal discharge. The scope of this study was to evaluate the reliability for color, smell, and viscosity of vaginal discharge from healthy cows and cows with APM. Fifteen investigators evaluated 6 vaginal discharge samples 10 times. Subsequently, the investigators rated the health status of the cows and the diagnostic value of color, smell, and viscosity. In a final questionnaire, the investigators estimated their ability to diagnose APM correctly and the influence of experience. Reliability was tested using Cohen's kappa (?). Our study revealed slight to moderate reliabilities concerning the assessment of vaginal discharge. Overall interobserver reliability for color, smell, and viscosity was ?=0.15, 0.27, and 0.44, respectively. Overall intraobserver reliability for color, smell, and viscosity was ?=0.35, 0.39, and 0.6, respectively. By means of a questionnaire, overall personal expertise to detect cows suffering from APM correctly as such was estimated to be 59%, whereas the diagnostic value of a combination of color, smell, and viscosity to detect cows with APM correctly was estimated to be 91.1% perfect. We found a discrepancy between reliability and the personal perception of diagnostic value. Our study shows that the sensorial assessment of color, smell, and viscosity of vaginal discharge in cows postpartum is subjective. PMID:26026759

  3. Obstetrical Complications and Violent Delinquency: Testing Two Developmental Pathways.

    ERIC Educational Resources Information Center

    Arseneault, Louise; Tremblay, Richard E.; Boulerice, Bernard; Saucier, Jean-Francois

    2002-01-01

    Assessed interaction between obstetrical complications and early family adversity in predicting violent behavior during childhood and adolescence among 849 boys from low SES areas. Found that elevated scores on scale of obstetrical complications (preeclampsia, umbilical cord prolapse, induced labor) increased risk of being violent at 6 and 17

  4. Pathophysiology of pulmonary complications of acute pancreatitis

    PubMed Central

    Browne, George W; Pitchumoni, CS

    2006-01-01

    Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia, acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids, chemoattractants such as tumor necrsosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, IL-8, fMet-leu-phe (a bacterial wall product), nitric oxide, substance P, and macrophage inhibitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines. PMID:17131469

  5. Complications of Macular Peeling

    PubMed Central

    Asencio-Duran, Mnica; Manzano-Muoz, Beatriz; Vallejo-Garca, Jos Luis; Garca-Martnez, Jess

    2015-01-01

    Macular peeling refers to the surgical technique for the removal of preretinal tissue or the internal limiting membrane (ILM) in the macula for several retinal disorders, ranging from epiretinal membranes (primary or secondary to diabetic retinopathy, retinal detachment) to full-thickness macular holes, macular edema, foveal retinoschisis, and others. The technique has evolved in the last two decades, and the different instrumentations and adjuncts have progressively advanced turning into a safer, easier, and more useful tool for the vitreoretinal surgeon. Here, we describe the main milestones of macular peeling, drawing attention to its associated complications. PMID:26425351

  6. [Infectious complications of lymphedema].

    PubMed

    Vaillant, L; Gironet, N

    2002-06-01

    Erysipelas and lymphangitis are frequent complications of lymphedemas (20 to 30%). The most important risk factor for erysipelas is lymphedema since this is a protein rich edema that contributes to the risk of infection. In case of lymphedema the treatment is the usual consensus treatment for erysipelas. A prophylactic treatment with penicillin is requested as soon as the first recurrence. This prophylactic treatment includes skin care, particularly treatment of injuries and intertrigos. Hyperplastic skin leads to maceration and then mycoses. Physiotherapy does not increase the risk for infection. Moreover an infection needs a complex decongestive physiotherapy which decreases risks of recurrence. PMID:12162204

  7. Neurologic complications of immunization.

    PubMed

    Bale, James F

    2004-06-01

    In the United States and many other developed countries, active immunization of children has virtually eliminated poliomyelitis, measles, rubella, tetanus, and other diseases, such as disease due to Haemophilus influenzae type b. Individual vaccines can produce systemic or neurologic reactions ranging from minor events, such as pain and erythema at the injection site, to major complications, such as seizures, shock, encephalopathy, or death. Immunization programs have also generated considerable controversy, as witnessed by recent concerns regarding the relationship between vaccines or their constituents and autism or multiple sclerosis. This review summarizes current information regarding vaccines, the diseases that they prevent, and the potential relationships between vaccines and neurologic disease. PMID:15446387

  8. Complications of decorative tattoo.

    PubMed

    Shinohara, Michi M

    2016-01-01

    Decorative tattoo is a popular practice that is generally safe when performed in the professional setting but can be associated with a variety of inflammatory, infectious, and neoplastic complications, risks that may be increased with current trends in home tattooing. Modern tattoo inks contain azo dyes and are often of unknown composition and not currently regulated for content or purity. Biopsy of most (if not all) tattoo reactions presenting to the dermatologist is recommended, given recent clusters of nontuberculous mycobacterial infections occurring within tattoo, as well as associations between tattoo reactions and systemic diseases such as sarcoidosis. PMID:26903190

  9. Neurologic complications of cardiac tests and procedures.

    PubMed

    Sila, Cathy

    2014-01-01

    Arterial or central venous vascular access is the cornerstone of invasive cardiac diagnosis, monitoring, and therapeutics. Although procedural safety has significantly improved with protocols perfected over decades of use, their prevalence renders even the uncommon neurologic complication clinically relevant. Serious peripheral nerve complications result from direct or indirect nerve injuries in the setting of a hematoma or compartment syndrome. Functional outcome is dependent upon prompt diagnosis and early treatment, so proceduralists should be aware of the relevant anatomy and early signs of nerve injury. Ischemic stroke is the most common central nervous system complication of diagnostic and therapeutic cardiac catheterization, and is presumed to be due to embolization of atherosclerotic plaque or thrombus dislodged during guiding catheter manipulation, platelet-fibrin thrombus that forms on the catheters, or air that appears during catheter flushing. Acute neurologic deterioration after thrombolysis for acute myocardial infarction should be presumed to be an intracranial hemorrhage until proven otherwise. The ideal angiography suite of the future is patientcentric and multipurpose, coordinating diagnostic and therapeutic strategies for multivascular disease, allowing for multispecialty collaboration, and, in the event of a neurologic complication of a cardiac procedure, facilitating the various treating physicians to converge efficiently upon the patient. PMID:24365287

  10. Is the cold loop hysteroscopic technique a myometrial sparing treatment for placenta accreta residuals in a puerperal uterus?

    PubMed

    Mazzon, Ivano; Favilli, Alessandro; Grasso, Mario; Horvath, Stefano; Gerli, Sandro

    2016-05-01

    Placenta accreta is a life-threatening obstetric pathology characterized by an abnormal invasion of chorionic villi into the uterine wall. The management represents a challenge for the gynecologist, especially in patients desiring to preserve their fertility. Several methods have been proposed to avoid hysterectomy. A case of a hysteroscopic conservative management with the cold loop technique in a puerpera with a large mass of placenta accreta residuals is described. The chorionic tissue was safely detached and it was subsequently removed by an electric cutting loop. Even in the absence of a clear cleavage plane, the thermal damage of surrounding healthy myometrium and dreadful complications as uterine perforation due to the electric cutting loop were avoided. The cold-loop hysteroscopic resection seems to be a safe and effective choice for the treatment of retained placenta accreta in patients desiring to preserve fertility. Moreover, it can also be proposed to patients who need to be treated immediately after delivery. PMID:26212585

  11. Imaging Complications of Renal Transplantation.

    PubMed

    Moreno, Courtney Coursey; Mittal, Pardeep K; Ghonge, Nitin P; Bhargava, Puneet; Heller, Matthew T

    2016-03-01

    Renal transplant complications are categorized as those related to the transplant vasculature, collecting system, perinephric space, renal parenchyma, and miscellaneous complications including posttransplant lymphoproliferative disorder. Many of these renal transplant complications are diagnosed with imaging. Medical complications including rejection, acute tubular necrosis, and drug toxicity also can impair renal function. These medical complications are typically indistinguishable at imaging, and biopsy may be performed to establish a diagnosis. Normal transplant anatomy, imaging techniques, and the appearances of renal transplant complications at ultrasound, computed tomography, and MR imaging are reviewed. PMID:26896222

  12. Complications of Lateral Epicondylar Release.

    PubMed

    Pomerantz, Michael Lucius

    2016-04-01

    Reported complication rates are low for lateral epicondylitis management, but the anatomic complexity of the elbow allows for possible catastrophic complication. This review documents complications associated with lateral epicondylar release: 67 studies reporting outcomes of lateral epicondylar release with open, percutaneous, or arthroscopic methods were reviewed and 6 case reports on specific complications associated with the procedure are included. Overall complication rate was 3.3%. For open procedures it was 4.3%, percutaneous procedures 1.9%, and arthroscopic procedures 1.1%. In higher-level studies directly comparing modalities, the complication rates were 1.3%, 0%, and 1.2%, respectively. PMID:26772953

  13. Vascular complications in the diabetic pregnancy.

    PubMed

    Leguizamn, Gustavo; Trigubo, Denise; Pereira, Juan Ignacio; Vera, Mara Fernanda; Fernndez, Jos Alberto

    2015-04-01

    Long-standing hyperglycemia frequently leads to vasculopathy. Microvascular disease is characterized by retinopathy and nephropathy, while macrovascular involvement can affect coronary arteries. Diabetic autonomic neuropathy, when present, is generally associated with retinal and/or renal involvement. Early identification of these diabetic complications allows appropriate counseling and early treatment. Among women with diabetic vasculopathy, nephropathy, chronic hypertension, preeclampsia, preterm delivery, and fetal growth restriction are frequently observed. Furthermore, women with impaired renal function in early pregnancy have increased risk of long-term deterioration of glomerular filtration rate. Proliferative retinopathy can progress during pregnancy and 1year after delivery, but long-term effects are not likely to occur. When coronary artery disease or gastroparesis diabeticorum are present, excessive maternal and fetal morbidity is observed. When modern management is synchronized with early medical care, favorable maternal and perinatal outcomes can be expected. PMID:25732848

  14. Radiology of cardiac devices and their complications

    PubMed Central

    Dipoce, J; Spindola-Franco, H

    2015-01-01

    This article familiarizes the reader with several different cardiac devices including pacemakers and implantable cardioverter defibrillators, intra-aortic balloon pumps, ventricular assist devices, valve replacements and repairs, shunt-occluding devices and passive constraint devices. Many cardiac devices are routinely encountered in clinical practice. Other devices are in the early stages of development, but circumstances suggest that they too will become commonly found. The radiologist must be familiar with these devices and their complications. PMID:25411826

  15. Thrombosis of splenic artery pseudoaneurysm complicating pancreatitis.

    PubMed Central

    De Ronde, T; Van Beers, B; de Cannire, L; Trigaux, J P; Melange, M

    1993-01-01

    The natural history of pseudoaneurysms complicating pancreatitis is unknown. A patient with chronic pancreatitis is described in whom thrombosis of a splenic artery pseudoaneurysm occurred. Early diagnosis and radical treatment of a bleeding pseudoaneurysm are mandatory. When elective treatment is considered, however, contrast enhanced computed tomography may be useful just before surgery as thrombosis may occur. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:8406167

  16. Complications of balloon packing in epistaxis.

    PubMed

    Vermeeren, Lenka; Derks, Wynia; Fokkens, Wytske; Menger, Dirk-Jan

    2015-10-01

    Although balloon packing appears to be efficient to control epistaxis, severe local complications can occur. We describe four patients with local lesions after balloon packing. Prolonged balloon packing can cause damage to nasal mucosa, septum and alar skin (nasal mucosa, the cartilaginous skeleton and the overlying soft-tissue envelope) and should, therefore, be avoided. We suggest early nasendoscopy in general anesthesia to identify and treat the bleeding focus, if bleeding cannot be controlled with regular packing. PMID:25647471

  17. Unusual septoplasty complication: Streptococcus viridans endocarditis.

    PubMed

    Leonard, D W; Thompson, D H

    1998-10-01

    Infection is an infrequently reported complication following septoplasty and septorhinoplasty. Among the recognized but rare infections are toxic shock syndrome, spinal osteomyelitis, meningitis, septic cavernous sinus thrombosis and endocarditis. A high index of suspicion is required to diagnose these infections early and thereby minimize morbidity and mortality. We present a case of endocarditis following septoplasty in a patient who had no identifiable preoperative risk factors but who experienced recurrent fever and chills postoperatively. PMID:9818534

  18. Common surgery, uncommon complication

    PubMed Central

    Akdeniz, Hande; Ozer, Kadri; Dikmen, Adile; Kocer, Uger

    2015-01-01

    Ingrown nail surgery is the one of the most common surgeries in outpatient clinics that are generally perfomed in response to patient complaints. Still, making simple observations, taking patient histories and conducting further tests are often neglected by outpatient clinics. Consequently, it is important to be aware if ingrown nail is associated with any underlying diseases that can lead to major complications. In this article, we report on two cases ending in amputation that were performed with Winograd’s partial matrix excision procedure for ingrown nails. Such a complication is rare, unexpected, and most unwanted in forefoot surgery. After a detailed analysis of the situation, we discovered that both patients were smokers, and one of them had Buerger’s disease. These conditions led to the ingrown nails in addition to poor wound healing. This case report emphasizes the fact that even when performing minor procedures, obtaining a detailed history and conducting an examination are of paramount importance. Patient selection is also a considerable factor, especially for patients who are smokers, who may experience a worst case surgical scenario. PMID:26693080

  19. Common surgery, uncommon complication.

    PubMed

    Akdeniz, Hande; Ozer, Kadri; Dikmen, Adile; Kocer, Uger

    2015-10-01

    Ingrown nail surgery is the one of the most common surgeries in outpatient clinics that are generally perfomed in response to patient complaints. Still, making simple observations, taking patient histories and conducting further tests are often neglected by outpatient clinics. Consequently, it is important to be aware if ingrown nail is associated with any underlying diseases that can lead to major complications. In this article, we report on two cases ending in amputation that were performed with Winograd's partial matrix excision procedure for ingrown nails. Such a complication is rare, unexpected, and most unwanted in forefoot surgery. After a detailed analysis of the situation, we discovered that both patients were smokers, and one of them had Buerger's disease. These conditions led to the ingrown nails in addition to poor wound healing. This case report emphasizes the fact that even when performing minor procedures, obtaining a detailed history and conducting an examination are of paramount importance. Patient selection is also a considerable factor, especially for patients who are smokers, who may experience a worst case surgical scenario. PMID:26693080

  20. High incidence of cardiovascular complications in pheochromocytoma.

    PubMed

    Zelinka, T; Petrk, O; Turkov, H; Holaj, R; Strauch, B; Krek, M; Vrnkov, A B; Musil, Z; Dukov, J; Kubinyi, J; Michalsk, D; Novk, K; Widimsk, J

    2012-05-01

    Excess of catecholamines in pheochromocytoma is usually accompanied with classical symptoms and signs. In some cases, severe cardiovascular complications (e. g., heart failure, myocardial infarction) may occur. We performed a retrospective analysis focused on the incidence of cardiovascular complications (classified as follows: arrhythmias, myocardial involvement or ischemia and atherosclerosis, cerebrovascular impairment) before the establishment of diagnosis of pheochromocytoma among 145 subjects treated in our hospital. Cardiovascular complications occurred in 28 subjects, but these subjects did not differ significantly from subjects without complications in age, gender, body mass index, paroxysmal symptoms, symptom duration, tumor dimension, catecholamine secretory phenotype, and incidence of hypertension or diabetes mellitus. Arrhythmias occurred in 15 subjects (2 arrhythmia types in 2 subjects): atrial fibrillation in 9 subjects, supraventricular tachycardia in 3 cases, and ventricular tachycardia in 2 patients. Significant bradycardia was noted in 3 cases. Five subjects presented with heart failure with decreased systolic function (takotsubo-like cardiomyopathy found in 2 cases). One subject suffered from hypertrophic obstructive cardiomyopathy. Seven subjects presented with non-ST-segment elevation myocardial infarction, 2 patients with ST-segment myocardial infarction, and 1 subject underwent coronary artery bypass grafting. Two subjects suffered from significant peripheral atherosclerosis. Among cerebrovascular complications, transient ischemic attack was found in 3 cases, 2 subjects suffered from stroke, and subarachnoidal bleeding occurred in 1 patient. One subject suffered from diffuse neurological impairment due to multiple ischemic white matter lesions. These data show relatively high incidence of cardiovascular complications (19.3%) in subjects with pheochromocytoma. Early diagnosis is mandatory to prevent severe complications in pheochromocytoma. PMID:22517556

  1. Focus on treatment complications and optimal management surgery

    PubMed Central

    Hendriks, Jeroen M.; Lauwers, Patrick

    2014-01-01

    Thoracic surgery comprises major procedures which may be challenging, not only from a technical point of view but also regarding anesthetic and postoperative management. Complications are common occurrences which are also related to the comorbidity of the patients. After major lung resections pulmonary and pleural complications are often encountered. In this overview more surgically related complications are discussed, focusing on postpneumonectomy pulmonary edema, thromboembolic disease including pulmonary embolism, prolonged air leak, lobar torsion, persistent pleural space, empyema and bronchopleural fistula. Prevention, timely recognition, and early adequate treatment are key points as complications initially considered to be minor, may suddenly turn into life-threatening events. To this end multidisciplinary cooperation is necessary. Preoperative smoking cessation, adequate pain control, attention to nutritional status, incentive spirometry and early mobilization are important factors to reduce the incidence of postoperative complications. PMID:25806298

  2. Complicated bile duct stones

    PubMed Central

    Roy, Ashwin; Martin, Derrick

    2013-01-01

    Common bile duct stones (CBDSs) are solid deposits that can either form within the gallbladder or migrate to the common bile duct (CBD), or form de novo in the biliary tree. In the USA around 15% of the population have gallstones and of these, 3% present with symptoms annually. Because of this, there have been major advancements in the management of gallstones and related conditions. Management is based on the patient's risk profile; young and healthy patients are likely to be recommended for surgery and elderly patients with comorbidities are usually recommended for endoscopic procedures. Imaging of gallstones has advanced in the last 30 years with endoscopic retrograde cholangiopancreatography evolving from a diagnostic to a therapeutic procedure in removing CBDSs. We present a complicated case of a patient with a CBDS and periampullary diverticulum and discuss the techniques used to diagnose and remove the stone from the biliary system. PMID:23946532

  3. Receiver operating characteristic curve analysis to determine the diagnostic performance of serum haptoglobin concentration for the diagnosis of acute puerperal metritis in dairy cows.

    PubMed

    Burfeind, O; Sannmann, I; Voigtsberger, R; Heuwieser, W

    2014-10-01

    Acute puerperal metritis (APM) in dairy cows is characterized by fever and fetid vaginal discharge within 21 days in milk (DIM). Increased serum haptoglobin concentration (Hp) can support the diagnosis of APM. However, there is a dearth of information of the test performance of Hp as a measure for APM with a consistent definition and considering parity. The objective of this trial was to study the test performance of Hp to distinguish healthy cows from cows with APM. A total of 33 of 60 (55.0%) primiparous cows and 43 of 133 (32.3%) multiparous cows developed APM. Primiparous cows with APM had the greatest Hp. However, in primiparous cows Hp did not significantly differ between healthy cows (DIM 2: 1.49 0.64 mg/mL; DIM 5: 2.13 0.66 mg/mL; DIM 10: 1.46 0.85 mg/mL) and cows with APM (DIM 2: 1.78 0.62 mg/mL; DIM 5: 2.48 0.64 mg/mL; DIM 10: 1.60 0.81 mg/mL). In multiparous cows, Hp was greater in cows with APM (DIM 2: 1.27 0.68 mg/mL; DIM 5: 1.89 0.94 mg/mL; DIM 10: 1.23 0.78 mg/mL) than in healthy cows (DIM 2: 0.99 0.68 mg/mL; DIM 5: 1.10 0.80 mg/mL; DIM 10: 0.83 0.68 mg/mL). Sensitivity and specificity of Hp to diagnose APM in multiparous cows ranged from 72% to 79% and 54% to 71% on DIM 2, 5 and 10, respectively. PMID:25128191

  4. An update on pulmonary complications of hematopoietic stem cell transplantation.

    PubMed

    Chi, Amy K; Soubani, Ayman O; White, Alexander C; Miller, Kenneth B

    2013-12-01

    The indications for hematopoietic stem cell transplantation (HSCT) continue to expand. However, the risk for pulmonary complications post-HSCT continues to be high. Early recognition and treatment of pulmonary complications may improve outcomes. This is an overview of diagnosis, manifestations, and treatment of the most common infectious and noninfectious pulmonary complications post-HSCT. Knowing the patient's timeframe post-HSCT (preengraftment, postengraftment, late), type of HSCT (allogeneic vs autologous), radiographic findings, and clinical presentation can help to differentiate between the many pulmonary complications. This article will also address pretransplantation evaluation and infectious and noninfectious complications in the patient post-HSCT. While mortality post-HSCT continues to improve, respiratory failure continues to be the leading cause of ICU admissions for patients who have undergone HSCT. Mechanical ventilation is a predictor of poor outcomes in these patients, and further research is needed regarding their critical care management, treatment options for noninfectious pulmonary complications, and mortality prediction models posttransplantation. PMID:24297123

  5. Zebrafish sex: a complicated affair

    PubMed Central

    Liew, Woei Chang

    2014-01-01

    In this review, we provide a detailed overview of studies on the elusive sex determination (SD) and gonad differentiation mechanisms of zebrafish (Danio rerio). We show that the data obtained from most studies are compatible with polygenic sex determination (PSD), where the decision is made by the allelic combinations of several loci. These loci are typically dispersed throughout the genome, but in some teleost species a few of them might be located on a preferential pair of (sex) chromosomes. The PSD system has a much higher level of variation of SD genotypes both at the level of gametes and the sexual genotype of individuals, than that of the chromosomal sex determination systems. The early sexual development of zebrafish males is a complicated process, as they first develop a ‘juvenile ovary’, that later undergoes a transformation to give way to a testis. To date, three major developmental pathways were shown to be involved with gonad differentiation through the modulation of programmed cell death. In our opinion, there are more pathways participating in the regulation of zebrafish gonad differentiation/transformation. Introduction of additional powerful large-scale genomic approaches into the analysis of zebrafish reproduction will result in further deepening of our knowledge as well as identification of additional pathways and genes associated with these processes in the near future. PMID:24148942

  6. Dermatological complications of obesity.

    PubMed

    Garca Hidalgo, Linda

    2002-01-01

    Obesity is a health problem of considerable magnitude in the Western world. Dermatological changes have been reported in patients with obesity, including: acanthosis nigricans and skin tags (due to insulin resistance); hyperandrogenism; striae due to over extension; stasis pigmentation due to peripheral vascular disease; lymphedema; pathologies associated with augmented folds; morphologic changes in the foot anatomy due to excess load; and complications that may arise from hospitalization. Acanthosis nigricans plaques can be managed by improved control of hyperinsulinemia; the vitamin D3 analog calcipitriol has also been shown to be effective. Skin tags can be removed by snipping with curved scissors, by cryotherapy or by electrodesiccation. Hyperandrogenism, a result of increased production of endogenous androgens due to increased volumes of adipose tissue (which synthesizes testosterone) and hyperinsulinemia (which increases the production of ovarian androgens) needs to be carefully assessed to ensure disorders such as virilizing tumors and congenital adrenal hyperplasia are treated appropriately. Treatment of hyperandrogenism should be centred on controlling insulin levels; weight loss, oral contraceptive and antiandrogenic therapies are also possible treatment options. The etiology of striae distensae, also known as stretch marks, is yet to be defined and treatment options are unsatisfactory at present; striae rubra and alba have been treated with a pulsed dye laser with marginal success. The relationship between obesity and varicose veins is controversial; symptoms are best prevented by the use of elastic stockings. Itching and inflammation associated with stasis pigmentation, the result of red blood cells escaping into the tissues, can be treated with corticosteroids. Lymphedema is associated with dilatation of tissue channels, reduced tissue oxygenation and provides a culture medium for bacterial growth. Lymphedema treatment is directed towards reducing the limb girth and weight, and the prevention of infection. Intertrigo is caused by friction between skin surfaces, combined with moisture and warmth, resulting in infection. This infection, most commonly candidiasis, is best treated with topical antifungal agents; systemic antifungal therapy may be required in some patients. Excess load on the feet can result in morphological changes that require careful diagnosis; insoles may offer some symptom relief while control of obesity is achieved. Obesity-related dermatoses associated with hospitalization, such as pressure ulcers, diminished wound healing, dermatoses secondary to respiratory conditions, and incontinence, must all be carefully managed with an emphasis on prevention where possible. Recognition and control of the dermatological complications of obesity play an important role in diminishing the morbidity of obesity. PMID:12180897

  7. Stage IB carcinoma of the cervix, the Norwegian Radium Hospital: results and complications. III. Urinary and gastrointestinal complications

    SciTech Connect

    Kjorstad, K.E.; Martimbeau, P.W.; Iversen, T.

    1983-02-01

    The combination of surgery and radiotherapy for early cases of cancer of the cervix has been accused of producing prohibitive complication rates. In a series of 612 patients with cancer of the cervix, Stage IB, the frequency of major complications from the urinary and gastrointestinal tract has been studied, and an attempt has been made in determining the most probable etiology of these complications. No significant increase in complications can be attributed to the use of preoperative intracavitary irradiation. In patients with pelvic lymph node metastases the combination of radical surgery and a full course of radiotherapy is associated with a high complication risk, as 12% of these patients developed major complications. Their 5-year survival, however, was high: 54%.

  8. COMPLICATIONS OF TATTOOING

    PubMed Central

    Lubeck, Glenn; Epstein, Ervin

    1952-01-01

    Pathologic consequence of tattooing is relatively rare, but in light of the great number of persons in military service, where tattooing seems to be popular, consideration of the complications seems worth while. Four unusual cases of patients with cutaneous lesions in tattoos are reported. One patient had Boeck's sarcoid, in which the cutaneous eruption was limited solely to the tattooed areas on the body and involved all the various colors of the tattoo. The cutaneous eruption was only a single manifestation of generalized sarcoidosis. Another patient had secondary syphilis with the cutaneous lesions involving multi-colored tattoos, including the red areas. These tattoos were applied in Hawaii, and presumably the red dye was not the usual cinnabar (mercuric sulfide). As a general rule, the cutaneous lesions of secondary syphilis do not involve the red areas because of the treponomicidal action of mercuric sulfide. In the third case the characteristic eruption of discoid lupus erythematosus was present. It began over the red areas of a tattoo on the patient's forearm. It has been stated that mercuric sulfide is a photo-sensitizing agent, and it is believed that this explains the localization of the eruption in this case. The fourth patient had eruption, caused by mercury sensitivity, in an area of tattoo. The eruption was noted soon after the tattooing was done, and it persisted for seven years. PMID:14905289

  9. Hematologic complications of pregnancy.

    PubMed

    Townsley, Danielle M

    2013-07-01

    Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that occur during pregnancy is difficult owing to the paucity of evidence available to guide consultants. This review discusses specifically the diagnosis and management of benign hematologic disorders occurring during pregnancy. Anemia secondary to iron deficiency is the most frequent hematologic complication and is easily treated with oral iron formulations; however, care must be taken not to miss other causes of anemia, such as sickle cell disease. Thrombocytopenia is also a common reason for consulting the hematologist, and distinguishing gestational thrombocytopenia from immune thrombocytopenia (ITP), preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), or thrombotic thrombocytopenic purpura (TTP) is essential since the treatment differs widely. Occasionally the management of mother and infant involves the expeditious recognition of neonatal alloimmune thrombocytopenia (NAIT), a condition that is responsible for severe life-threatening bleeding of the newborn. Additionally, inherited and acquired bleeding disorders affect pregnant women disproportionately and often require careful monitoring of coagulation parameters to prevent bleeding in the puerperium. Finally, venous thromboembolism (VTE) during pregnancy is still largely responsible for mortality during pregnancy, and the diagnosis, treatment options and guidelines for prevention of VTE during pregnancy are explored. PMID:23953339

  10. Complications of radiation therapy

    SciTech Connect

    Dalinka, M.K.; Mazzeo, V.P. Jr.

    1985-01-01

    The skeletal effects of radiation are dependent upon many variables, but the pathologic features are consistent. Radiation may cause immediate or delayed cell death, cellular injury with recovery, arrest of cellular division, or abnormal repair with neoplasia. Radiation necrosis and radiation-induced neoplasm still occur despite the use of supervoltage therapy. Complications of radiotherapy are well known and have led to more judicious use of this therapeutic modality. With few exceptions, benign bone tumors are no longer treated with irradiation. Radiation necrosis may be difficult to differentiate from sarcoma arising in irradiated bone. They both occur within the field of irradiation. Radiation necrosis often has a long latent period which is, of course, the rule in radiation-induced neoplasia. A soft tissue mass favors the diagnosis of neoplasia, while its absence suggests radiation necrosis. Lack of pain favors necrosis. Calcification may occur in radiation necrosis and does not indicate neoplasia. A lack of progression on serial roentgenograms also favors radiation necrosis. 76 references.

  11. Hematologic Complications of Pregnancy

    PubMed Central

    Townsley, Danielle M.

    2013-01-01

    Pregnancy induces a number of physiologic changes that affect the hematologic indices, either directly or indirectly. Recognizing and treating hematologic disorders that occur during pregnancy is difficult owing to the paucity of evidence available to guide consultants. This paper specifically reviews the diagnosis and management of benign hematologic disorders occurring during pregnancy. Anemia secondary to iron deficiency is the most frequent hematologic complication and is easily treated with oral iron formulations,; however care must be taken not to miss other causes of anemia, such as sickle cell disease. Thrombocytopenia is also a common reason for consulting the hematologist and distinguishing gestational thrombocytopenia from immune thrombocytopenia (ITP), preeclampsia, HELLP syndrome, or thrombotic thrombocytopenic purpura (TTP) is essential since the treatment differs widely. Occasionally the management of mother and infant involves the expeditious recognition of neonatal alloimmune thrombocytopenia (NAIT), a condition that is responsible for severe life-threatening bleeding of the newborn. Additionally, inherited and acquired bleeding disorders affect pregnant women disproportionately and often require careful monitoring of coagulation parameters in order to prevent bleeding in the puerperium. Finally, venous thromboembolism (VTE) during pregnancy is still largely responsible for mortality during pregnancy and the diagnosis, treatment options and guidelines for prevention of VTE during pregnancy are explored. PMID:23953339

  12. Complications of pediatric trauma.

    PubMed

    Czerwinski, S J

    1991-09-01

    MSOF is a life-threatening complication of trauma. The body is a dynamic interrelated group of systems that work together efficiently. Changes in one system generally have a widespread impact, and soon the entire system is changed. In children with MSOF, the normal equilibrium that is maintained between organ systems does not exist. Generalized disruption of organ functions occur, and the body attempts to compensate and regain its homeostasis. This activity will often benefit certain organs and harm others. If the disruption continues and compensation fails, organ dysfunction occurs and general chaos reigns. Medical and nursing interventions are directed toward supporting individual organ systems before failure occurs. Attempts to provide this support for one system can cause adverse effects to occur in other systems. Although this is a potential result of medical and nursing interventions, often there is no other choice. It is essential that nurses be aware of the systemic consequences of these interventions and carefully evaluate them. Although overall mortality rates are high, children have a better chance for survival than adults. Expert nursing assessments, interventions, and evaluations are essential to maximize this outcome. More research in the area of MSOF in children is necessary, with specific attention to nursing management and the effect on patient outcome. PMID:1883588

  13. Documented Complications of Staple Hemorrhoidopexy: A Systematic Review

    PubMed Central

    Porrett, Liesel J.; Porrett, Jemma K.; Ho, Yik-Hong

    2015-01-01

    A systematic review addressing reported complications of stapled hemorrhoidopexy was conducted. Articles were identified via searching OVID and MEDLINE between July 2011 and October 2013. Limitations were placed on the search criteria with articles published from 1998 to 2013 being included in this review. No language restrictions were placed on the search, however foreign language articles were not translated. Two reviewers independently screened the abstracts for relevance and their suitability for inclusion. Data extraction was conducted by both reviewers and entered and analyzed in Microsoft Excel. The search identified 784 articles and 78 of these were suitable for inclusion in the review. A total of 14,232 patients underwent a stapled hemorrhoidopexy in this review. Overall complication rates of stapled hemorrhoidopexy ranged from 3.3%81% with 5 mortalities documented. Early and late complications were defined individually with overall data suggesting that early complications ranged from 2.3%58.9% and late complications ranged from 2.5%80%. Complications unique to the procedure were identified and rates recorded. Both early and late complications unique to stapled hemorrhoidopexy were identified and assessed. PMID:25594639

  14. Gastrointestinal Complications and Cardiac Surgery

    PubMed Central

    Allen, Sara J.

    2014-01-01

    Abstract: Gastrointestinal (GI) complications are an uncommon but potentially devastating complication of cardiac surgery. The reported incidence varies between .3% and 5.5% with an associated mortality of .387%. A wide range of GI complications are reported with bleeding, mesenteric ischemia, pancreatitis, cholecystitis, and ileus the most common. Ischemia is thought to be the main cause of GI complications with hypoperfusion during cardiac surgery as well as systemic inflammation, hypothermia, drug therapy, and mechanical factors contributing. Several nonischemic mechanisms may contribute to GI complications, including bacterial translocation, adverse drug reactions, and iatrogenic organ injury. Risk factors for GI complications are advanced age (>70 years), reoperation or emergency surgery, comorbidities (renal disease, respiratory disease, peripheral vascular disease, diabetes mellitus, cardiac failure), perioperative use of an intra-aortic balloon pump or inotrope therapy, prolonged surgery or cardiopulmonary bypass, and postoperative complications. Multiple strategies to reduce the incidence of GI complications exist, including risk stratification scores, targeted inotrope and fluid therapy, drug therapies, and modification of cardiopulmonary bypass. Currently, no single therapy has consistently proven efficacy in reducing GI complications. Timely diagnosis and treatment, while tailored to the specific complication and patient, is essential for optimal management and outcomes in this challenging patient population. PMID:25208431

  15. Procedural Changes to Decrease Complications in Laparoscopic Gastric Bypass

    PubMed Central

    Beitner, Melissa; Luo, Yuying

    2015-01-01

    Background and Objectives: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a complex procedure performed in a patient population with significant medical comorbidities. Evaluation and modification of surgical techniques can minimize the complications associated with the lengthy learning curve for this procedure. The purpose of this study was to evaluate a single surgeon's decade-long experience with LRYGB, to determine whether complications decreased with experience and surgical modifications improved perioperative outcomes. Methods: A retrospective review of all procedures performed by a fellowship-trained surgeon (MK) from December 1, 2000, to October 31, 2013, identified patients who underwent LRYGB. We evaluated perioperative outcomes in 1117 patients and examined the impact of modification of surgical techniques on complications. The patients were divided into 4 groups: cases 1–100 (group 1), cases 101–400 (group 2), cases 401–700 (group 3), and cases 701-1117 (group 4). Results: Operating time decreased significantly after the initial 100 cases, from 179.1 minutes for group 1 to 122.1 minutes for group 4. With experience, early complication rates improved from 25.0% to 5.0%, but the rates of early reoperation increased from 1.0% to 2.2% over the 4 case groups. Late complication and reoperation rates increased from 4.0% to 10.5%. However, rates of bleeding, early stricture, internal hernia, and wound infection all decreased after the modification of surgical techniques. Conclusions: Operating time and early complication rates decreased with operative experience, but late complication and early and late reoperation rates increased. However, after modifications of surgical technique, common complications of LRYGB decreased to rates lower than those reported in several gastric bypass case series in the literature. The findings in this study will be helpful to fellow bariatric surgeons who are refining their strategies for reducing morbidity related to LRGYB. PMID:25848188

  16. [Intraoperative and postoperative complications of splenectomy].

    PubMed

    Petrovi?, M; Popovic, M; Knezevi?, S; Mati?, S; Goti?, M; Milovanovi?, A; Zuvela, M; Artiko, V; Dugali?, V; Rankovi?, V

    2002-01-01

    Spleen is being surgically removed because of trauma, in diagnostic and-or therapeutical purposes because of the benignant and malignant diseases. The percentage of morbidity during and after splenectomy is relatively low. During surgery might occur bleeding, trauma of the pancreatic tail, stomach, lineal flexure of the colon, left hemidiafragm, left suprarenal gland and upper pole of the left kidney, which must be correspondingly reclaimed during the same intervention. In the early postoperative period, postoperative bleeding, subfrenic abscess, pulmonal atelectasis, bronchopneumonia and left pleural extravasations might occur. Especially is important notification of these events in due time and adequate conservative and surgical treatment. After splenectomy, there is an increase of the number of trombocytes, which might lead to the tromboembolic complications. In the prevention of these complications in the postoperative period prolonged antiagregation therapy is suggested. Postsplenectomy sepsis is very late, general complication of splenectomy, which occurs because of the lower immunity in the child age. To prevent these complications, partial splenectomies, reimplantations of the spleen, prolonged application of the penicillin medicines after splenectomy and antipneumococcal vaccine are performed. PMID:12587454

  17. Neurologic complications in galactosemia.

    PubMed

    Koch, T K; Schmidt, K A; Wagstaff, J E; Ng, W G; Packman, S

    1992-01-01

    Two siblings, a 27-year-old man and his 24-year-old sister were diagnosed with classic transferase deficiency galactosemia at birth and were treated with strict lactose restriction. Despite well-documented dietary management, both siblings are mentally retarded and manifest a progressive neurologic condition characterized by hypotonia, hyperreflexia, dysarthria, ataxia, and a postural and kinetic tremor. Magnetic resonance imaging revealed moderate cortical atrophy, a complete lack of normal myelination, and multifocal areas of increased signal in the periventricular white matter on T2-weighting. These patients suggest that even with early diagnosis and treatment, individuals with galactosemia may have significant neurologic morbidity with abnormalities of white matter development. This finding raises the possibility of biochemical heterogeneity within the classic transferase deficiency group, as well as the possibility of a lack of available galactose metabolites necessary for glycolipid synthesis causing a disruption of normal myelin development. PMID:1622520

  18. [Complicated abscesses of the lungs].

    PubMed

    Gukasian, E A; Muromskiĭ, Iu A

    1985-07-01

    The work is based upon the treatment of 445 patients with complicated abscesses of the lungs for the period from 1963 to 1984. 158 operations were performed in 149 patients. General lethality in patients with complicated abscesses of the lungs was 11%. The operative treatment is thought to be absolutely indicated in patients with abscesses of the lungs complicated by hemorrhage and in patients with gangrenous abscesses of the lungs. PMID:4060481

  19. Rare extrapulmonary complications of Mycoplasma pneumoniae infection.

    PubMed

    Dhaliwal, Kiran; Enright, Kevin

    2016-01-01

    Stevens-Johnsons syndrome (SJS) is a rare extra-pulmonary complication of Mycoplasma pneumoniae infection. We present the case of a 26-year-old man with fever, cough, extensive oral mucosal ulceration and a widespread truncal rash. He was diagnosed with M. pneumoniae-induced SJS. He responded well to antibiotics and steroids initially, but went on to develop pseudomembranous conjunctivitis requiring bilateral amniotic membrane grafting.SJS is most commonly drug-induced, however, M. pneumoniae is the commonest infectious cause and should be considered in the differential diagnosis. It is also important to get specialist care involved early to minimise the long-term effects of any complications. PMID:26837942

  20. Pulmonary complications of AIDS: radiologic features. [AIDS

    SciTech Connect

    Cohen, B.A.; Pomeranz, S.; Rabinowitz, J.G.; Rosen, M.J.; Train, J.S.; Norton, K.I.; Mendelson, D.S.

    1984-07-01

    Fifty-two patients with pulmonary complications of acquired immunodeficiency syndrome (AIDS) were studied over a 3-year period. The vast majority of the patients were homosexual; however, a significant number were intravenous drug abusers. Thirteen different organisms were noted, of which Pneumocystis carinii was by far the most common. Five patients had neoplasia. Most patients had initial abnormal chest films; however, eight patients subsequently shown to have Pneumocystis carinii pneumonia had normal chest films. A significant overlap in chest radiographic findings was noted among patients with different or multiple organisms. Lung biopsy should be an early consideration for all patients with a clinical history consistent with the pulmonary complications of AIDS. Of the 52 patients, 41 had died by the time this report was completed.

  1. A Rare Complication of Chylous Leakage After Open Partial Nephrectomy Successfully Resolved by Somatostatin Analogue

    PubMed Central

    Kobayashi, Minoru; Kambara, Tsunehito; Kamai, Takao

    2015-01-01

    We report the first case of a rare complication of chylous leakage after open left partial nephrectomy. The recent literature on chylous ascites after nephrectomy is reviewed and hypothesized the etiology of this rare complication. We propose an early use of octreotide, somatostatin analogue, together with diet modification to gain rapid resolution of this confounded complication.

  2. Hepatopulmonary Fistula: a life threatening complication of hydatid disease.

    PubMed

    Gulamhussein, Mohamed Amirali; Patrini, Davide; Pararajasingham, Jonathan; Adams, Benjamin; Shukla, Rajeev; Velissaris, Dimitrios; Lawrence, David; Panagiotopoulos, Nikolaos

    2015-01-01

    Despite extensive infection control measures against parasitic diseases, hydatid disease, caused by Echinococcus granulosus, still occurs in a minor group of our population. If the infection is not treated adequately, it goes on to developing life-threatening complications, one of which is hepatopulmonary fistula. These complications usually warrant early surgical intervention, or else may lead to extensive sepsis and ultimately death. We discuss the case of an elderly female suffering from pulmonary hydatid disease, further complicated by a hepatopulmonary fistula and underwent surgical treatment. This case emphasises the importance of early recognition of pulmonary hydatid disease given its atypical nature of presentation before the disease is further exacerbated by this aggressive complication. Furthermore, it is imperative to incorporate radical surgery as the first-line treatment in established hepatopulmonary fistula, in order to prevent further clinical deterioration and curative outcome. PMID:26220789

  3. Male soprano voice: a rare complication of thyroidectomy.

    PubMed

    Sataloff, R T; Spiegel, J R; Carroll, L M; Heuer, R J

    1992-01-01

    A soprano voice from cricothyroid fusion is a rare complication following thyroidectomy. Thyroid surgeons should be aware of this possibility and recognize it early if voice pitch rises following thyroid surgery. This patient's unfortunate complication may prove fortuitous for phonosurgeons and their patients. Cricothyroid fusion may provide a better long-term retention of frequency elevation than traditional cricothyroid approximation. It is also a reversible procedure. Cricothyroid fusion should be investigated as an alternative to cricothyroid approximation for pitch modification. PMID:1731164

  4. Complications of Distal Radius Fixation.

    PubMed

    Lee, Dennis S; Weikert, Douglas R

    2016-04-01

    Complications following any form of distal radius fixation remain prevalent. With an armamentarium of fixation options available to practicing surgeons, familiarity with the risks of newer plate technology as it compares with other conventional methods is crucial to optimizing surgical outcome and managing patient expectations. This article presents an updated review on complications following various forms of distal radius fixation. PMID:26772950

  5. Complications of Laparoscopic Gynecologic Surgery

    PubMed Central

    Fuentes, Maria Naveiro; Naveiro Rilo, Jos Cesreo; Paredes, Aida Gonzlez; Aguilar Romero, Mara Teresa; Parra, Jorge Fernndez

    2014-01-01

    Background and Objectives: To analyze the frequency of complications during laparoscopic gynecologic surgery and identify associated risk factors. Methods: A descriptive observational study was performed between January 2000 and December 2012 and included all gynecologic laparoscopies performed at our center. Variables were recorded for patient characteristics, indication for surgery, length of hospital stay (in days), major and minor complications, and conversions to laparotomy. To identify risk factors and variables associated with complications, crude and adjusted odds ratios were calculated with unconditional logistic regression. Results: Of all 2888 laparoscopies included, most were procedures of moderate difficulty (adnexal surgery) (54.2%). The overall frequency of major complications was 1.93%, and that of minor complications was 4.29%. The level of technical difficulty and existence of prior abdominal surgery were associated with a higher risk of major complications and conversions to laparotomy. Conclusion: Laparoscopic gynecologic surgery is associated with a low frequency of complications but is a procedure that is not without risk. Greater technical difficulty and prior surgery were factors associated with a higher frequency of complications. PMID:25392659

  6. Diabetic Complications and Amputation Prevention

    MedlinePLUS

    ... small foot problems can turn into serious complications. Diabetes-related Foot and Leg Problems Infections and ulcers (sores) that ... This is a common – and serious – complication of diabetes and can lead to a loss of your foot, your leg, or your life. Corns and calluses. ...

  7. [Complications caused by intravenous therapy].

    PubMed

    Quirós Luque, José María; Gago Fornells, Manuel

    2005-11-01

    Nursing professionals must know everything related to complications caused by intravenous therapy including the ways to prevent and solve these complications. We need not forget that nurses are the ones mainly responsible for the insertion, manipulation, removal and care of catheters. PMID:16363113

  8. Post-transplant hepatic complications: Imaging findings

    PubMed Central

    Drudi, F.M.; Pagliara, E.; Cantisani, V.; Arduini, F.; D'Ambrosio, U.; Alfano, G.

    2007-01-01

    Transplantation is considered definitive therapy for acute or chronic irreversible pathologies of the liver, and the increased survival rates are mainly due to improved immunosuppressive therapies and surgical techniques. However, early diagnosis of possible graft dysfunction is crucial to liver graft survival. Diagnostic imaging plays an important role in the evaluation of the liver before and after transplant and in the detection of complications such as vascular and biliary diseases, acute and chronic rejection and neoplastic recurrence. Integrated imaging using color-Doppler, CT, MRI and traditional x-ray reach a high level of sensitivity and specificity in the management of transplanted patients. PMID:23395917

  9. [Neurologic complications following liver transplantation].

    PubMed

    Shibolet, Oren; Safadi, Rifaat; Ashur, Yaffa; Eid, Ahmed; Ilan, Yaron

    2002-01-01

    Neurologic complications are very common following liver transplantation and appear in 30%-90% of the patients. These complications represent a wide array of etiologies, often presenting complicated diagnostic options. The primary liver disease for which the patient underwent the transplantation can cause neurologic complications, or they can be a presentation of a metabolic or vascular derangement. The medications given to liver transplanted patients can cause neurologic complication either directly via drug side effects or indirectly via immune-suppression and secondary opportunistic infections of the nervous system. We present two cases of liver transplanted patients, one suffering from a complex neurologic syndrome attributed to her primary Wilsons disease and the second with recurrent encephalopathy following transplantation attributed to a porto-systemic shunt. We review the current literature on the subject. PMID:11851103

  10. Dealing with surgical left ventricular assist device complications

    PubMed Central

    Kilic, Arman; Acker, Michael A.

    2015-01-01

    Left ventricular assist devices (LVAD) will undoubtedly have an increasing role due to the aging population, anticipated concomitant increase in the prevalence of end-stage heart failure, and improvements in LVAD technology and outcomes. As with any surgical procedure, LVAD implantation is associated with an adverse event profile. Such complications of LVAD therapy include bleeding, infection, pump thrombosis, right heart failure, device malfunction, and stroke. Although each has a unique management, early recognition and diagnosis of these complications is uniformly paramount. In this review, we provide an overview of managing surgical complications of LVADs. PMID:26793336

  11. Interventional Radiological Treatment of Renal Transplant Complications: A Pictorial Review

    PubMed Central

    la Torre, Michele Fabio; Santoro, Marco; Dattesi, Roberta; Nestola, Massimiliano; Posa, Alessandro; Romagnoli, Jacopo; Citterio, Franco; Bonomo, Lorenzo

    2015-01-01

    Renal transplantation is the treatment of choice for patients with chronic renal failure, which produces a dramatic improvement in the quality of life and survival rates, in comparison to long-term dialysis. Nowadays, new imaging modalities allow early diagnosis of complications, and thanks to the recent developments of interventional techniques, surgery may be avoided in most cases. Knowledge in the types of renal transplant complications is fundamental for a correct pre-operative planning. In this article, we described the most common or clinically relevant renal transplant complications and explained their interventional management. PMID:25995689

  12. A rare complication after renal transplantation: Forgotten stent.

    PubMed

    Karab?cak, Mustafa; Ipekci, Tumay; Isoglu, Cemal Selcuk; Keskin, Mehmet Zeynel; Ekin, Rahmi Gokhan; Budak, Salih; Turk, Hakan; Celik, Orcun; Ilbey, Yusuf Ozlem

    2015-06-01

    In renal transplantation surgery, double J stents (DJS) are often used to reduce complications, protect the anastomosis between ureter and bladder, provide drainage in ureteral obstructions and enhance healing if there is an ureter injury. Urinary tract infections, hematuria and irritative voiding symptoms are the early complications of DJS. Migration, fragmentation, encrustation and rarely sepsis are among the late complications of DJS. In this report we describe a renal transplantation case whose DJS stent was forgotten because the patient did not attend the regular follow-up and noticed 5 years after surgery. PMID:26150043

  13. Stoma complications: a multivariate analysis.

    PubMed

    Duchesne, Juan C; Wang, Yi-Zarn; Weintraub, Sharon L; Boyle, Michael; Hunt, John P

    2002-11-01

    Construction of a gastrointestinal stoma is a frequently performed surgical procedure. We sought to analyze a large cohort to document the frequency and types of ostomy complications and the risk factors associated with them. The charts of patients undergoing a procedure which resulted in ostomy during a 3-year period were reviewed. Demographics, indication, ostomy type/location, perioperative risk factors, and complications were recorded. Case-control methodology was used to determine crude odds ratios and multiple logistic regression was used to calculate adjusted odds ratios. A P value of less than 0.05 was considered significant. An ostomy was constructed in 204 patients and records were available for 164. Forty-one patients (25.0%) had ostomy complications. Sixteen of these complications (39.0%) occurred within one month of the procedure. Complications included prolapse in nine (22%), necrosis in nine (22%), stenosis in seven (17%), irritation in seven (17%), infection in six (15%), bleeding in two (5%), and retraction in two (5%). Gender, cancer, trauma, diverticulitis, emergency surgery, ileostomy, and ostomy location/type were not associated with a stoma complication. Significant predictors of ostomy malfunction are presented as odds ratios (ORs) with 95 per cent confidence intervals (CIs) and include inflammatory bowel disease (OR = 4.49; 95% CI = 1.16-17.36) and obesity (OR = 2.66; 95% CI = 1.15-6.16). The care of an enterostomal nurse was found to prevent complications (OR = 0.15; 95% CI = 0.03-0.69). We conclude that ostomies have a high risk of complication, which is not related to stoma location or type. Obesity and inflammatory bowel disease predispose to complications. Enterostomal nursing may be instrumental in preventing complications. PMID:12455788

  14. Wernicke's Encephalopathy Complicating Hyperemesis during Pregnancy

    PubMed Central

    Berdai, Mohamed Adnane; Labib, Smael; Harandou, Mustapha

    2016-01-01

    Wernicke's encephalopathy is caused by severe thiamine deficiency; it is mostly observed in alcoholic patients. We report the case of a 28-year-old woman, at 17 weeks of gestational age, with severe hyperemesis gravidarum. She presented with disturbance of consciousness, nystagmus, ophthalmoplegia, and ataxia. The resonance magnetic imagery showed bilaterally symmetrical hyperintensities of thalamus and periaqueductal area. The case was managed with very large doses of thiamine. The diagnosis of Wernicke's encephalopathy was confirmed later by a low thiamine serum level. The patient was discharged home on day 46 with mild ataxia and persistent nystagmus. Wernicke's encephalopathy is a rare complication of hyperemesis gravidarum. It should be diagnosed as early as possible to prevent long-term neurological sequela or death. Thiamine supplementation in pregnant women with prolonged vomiting should be initiated, especially before parenteral dextrose infusion. Early thiamine replacement will reduce maternal morbidity and fetal loss rate. PMID:26989522

  15. Ocular Complications of Leprosy in Yemen

    PubMed Central

    Salem, Raga A. A.

    2012-01-01

    Objectives: This study was conducted to identify the main ocular- and vision-threatening complications of leprosy in Yemen. Methods: This is a cross-sectional observational study which took place from February to July 2010. Leprosy patients attending the Skin and Venereal Diseases Hospital in the City of Light in Taiz, Yemen, who consented to participate in the study, were enrolled. Detailed demographic and medical histories were taken and clinical examination findings were recorded. A detailed eye examination, including visual acuity (VA), slit-lamp, and fundus examinations, was conducted on each patient by a qualified ophthalmologist. Results: A total of 192 patients (180 male, 12 female, with a male to female ratio of 15:1) were included in the study. The majority of the patients (157; 81.8%) were over 40 years. Over two-thirds of the patients (129; 67.2%) had had leprosy for more than 20 years. Ocular complications were found in 97% of cases; 150 (39.1%) of the patients eyes had at least one pathology. Eyelid involvement was the most common problem observed in 102 (26.5%) patients. Half of the eyes (192; 50%) had a VA of <6/60. The main cause of blindness among these patients was corneal opacity detected in 69 out of 192 patients (35.9%). Conclusion: Ocular complications are frequent among leprosy patients in Yemen. They are true vision-threatening lesions. It is important to prevent these lesions through early diagnosis and adequate treatment. PMID:23275842

  16. Neurologic complications of liver transplantation.

    PubMed

    Wijdicks, Eelco F M; Hocker, Sara E

    2014-01-01

    A new spectrum of neurologic complications has appeared with treatment of the organ transplant recipient. There are specific problems in liver recipients. Most pertinent is the management of acute fulminant hepatic failure and emerging brain edema that can only be definitively treated with acute liver transplantation. In some patients neurologic complications appear as a result of immunosuppressive drugs or due to infectious complications in immunocompromised patients. Neurologists seeing patients in a transplant unit should be prepared to see confused or obtunded critically ill patients with multiple medical problems, procedures, and polypharmacy. This chapter discusses the challenges of the transplant team and the consulting neurologist. PMID:24365417

  17. [Prevalence of ulcer disease complications].

    PubMed

    Za?tsev, O V; Tarasenko, S V; Kope?kin, A A; Kariukhin, I V; Larionova, A A

    2011-01-01

    The epidemiology of complications of a peptic ulcer is studied: bleedings, perforations and pylorodudenal stenoses. 1799 patients are included in research that were on hospitalisation in 1995-2009. A frequency of all the complications has declined. Middle age of patients with the complicated ulcer enlarged: in case of an ulcerative bleeding--at the expense of reduction of a share of male at the age of 36-60 years, in case of a perforated ulcer--because of appreciable reduction of a percentage of male at the age of 21-35 years. PMID:22629752

  18. Pneumococcal Disease Symptoms and Complications

    MedlinePLUS

    ... World Health Organization National Foundation for Infectious Diseases Sepsis Symptoms and Complications Recommend on Facebook Tweet Share ... drinking, low alertness, and vomiting. Pneumococcal bacteremia and sepsis are blood infections. Symptoms include: Fever Chills Low ...

  19. Complications in cochlear implant surgery

    PubMed Central

    Gheorghe, DC; Zamfir-Chiru-Anton, A

    2015-01-01

    For the last 6 years, cochlear implantation has become a standard practice in our department. The number of patients rose from 5 to 21/ year. Using multiple types of cochlear implants and indicating the surgery also to malformed inner ears led to the encounter of some complications. Objective: to present the surgical complications from our department. Material: all the patients admitted and operated in our clinic have been reviewed. Results: 9 complications (8,86%) have occurred: the impossibility of establishing a reliable cochleostomy (due to ossification), air in the cochlea through lack of sealing of the cochleostomy (exteriorization of the electrode array), cochlear implant postoperative migration from its bed, weak hearing discrimination due to double electrodes in the scala tympani, gusher. Conclusions: cochlear implanting needs to respect the technical steps of the surgery and the best technical/ tactical solution has to be found to whatever complications arise in complex or malformed cases! PMID:26351535

  20. Maternal complications in diabetic pregnancy.

    PubMed

    Hawthorne, Gillian

    2011-02-01

    Pregnant women with diabetes have to manage both the effect of pregnancy on glucose control and its effect on pre-existing diabetic complications. Most women experience hypoglycaemia as a consequence of tightened glycaemic control and this impacts on daily living. Less commonly, diabetic ketoacidosis, a serious metabolic decompensation of diabetic control and a medical emergency, can cause foetal and maternal mortality. Microvascular complications of diabetes include retinopathy and nephropathy. Retinopathy can deteriorate during pregnancy; hence, regular routine examination is required and, if indicated, ophthalmological input. Diabetic nephropathy significantly increases the risk of obstetric complications and impacts on foetal outcomes. Pregnancy outcome is closely related to pre-pregnancy renal function. Diabetic pregnancy is contraindicated if the maternal complications of ischaemic heart disease or diabetic gastropathy are known to be present before pregnancy as there is a significant maternal mortality associated with both of these conditions. PMID:21130689

  1. Unusual Complications of Quinalphos Poisoning

    PubMed Central

    Viswanathan, Stalin

    2013-01-01

    This 40-year-old man was treated for suicidal quinalphos 25%EC consumption. He developed intermediate syndrome with normal response to repetitive nerve stimulation, pancreatitis with high enzyme elevations, and normal computed tomography and excreted black, brown, and orange urine sequentially over the first nine days of hospitalization. The last complication has not been previously reported with any organophosphate compound. He finally succumbed to complication of ventilator associated pneumonia related septic shock and ventricular tachycardia. PMID:23762661

  2. The genetics of diabetic complications.

    PubMed

    Ahlqvist, Emma; van Zuydam, Natalie R; Groop, Leif C; McCarthy, Mark I

    2015-05-01

    The rising global prevalence of diabetes mellitus is accompanied by an increasing burden of morbidity and mortality that is attributable to the complications of chronic hyperglycaemia. These complications include blindness, renal failure and cardiovascular disease. Current therapeutic options for chronic hyperglycaemia reduce, but do not eradicate, the risk of these complications. Success in defining new preventative and therapeutic strategies hinges on an improved understanding of the molecular processes involved in the development of these complications. This Review explores the role of human genetics in delivering such insights, and describes progress in characterizing the sequence variants that influence individual predisposition to diabetic kidney disease, retinopathy, neuropathy and accelerated cardiovascular disease. Numerous risk variants for microvascular complications of diabetes have been reported, but very few have shown robust replication. Furthermore, only limited evidence exists of a difference in the repertoire of risk variants influencing macrovascular disease between those with and those without diabetes. Here, we outline the challenges associated with the genetic analysis of diabetic complications and highlight ongoing efforts to deliver biological insights that can drive translational benefits. PMID:25825086

  3. Effect of intrauterine infusion of an organic-certified product on uterine health, survival, and fertility of dairy cows with toxic puerperal metritis.

    PubMed

    Pinedo, P J; Velez, J S; Bothe, H; Merchan, D; Pieiro, J M; Risco, C A

    2015-05-01

    The objective was to evaluate the effect of intrauterine infusion of an organic certified product (Optimum UterFlush, Van Beek Natural Science, Orange City, IA) on uterine health, survival, and fertility of cows affected with toxic puerperal metritis (TPM) in an organic dairy farm. Cows with TPM were defined as having an abnormally enlarged uterus and a fetid watery red-brown vaginal discharge, associated with systemic illness and fever (rectal temperature ?39.5C), within 12 d postpartum. Cows diagnosed with TPM (n=220; study d 0) were blocked by parity (1 and ?2) and randomly assigned into 1 of 2 intrauterine treatments applied every other day for a total of 3 applications: (1) control (CON)=200mL of povidone iodine diluted in 2L of distilled water (n=113); (2) Optimum UterFlush (UF)=3.75mL diluted in 117mL of distilled water (n=107). All enrolled cows received hypertonic saline solution (500mL 7.2% i.v.), dextrose (500mL 50% i.v.), and oral aspirin (5 boluses/d). Outcome variables for treatment efficacy included fever and presence of fetid vaginal discharge at study d 6 and 14, survival at study d 6 and 14 and at 30 and 100 DIM, and reproductive performance. Control variables were parity, BCS at enrollment, calving season, and milk yield. Occurrence of fever at d 6 and 14 was not different between the 2 treatment groups. Presence of fetid vaginal discharge at d 6 and 14 was lower in cows treated with UF compared with cows in the CON group (10.7 vs. 28% and 1.1 vs. 9.1%). The odds (95% confidence interval) for survival and remaining in the farm at study d 6 and 14 and at 30 and 100 DIM for cows in the UF treatment were 4.67 (1.38-15.8), 2.77 (1.25-6.10), 3.13 (1.22-8.02), and 2.82 (1.38-5.71) times the odds of cows in the CON group, respectively. The odds of AI until 150 DIM and the interval from calving to first AI were not different between the 2 treatments. However, pregnancy was affected by treatment; the odds (95% confidence interval) of pregnancy at the first AI, 150 DIM, and 300 DIM for cows treated with UF were 2.15 (1.05-4.40), 1.81 (1.04-3.15), and 1.92 (1.09-3.38) times the odds of cows in the CON group, respectively. Days to pregnancy were similar in both treatment groups, but the number of artificial inseminations per pregnancy were different (2.69 vs. 2.02 for cows in the CON and UF treatments). Results indicate that cows with TPM administered intrauterine infusion of Optimum UterFlush had higher odds of recovering and improved reproductive performance compared with cows treated with povidone iodine. PMID:25771053

  4. Pancreaticoduodenectomy: expected post-operative anatomy and complications

    PubMed Central

    Lavelle, L P; Hoare, S M; O'Neill, A C; Awan, F N; Malone, D E; Ryan, E R; McCann, J W; Heffernan, E J

    2014-01-01

    Pancreaticoduodenectomy is a complex, high-risk surgical procedure performed for tumours of the pancreatic head and other periampullary structures. The rate of perioperative mortality has decreased in the past number of years but perioperative morbidity remains high. This pictorial review illustrates expected findings in early and late post-operative periods, including mimickers of pathology. It aims to familiarize radiologists with the imaging appearances of common and unusual post-operative complications. These are classified into early non-vascular complications such as delayed gastric emptying, post-operative collections, pancreatic fistulae and bilomas; late non-vascular complications, for example, biliary strictures and hepatic abscesses; and vascular complications including haemorrhage and ischaemia. Options for minimally invasive image-guided management of vascular and non-vascular complications are discussed. Familiarity with normal anatomic findings is essential in order to distinguish expected post-operative change from surgical complications or recurrent disease. This review summarizes the normal and abnormal radiological findings following pancreaticoduodenectomy. PMID:25026968

  5. Preventing microvascular complications in type 1 diabetes mellitus.

    PubMed

    Viswanathan, Vijay

    2015-04-01

    Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM) by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c) level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c <7.5% across all ages replaces previous guidelines that had called for different targets by age. Evidence shows that prevalence of microvascular complications is greater in patients with age >20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour. PMID:25941647

  6. BCG vaccination in SCID patients: complications, risks and vaccination policies

    PubMed Central

    Marciano, Beatriz E; Huang, Chiung-Yu; Joshi, Gyan; Rezaei, Nima; Carvalho, Beatriz Costa; Allwood, Zoe; Ikinciogullari, Aydan; Reda, Shereen M; Gennery, Andrew; Thon, Vojtech; Espinosa-Rosales, Francisco; Al-Herz, Waleed; Porras, Oscar; Shcherbina, Anna; Szaflarska, Anna; Kili, ?ebnem; Franco, Jose L; Raccio, Andrea C Gmez; Roxo-Jr, Persio; Esteves, Isabel; Galal, Nermeen; Grumach, Anete Sevciovic; Al-Tamemi, Salem; Yildiran, Alisan; Orellana, Julio C; Yamada, Masafumi; Morio, Tomohiro; Liberatore, Diana; Ohtsuka, Yoshitoshi; Lau, Yu-Lung; Nishikomori, Ryuta; Torres-Lozano, Carlos; Mazzucchelli, Juliana TL; Vilela, Maria MS; Tavares, Fabiola S; Cunha, Luciana; Pinto, Jorge A; Espinosa-Padilla, Sara E; Hernandez-Nieto, Leticia; Elfeky, Reem A; Ariga, Tadashi; Toshio, Heike; Dogu, Figen; Cipe, Funda; Formankova, Renata; Nuez-Nuez, M Enriqueta; Bezrodnik, Liliana; Marques, Jose Gonalo; Pereira, Mara I; Listello, Viviana; Slatter, Mary A; Nademi, Zohreh; Kowalczyk, Danuta; Fleisher, Thomas A.; Davies, Graham; Neven, Bndicte; Rosenzweig, Sergio D

    2014-01-01

    Background SCID is a syndrome characterized by profound T cell deficiency. BCG vaccine is contraindicated in SCID patients. Because most countries encourage BCG vaccination at birth, a high percent of SCID patients are vaccinated before their immune defect is detected. Objectives To describe the complications and risks associated with BCG vaccination in SCID patients. Methods An extensive standardized questionnaire evaluating complications, therapeutics, and outcome regarding BCG in patients diagnosed with SCID was widely distributed. Summary statistics and association analysis was performed. Results Data on 349 BCG vaccinated SCID patients from 28 centers in 17 countries was analyzed. Fifty-one percent of the patients developed BCG complications, 34% disseminated and 17% localized (a 33,000 and 400 fold increase, respectively, over the general population). Patients receiving early vaccination (? 1 month) showed an increased prevalence of complications (p=0.006) and death due to BCG complications (p<0.0001). The odds of experiencing complications among patients with T cells ? 250/uL at diagnosis was 2.1 times higher (95% CI, 1.4-3.4; p = 0.001) than among those with T cells > 250/uL. BCG complications were reported in 2/78 patients who received anti-mycobacterial therapy while asymptomatic and no deaths due to BCG complications occurred in this group. In contrast 46 BCG-associated deaths were reported among 160 patients treated with anti-mycobacterial therapy for a symptomatic BCG infection (p<0.0001). Conclusions BCG vaccine has a very high rate of complications in SCID patients, which increase morbidity and mortality rates. Until safer and more efficient anti-tuberculosis vaccines become available, delay in BCG vaccination should be considered to protect highly vulnerable populations from preventable complications. PMID:24679470

  7. Bilateral chylothorax as a complication of internal jugular vein cannulation

    PubMed Central

    Saxena, Puneet; Shankar, Subramanian; Kumar, Vivek; Naithani, Nardeep

    2015-01-01

    Central venous catheterization is one of the most prevalent procedures in the Intensive Care Unit. Complications are reported in about 15% of the patients and usually comprise of infection, arterial puncture, malpositioning, pneumothorax, local hematoma, hemothorax, and so on. Chylothorax is a rare complication of this procedure. We present a 42-year-old lady, who developed bilateral massive chylothorax after cannulation of her left internal jugular vein (IJV), due to direct injury to the thoracic duct during the procedure. The patient was successfully managed with bilateral chest tube drainage and omission of oral feeds for four days. Development of bilateral chylothorax as a complication of IJV cannulation is rare, but merits reporting, in view of a large number of central venous cannulations being undertaken. Critical care professionals should be aware of this rare complication of a common procedure to facilitate early identification and institute appropriate therapy. PMID:26180388

  8. Imaging of complications of acute mastoiditis in children.

    PubMed

    Vazquez, Elida; Castellote, Amparo; Piqueras, Joaquim; Mauleon, Susana; Creixell, Santiago; Pumarola, Felix; Figueras, Concepcin; Carreo, Juan-Carlos; Lucaya, Javier

    2003-01-01

    Acute mastoiditis is a serious complication of acute otitis media in children. Suppurative disease in the mastoid region occasionally spreads to the adjacent dura mater of the posterior and middle cranial fossae and the sigmoid sinus by means of thrombophlebitis, osseous erosion, or anatomic pathways, producing intracranial complications. Computed tomography (CT) should be performed early in the course of the disease to classify the mastoiditis as incipient or coalescent and to detect intracranial complications. On the basis of the clinical features and imaging findings, the disease is managed conservatively with intravenously administered antibiotics or treated with mastoidectomy and drainage plus antibiotic therapy. CT is therefore a decisive diagnostic tool in determining the type of therapy. In addition, magnetic resonance imaging is performed in patients with clinical symptoms or CT findings suggestive of intracranial complications because of its higher sensitivity for detection of extraaxial fluid collections and associated vascular problems. PMID:12640152

  9. Toxic stress, inflammation and symptomatology of chronic complications in diabetes

    PubMed Central

    Downs, Charles A; Faulkner, Melissa Spezia

    2015-01-01

    Diabetes affects at least 382 million people worldwide and the incidence is expected to reach 592 million by 2035. The incidence of diabetes in youth is skyrocketing as evidenced by a 21% increase in type 1 diabetes and a 30.5% increase in type 2 diabetes in the United States between 2001 and 2009. The effects of toxic stress, the culmination of biological and environmental interactions, on the development of diabetes complications is gaining attention. Stress impacts the hypothalamus-pituitary-adrenal axis and contributes to inflammation, a key biological contributor to the pathogenesis of diabetes and its associated complications. This review provides an overview of common diabetic complications such as neuropathy, cognitive decline, depression, nephropathy and cardiovascular disease. The review also provides a discussion of the role of inflammation and stress in the development and progression of chronic complications of diabetes, associated symptomatology and importance of early identification of symptoms of depression, fatigue, exercise intolerance and pain. PMID:25987953

  10. Complications

    MedlinePLUS

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  11. Complications of Minimally Invasive Cosmetic Procedures: Prevention and Management

    PubMed Central

    Levy, Lauren L; Emer, Jason J

    2012-01-01

    Over the past decade, facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular. Office-based, minimally invasive procedures can promote a youthful appearance with minimal downtime and low risk of complications. Injectable botulinum toxin (BoNT), soft-tissue fillers, and chemical peels are among the most popular non-invasive rejuvenation procedures, and each has unique applications for improving facial aesthetics. Despite the simplicity and reliability of office-based procedures, complications can occur even with an astute and experienced injector. The goal of any procedure is to perform it properly and safely; thus, early recognition of complications when they do occur is paramount in dictating prevention of long-term sequelae. The most common complications from BoNT and soft-tissue filler injection are bruising, erythema and pain. With chemical peels, it is not uncommon to have erythema, irritation and burning. Fortunately, these side effects are normally transient and have simple remedies. More serious complications include muscle paralysis from BoNT, granuloma formation from soft-tissue filler placement and scarring from chemical peels. Thankfully, these complications are rare and can be avoided with excellent procedure technique, knowledge of facial anatomy, proper patient selection, and appropriate pre- and post-skin care. This article reviews complications of office-based, minimally invasive procedures, with emphasis on prevention and management. Practitioners providing these treatments should be well versed in this subject matter in order to deliver the highest quality care. PMID:23060707

  12. Pulmonary complications in hematopoietic SCT: a prospective study.

    PubMed

    Lucena, C M; Torres, A; Rovira, M; Marcos, M A; de la Bellacasa, J P; Snchez, M; Domingo, R; Gabarrus, A; Mensa, J; Agust, C

    2014-10-01

    Pulmonary complications are common and often lethal in hematopoietic SCT recipients. The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year. For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed. We identified 73 pulmonary complications in 169 patients: 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed. Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia. A specific diagnosis was obtained in 83% of the cases. A non-invasive test gave a specific diagnosis in 59% of the episodes. The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections. Early bronchoscopy (?5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P=0.02) for pulmonary infections. Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications. Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management. PMID:25046219

  13. Urological surgery in elderly patients: results and complications

    PubMed Central

    Brodak, Milos; Tomasek, Jan; Pacovsky, Jaroslav; Holub, Lukas; Husek, Petr

    2015-01-01

    Purpose Owing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients. Methods The authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the DindoClavien scale. Results The median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22%) complications were recorded. The most serious were as follows: one patient (<0.5%) died; and four (<2%) patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc. Conclusion Surgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease. PMID:25673978

  14. Neurological complications of underwater diving.

    PubMed

    Rosi?ska, Justyna; ?ukasik, Maria; Kozubski, Wojciech

    2015-01-01

    The diver's nervous system is extremely sensitive to high ambient pressure, which is the sum of atmospheric and hydrostatic pressure. Neurological complications associated with diving are a difficult diagnostic and therapeutic challenge. They occur in both commercial and recreational diving and are connected with increasing interest in the sport of diving. Hence it is very important to know the possible complications associated with this kind of sport. Complications of the nervous system may result from decompression sickness, pulmonary barotrauma associated with cerebral arterial air embolism (AGE), otic and sinus barotrauma, high pressure neurological syndrome (HPNS) and undesirable effect of gases used for breathing. The purpose of this review is to discuss the range of neurological symptoms that can occur during diving accidents and also the role of patent foramen ovale (PFO) and internal carotid artery (ICA) dissection in pathogenesis of stroke in divers. PMID:25666773

  15. [Pregnancy complicated by diabetes mellitus].

    PubMed

    Kinalski, Maciej; Sledziewski, Adam; Majkowicz-M?ynarczyk, Amelia; Ku?micki, Mariusz

    2004-01-01

    Interdisciplinary team work and recommendations of diabetologist and obstetrician is the condition of success of antenatal care and consequently perinatal outcome in pregnancy complicated by diabetes. Careful insight into the metabolic, haemodynamic and vascular disturbances is the basic of contemporary surveillance in diabetic pregnancy. The authors emphasise that a diabetic pregnant woman must not only pay attention to adequate nutrition and balanced exercise, but also be aware of and cope with characteristic, momentary swings in glycemia in order to overcome them by appropriate insulin therapy. Continuous supervision for several other complications associated with diabetic pregnancy, viz. hypertension, retinopathy, thyroid dysfunction, nephropathy and the threat of in utero foetal death is justified. Briefly, rigorous measures to sustain normoglycemia and normal blood pressure, examination of the retina, thyroid and renal functions as well as foetal status evaluation are paramount in appropriate management of major common diabetic complications in pregnancy. PMID:15858241

  16. Fasting: The History, Pathophysiology and Complications

    PubMed Central

    Kerndt, Peter R.; Naughton, James L.; Driscoll, Charles E.; Loxterkamp, David A.

    1982-01-01

    An appreciation of the physiology of fasting is essential to the understanding of therapeutic dietary interventions and the effect of food deprivation in various diseases. The practice of prolonged fasting for political or religious purposes is increasing, and a physician is likely to encounter such circumstances. Early in fasting weight loss is rapid, averaging 0.9 kg per day during the first week and slowing to 0.3 kg per day by the third week; early rapid weight loss is primarily due to negative sodium balance. Metabolically, early fasting is characterized by a high rate of gluconeogenesis with amino acids as the primary substrates. As fasting continues, progressive ketosis develops due to the mobilization and oxidation of fatty acids. As ketone levels rise they replace glucose as the primary energy source in the central nervous system, thereby decreasing the need for gluconeogenesis and sparing protein catabolism. Several hormonal changes occur during fasting, including a fall in insulin and T3 levels and a rise in glucagon and reverse T3 levels. Most studies of fasting have used obese persons and results may not always apply to lean persons. Medical complications seen in fasting include gout and urate nephrolithiasis, postural hypotension and cardiac arrhythmias. ImagesFigure 4. PMID:6758355

  17. [Psychiatric complications of cannabis use].

    PubMed

    Coscas, Sarah; Benyamina, Amine; Reynaud, Michel; Karila, Laurent

    2013-12-01

    Cannabis is the most widely used illicit substance, especially among young people. Cannabis use is extremely commonplace and frequently comorbid with psychiatric disorders that raise questions about the etiology. The use of cannabis is an aggravating factor of all psychiatric disorders. Psychiatric complications are related to the age of onset, duration of exposure and individual risk factors of the individual (mental and social health). The panic attack is the most common complication. The link with psychosis is narrow that leads to increased prevention for vulnerable populations. Cannabis is also an indicator of increased depressive vulnerability and an aggravating factor for bipolar disorder. PMID:24579344

  18. Complications of Distal Biceps Repair.

    PubMed

    Garon, Mark Tyson; Greenberg, Jeffrey A

    2016-04-01

    Modern techniques to repair the distal biceps tendon include one-incision and 2-incision techniques that use transosseous sutures, suture anchors, interference screws, and/or cortical buttons to achieve a strong repair of the distal biceps brachii. Repair using these techniques has led to improved functional outcomes when compared with nonoperative treatment. Most complications consist of neuropraxic injuries to the lateral antebrachial cutaneous nerve, posterior interosseous nerve, stiffness and weakness with forearm rotation, heterotopic ossification, and wound infections. Although complications certainly affect outcomes, patients with distal biceps repairs report a high satisfaction rate after repair. PMID:26772952

  19. Surgical Complications of Gynecologic Surgery

    PubMed Central

    Weekes, Leroy R.; Gandhi, Shobhana Anil; Gandhi, Anil Krishnakumar

    1977-01-01

    Complications of gynecological surgery are considerable and when reviewed in detail are almost frightening. There is no substitute for experience and intimate knowledge of the intricate pelvic structures in health and disease. Anyone who is active in the field is sooner or later going to experience some difficulty whether it be due to his miscalculation or to innate conditions in the patient which are beyond his/her control. It is the responsibility of the pelvic surgeon to recognize the complication and apply proper corrective measures. The patient should not be given false hopes of sure success nor should she be deprived of whatever hope for success does exist. PMID:572875

  20. Managing complications in cirrhotic patients

    PubMed Central

    Angeli, Paolo; Cordoba, Juan; Farges, Oliver; Valla, Dominique

    2015-01-01

    Liver cirrhosis is a serious and potentially life-threatening condition. This life-threatening condition usually arises from complications of cirrhosis. While variceal bleeding is the most acute and probably best studied, several other complications of liver cirrhosis are more insidious in their onset but nevertheless more important for the long-term management and outcome of these patients. This review summarizes the topics discussed during the UEG-EASL Hepatology postgraduate course of the United European Gastroenterology Week 2013 and discusses emergency surgical conditions in cirrhotic patients, the management of hepatic encephalopathy, ascites and hepatorenal syndrome, coagulation disorders, and liver cancer. PMID:25653862

  1. Not to Complicate Matters, but ...

    ERIC Educational Resources Information Center

    Jacoby, Russell

    2008-01-01

    The writer discusses the current academic enthrallment with complicating seemingly every aspect of every event or phenomenon, arguing that the fashion elevates confusion from a transitional stage into an end goal. Rather than scholarly clarification, says Jacoby, people celebrate the fact that everything can be "problematized," rejoicing in

  2. Neurological Complications of VZV Reactivation

    PubMed Central

    Nagel, Maria A.

    2014-01-01

    Purpose of the review Varicella zoster virus (VZV) reactivation results in zoster, which may be complicated by postherpetic neuralgia, myelitis, meningoencephalitis and VZV vasculopathy. This review highlights the clinical features, laboratory abnormalities, imaging changes and optimal treatment of each of those conditions. Because all of these neurological disorders produced by VZV reactivation can occur in the absence of rash, the virological tests proving that VZV caused disease are discussed. Recent findings After primary infection, VZV becomes latent in ganglionic neurons along the entire neuraxis. With a decline in VZV-specific cell-mediated immunity, VZV reactivates from ganglia and travels anterograde to the skin to cause zoster, which is often complicated by postherpetic neuralgia. VZV can also travel retrograde to produce meningoencephaltis, myelitis and stroke. When these complications occur without rash, VZV-induced disease can be diagnosed by detection of VZV DNA or anti-VZV antibody in CSF and treated with intravenous acyclovir. Summary Awareness of the expanding spectrum of neurological complications caused by VZV reactivation with and without rash will improve diagnosis and treatment. PMID:24792344

  3. Major Depression and Complicated Grief

    MedlinePLUS

    ... grief process Next Topic Coping with loss Major depression and complicated grief Depression It’s common for people to have sadness, pain, ... might be getting worse—going into a major depression. About 1 in 5 bereaved people will develop ...

  4. Complications of Pediatric Elbow Fractures.

    PubMed

    Hyatt, Brad T; Schmitz, Matthew R; Rush, Jeremy K

    2016-04-01

    Fractures about the elbow in children are common and varied. Both diagnosis and treatment can be challenging, and optimal treatment protocols continue to evolve with new research data. This article reviews common complications related to pediatric elbow fractures and presents recent literature to help guide treatment. PMID:26772946

  5. Not to Complicate Matters, but ...

    ERIC Educational Resources Information Center

    Jacoby, Russell

    2008-01-01

    The writer discusses the current academic enthrallment with complicating seemingly every aspect of every event or phenomenon, arguing that the fashion elevates confusion from a transitional stage into an end goal. Rather than scholarly clarification, says Jacoby, people celebrate the fact that everything can be "problematized," rejoicing in…

  6. Surgical complications of amyloid disease.

    PubMed Central

    O'Doherty, D. P.; Neoptolemos, J. P.; Bouch, D. C.; Wood, K. F.

    1987-01-01

    The case of a man with primary systemic amyloidosis without myelomatosis and long-term survival is described. The patient has had major surgical complications from large amyloid deposits in the colon, dorsal spine and peritoneal cavity. The patient remains well 14 years after diagnosis. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:3684836

  7. Complicating the Concept of Culture

    ERIC Educational Resources Information Center

    Anderson-Levitt, Kathryn M.

    2012-01-01

    This essay argues against a simple, reified view of culture as a set of ideas and norms belonging to a group or nation, and considers the implications of a more complicated concept for discussion of world culture and the global/local nexus. Most anthropologists define culture as the making of meaning, with an emphasis on the process itself as

  8. Manufacturing Complicated Shells And Liners

    NASA Technical Reports Server (NTRS)

    Sobol, Paul J.; Faucher, Joseph E.

    1993-01-01

    Explosive forming, wax filling, and any one of welding, diffusion bonding, or brazing used in method of manufacturing large, complicated shell-and-liner vessels or structures. Method conceived for manufacture of film-cooled rocket nozzles but applicable to joining large coaxial shells and liners in general.

  9. Third-trimester pregnancy complications.

    PubMed

    Newfield, Emily

    2012-03-01

    Complications arising in the third trimester often challenge the clinician to balance the concern for maternal well-being with the consequences of infant prematurity. The most serious and challenging antepartum issues relate to preterm labor and birth, hypertensive disorders, and bleeding events. This article guides the practitioner through decision-making and management of these problems. PMID:22309584

  10. Anaesthetic complications in plastic surgery

    PubMed Central

    Nath, Soumya Sankar; Roy, Debashis; Ansari, Farrukh; Pawar, Sundeep T.

    2013-01-01

    Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients’ experience and surgical outcome. PMID:24501480

  11. Diabetic retinopathy - ocular complications of diabetes mellitus

    PubMed Central

    Nentwich, Martin M; Ulbig, Michael W

    2015-01-01

    In industrialized nations diabetic retinopathy is the most frequent microvascular complication of diabetes mellitus and the most common cause of blindness in the working-age population. In the next 15 years, the number of patients suffering from diabetes mellitus is expected to increase significantly. By the year 2030, about 440 million people in the age-group 20-79 years are estimated to be suffering from diabetes mellitus worldwide (prevalence 7.7%), while in 2010 there were 285 million people with diabetes mellitus (prevalence 6.4%). This accounts for an increase in patients with diabetes in industrialized nations by 20% and in developing countries by 69% until the year 2030. Due to the expected rise in diabetic patients, the need for ophthalmic care of patients (i.e., exams and treatments) will also increase and represents a challenge for eye-care providers. Development of optimized screening programs, which respect available resources of the ophthalmic infrastructure, will become even more important. Main reasons for loss of vision in patients with diabetes mellitus are diabetic macular edema and proliferative diabetic retinopathy. Incidence or progression of these potentially blinding complications can be greatly reduced by adequate control of blood glucose and blood pressure levels. Additionally, regular ophthalmic exams are mandatory for detecting ocular complications and initiating treatments such as laser photocoagulation in case of clinical significant diabetic macular edema or early proliferative diabetic retinopathy. In this way, the risk of blindness can considerably be reduced. In advanced stages of diabetic retinopathy, pars-plana vitrectomy is performed to treat vitreous hemorrhage and tractional retinal detachment. In recent years, the advent of intravitreal medication has improved therapeutic options for patients with advanced diabetic macular edema. PMID:25897358

  12. Rarely seen complications of circumcision, and their management

    PubMed Central

    İnce, Bilsev; Dadacı, Mehmet; Altuntaş, Zeynep; Bilgen, Fatma

    2016-01-01

    Objective Circumcision, performed for religious or medical reasons is the procedure of surgical excision of the skin covering the glans penis, preputium in a certain shape and dimension so as to expose the tip of the glans penis. Short- and long- term complication rates of up to 50% have been reported, varying due to the recording system of different countries in which the procedure has been accepted as a widely performed simple surgical procedure. In this study, treatment procedures in patients presented to our clinic with complications after circumcision are described and methods to decrease the rate of the complications are reviewed. Material and metods Cases that presented to our clinic between 2010 and 2013 with early complications of circumcision were retrospectively reviewed. Cases with acceptedly major complications as excess skin excision, skin necrosis and total amputation of the glans were included in the study, while cases with minor complications such as bleeding, hematoma and infection were excluded from the study. Results Repair with full- thickness skin grafts was performed in patients with excess skin excision. In cases with skin necrosis, following the debridement of the necrotic skin, primary repair or repair with full- thickness graft was performed in cases where full- thickness skin defects developed and other cases with partial skin loss were left to secondary healing. Repair with an inguinal flap was performed in the case with glans amputation. Conclusion Circumcisions performed by untrained individuals are to be blamed for the complications of circumcision reported in this country. The rate of complications increases during the “circumcision feasts” where multiple circumcisions were performed. This also predisposes to transmission of various diseases, primarily hepatitis B/C and AIDS. Circumcision is a surgical procedure that should be performed by specialists under appropriate sterile circumstances in which the rate of complications would be decreased. The child may be exposed to recurrent psychosocial and surgical trauma when it is performed by incompetent individuals. PMID:27011875

  13. Risks and complications in rhinoplasty

    PubMed Central

    Rettinger, Gerhard

    2008-01-01

    Rhinoplasty is regarded to be associated with many risks as the expectations of patient and physician are not always corresponding. Besides of postoperative deformities many other risks and complications have to be considered. Reduction-rhinoplasty e.g. can cause breathing disturbances which are reported in 70% of all revision-rhinoplasty-patients. One has to be aware however that scars and loss of mucosal-sensation can also give the feeling of a blocked nose. The main risks of autogenous transplants are dislocation and resorption, while alloplasts can cause infection and extrusion. In this respect silicone implants can have a complication rate between 5-20%. Less complications are reported with other materials like Gore-Tex. Complications of skin and soft tissues can be atrophy, fibrosis, numbness, cysts originating from displaced mucosa or subcutaneous granulomas caused by ointment material. Postoperative swelling depends mainly on the osteotomy technique. Percutaneous osteotomies cause less trauma, but may result in visible scars. Infections are rare but sometimes life-threatening (toxic-shock-syndrome). The risk is higher, when sinus surgery and rhinoplasty are combined. Osteotomies can also cause injuries of the orbital region. Necrosis of eye-lids by infections and blindness by central artery occlusion are known. There are reports on various other risks like rhinoliquorrhea, brain damage, fistulas between sinus-cavernosus and carotid artery, aneurysms and thrombosis of the cavernous sinus. Discoloration of incisors are possible by damage of vessels and nerves. Rhinoplasty can also become a court-case in dissatisfied patients, a situation that may be called a typical complication of rhinoplasty. It can be avoided by proper patient selection and consideration of psychological disturbances. Postoperative deformities are considered as main risks of rhinoplasty, causing revision surgery in 5% to 15% of the cases. The analysis of postoperative deformities allowes the identification of specific risks. The most frequent postoperative deformity is the pollybeak when a deep naso-frontal angle, cartilaginous hump and reduced tip projection are present preoperatively. The pollybeak is the indication in about 50% of all revision rhinoplasties. Other frequent postoperative deformities are a pendant and wide nasal tip, retractions of the columella base or irregularities of the nasal dorsum. These deformities are very often combined and caused by a loss of septal support. This is why the stability of the caudal septum in septorhinoplasty is the key for a predictable result. Maintaining the position of the tip and the columella is one of the main issues to avoid typical postoperative deformities. The risks for rhinoplasty-complications can be reduced with increasing experience. A prerequisite is continuing education and an earnest distinction between complication and mistake. PMID:22073084

  14. Augmentation cystoplasty: Contemporary indications, techniques and complications.

    PubMed

    Veeratterapillay, Rajan; Thorpe, Andrew C; Harding, Chris

    2013-10-01

    Augmentation cystoplasty (AC) has traditionally been used in the treatment of the low capacity, poorly compliant or refractory overactive bladder (OAB). The use of intravesical botulinum toxin and sacral neuromodulation in detrusor overactivity has reduced the number of AC performed for this indication. However, AC remains important in the pediatric and renal transplant setting and still remains a viable option for refractory OAB. Advances in surgical technique have seen the development of both laparoscopic and robotic augmentation cystoplasty. A variety of intestinal segments can be used although ileocystoplasty remains the most common performed procedure. Early complications include thromboembolism and mortality, whereas long-term problems include metabolic disturbance, bacteriuria, urinary tract stones, incontinence, perforation, the need for intermittent self-catheterization and carcinoma. This article examines the contemporary indications, published results and possible future directions for augmentation cystoplasty. PMID:24235795

  15. Major vascular injuries complicating knee arthroscopy

    PubMed Central

    Bancu, Serban; Muresan, Mircea; Sala, Daniela

    2015-01-01

    Starting with a case report, we made a detailed review of the literature, with the purpose of identifying and analyzing the type of iatrogenic vascular lesion following knee arthroscopy and the method of vascular repair. A PubMed literature search was undertaken to locate all reported cases of major vascular iatrogenic injuries during arthroscopic knee procedures. We identified 39 papers which report a total of 62 cases of major iatrogenic popliteal lesions after knee arthroscopy, between 1985 and 2014. The type of arthroscopic intervention performed, the type of iatrogenic vascular lesion encountered, the time passed until its discovery and treatment, the method of vascular reconstruction, and the postoperative course are presented. Postarthroscopy vascular complications are infrequent but potentially disastrous for the condition of the affected inferior limb. An early diagnosis and reintervention are mandatory for a good postoperative outcome. PMID:26240627

  16. Pleural procedural complications: prevention and management

    PubMed Central

    Psallidas, Ioannis; Wrightson, John M.; Hallifax, Robert J.; Rahman, Najib M.

    2015-01-01

    Pleural disease is common with a rising case frequency. Many of these patients will be symptomatic and require diagnostic and/or therapeutic procedures. Patients with pleural disease present to a number of different medical specialties, and an equally broad range of clinicians are therefore required to have practical knowledge of these procedures. There is often underestimation of the morbidity and mortality associated with pleural interventions, even those regarded as being relatively straightforward, with potentially significant implications for processes relating to patient safety and informed consent. The advent of thoracic ultrasound (TUS) has had a major influence on patient safety and the number of physicians with the necessary skill set to perform pleural procedures. As the variety and complexity of pleural interventions increases, there is increasing recognition that early specialist input can reduce the risk of complications and number of procedures a patient requires. This review looks at the means by which complications of pleural procedures arise, along with how they can be managed or ideally prevented. PMID:26150919

  17. Prevention of the Musculoskeletal Complications of Hemophilia

    PubMed Central

    Rodriguez-Merchan, E. C.

    2012-01-01

    Hemophilia is an inherited disorder of clotting factor deficiencies resulting in musculoskeletal bleeding, including hemarthroses, leading to musculoskeletal complications. The articular problems of hemophiliac patients begin in infancy. These include: recurrent hemarthroses, chronic synovitis, flexion deformities, hypertrophy of the growth epiphyses, damage to the articular cartilage, and hemophilic arthropathy. The most commonly affected joints are the ankle, the knee, and the elbow. Hematologic prophylactic treatment from ages 2 to 18 years could avoid the development of hemophilic arthropathy if the concentration of the patient's deficient factor is prevented from falling below 1% of normal. Hemarthroses can be prevented by the administration of clotting factor concentrates (prophylaxis). However, high costs and the need for venous access devices in younger children continue to complicate recommendations for universal prophylaxis. Prevention of joint arthropathy needs to focus on prevention of hemarthroses through prophylaxis, identifying early joint disease through the optimal use of cost-effective imaging modalities and the validation of serological markers of joint arthropathy. Screening for effects on bone health and optimal management of pain to improve quality of life are, likewise, important issues. Major hemarthrosis and chronic hemophilic synovitis should be treated aggressively to prevent hemophilic arthropathy. PMID:22778972

  18. Complications of autologous hematopoietic stem cell transplantation.

    PubMed

    Lambertenghi Deliliers, G; Annaloro, C; Lambertenghi Deliliers, D

    2000-01-01

    Myeloablative therapy followed by autologous hematopoietic stem cell (HSC) transplantation is a therapeutic option proposed for a variety of hematological and non-hematological diseases. However, although mortality due to this procedure is steadily decreasing, patients are still exposed to the risk of a number of complications negatively affecting their expectancy or quality of life. Adverse events due to HSC harvesting are rare and generally reversible. The early post-transplant complications include infections, mucositis, hepatic veno-occlusive disease and various acute organ toxicities. Immune derangement is a leading cause of most late events, such as viral or fungal infections, auto-immune manifestations and secondary neoplasms, of which secondary AML/MDS are the most commonly reported. In line with the favoured pathogenetic explanation, neoplastic clones previously established during conventional treatment are harvested and reinfused at the time of autografting. Other late effects are single organ dysfunction due to the underlying disease and treatment toxicities combined with infectious and post-infectious phenomena. The lungs, heart, CNS and reproductive system are the most investigated targets, but no clinical patterns have been identified as specific for autografting. PMID:11204025

  19. Lymphatic complications after vascular interventions

    PubMed Central

    Obara, Andrzej; Maruszynski, Marek; Witkowski, Adam; D?browski, Maciej; Chmielak, Zbigniew

    2014-01-01

    Introduction Lymphorrhea due to classical and mini-invasive surgical interventions on femoral and popliteal arteries is a serious hindrance to patient treatment. Depending on the experience of a particular center, the incidence and frequency of this type of complication may constitute a serious clinical problem. While the level of lymphorrhea intensity and its duration result in certain foreseeable consequences, their treatment can be a time-consuming and multistep procedure. Aim To compare different types of vascular interventions with lymphorrhea occurrence. Material and methods The authors conducted a retrospective analysis of lymphatic complications based on the material collected between 2005 and 2012 at the Department of Vascular and Endovascular Surgery of the Military Institute of Medicine in Warsaw and in the Department of Interventional Cardiology and Angiology of the Institute of Cardiology in Anin, Warsaw, in 20092012. Results Maintaining due thoroughness when dissecting tissues and treating the cutting line in this area with ligatures and tissue puncture are the most reliable methods of minimizing the risk of lymphatic leakage after surgical procedures performed in a classical way. The lymphatic complication under analysis is far less likely to occur when procedures are performed as planned and an endovascular technique is used statistical significance p < 0.05. Minimally invasive and fully percutaneous procedures performed via needle puncture, including the use of the fascial closure technique to close the femoral artery, eliminate the likelihood of the occurrence of this vascular complication statistical significance was found with p value less than 0.05. Conclusions We concluded that in every case by minimizing the vascular approach we protected the patient against lymphatic complications. PMID:25337168

  20. [Effect of age on medical complications in acute carbon monoxide poisoning].

    PubMed

    Targosz, Dorota; Pach, Dorota

    2002-01-01

    The aim of the study was to compare the frequency and clinical course of carbon monoxide poisonings (early or delayed medical complication or death) regarding the age of patients. All symptoms which were not diagnosed on admission but occurred during first three weeks after carbon monoxide exposure were stated as early complication and after three weeks as delayed. A full recovery was noted in 61.8% of patients younger than 60 and only in 28.4% of patients older than 60 years (p < 0.01). The frequency of medical complications and number of deaths were significantly higher in the group of older persons. The toxic myocardial injury followed by respiratory tract inflammations were predominant early complications and a psychoorganic syndrome was a predominant late complication in the oldest group of CO poisoned patients. PMID:12183996

  1. Practical approach to management of respiratory complications in neurological disorders

    PubMed Central

    Mangera, Zaheer; Panesar, Gurkirat; Makker, Himender

    2012-01-01

    Patients with certain neurological diseases are at increased risk of developing chest infections as well as respiratory failure due to muscular weakness. In particular, patients with certain neuromuscular disorders are at higher risk. These conditions are often associated with sleep disordered breathing. It is important to identify patients at risk of respiratory complications early in the course of their disease, although patients with neuromuscular disorders often present in the acute setting with respiratory involvement. This review of the respiratory complications of neurological disorders, with a particular focus on neuromuscular disorders, explores why this happens and looks at how to recognize, investigate, and manage these patients effectively. PMID:22505823

  2. [Treatment of otogenic intracranial complications. Therapeutic and diagnostic difficulties].

    PubMed

    Gadzhimirzaev, G A; Magomedov, A M

    2006-01-01

    The article presents the results of clinical, laboratory, CT and MRT examination and treatment of patients with otogenic intracranial complications (OIC) hospitalized to ENT clinics for the last 10 years. The statistics show that the number of OIC patients tends to decrease for the last 40 years. This may be explained by perfection of specialized ENT service in backcountry rural districts. It is emphasized that use of antibiotics and other anti-inflammatory drugs before hospitalization changes a clinical OIC picture and complicates early diagnosis especially the diagnosis of cerebral and cerebellar abscesses. PMID:16912663

  3. Complications Related to the Treatment of Slipped Capital Femoral Epiphysis.

    PubMed

    Roaten, John; Spence, David D

    2016-04-01

    Slipped capital femoral epiphysis (SCFE) is a condition of the immature hip in which mechanical overload of the proximal femoral physis results in anterior and superior displacement of the femoral metaphysis relative to the epiphysis. The treatment of SCFE is surgical, as the natural history of nonsurgical treatment is slip progression and early arthritis. Despite advances in treatment, much controversy exists regarding the best treatment, and complication rates remain high. Complications include osteonecrosis, chondrolysis, SCFE-induced impingement, and related articular degeneration, fixation failure and deformity progression, growth disturbance of the proximal femur, and development of bilateral disease. PMID:26772949

  4. Chronic suppurative otitis media: complicated versus uncomplicated disease.

    PubMed

    Rupa, V; Raman, R

    1991-01-01

    To determine prognostic factors in patients with chronic otitis media who develop suppurative complications, we performed a retrospective study of all patients with chronic suppurative otitis media who underwent mastoid surgery between the years 1981 and 1989. Patients who developed complications were compared with those who did not with respect to six prognostic variables. The results indicated that patients with complications were younger (p less than 0.001), had shorter duration of ear discharge (p less than 0.001), were more likely to have pars tensa perforations (p less than 0.05), and had a higher degree of mastoid sclerosis in the operated and contralateral ears (p less than 0.001). The presence of cholesteatoma and the sex of the patient were of no prognostic value. Bacteriology of CSF and pus specimens from patients who developed intracranial complications mostly revealed mixed flora (62.9%). Proteus species was the most frequent isolate (34%) and anaerobes were present in 21.3% of specimens. Mastoid abscess occurred in more than half the patients in the complicated group. Brain abscess (57.4%) was the most frequent intracranial complication. On the basis of our findings we recommend that risk factors in patients with chronic suppurative otitis media be identified early to enable effective measures to be taken to eradicate the disease. PMID:1887779

  5. Suicide bereavement and complicated grief

    PubMed Central

    Tal Young, Ilanit; Iglewicz, Alana; Glorioso, Danielle; Lanouette, Nicole; Seay, Kathryn; Ilapakurti, Manjusha; Zisook, Sidney

    2012-01-01

    Losing a loved to suicide is one is one of life's most painful experiences. The feelings of loss, sadness, and loneliness experienced after any death of a loved one are often magnified in suicide survivors by feelings of quilt, confusion, rejection, shame, anger, and the effects of stigma and trauma. Furthermore, survivors of suicide loss are at higher risk of developing major depression, post-traumatic stress disorder, and suicidal behaviors, as well as a prolonged form of grief called complicated grief. Added to the burden is the substantial stigma, which can keep survivors away from much needed support and healing resources. Thus, survivors may require unique supportive measures and targeted treatment to cope with their loss. After a brief description of the epidemiology and circumstances of suicide, we review the current state of research on suicide bereavement, complicated grief in suicide survivors, and grief treatment for survivors of suicide. PMID:22754290

  6. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview.

    PubMed

    Nathan, David M

    2014-01-01

    OBJECTIVE The Diabetes Control and Complications Trial (DCCT) was designed to test the glucose hypothesis and determine whether the complications of type 1 diabetes (T1DM) could be prevented or delayed. The Epidemiology of Diabetes Interventions and Complications (EDIC) observational follow-up determined the durability of the DCCT effects on the more-advanced stages of diabetes complications including cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS The DCCT (1982-1993) was a controlled clinical trial in 1,441 subjects with T1DM comparing intensive therapy (INT), aimed at achieving levels of glycemia as close to the nondiabetic range as safely possible, with conventional therapy (CON), which aimed to maintain safe asymptomatic glucose control. INT utilized three or more daily insulin injections or insulin pump therapy guided by self-monitored glucose. EDIC (1994-present) is an observational study of the DCCT cohort. RESULTS The DCCT followed >99% of the cohort for a mean of 6.5 years and demonstrated a 35-76% reduction in the early stages of microvascular disease with INT, with a median HbA1c of 7%, compared with CONV, with a median HbA1c of 9%. The major adverse effect of INT was a threefold increased risk of hypoglycemia, which was not associated with a decline in cognitive function or quality of life. EDIC showed a durable effect of initial assigned therapies despite a loss of the glycemic separation (metabolic memory) and demonstrated that the reduction in early-stage complications during the DCCT translated into substantial reductions in severe complications and CVD. CONCLUSIONS DCCT/EDIC has demonstrated the effectiveness of INT in reducing the long-term complications of T1DM and improving the prospects for a healthy life span. PMID:24356592

  7. Oral complications in cancer patients

    SciTech Connect

    Carl, W.

    1983-02-01

    Ionizing radiation used in treating the head and neck area produces oral side effects such as mucositis, salivary changes, trismus and radiation caries. Sequelae of cancer chemotherapy often include oral stomatitis, myelosuppression and immunosuppression. Infections of dental origin in compromised patients are potentially lethal. Specific programs to eliminate dental pathology before radiation and chemotherapy, and to maintain oral hygiene during and after therapy, will minimize these complications.

  8. Hemorrhagic complications in dermatologic surgery

    PubMed Central

    Bunick, Christopher G.; Aasi, Sumaira Z.

    2014-01-01

    The ability to recognize, manage, and, most importantly, prevent hemorrhagic complications is critical to performing dermatologic procedures that have safe and high quality outcomes. This article reviews the preoperative, intraoperative, and postoperative factors and patient dynamics that are central to preventing such an adverse outcome. Specifically, the role that anticoagulants and antiplatelet agents, hypertension, and other medical conditions play in the development of postoperative hemorrhage are discussed. In addition, this article provides practical guidelines on managing bleeding during and after surgery. PMID:22515669

  9. Permanent makeup: indications and complications.

    PubMed

    De Cuyper, Christa

    2008-01-01

    Cosmetic tattoos, simulating makeup, have become very popular in the last decades; the technique of micropigmentation consists of implantation of pigment into the skin using a tattoo pen. The procedure can also be used to camouflage vitiligo, to mask scars, and as an adjunct to reconstructive surgery. Risks and complications include infections, allergic reactions, scarring, fanning, fading, and dissatisfaction about color and shape. Lasers offer the best cosmetic result for removal of unwanted tattoos. PMID:18280902

  10. Complications of Guillain-Barré syndrome.

    PubMed

    Wang, Ying; Zhang, Hong-Liang; Wu, Xiujuan; Zhu, Jie

    2016-04-01

    Guillain-Barré syndrome (GBS) is an immune-mediated disorder in the peripheral nervous system with a wide spectrum of complications. A good understanding of the complications of GBS assists clinicians to recognize and manage the complications properly thereby reducing the mortality and morbidity of GBS patients. Herein, we systemically review the literature on complications of GBS, including short-term complications and long-term complications. We summarize the frequency, severity, clinical manifestations, managements and possible mechanisms of different kinds of complications, and point out the flaws of current studies as well as demonstrate the further investigations needed. PMID:26642351

  11. Neurologic complications after liver transplantation

    PubMed Central

    ivkovi?, Saa A

    2013-01-01

    Neurologic complications are relatively common after solid organ transplantation and affect 15%-30% of liver transplant recipients. Etiology is often related to immunosuppressant neurotoxicity and opportunistic infections. Most common complications include seizures and encephalopathy, and occurrence of central pontine myelinolysis is relatively specific for liver transplant recipients. Delayed allograft function may precipitate hepatic encephalopathy and neurotoxicity of calcineurin inhibitors typically manifests with tremor, headaches and encephalopathy. Reduction of neurotoxic immunosuppressants or conversion to an alternative medication usually result in clinical improvement. Standard preventive and diagnostic protocols have helped to reduce the prevalence of opportunistic central nervous system (CNS) infections, but viral and fungal CNS infections still affect 1% of liver transplant recipients, and the morbidity and mortality in the affected patients remain fairly high. Critical illness myopathy may also affect up to 7% of liver transplant recipients. Liver insufficiency is also associated with various neurologic disorders which may improve or resolve after successful liver transplantation. Accurate diagnosis and timely intervention are essential to improve outcomes, while advances in clinical management and extended post-transplant survival are increasingly shifting the focus to chronic post-transplant complications which are often encountered in a community hospital and an outpatient setting. PMID:24023979

  12. Mitochondrial Hormesis and Diabetic Complications

    PubMed Central

    2015-01-01

    The concept that excess superoxide production from mitochondria is the driving, initial cellular response underlying diabetes complications has been held for the past decade. However, results of antioxidant-based trials have been largely negative. In the present review, the data supporting mitochondrial superoxide as a driving force for diabetic kidney, nerve, heart, and retinal complications are reexamined, and a new concept for diabetes complications—mitochondrial hormesis—is presented. In this view, production of mitochondrial superoxide can be an indicator of healthy mitochondria and physiologic oxidative phosphorylation. Recent data suggest that in response to excess glucose exposure or nutrient stress, there is a reduction of mitochondrial superoxide, oxidative phosphorylation, and mitochondrial ATP generation in several target tissues of diabetes complications. Persistent reduction of mitochondrial oxidative phosphorylation complex activity is associated with the release of oxidants from nonmitochondrial sources and release of proinflammatory and profibrotic cytokines, and a manifestation of organ dysfunction. Restoration of mitochondrial function and superoxide production via activation of AMPK has now been associated with improvement in markers of renal, cardiovascular, and neuronal dysfunction with diabetes. With this Perspective, approaches that stimulate AMPK and PGC1α via exercise, caloric restriction, and medications result in stimulation of mitochondrial oxidative phosphorylation activity, restore physiologic mitochondrial superoxide production, and promote organ healing. PMID:25713188

  13. Complications of Frontal Sinus Fractures

    PubMed Central

    Metzinger, Stephen E.; Metzinger, Rebecca C.

    2009-01-01

    Frontal sinus fracture represents 5 to 12% of all maxillofacial fractures. Because of the anatomic position of the frontal sinus and the enormous amount of force required to create a fracture in this area, these injuries are often devastating and associated with other trauma. Associated injuries include skull base, intracranial, ophthalmologic, and maxillofacial. Complications should be categorized to address these four areas as well as the skin–soft tissue envelope, muscle, and bone. Other variables that should be examined are age of the patient, gender, mechanism of injury, fracture pattern, method of repair, and associated injuries. Management of frontal sinus fractures is so controversial that the indications, timing, method of repair, and surveillance remain disputable among several surgical specialties. The one universal truth that is agreed upon is that all patients undergoing reconstructive surgery of the frontal sinus have a lifelong risk for delayed complications. It is hoped that when patients do experience the first symptoms of a complication, they seek immediate medical attention and avoid potentially life-threatening situations and the need for crippling or disfiguring surgery. The best way to facilitate this is through long-term follow-up and routine surveillance. PMID:22110794

  14. Oxidative stress and diabetic complications

    PubMed Central

    Giacco, Ferdinando; Brownlee, Michael

    2010-01-01

    Oxidative stress plays a pivotal role in the development of diabetes complications, both microvascular and cardiovascular. The metabolic abnormalities of diabetes cause mitochondrial superoxide overproduction in endothelial cells of both large and small vessels, and also in the myocardium. This increased superoxide production causes the activation of five major pathways involved in the pathogenesis of complications: polyol pathway flux, increased formation of advanced glycation end-products (AGEs), increased expression of the receptor for AGEs and its activating ligands, activation of protein kinase C (PKC) isoforms, and overactivity of the hexosamine pathway. It also directly inactivates two critical antiatherosclerotic enzymes, eNOS and prostacyclin synthase. Through these pathways, increased intracellular ROS cause defective angiogenesis in response to ischemia, activate a number of pro-inflammatory pathways, and cause long-lasting epigenetic changes which drive persistent expression of proinflammatory genes after glycemia is normalized (hyperglycemic memory). Atherosclerosis and cardiomyopathy in type 2 diabetes are caused in part by pathway-selective insulin resistance, which increases mitochondrial ROS production from free fatty acids and by inactivation of anti-atherosclerosis enzymes by ROS. Overexpression of superoxide dismutase in transgenic diabetic mice prevents diabetic retinopathy, nephropathy, and cardiomyopathy. The aim of this review is to highlight advances in understanding the role of metabolite-generated ROS in the development of diabetic complications. PMID:21030723

  15. The Cardiac Complications of Methamphetamines.

    PubMed

    Paratz, Elizabeth D; Cunningham, Neil J; MacIsaac, Andrew I

    2016-04-01

    Methamphetamines are increasingly popular drugs of abuse in Australia, and are rising in purity. The rising popularity and purity of methamphetamines has notably increased demands upon Australian medical services. Methamphetamines are sympathomimetic amines with a range of adverse effects upon multiple organ systems. Cardiovascular complications are the second leading cause of death in methamphetamine abusers, and there appears to be a high prevalence of cardiac pathology. Cardiovascular pathology frequently seen in methamphetamine abusers includes hypertension, aortic dissection, acute coronary syndromes, pulmonary arterial hypertension and methamphetamine-associated cardiomyopathy. The rising prevalence of methamphetamine abuse is likely to increase the burden of cardiovascular pathology in Australians. A National Parliamentary Enquiry was opened in March 2015 to address concerns regarding the medical and social impacts of methamphetamine abuse. From April 2015, a National 'Ice Taskforce' was also created in parallel. Reversal of cardiac pathology appears to be achievable with abstinence from methamphetamines and initiation of appropriate treatment. It is key to appreciate that the pathogenesis of methamphetamine-induced cardiac complications arises as a result of the specific toxic effects of methamphetamines. Clinical management is hence individualised; suggested management approaches for methamphetamine-induced cardiac complications are detailed within this article. PMID:26706652

  16. Superficial fascial system repair: an abdominoplasty technique to reduce local complications after caesarean delivery.

    PubMed

    Al-Benna, Sammy; Al-Ajam, Yazan; Tzakas, Elias

    2009-05-01

    Abdominal incision complications are a major source of morbidity after caesarean delivery. Repair of the superficial fascial system may avert local complications after caesarean delivery by minimising tension to the skin and increasing the initial biomechanical strength of wound which has the potential to decrease early wound dehiscence and as a by-product correct suprapubic bulging. PMID:18810475

  17. Hematologic effects and complications of snake envenoming.

    PubMed

    Berling, Ingrid; Isbister, Geoffrey K

    2015-04-01

    Hematologic abnormalities are the most common effects of snake envenoming globally. Venom-induced consumption coagulopathy (VICC) is the commonest and most important. Other hematologic abnormalities are an anticoagulant coagulopathy and thrombotic microangiopathy. Venom-induced consumption coagulopathy is a venom-induced activation of the clotting pathway by procoagulant toxins, resulting in clotting factor consumption and coagulopathy. The type of procoagulant toxin differs between snakes and can activate prothrombin, factor X, and factor V or consume fibrinogen. The most useful investigation in VICC is a prothrombin time/international normalized ratio. The d-dimer may assist in early diagnosis, but fibrinogen levels often add little in the clinical setting. Bedside investigations would be ideal, but point-of-care testing international normalized ratio and whole blood clotting tests have been shown to be unreliable in VICC. The major complication of VICC is hemorrhage, including intracranial hemorrhage which is often fatal. The role of antivenom in VICC is controversial and may only be beneficial for some types of snakes including Echis spp where the duration of abnormal clotting is reduced from more than a week to 24 to 48 hours. In contrast, antivenom does not appear to speed the recovery of VICC in Australian snake envenoming. Other treatments for VICC include factor replacement, observation and prevention of trauma, and heparin. An Australian study showed that fresh-frozen plasma speeds recovery of VICC, but early use may increase consumption. There is no evidence to support heparin. PMID:25556574

  18. Anorectal Complications During Neutropenic Period in Patients with Hematologic Diseases

    PubMed Central

    Solmaz, Soner; Korur, Aslı; Gereklioğlu, Çiğdem; Asma, Süheyl; Büyükkurt, Nurhilal; Kasar, Mutlu; Yeral, Mahmut; Kozanoğlu, İlknur; Boğa, Can; Ozdoğu, Hakan

    2016-01-01

    Background Neutropenic patients are susceptible to any anorectal disease, and symptomatic anorectal disease afflicts 2–32% of oncology patients. Perianal infections are the most feared complication, considering the lack of natural defense against infectious microorganisms. When septic complications develop, the anorectal disease is potentially fatal, especially in neutropenic patients in whom mortality rates range between 11–57%. Although anorectal diseases are a frequent complication with potentially fatal outcomes among patients with hematologic diseases, sufficient data are not available in the literature. In this study, we aimed to investigate the anorectal complications developing during the neutropenic period in patients with hematologic diseases. Methods A total of 79 patients whose neutropenic period (absolute neutrophil count <500/mcL) continued for 7 days, or longer were included in the study. Results A total of 34 patients out of 79 (43%) were detected to develop anorectal complications, of them 6 (7.6%) developed an anorectal infection. The patients were characterized according to the hematological disease and its status (active or not), the type of treatment and the presence of a history of an anorectal pathology before the onset of the hematologic disease. Nineteen (24.1%) patients had the history of anorectal disturbances before diagnosis of the hematologic disease, and recurrence of an anorectal pathology was found in 14 out of 19 patients(73.7%). In addition, the overall mortality rate was higher among the patients who developed anorectal complications compared to another group (41.2% vs. 22.2%, p=0.059). Conclusion Anorectal pathology is a common complication with high recurrence rate in neutropenic patients. Perianal infections are important as they can cause life-threatening outcomes although they are relatively rare among all anorectal complications. Therefore perianal signs and symptoms should be meticulously evaluated concerning early diagnosis and treatment. PMID:26977278

  19. [Infectious complications in patients after cardiac arrest undergoing therapeutic hypothermia].

    PubMed

    Skora, R

    2011-05-01

    Therapeutic hypothermia is currently recommended neuroprotective therapeutic measure for comatose patients after cardiac arrest. Hypothermia has been proven not only to affect the neurological outcomes but also the survival of patients after cardiac arrest. This communication summarizes the issue of early infectious complications in patients after cardiac arrest undergoing therapeutic hypothermia. Diagnosis of infectious events is complicated in patients after cardiac arrest not only by the physiological effects of therapeutic hypothermia but also by the consequences of reperfusion injury and development of postresuscitation disease associated with systemic inflammatory response syndrome. Furthermore, there are discussed limited diagnostic options of infectious complications. The significance of the usual symptoms of infections is reduced, as well as the value of laboratory markers such as procalcitonin and C-reactive protein. Finally, the possibility of antibiotic treatment and eventual antibiotic prophylaxis during therapeutic hypothermia in patients after cardiac arrest outside hospitals is mentioned. PMID:21695930

  20. Complications arising from ritual circumcision: pathogenesis and possible prevention.

    PubMed

    Menahem, S

    1981-01-01

    Over a period of six years, five seriously ill infants were referred with complications arising from ritual circumcision performed by nonphysicians. Four infants developed systemic infections; in three of them, including one with early meningitis, there was septicemia. The common predisposing factor was an excessively tight dressing over an infected penile wound, leading to urinary retention, urinary tract infection and septicemia. In the fifth infant, the glans had been partially amputated and required a suture; a second dressing tightly applied to control the bleeding was removed without subsequent problems. To prevent the above complications, careful attention should be paid to the baby's voiding within the first 6 to 8 h after circumcision. In addition, it is suggested that all dressings should be removed, or at least replaced, on the day following circumcision, when the likelihood or primary hemorrhage has passed. These two simple maneuvers may avoid the above-mentioned complications. PMID:7461946

  1. [Postoperative hemoglobin course and septic complications following stomach resection].

    PubMed

    Jaeger, K; Holtz, J; Horch, R; Schobert, M

    1987-01-01

    Preoperative and postoperative haemoglobin curves were studied in male patients, following two-third gastrectomy. A group with early septic complications was compared to one without. The groups were comparable for age distribution and pathological patterns (ulcer/gastric stenosis and carcinoma). Preoperative haemoglobin mean values were a the lower normal limit and dropped to 10.8 g/dl in the group with complications on the fifth day from surgery, but stayed constant at 12 g/dl in the control group, as of the second postoperative day. Haemoglobin dropped to mean values around 11 g/dl immediately after surgery in patients with severe complications, such as suture dehiscence. All groups deviated clearly from normal Hb. PMID:3591049

  2. Imaging of complications from hematopoietic stem cell transplant

    PubMed Central

    Pandey, Tarun; Maximin, Suresh; Bhargava, Puneet

    2014-01-01

    Stem cell transplant has been the focus of clinical research for a long time given its potential to treat several incurable diseases like hematological malignancies, diabetes mellitus, and neuro-degenerative disorders like Parkinson disease. Hematopoietic stem cell transplantation (HSCT) is the oldest and most widely used technique of stem cell transplant. HSCT has not only been used to treat hematological disorders including hematological malignancies, but has also been found useful in treamtent of genetic, immunological, and solid tumors like neuroblastoma, lymphoma, and germ cell tumors. In spite of the rapid advances in stem cell technology, success rate with this technique has not been universal and many complications have also been seen with this form of therapy. The key to a successful HSCT therapy lies in early diagnosis and effective management of complications associated with this treatment. Our article aims to review the role of imaging in diagnosis and management of stem cell transplant complications associated with HSCT. PMID:25489126

  3. Cardiovascular Complications in CKD Patients: Role of Oxidative Stress

    PubMed Central

    Gosmanova, Elvira O.; Le, Ngoc-Anh

    2011-01-01

    Starting with the early stages, patients with chronic kidney disease (CKD) experience higher burden of cardiovascular disease (CVD). Moreover, CVD complications are the major cause of mortality in CKD patients as compared with complications from chronic kidney failure. While traditional CVD risk factors, including diabetes, hypertension, hyperlipidemia, obesity, physical inactivity, may be more prevalent among CKD patients, these factors seem to underestimate the accelerated cardiovascular disease in the CKD population. Search for additional biomarkers that could explain the enhanced CVD risk in CKD patients has gained increasing importance. Although it is unlikely that any single nontraditional risk factor would fully account for the increased CVD risk in individuals with CKD, oxidative stress appears to play a central role in the development and progression of CVD and its complications. We will review the data that support the contribution of oxidative stress in the pathogenesis of CVD in patients with chronic kidney failure. PMID:21253517

  4. Imaging of complications from hematopoietic stem cell transplant.

    PubMed

    Pandey, Tarun; Maximin, Suresh; Bhargava, Puneet

    2014-10-01

    Stem cell transplant has been the focus of clinical research for a long time given its potential to treat several incurable diseases like hematological malignancies, diabetes mellitus, and neuro-degenerative disorders like Parkinson disease. Hematopoietic stem cell transplantation (HSCT) is the oldest and most widely used technique of stem cell transplant. HSCT has not only been used to treat hematological disorders including hematological malignancies, but has also been found useful in treamtent of genetic, immunological, and solid tumors like neuroblastoma, lymphoma, and germ cell tumors. In spite of the rapid advances in stem cell technology, success rate with this technique has not been universal and many complications have also been seen with this form of therapy. The key to a successful HSCT therapy lies in early diagnosis and effective management of complications associated with this treatment. Our article aims to review the role of imaging in diagnosis and management of stem cell transplant complications associated with HSCT. PMID:25489126

  5. [Neurological complications in cancer patients].

    PubMed

    Hundsberger, Thomas; Roth, Patrick; Roelcke, Ulrich

    2014-08-20

    Neurological symptoms in cancer patients have a great impact on quality of life and need an interdisciplinary approach. They lead to significant impairment in activities of daily living (gait disorders, dizziness), a loss of patients independency (vegetative disturbances, wheel-chair dependency) and interfere with social activities (ban of driving in case of epilepsy). In this article we describe three main and serious neurological problems in the context of oncological patients. These are chemotherapy-induced polyneuropathy, malignant spinal cord compression and epileptic seizures. Our aim is to increase the awareness of neurological complications in cancer patients to improve patients care. PMID:25146945

  6. Ocular complications of Wegener's granulomatosis.

    PubMed

    Bullen, C L; Liesegang, T J; McDonald, T J; DeRemee, R A

    1983-03-01

    140 patients with biopsy-proven Wegener's granulomatosis were examined during a 16-year period at the Mayo Clinic. Forty patients had diverse and explosive ophthalmic involvement, including conjunctivitis, episcleritis, scleritis, corneal ulceration, uveitis, retinal vasculitis, optic neuropathy, orbital mass, orbital cellulitis, and obstruction of the nasolacrimal duct. The multiple ophthalmic and systemic complications in these 40 patients and the importance of establishing the pathologic diagnosis are discussed. Treatment with corticosteroids and immunosuppressive agents has dramatically improved the prognosis, although substantial mortality (four patients died of Wegener's granulomatosis) and ocular morbidity (three eyes were enucleated) are still associated with this disease. PMID:6602963

  7. Complications of Carpal Tunnel Release.

    PubMed

    Karl, John W; Gancarczyk, Stephanie M; Strauch, Robert J

    2016-04-01

    Carpal tunnel release for compression of the median nerve at the wrist is one of the most common and successful procedures in hand surgery. Complications, though rare, are potentially devastating and may include intraoperative technical errors, postoperative infection and pain, and persistent or recurrent symptoms. Patients with continued complaints after carpal tunnel release should be carefully evaluated with detailed history and physical examination in addition to electrodiagnostic testing. For those with persistent or recurrent symptoms, a course of nonoperative management including splinting, injections, occupational therapy, and desensitization should be considered prior to revision surgery. PMID:26772951

  8. Ocular complications of bungee jumping

    PubMed Central

    Hassan, H Mohammed J; Mariatos, Georgios; Papanikolaou, Theocharis; Ranganath, Akshatha; Hassan, Hala

    2012-01-01

    Aim In this paper, we will try to highlight the importance of various investigations and their crucial role in identifying whether the defect is structural or functional. Case history A 24-year-old woman presented with ocular complications after bungee jumping. Subsequently, although all ophthalmic signs resolved, she complained of decreased vision in her left eye. Conclusion Initial ophthalmic injury was detected by optical coherence tomography scan showing a neurosensory detachment of the fovea. This was not initially detected on slit-lamp examination or fluorescein angiography. On later examination, although the optical coherence tomography scan showed no structural damage, electrodiagnostic tests showed a functional defect at the fovea. PMID:23055687

  9. Chikungunya Myeloradiculopathy: A Rare Complication

    PubMed Central

    Krishnan, Mohana; Rahul; Krishnamoorthy

    2012-01-01

    Chikungunya, an alpha virus belonging to the family of Togaviridae is transmitted to humans by the bite of Aedes aegypti mosquito and presents with fever, headache, rash, and severe arthralgia. Chikungunya virus is not known to be neurotropic, but cases of meningoencephalitis have been reported during outbreaks. The clinical, laboratory and neuroimaging findings of a 56-year-old man who initially developed Chikungunya fever with arthralagia and later on lead to Chikungunya myeloradiculopathy, a relatively unknown and rare complication of the infection has been presented. PMID:23326078

  10. Influence of Acute Complications on Outcome 3 Months after Ischemic Stroke

    PubMed Central

    Grube, Maike Miriam; Koennecke, Hans-Christian; Walter, Georg; Meisel, Andreas; Sobesky, Jan; Nolte, Christian Hans; Wellwood, Ian; Heuschmann, Peter Ulrich

    2013-01-01

    Background Early medical complications are potentially modifiable factors influencing in-hospital outcome. We investigated the influence of acute complications on mortality and poor outcome 3 months after ischemic stroke. Methods Data were obtained from patients admitted to one of 13 stroke units of the Berlin Stroke Registry (BSR) who participated in a 3-months-follow up between June 2010 and September 2012. We examined the influence of the cumulative number of early in-hospital complications on mortality and poor outcome (death, disability or institutionalization) 3 months after stroke using multivariable logistic regression analyses and calculated attributable fractions to determine the impact of early complications on mortality and poor outcome. Results A total of 2349 ischemic stroke patients alive at discharge from acute care were included in the analysis. Older age, stroke severity, pre-stroke dependency and early complications were independent predictors of mortality 3 months after stroke. Poor outcome was independently associated with older age, stroke severity, pre-stroke dependency, previous stroke and early complications. More than 60% of deaths and poor outcomes were attributed to age, pre-stroke dependency and stroke severity and in-hospital complications contributed to 12.3% of deaths and 9.1% of poor outcomes 3 months after stroke. Conclusion The majority of deaths and poor outcomes after stroke were attributed to non-modifiable factors. However, early in-hospital complications significantly affect outcome in patients who survived the acute phase after stroke, underlining the need to improve prevention and treatment of complications in hospital. PMID:24086621

  11. Perioperative thrombotic complications in liver transplantation

    PubMed Central

    Feltracco, Paolo; Barbieri, Stefania; Cillo, Umberto; Zanus, Giacomo; Senzolo, Marco; Ori, Carlo

    2015-01-01

    Although the perioperative bleeding complications and the major side effects of blood transfusion have always been the primary concern in liver transplantation (OLT), the possible cohesion of an underestimated intrinsic hypercoagulative state during and after the transplant procedure may pose a major threat to both patient and graft survival. Thromboembolism during OLT is characterized not only by a complex aetiology, but also by unpredictable onset and evolution of the disease. The initiation of a procoagulant process may be triggered by various factors, such as inflammation, venous stasis, ischemia-reperfusion injury, vascular clamping, anatomical and technical abnormalities, genetic factors, deficiency of profibrinolytic activity, and platelet activation. The involvement of the arterial system, intracardiac thrombosis, pulmonary emboli, portal vein thrombosis, and deep vein thrombosis, are among the most serious thrombotic events in the perioperative period. The rapid detection of occlusive vascular events is of paramount importance as it heavily influences the prognosis, particularly when these events occur intraoperatively or early after OLT. Regardless of the lack of studies and guidelines on anticoagulant prophylaxis in this setting, many institutions recommend such an approach especially in the subset of patients at high risk. However, the decision of when, how and in what doses to use the various chemical anticoagulants is still a difficult task, since there is no common consensus, even for high-risk cases. The risk of postoperative thromboembolism causing severe hemodynamic events, or even loss of graft function, must be weighed and compared with the risk of an important bleeding. In this article we briefly review the risk factors and the possible predictors of major thrombotic complications occurring in the perioperative period, as well as their incidence and clinical features. Moreover, the indications to pharmacological prophylaxis and the current treatment strategies are also summarized. PMID:26185371

  12. Oral complications of HIV disease.

    PubMed

    Leao, Jair C; Ribeiro, Camila M B; Carvalho, Alessandra A T; Frezzini, Cristina; Porter, Stephen

    2009-05-01

    Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS. PMID:19488613

  13. Oral Complications of HIV Disease

    PubMed Central

    Leao, Jair C.; Ribeiro, Camila M. B.; Carvalho, Alessandra A. T.; Frezzini, Cristina; Porter, Stephen

    2009-01-01

    Oral lesions are among the early signs of HIV infection and can predict its progression to acquired immunodeficiency syndrome (AIDS). A better understanding of the oral manifestations of AIDS in both adults and children has implications for all health care professionals. The knowledge of such alterations would allow for early recognition of HIV-infected patients. The present paper reviews epidemiology, relevant aspects of HIV infection related to the mouth in both adults and children, as well as current trends in antiretroviral therapy and its connection with orofacial manifestations related to AIDS. PMID:19488613

  14. Necrotizing Fasciitis of the Nose Complicated with Cavernous Sinus Thrombosis

    PubMed Central

    Swaminath, D.; Narayanan, R.; Orellana-Barrios, M. A.; Temple, B.

    2014-01-01

    Necrotizing fasciitis is a rapidly progressive life threatening bacterial infection of the skin, the subcutaneous tissue, and the fascia. We present a case of necrotizing fasciitis involving the nose complicated by cavernous sinus thrombosis. Few cases of septic cavernous sinus thrombosis have been reported to be caused by cellulitis of the face but necrotizing fasciitis of the nose is rare. It is very important to recognize the early signs of cavernous thrombosis. Treatment for septic cavernous sinus thrombosis is controversial but early use of empirical antibiotics is imperative. PMID:24876978

  15. Necrotizing fasciitis of the nose complicated with cavernous sinus thrombosis.

    PubMed

    Swaminath, D; Narayanan, R; Orellana-Barrios, M A; Temple, B

    2014-01-01

    Necrotizing fasciitis is a rapidly progressive life threatening bacterial infection of the skin, the subcutaneous tissue, and the fascia. We present a case of necrotizing fasciitis involving the nose complicated by cavernous sinus thrombosis. Few cases of septic cavernous sinus thrombosis have been reported to be caused by cellulitis of the face but necrotizing fasciitis of the nose is rare. It is very important to recognize the early signs of cavernous thrombosis. Treatment for septic cavernous sinus thrombosis is controversial but early use of empirical antibiotics is imperative. PMID:24876978

  16. Complications of chronic renal insufficiency: beyond cardiovascular disease.

    PubMed

    Zabetakis, P M; Nissenson, A R

    2000-12-01

    The less rigorous attention to the management of the complications of chronic renal insufficiency (CRI) and its comorbid conditions has potentially tragic consequences. In fact, with early recognition and intervention, many of the complications of CRI and its comorbid conditions can be ameliorated or prevented. We review here the most prevalent, troublesome, and potentially preventable complications and comorbidities of CRI with a view toward developing high-quality, cost-effective strategies for delivering early interventional care. Complications of CRI include malnutrition, anemia, disorders of divalent ion metabolism and osteodystrophy, metabolic acidosis, and dyslipidemia. Important comorbid conditions of CRI are hypertension, diabetes mellitus, and cardiovascular disease. Clinical intuition suggests that early intervention will avert morbidity related to the hypoalbuminemia and other nutritional disorders of CRI, the metabolic acidosis, and the dyslipidemias, but prospective data are lacking at present. Correction of anemia, usually with recombinant human erythropoietin, may be key to the prevention of cardiac disease and other comorbidities of CRI. Incipient disorders of bone and mineral metabolism are managed prospectively using such measures as protein restriction to reduce phosphorus intake, phosphate binders, calcium supplementation, and vitamin D analogues. Hypertension, whatever its original etiology, is clearly an important risk factor for the progression of kidney failure and for the development of diffuse vascular disease; appropriate and aggressive treatment is essential. In patients with diabetic nephropathy, the principles of both primary and secondary prevention have been validated in several large trials of glycemic and blood pressure control. The seeds of these insidious, challenging, and costly comorbid conditions are sown very early in CRI, at a time when they are-in theory-most amenable to intervention. We therefore must be as proactive as possible in the timely implementation of relatively simple therapies that have the potential to prevent some of these adverse outcomes of CRI. PMID:11118156

  17. Bacterial infections complicating tongue piercing

    PubMed Central

    Yu, Catherine HY; Minnema, Brian J; Gold, Wayne L

    2010-01-01

    Tongue piercing has become an increasingly popular form of body art. However, this procedure can occasionally be complicated by serious bacterial infections. The present article reports a case of prosthetic valve endocarditis caused by a Gemella species in a patient with a pierced tongue, and reviews 18 additional cases of local and systemic bacterial infections associated with tongue piercing. Infections localized to the oral cavity and head and neck region included molar abscess, glossal abscess, glossitis, submandibular lymphadenitis, submandibular sialadenitis, Ludwigs angina and cephalic tetanus. Infections distal to the piercing site included eight cases of infective endocarditis, one case of chorioamnionitis and one case of cerebellar abscess. Oropharyngeal flora were isolated from all cases. While bacterial infections following tongue piercing are rare, there are reports of potentially life-threatening infections associated with the procedure. Both piercers and their clients should be aware of these potential complications, and standardized infection prevention and control practices should be adopted by piercers to reduce the risk. PMID:21358880

  18. Painless thyroiditis complicated by acromegaly.

    PubMed

    Saito, Takatoshi; Tojo, Katsuyoshi; Tajima, Naoko

    2010-01-01

    The serum thyroid stimulating hormone (TSH) level is decreased in acromegalic patients. Although this phenomenon is thought to be caused by the enhanced secretion of somatostatin which suppresses TSH production, it has not yet been proven. We describe a 60-year-old woman with acromegaly who showed a low concentration of TSH. We diagnosed her as painless thyroiditis based on an increased level of thyroglobulin, depressed radioactive iodine uptake (RAIU), normal vascularity and mild swelling of the thyroid, and normal T3, T4, free T3 and free T4 levels. To our knowledge, this is the second reported case of acromegaly complicated by painless thyroiditis. The differential diagnosis between central hypothyroidism and painless thyroiditis is so important. Since it is difficult to diagnose precisely based on only the data of a low level of TSH and normal levels of thyroid hormones, we consider that measurement of thyroglobulin and RAIU is necessary when the complication of painless thyroiditis is suspected. PMID:20075583

  19. Clinical experience with hyaluronic acid-filler complications.

    PubMed

    Park, Tae-Hwan; Seo, Sang-Won; Kim, June-Kyu; Chang, Choong-Hyun

    2011-07-01

    Hyaluronic acid (HA) fillers have become the material of choice for soft-tissue augmentation. HA fillers are longer lasting, less immunogenic and can be broken down by hyaluronidase. These advantages make HA fillers the most common of the temporary fillers on the market. However, early and delayed complications, ranging from minor to severe, can occur following HA-filler injection. We evaluated and treated 28 cases of HA-filler-related complications that were referred to our hospital over a period of 5 years from July 2004 to October 2009. Twenty-eight patients were included in our study; 82.1% of the patients were female and 17.9% were male. Complications were roughly classified as nodular masses, inflammation, tissue necrosis and dyspigmentation. Affected locations, in descending order of frequency, were the perioral area, forehead, including glabella, nose, nasolabial fold, mentum, including marionette wrinkles, cheek area and periocular wrinkles. The most disastrous complication was alar rim necrosis following injection of the nasolabial fold. We propose two 'danger zones' that are particularly vulnerable to tissue necrosis following filler injection: the glabella and nasal ala. Although there is no definite treatment modality for the correction of HA-filler complications, we have managed them with various available treatment modalities aimed at minimising patient morbidity. PMID:21310674

  20. Persistent ductus arteriosus complicating the respiratory distress syndrome.

    PubMed Central

    Jones, R W; Pickering, D

    1977-01-01

    Persistent ductus arteriosus (PDA) complicated the clinical course in 45 (15%) of 299 babies with the respiratory distress syndrome (RDS) presenting over a 3-year period. The incidence of PDA complicating RDS rose with decreasing birthweight and was highest in babies with severe RDS as judged by the use of assisted ventilation. In babies with a birthweight of less than 1500 g, PDA occurred as a complication of RDS in 25% of cases. In babies who recieved intermittent positive pressure ventilation (IPPV) for management of RDS, the incidence of PDA was 35%. Overall mortality for babies with RDS was 17%; when PDA occurred as a complication mortality was 31%. In survivors, spontaneous closure of the PDA occurred in all except one infant. The development of signs of PDA in 19 babies either necessitated a renewal of IPPV or prevented "weaning" from IPPV or from continuous positive airways pressure. 9 (47%) of these babies died, 8 of them after the first week of life. The frequency of PDA complicating RDS and the relatively high mortality in this conservatively-treated group of babies is emphasized. The incidence reported here is likely to increase with the increased survival of very low birthweight infants with severe RDS. The high incidence of late deaths in babies who develop signs of PDA associated with an inability to wean from assisted ventilation suggests that early surgical ligation of the PDA in these babies should be considered. The results of a conservative approach to management of these infants are presented. PMID:324406

  1. [Special surgical complications in chronic inflammatory bowel diseases].

    PubMed

    Kroesen, A J

    2015-04-01

    After colorectal and anorectal interventions for chronic inflammatory bowel diseases, specific complications can occur.In Crohn's disease these complications mainly occur after proctocolectomy. Pelvic sepsis can be prevented by omentoplasty with fixation inside the pelvis. A persisting sepsis of the sacral cavity can be treated primarily by dissection of the anal sphincter which ensures better drainage. In cases of chronic sacral sepsis, transposition of the gracilis muscle is a further effective option. Early recurrence of a transsphincteric anal fistula should be treated by reinsertion of a silicon seton drainage.Complications after restorative proctocolectomy are frequent and manifold (35%). The main acute complications are anastomotic leakage and pelvic sepsis. Therapy consists of transperineal drainage of the abscess with simultaneous transanal drainage. Late complications due to technical and septic reasons are still a relevant problem even 36 years after introduction of this operative technique. A consistent approach with detailed diagnostic and surgical therapy results in a 75% rescue rate of ileoanal pouches. PMID:25693779

  2. Complications of anterior cruciate ligament reconstruction: MR imaging.

    PubMed

    Papakonstantinou, Olympia; Chung, Christine B; Chanchairujira, Kullanuch; Resnick, Donald L

    2003-05-01

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. PMID:12695835

  3. Infrared Thermal Imaging for Automated Detection of Diabetic Foot Complications

    PubMed Central

    van Netten, Jaap J.; van Baal, Jeff G.; Liu, Chanjuan; van der Heijden, Ferdi; Bus, Sicco A.

    2013-01-01

    Background Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the applicability of high-resolution infrared thermal imaging for noninvasive automated detection of signs of diabetic foot disease. Methods The plantar foot surfaces of 15 diabetes patients were imaged with an infrared camera (resolution, 1.2 mm/pixel): 5 patients had no visible signs of foot complications, 5 patients had local complications (e.g., abundant callus or neuropathic ulcer), and 5 patients had diffuse complications (e.g., Charcot foot, infected ulcer, or critical ischemia). Foot temperature was calculated as mean temperature across pixels for the whole foot and for specified regions of interest (ROIs). Results No differences in mean temperature >1.5 C between the ipsilateral and the contralateral foot were found in patients without complications. In patients with local complications, mean temperatures of the ipsilateral and the contralateral foot were similar, but temperature at the ROI was >2 C higher compared with the corresponding region in the contralateral foot and to the mean of the whole ipsilateral foot. In patients with diffuse complications, mean temperature differences of >3 C between ipsilateral and contralateral foot were found. Conclusions With an algorithm based on parameters that can be captured and analyzed with a high-resolution infrared camera and a computer, it is possible to detect signs of diabetic foot disease and to discriminate between no, local, or diffuse diabetic foot complications. As such, an intelligent telemedicine monitoring system for noninvasive automated detection of signs of diabetic foot disease is one step closer. Future studies are essential to confirm and extend these promising early findings. PMID:24124937

  4. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon’s guide

    PubMed Central

    Sarkhosh, Kourosh; Birch, Daniel W.; Sharma, Arya; Karmali, Shahzeer

    2013-01-01

    Obesity is a common disease affecting adults and children. The incidence of obesity in Canada is increasing. Laparoscopic sleeve gastrectomy (LSG) is a relatively new and effective procedure for weight loss. Owing to an increase in the number of bariatric surgical procedures, general surgeons should have an understanding of the complications associated with LSG and an approach for dealing with them. Early postoperative complications following LSG that need to be identified urgently include bleeding, staple line leak and development of an abscess. Delayed complications include strictures, nutritional deficiencies and gastresophageal reflux disease. We discuss the principles involved in the management of each complication. PMID:24067520

  5. Glucose Control and Diabetic Complications

    PubMed Central

    Lubin, Stan

    1991-01-01

    Tight glucose control is clearly beneficial in the pregnant insulin-dependent diabetic. In other areas (retinopathy, established nephropathy, and hypoglycemia) the question whether tight control of diabetes is justified remains unanswered. Preliminary evidence suggests that tight control, if begun early, can prevent clinical nephropathy and neuropathy. PMID:21229036

  6. Management of complications after laparoscopic Roux-en-Y gastric bypass.

    PubMed

    Bell, B J; Bour, E S; Scott, J D; Cobb, W S; Carbonell, A M

    2009-06-01

    Obesity has become an increasing problem in developed countries and laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the leading treatments for this disease. Although studies show that it is effective in reducing weight and lessening comorbidities, both early and late complications can occur. Early complications include venous thromboembolism, anastomotic leak, and hemorrhage. Late complications include obstruction, anastomotic stenosis, fistula, ulcer, cholelithiasis and nutritional deficiencies. Diagnosis of these complications is often challenging due to the lack of specificity of the presenting signs and symptoms. A high index of suspicion for detecting these complications is universally advocated. Fortunately, mortality from this procedure is rare. Management of the complications is generally consistent with basic surgical principles and surgical reinterventions can often be performed either endoscopically or laparoscopically depending on the situation and the surgeon's expertise. The available literature is confounded by mixing of results between open and laparoscopic techniques as well as the substantial differences in technique between authors reporting their outcomes. Although there is no consensus for managing the reported complications of LRYGB surgery, this article reviews the current literature and describes the presentation, diagnosis, and management of each of the early and late complications associated with the procedure. PMID:19536052

  7. Late surgical complications after gastric by-pass: a literature review

    PubMed Central

    PALERMO, Mariano; ACQUAFRESCA, Pablo A.; ROGULA, Tomasz; DUZA, Guillermo E.; SERRA, Edgardo

    2015-01-01

    Introduction Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones. Method Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. Results There were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula. Conclusion Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention. PMID:26176254

  8. Safety and Tolerability of Doripenem in Hospitalized Children With Complicated Intra-Abdominal Infection, Complicated Urinary Tract Infections and Pneumonia.

    PubMed

    Cannavino, Christopher R; Castaneda-Ruiz, Bibiana; Redman, Rebecca; Go, Oscar; Cirillo, Iolanda; Barauskas, Vidmantas; Senatorova, Ganna; Emeryk, Andrzej; Bradley, John S

    2015-11-01

    Three multicenter, randomized, controlled studies evaluated doripenem in children 3 months to <18 years of age, with complicated intra-abdominal or urinary tract infections and bacterial pneumonia.In the 66 patients treated with doripenem before early termination of the studies for nonsafety reasons, doripenem was safe and generally well tolerated. Low enrollment limited ability to assess benefits and risks of doripenem in children. PMID:26226440

  9. Antibiotics May Not Help After 'Complicated' Appendectomy

    MedlinePLUS

    ... traditional teaching is that all patients with complicated appendicitis receive post-operative antibiotics to reduce the risk ... may not be necessary following surgery for complicated appendicitis." He explained that "antibiotics are not without risks, ...

  10. Kawasaki Disease: Complications, Treatment and Prevention

    MedlinePLUS

    ... for High Blood Pressure Symptoms, Diagnosis & Monitoring of High Blood Pressure Prevention & Treatment of High Blood Pressure High Blood Pressure Tools & Resources Stroke More Kawasaki Disease: Complications, Treatment and Prevention Updated:Jul 24,2013 Complications The ...

  11. Post-operative pulmonary complications after thoracotomy

    PubMed Central

    Sengupta, Saikat

    2015-01-01

    Pulmonary complications are a major cause of morbidity and mortality in the post-operative period after thoracotomy. The type of complications and the severity of complications depend on the type of thoracic surgery that has been performed as well as on the patient's pre-operative medical status. Risk stratification can help in predicting the possibility of the post-operative complications. Certain airway complications are more prone to develop with thoracic surgery. Vocal cord injuries, bronchopleural fistulae, pulmonary emboli and post-thoracic surgery non-cardiogenic pulmonary oedema are some of the unique complications that occur in this subset of patients. The major pulmonary complications such as atelectasis, bronchospasm and pneumonia can lead to respiratory failure. This review was compiled after a search for search terms within ‘post-operative pulmonary complications after thoracic surgery and thoracotomy’ on search engines including PubMed and standard text references on the subject from 2000 to 2015. PMID:26556921

  12. Atlantooccipital septic arthritis complicating recurrent otitis media.

    PubMed

    Asher, Zoe; Cranswick, Noel; Rao, Padma; Steer, Andrew C

    2013-01-01

    Otitis media is known to have a number of complications. We present the first reported case of atlantooccipital septic arthritis as a complication of Streptococcus pneumoniae otitis media in an 8-month-old boy. PMID:22744442

  13. Unusual auricular complications in cutaneous oncology.

    PubMed

    Leshin, B; Hess, S P; White, W L; Matthews, B L; Koufman, J A

    1991-11-01

    The anatomic complexity of the pinna predisposes that structure to a variety of unique, site specific postoperative complications following management of skin cancer. We describe four unusual auricular complications: 1) radiochondronecrosis; 2) autonecrosis of skin during second intention healing; 3) hearing loss secondary to tragal retraction over the external auditory canal; and 4) extension of tumor through fenestrated cartilage. Well-known postoperative auricular complications are reviewed and anticipation and recognition of these unusual complications are emphasized. PMID:1757651

  14. Arteriovenous fistula complication following MRI

    PubMed Central

    Kirkman, Danielle; Junglee, Naushad; Mullins, Paul; Macdonald, Jamie Hugo

    2012-01-01

    Health professionals should be aware of medical procedures that cause vascular access complications. This case describes a haemodialysis patient who experienced pain, swelling and bruising over a radiocephalic fistula following MRI. Exactly the same signs and symptoms were evident following a second scan performed 3?months later. Plausible explanations include a radio frequency-induced electrical current being formed at the arteriovenous fistula, or varying gradients of the MRI sequence stimulating peripheral nerves, leading to a site of increased tissue stimulation. Of note, a juxta-anastomotic venous stenosis was confirmed by fistulogram 4?days after the second scan, although whether this access failure was due to the MRI scan per se could not be ascertained. Nevertheless, these previously undocumented observations suggest that careful patient and fistula monitoring is required when completing MRI scans in those with an arteriovenous fistula. PMID:22927271

  15. Skeletal complications of eating disorders.

    PubMed

    Donaldson, Abigail A; Gordon, Catherine M

    2015-09-01

    Anorexia nervosa (AN) is a psychiatric illness with profound medical consequences. Among the many adverse physical sequelae of AN, bone health is impacted by starvation and can be permanently impaired over the course of the illness. In this review of skeletal complications associated with eating disorders, we discuss the epidemiology, neuroendocrine changes, adolescent vs. adult skeletal considerations, orthopedic concerns, assessment of bone health, and treatment options for individuals with AN. The focus of the review is the skeletal sequelae associated with anorexia nervosa, but we also briefly consider other eating disorders that may afflict adolescents and young adults. The review presents updates to the field of bone health in AN, and also suggests knowledge gaps and areas for future investigation. PMID:26166318

  16. ORTHOPEDIC COMPLICATIONS IN HIV PATIENTS

    PubMed Central

    Lima, Ana Lúcia Lei Munhoz; Godoy, Alexandre Leme; Oliveira, Priscila Rosalba Domingos; Gobbi, Ricardo Gomes; de Almeida Silva, Camila; Martino, Patricia Bernardelli; Gutierrez, Eliana Bataggia; Gianna, Maria Clara; Camanho, Gilberto Luis

    2015-01-01

    The considerable increase of the life expectancy of HIV-infected patients in the age of highly-powerful antiretroviral treatment results in important metabolic and bone-joint changes resulting from a long-lasting viral infection time and from this treatment. The most common orthopaedic complications are bone mineralization changes, osteonecrosis, carpal tunnel syndrome and gleno-humeral adhesive capsulitis, with different clinical presentation features, natural disease progression and therapeutic response compared to the overall population. Literature reports are initial, and the experience of the multidisciplinary service of the University of Sao Paulo's Institute of Orthopaedics and Traumatology enables us a more indepth knowledge about the various pathologies involved and the development of treatment protocols that are appropriate to these diagnoses.

  17. [Infection complicated with diabetes mellitus].

    PubMed

    Nemoto, Ken-ichi; Maegawa, Hiroshi

    2015-12-01

    Patients with diabetes mellitus are believed to be suspected to be immunocompromized hosts. Many reports have pointed out that diabetic patients are susceptible to certain infections such as surgical site infections, malignant otitis externa, mucormycosis, and necrotizing fasciitis. But their etiology seems to be non-uniform, heterogenous and individualized. Above all, obesity-related infections are also increasing accompanied with the recent rising incidence of obesity. Further studies should be addressed about the relationships between infections and diabetes which include the factors of body mass index, life style, degree of diabetes complications, and poor glycemic control duration. They could live a normal life the same as healthy subjects if good glycemic control is achieved without hypoglycemia. PMID:26666157

  18. Pulmonary hypertension complicating multiple myeloma

    PubMed Central

    Mark, Tomer M.; Niesvizky, Ruben; Sobol, Irina

    2015-01-01

    Abstract Pulmonary hypertension (PH) is an infrequently reported complication of multiple myeloma (MM). PH has been more commonly associated with amyloidosis, myeloproliferative diseases, and the POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome. PH in MM is typically mild to moderate and may be secondary to a variety of conditions, which include left ventricular dysfunction, high-output cardiac failure, chronic kidney disease, treatment-related toxicities, and precapillary involvement. We describe 3 patients with MM and severe PH. Each patient underwent right heart catheterization. All patients demonstrated elevated pulmonary pressures, transpulmonary gradients, and pulmonary vascular resistance. Each patient was ultimately treated with pulmonary vasodilator therapy with improvement in cardiopulmonary symptoms. Additional studies are needed to define the prevalence, prognosis, and pathogenesis of PH in this complex population and to help clarify who may benefit from targeted PH therapy. PMID:26401262

  19. Complications after ileal pouch-anal anastomosis in Korean patients with ulcerative colitis

    PubMed Central

    Ryoo, Seung-Bum; Oh, Heung-Kwon; Han, Eon Chul; Ha, Heon-Kyun; Moon, Sang Hui; Choe, Eun Kyung; Park, Kyu Joo

    2014-01-01

    AIM: To investigate the outcomes of treatments for complications after ileal pouch-anal anastomosis (IPAA) in Korean patients with ulcerative colitis. METHODS: Between March 1998 and February 2013, 72 patients (28 male and 44 female, median age 43.0 years 14.0 years) underwent total proctocolectomy with IPAA. The study cohort was registered prospectively and analyzed retrospectively. Patient characteristics, medical management histories, operative findings, pathology reports and postoperative clinical courses, including early postoperative and late complications and their treatments, were reviewed from a medical record system. All of the ileal pouches were J-pouch and were performed with either the double-stapling technique (n = 69) or a hand-sewn (n = 3) technique. RESULTS: Thirty-one (43.1%) patients had early complications, with 12 (16.7%) patients with complications related to the pouch. Pouch bleeding, pelvic abscesses and anastomosis ruptures were managed conservatively. Patients with pelvic abscesses were treated with surgical drainage. Twenty-seven (38.0%) patients had late complications during the follow-up period (82.5 50.8 mo), with 21 (29.6%) patients with complications related to the pouch. Treatment for pouchitis included antibiotics or anti-inflammatory drugs. Pouch-vaginal fistulas, perianal abscesses or fistulas and anastomosis strictures were treated surgically. Pouch failure developed in two patients (2.8%). Analyses showed that an emergency operation was a significant risk factor for early pouch-related complications compared to elective procedures (55.6% vs 11.1%, P < 0.05). Pouchitis was related to early (35.3%) and the other late pouch-related complications (41.2%) (P < 0.05). The complications did not have an effect on pouch failure nor pouch function. CONCLUSION: The complications following IPAA can be treated successfully. Favorable long-term outcomes were achieved with a lower pouch failure rate than reported in Western patients. PMID:24966620

  20. Significant pneumothorax complicating a fractured clavicle.

    PubMed Central

    Williams, R J

    1995-01-01

    Pneumothorax has been described as a complication of a fractured clavicle only three times. It is an important and potentially serious complication. This case report describes a fractured clavicle complicated by a significant pneumothorax which required chest drain insertion. Images Fig. 1 PMID:8581255

  1. Common complications of pediatric neuromuscular disorders.

    PubMed

    Skalsky, Andrew J; Dalal, Pritha B

    2015-02-01

    Children with pediatric neuromuscular disorders experience common complications, primarily due to immobility and weakness. Musculoskeletal complications include hip dysplasia with associated hip subluxation or dislocation, neuromuscular scoliosis, and osteoporosis and resulting fractures. Constipation, gastroesophageal reflux, and obesity and malnutrition are commonly experienced gastrointestinal complications. Disordered sleep also is frequently observed, which affects both patients and caregivers. PMID:25479776

  2. COMPLICATIONS REQUIRING HOSPITAL MANAGEMENT AFTER BARIATRIC SURGERY

    PubMed Central

    WRZESINSKI, Aline; CORRÊA, Jéssica Moraes; FERNANDES, Tainiely Müller Barbosa; MONTEIRO, Letícia Fernandes; TREVISOL, Fabiana Schuelter; do NASCIMENTO, Ricardo Reis

    2015-01-01

    Background: The actual gold standard technique for obesity treatment is the Roux-en-Y gastric bypass. However, complications may occur and the surgeon must be prepared for them. Aim: To evaluate retrospectively the complications occurrence and associated factors in patients who underwent bariatric surgery. Methods: In this study, 469 medical charts were considered, from patients and from data collected during outpatient consultations. The variables considered were gender, age, height, pre-operatory BMI, pre-operatory weight, pre-operatory comorbidities, time of hospital stay, postoperative complications that demanded re-admission to the hospital and the time elapsed between the procedure and the complication. The patients' follow up was, at least, one year. Results: The incidence of postoperative complications that demanded a hospital care was 24,09%. The main comorbidity presented in this sample was hepatic steatosis. The comorbidity that was associated with the postoperative period was type 2 diabetes. There was a tendency for the female gender be related to the complications. The cholecystectomy was the most frequent complication. Complications occurred during the first year in 57,35%. Conclusion: The most frequent complication was the need to perform a cholecystectomy, where the most frequent comorbidity was hepatic steatosis. Over half the complications occurred during the first year postoperatively. Type 2 diabetes was associated with the occurrence of postoperative complications; women had the highest incidence; body mass index was not associated with the occurrence of complications. PMID:26537263

  3. PERIFOVEAL VITREOUS DETACHMENT AND ITS MACULAR COMPLICATIONS

    PubMed Central

    Johnson, Mark W

    2005-01-01

    Purpose To evaluate the vitreoretinal relationship in eyes with idiopathic macular disorders putatively caused by vitreomacular traction associated with early stages of age-related posterior vitreous detachment (PVD). Methods Retrospective observational case series of 43 eyes of 40 patients diagnosed with one of several idiopathic vitreomacular conditions. Included patients had no biomicroscopic evidence for complete PVD on presentation and underwent a specific clinical assessment of the vitreoretinal relationship. Affected eyes were evaluated with slit-lamp biomicroscopy, B-scan ultrasonography, optical coherence tomography, and/or intraoperative examination of the posterior hyaloid. Results By one or more examination techniques, 41 (95.3%) of the 43 study eyes had evidence of vitreous detachment from the perifoveal macular region and the remaining two eyes had complete PVD. When measurable, the size of the vitreomacular adhesion varied by diagnosis. Of 31 eyes with perifoveal vitreous detachment seen in follow-up, only three (9.7%) showed progression to complete PVD over an average preoperative or total follow-up period of 30.0 months (range, 2 to 237 months). Surgical or spontaneous separation of the residual vitreomacular adhesion in 16 eyes was followed in 15 (93.8%) by partial or complete resolution of the symptoms and signs of macular traction. Conclusions Age-related PVD appears to be an insidious, chronic event that begins in the perifoveal macula and evolves over a prolonged period of time prior to vitreopapillary separation. Though usually asymptomatic, its early (perifoveal) stages may be complicated by one of several macular pathologies, determined in part by the size of the residual vitreomacular adhesion. PMID:17057817

  4. Complications of female circumcision in the Sudan.

    PubMed

    El Dareer, A

    1983-07-01

    This paper aims to identify and determine the prevalence of health problems encountered as a result of practising the Pharaonic, Intermediate and Sunna types of circumcision. A population of 3210 females from Northern Sudan were chosen by multistage random sampling. The study was carried out by means of a detailed questionnaire. Two types of complications were found: immediate and delayed. The immediate complications amounted to 790 (25%) from all the circumcised cases. The frequency for each type was: Pharaonic 26%, Intermediate 24%, Sunna 8%. The most common immediate complications were: difficulty in passing urine, wound infection and bleeding. The delayed complications amounted to 1023 (32%): Pharaonic 33%, Intermediate 31% and Sunna 15%. The most common delayed complications were the urinary tract infection, chronic pelvic infection, and results of tight circumcision. Circumcised respondents sometimes suffered more than one complication. The pattern of complications of Intermediate and Pharaonic circumcision was found to be the same. PMID:6879696

  5. Surgical Treatments for Infantile Purulent Meningitis Complicated by Subdural Effusion

    PubMed Central

    Wang, Xianshu; Zhang, Xiaoru; Cao, Hongbin; Jing, Shiyuan; Yang, Zhiguo; Cheng, Zhenghai; Liu, Ye; Li, Xin; Gao, Feifei; Ji, Yuanqi

    2015-01-01

    Background Infantile purulent meningitis (PM) is a commonly severe intracranial infectious disease in infants under age 1 year. In recent years, several diagnostic and treatment methods were reported, but in these cases the neurological complications and sequel were often observed, among which subdural effusion (SE) is the most common complication in PM. Timely diagnosis and early intervention are vital for better outcomes. In this study, the surgical treatments for infantile PM complicated by SE were investigated. Material/Methods Patients who had PM complicated by SE in the Childrens Hospital of Hebei Province from June 2000 to June 2012 were retrospectively analyzed and 170 patients were enrolled in the study. Surgical treatment for each patient was adopted according to producing effusion time, leucocyte count, protein content, intracranial pressure, and bacteria culture, coupled with cranial ultrasound examination, CT, and MRI scans. Results Nearly, 15 patients were cured using serial taps, with a 50% cure rate. Seventeen out of 30 (56.6%) patients receiving subcutaneous reservoir drainage had better outcome. Nearly 80% of patients (55/69) who underwent minimally invasive trepanation and drainage were positive. Surgical procedure of minimally invasive trepanation and drainage combined with drug douche was effective in 63% of patients (19/30). In addition, 6 patients were cured with subdural-peritoneal shunt. Only 1 patient died, after the recurrence of meningitis, and the remaining 4 patients were cured by craniotomy. Conclusions For infantile PM complicated with SE, treatment needs be chosen according to the specific situation. Surgical procedure of minimally invasive trepanation and drainage is a very effective treatment in curing PM complicated by SE. The treatment was highly effective with the use of drug douche. Subdural-peritoneal shunt and craniotomy were as effective as in refractory cases. PMID:26482715

  6. Multicystic Benign Mesothelioma Complicating Pregnancy

    PubMed Central

    Tamhankar, V. A.

    2015-01-01

    Multicystic benign mesothelioma (MBM) is a rare peritoneal pathology typically affecting women in reproductive age. Though MBM is considered benign, these lesions are prone to recurrence and their growth could be modulated by the presence of oestrogen receptors. Acute presentation of MBM is still very rare in pregnancy and management options are not established. We describe a case of MBM presenting in early pregnancy with acute pain. This was successfully treated with surgical resection. Pregnancy continued uneventfully to term and no evidence of recurrent MBM was found at Caesarean section. PMID:26345310

  7. Thermal stress and diabetic complications

    NASA Astrophysics Data System (ADS)

    Ohtsuka, Yoshinori; Yabunaka, Noriyuki; Watanabe, Ichiro; Noro, Hiroshi; Fujisawa, Hiroyuki; Agishi, Yuko

    1995-06-01

    Activities of erythrocyte aldose reductase were compared in 34 normal subjects, 45 diabetic patients, and nine young men following immersion in water at 25, 39, and 42° C. Mean basal enzyme activity was 1.11 (SEM 0.12) U/g Hb and 2.07 (SEM 0.14) U/g Hb in normal controls and diabetic patients, respectively ( P<0.0001). Activities of the enzyme showed a good correlation with hemaglobin A1 (HbA1) concentrations ( P<0.01) but not with fasting plasma glucose concentrations. After immersion at 42° C for 10 min, enzyme activity was increased by 37.6% ( P<0.01); however, the activity decreased by 52.2% ( P<0.005) after immersion for 10 min at 39° C and by 47.0% ( P<0.05) at 25° C. These changes suggest that heat stress might aggravate diabetic complications, and body exposure to hot environmental conditions is not recommended for diabetic patients.

  8. Complications of tracheal gas insufflation.

    PubMed

    Kacmarek, R M

    2001-02-01

    Numerous reports of patient, lung model, and animal use of tracheal gas insufflation (TGI) have appeared in the literature over the past 10 years. However, no commercial TGI system is available. As a result, extreme care must be exercised if attempts are made to provide TGI. Numerous problems with noncommercial systems have been identified. Continuous-flow TGI results in an increase in peak pressure and delivered tidal volume. The use of a flow-limiting or pressure relief valve or a ventilator with an exhalation valve active during exhalation minimizes these problems. Ideally, TGI should only be activated during the expiratory phase. However, this requires that the TGI system be integrated with the mechanical ventilator. In addition, appropriate system monitoring should be available, including measurement of total positive end-expiratory pressure, peak inspiratory pressure, and tidal volume, and there should be a method of identifying increased carinal pressure and deactivating the TGI system if an obstruction occurs proximal to the point of TGI injection. As a result of the potential complications of TGI, this technique cannot be recommended for routine use until commercial systems are available. PMID:11175245

  9. Pulmonary complications of general surgery.

    PubMed

    Pierce, A K; Robertson, J

    1977-01-01

    1. Patients should be divided preoperatively into low- or high-risk categories, depending on their probability of developing postoperative pulmonary complications. The evaluation should include spirometry as well as an assessment of the previously defined risk factors. 2. Patients in a low-risk category need only instruction in deep breathing pre- and postoperatively. Routine use of supplemented oxygen postoperatively is reasonable until it can be demonstrated whether such is necessary. 3. High-risk patients should be as free as possible of respiratory secretions at the time of surgery. A regimen for this purpose includes cessation of smoking, and administration of inhaled bronchodilators followed by chest percussion and postural drainage. 4. High-risk patients should be carefully instructed in deep breathing and coughing preoperatively. A mechanical device such as an incentive spirometer may be beneficial in this regard. If it is not possible to achieve spontaneous deep breathing, an attempt to accomplish this by IPPB may be undertaken. The tidal volume desired should be ordered. If IPPB does not result in large tidal volumes, it should be discontinued. 5. The deep breathing procedure found to be most successful preoperativelly should be continued postoperatively. 6. The patient should be as mobile as possible while in bed and ambulated as soon as is feasible. 7. Patients with preoperative expiratory flows of less than 20% of predicted values or with chronic hypercapnia should be carefully observed for postoperative ventilatory failure. PMID:324360

  10. Vascular complications and gene therapy.

    PubMed

    Roy, Sayon; Rothschild, Jennifer G; Chen, Amy

    2003-02-01

    For gene therapy, the last few years have been an exciting period. Encouraging results from several successful gene therapy trials were reported. Children born with a life-threatening immune system disorder, severe combined immune deficiency (SCID), were cured after receiving gene therapy for replacement of their defective adenosine deaminase (ADA) gene. Gene therapy successes related to vascular complications were also reported. The first human gene therapy trial for a blood-vessel disorder was performed successfully, in which copies of an angiogenic gene, the vascular endothelial growth factor (VEGF) gene, were directly delivered to the area surrounding the diseased artery of the leg of a patient with peripheral artery disease. Within a few days, this stimulated the growth of new blood vessels around the blockage in the ailing blood vessel and helped avoid amputation. In 1998, a patient with genetically small arteries became the first to receive VEGF gene therapy in the heart. Multiple copies of a plasmid with the VEGF gene were delivered into the damaged area of the heart, and a few days later angiogenesis ensued that helped bypass the blocked vessel, with markedly reduced chest pain in the patient. Gene therapy is becoming a reality and, more importantly, it appears to be safe and does not require supplementary immuno-suppressing drugs. Gene therapy seems to have begun delivering on its promises. PMID:12718732

  11. Biliary Complications in Living Donor Liver Transplantation: Imaging Findings and the Roles of Interventional Procedures

    SciTech Connect

    Chang, Jung Min; Lee, Jeong Min; Suh, Kyung Suk; Yi, Nam Joon; Kim, Yong Tae; Kim, Se Hyung; Han, Joon Koo Choi, Byung Ihn

    2005-12-15

    Purpose. To describe the incidence, types, and findings of biliary complications in living donor liver transplantation (LDLT) and to determine the roles of interventional procedures. Materials and methods. Twenty-four biliary complications among 161 LDLT patients (24/161, 14.9%) were identified. These complications were divided into two groups according to the initial manifestation time, i.e., 'early' (<60 days) or 'late'. The CT and cholangiographic findings were reviewed regarding the presence of a stricture or leak and the location, and length, shape, and degree of the stricture. Both groups were categorized into three subgroups: leak, stricture, and both. The type of interventional procedures used and their roles were determined. Results. Early complications were identified in 14 of the 24 patients (58%) and late complications in 11 (46%). One patient showed both early and late complications. Biliary stricture was detected in 10 patients, leak in 10, and both in 5. By cholangiography, all strictures were irregular and short (mean length 15 {+-} 6 mm) at the anastomotic site and complete obstruction was observed in 2 patients with late stricture. Twenty-three of the 24 patients were treated using percutaneous and/or endoscopic drainage procedures with or without balloon dilatation. Seventeen (74%) showed a good response, but reoperations were inevitable in 6 (26%). All patients except those with complete obstruction showed a favorable outcome after interventional management. Conclusion. Biliary leaks and strictures are predominant complications in LDLT. Most show good responses to interventional treatment. However, complete obstruction needs additional operative management.

  12. Alcohol abuse-related severe acute pancreatitis with rhabdomyolysis complications

    PubMed Central

    SU, MAO-SHENG; JIANG, YING; YAN, XIAO-YUAN HU; ZHAO, QING-HUA; LIU, ZHI-WEI; ZHANG, WEN-ZHI; HE, LEI

    2013-01-01

    Non-traumatic rhabdomyolysis is a rare complication of acute pancreatitis. One of the major risk factors of both acute pancreatitis and rhabdomyolysis is alcohol abuse. However, only a few studies have reported the prognosis and association of severe acute pancreatitis (SAP) and rhabdomyolysis in alcohol abuse patients. In the present study, we report two cases presenting with SAP complicated by rhabdomyolysis following high-dose alcohol intake. The disease onset, clinical manifestations, laboratory data, diagnosis and treatment procedure of each patient were recorded, and the association with rhabdomyolysis was analyzed. Alcohol consumption was the most predominant cause of SAP and rhabdomyolysis in these patients. SAP-related rhabdomyolysis was primarily induced by the toxicity associated with pancreatic necrosis. The laboratory tests revealed that the concentration of serum creatine kinase (CK) and myoglobin increased and acute renal failure symptoms were present, which provided an exact diagnosis for SAP-induced rhabdomyolysis. Rhabdomyolysis and subsequent hypermyoglobinuria severely impaired kidney function and aggravated hypocalcemia. The therapy of early stage SAP complicated by rhabdomyolysis involved liquid resuscitation support. When first stage treatment fails, blood purification should be performed immediately. Both patients developed multiple organ failure (MOF) and succumbed to the disease. Considering the two cases presented, we conclude that alcohol-related SAP complicated by rhabdomyolysis may have a poor clinical prognosis. PMID:23251265

  13. Septic complications of corticosteroid administration after central nervous system trauma.

    PubMed Central

    DeMaria, E J; Reichman, W; Kenney, P R; Armitage, J M; Gann, D S

    1985-01-01

    The records of 197 consecutive multiple trauma patients were reviewed to define the infectious complications of corticosteroids used to treat brain and spinal cord injury. An injury severity score (ISS) and a central nervous system (CNS) injury score were determined for each patient. Patients with an ISS less than 20 did well with or without steroids and were excluded from further study. All deaths that occurred 5 or more days after injury were caused by sepsis, and all occurred in steroid recipients. Twenty-nine of 61 steroid-treated early survivors developed infectious complications, compared to eight of 55 patients who did not receive steroids (47.5% vs. 14.5%, p less than 0.001). There was no correlation between severity of CNS trauma and infectious complication rate. Steroid-treated patients frequently developed multiple pathogen primary infections and multiple, simultaneous septic foci. Patients treated with steroids more often developed infections caused by Staphylococcus aureus, assorted gram negative rods, anerobic bacteria, or fungi. The study strongly suggests a significant increase in both the incidence and severity of infectious complications occurring in patients treated with corticosteroids for CNS trauma. PMID:4015231

  14. Frequent Hemodialysis Fistula Infectious Complications

    PubMed Central

    Lok, Charmaine E.; Sontrop, Jessica M.; Faratro, Rose; Chan, Christopher T.; Zimmerman, Deborah Lynn

    2014-01-01

    Background Few studies have examined if infectious arteriovenous access complications vary with the cannulation technique and whether this is modified by dialysis frequency. We compared the infection rate between fistulas cannulated using buttonhole versus stepladder techniques for patients treated with short daily (SDH) or nocturnal hemodialysis at home (NHD). We also compared patients receiving conventional intermittent hemodialysis (CIHD) using stepladder cannulation. Methods Data were prospectively collected from 631 patients dialyzed with a fistula from 2001 to 2010 (Toronto and Ottawa, Canada). We compared the person-time incidence rate of bacteremia and local fistula infections using the exact binomial test. Results Forty-six (7.3%) patients received SDH (?5 sessions/week, 2-4 h/session), 128 (20.3%) NHD (?4 sessions/week, ?5 h/session) and 457 (72%) CIHD (3 sessions/week, ?4 h/session). Fifty percent of SDH and 72% of NHD patients used the buttonhole technique. There were 39 buttonhole-related bacteremias (rate: 0.196/1,000 fistula days) and at least 2 local buttonhole site infections. Staphylococcus aureus accounted for 85% of the bacteremias. There were 5 (13%) infection-related hospitalizations and 3 (10%) serious metastatic infections, including fistula loss. In comparison, there was 1 possible fistula-related infection in CIHD during follow-up (rate: 0.002/1,000 fistula days). Conclusions The rate of buttonhole-related infections was high among patients on frequent hemodialysis and more than 50 times greater than that among patients on CIHD with the stepladder technique. Most bacteremias were due to S. aureus with serious consequences. The risks and benefits of buttonhole cannulation require individual consideration with careful monitoring, prophylaxis and management. PMID:25473405

  15. [Pregnancy complicated by HELLP syndrome].

    PubMed

    Belowska, Anna; Ulman-W?odarz, Izabela; Galbierz-Kwiatkowska, Ewa

    2004-01-01

    HELLP syndrome belongs to the group of pathological disorders associated with pregnancy-induced hypertension and may accompany preeclampsia. The basic criteria for establishing the diagnosis are as follows: H--for hemolysis, EL--for elevated liver enzymes and LP--for low platelets. In this report the authors present the case of a 32 years old primipara admitted to the Obstetrics Clinic complaining of epigastric pain, nausea and vomiting. Medical history revealed previously diagnosed and treated reflux disease. In the 39th week of gestation epigastric pain manifested again, blood pressure was high (150/100) and on the basis of laboratory parameters HELLP syndrome was diagnosed (GPT 319 U/L, GOT 204 U/L, platelet 80 x 10(9)/L, antithrombin III 63.9%, D-dimer (+++)). With this case report, authors wished to point out the importance of early diagnosis and treatment of this rare, but having high percentage of perinatal mortality syndrome. PMID:15884197

  16. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

    Montes, Sergio Fernndez-Pello; Rodrguez, Ivan Gonzalez; Ugarteburu, Rodrigo Gil; Villamil, Luis Rodrguez; Mendez, Begoa Diaz; Gil, Patricio Suarez; Madera, Javier Mosquera

    2015-01-01

    AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery (radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery (radical prostatectomy and radical cystectomy). CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications. PMID:25984519

  17. Post-liver Transplant Biliary Complications

    PubMed Central

    Atwal, Tegpal; Pastrana, Mariel; Sandhu, Bimaljit

    2012-01-01

    Biliary tract complications remain a common source of morbidity and mortality in liver transplant (LT) recipients with an estimated incidence of 530% after orthotopic LT and a mortality rate of up to 10%. Biliary complications after LT may be related to various factors including hepatic artery thrombosis or stenosis, ischemia reperfusion injury, immunologic injury, infections, donor pool, and technical issues which include imperfect anastomosis and T-tube-related complications. Management of the detected biliary complications includes nonsurgical and surgical methods. A majority of these post transplant biliary complications can be treated with endoscopic retrograde cholangiography. If unsuccessful, a percutaneous intervention or surgery may be required. In this article, we review the incidence, clinical presentation, and management of the main types of biliary complications. PMID:25755409

  18. Factors associated with complicated buprenorphine inductions

    PubMed Central

    Whitley, Susan D.; Sohler, Nancy L.; Kunins, Hillary V.; Giovanniello, Angela; Li, Xuan; Sacajiu, Galit; Cunningham, Chinazo O.

    2016-01-01

    Despite data supporting its efficacy, barriers to implementation of buprenorphine for office-based treatment are present. Complications can occur during buprenorphine inductions, yet few published studies have examined this phase of treatment. To examine factors associated with complications during buprenorphine induction, we conducted a retrospective chart review of the first 107 patients receiving buprenorphine treatment in an urban community health center. The primary outcome, defined as complicated induction (precipitated or protracted withdrawal), was observed in 18 (16.8%) patients. Complicated inductions were associated with poorer treatment retention (than routine inductions) and decreased over time. Factors independently associated with complicated inductions included recent use of prescribed methadone, recent benzodiazepine use, no prior experience with buprenorphine, and a low initial dose of buprenorphine/naloxone. Findings from this study and further investigation of patient characteristics and treatment characteristics associated with complicated inductions can help guide buprenorphine treatment strategies. PMID:20682186

  19. Complications of arthroscopic surgery of the hip

    PubMed Central

    Papavasiliou, A. V.; Bardakos, N. V.

    2012-01-01

    Over recent years hip arthroscopic surgery has evolved into one of the most rapidly expanding fields in orthopaedic surgery. Complications are largely transient and incidences between 0.5% and 6.4% have been reported. However, major complications can and do occur. This article analyses the reported complications and makes recommendations based on the literature review and personal experience on how to minimise them. PMID:23610683

  20. Complications of closing wedge high tibial osteotomy

    PubMed Central

    Tunggal, James A. W.; Higgins, Gordon A.

    2009-01-01

    Closing wedge high tibial osteotomy is a common, effective and well-established procedure to treat unicompartment osteoarthrosis of the knee. It is, however, not without its complications. This article will discuss some of these complications and present an overview of the current literature. It will examine current thoughts on aetiology, techniques to try to avoid, and methods of treatment of these complications. PMID:19547973

  1. Pemphigus Foliaceus Complicated by Kaposi Varicelliform Eruption.

    PubMed

    Fang, Xiangang; Yang, Baoqi; Zhou, Guizhi; Liu, Yongxia; Zhang, Furen

    2015-12-01

    A Kaposi varicelliform eruption (KVE) refers to a widespread cutaneous infection with a virus that often causes local vesicular eruptions over a pre-existing skin disease. Pemphigus foliaceus complicated by KVE is rare. We report the case of a 68-year-old Chinese woman with pemphigus foliaceus complicated by KVE. A 68-year-old woman was admitted to our hospital with a 14-month history of erythema and bullae distributed over the entire body. Fourteen months prior to evaluation in our hospital she was diagnosed with pemphigus and was prescribed prednisone as primary therapy. One month prior to evaluation in our hospital more severe lesions recurred because of the sudden discontinuation of the prednisone treatment. She denied any systemic diseases. On physical examination, multiple erythematous erosions, crusts, and scales were noted on the face, trunk, and upper limbs (Figure 1, a). No bullae were present and the oral mucosa was not involved. Routine blood and urine testing, liver and kidney function, and blood glucose and lipid levels were normal. A biopsy of thoracic lesions revealed acantholysis on the upper spinous layer (Figure 1, b). Direct immunofluorescence (DIF) demonstrated immunoglobulin G (IgG) and immunoglobulin M (IgM) deposits in the epidermal intercellular space (Figure 1,c). Indirect immunofluorescence (IIF) showed circulating antibodies directed against the intercellular substance (titer=1:1280). A diagnosis of pemphigus foliaceus was made. Intravenous methylprednisolone (80 mg qd) combined with intravenous immune globulin 20g qd (0.4 g/kg/d for the first 3 days) was administered. After ten days, the lesions gradually resolved. On the 11th day, however, the patient reported malaise and complained that the facial lesions had suddenly worsened. On physical examination, a widespread eruption of several closely-grouped, painful blisters and crusts on the erythematous skin of the face and chest typical of a herpetic infection was noted (Figure 2, a). A biopsy of the chest revealed marked acantholysis with an intraepidermal vesicle, ballooning, and several multinucleated epithelial giant cells (Figure 2, b), which was ascribed to a herpes virus infection. Viral polymerase chain reaction (PCR) of the swab revealed herpes simplex virus type 1 (HSV-1). A diagnosis of KVE was established. In addition to methylprednisolone, oral valacyclovir (300 mg bid for 6 days) and intravenous immune globulin (10 g qd for the first 3 days) were administered. The KVE lesions subsided ten days later. KVE is a vesicular dermatosis caused by a viral infection in patients with a pre-existing skin disease. These viruses include HSV-1 and HSV-2, and rarely Coxsackie A16 and vaccinia viruses. The most common pre-existing dermatosis for KVE is atopic dermatitis, but KVE has been reported in many other dermatoses (1), such as autoimmune bullous dermatoses. The typical manifestation of KVE is the sudden appearance of monomorphic, umbilicated, and grouped vesicular lesions on the face, neck, axillae, chest, and upper extremities, usually accompanied by fever and malaise. The pathogenesis of KVE is unclear. Impaired skin barrier function in the above-mentioned diseases facilitates the spread of the viral infection (2). Furthermore, these patients, in whom the immune system is greatly suppressed due to the extensive application of immunosuppressive drugs, are more susceptible to different microbial infections, including viruses. In 1963, Marton and Angyal (3) reported the first case of KVE concurrent with pemphigus foliaceus. In fact, only a few cases of pemphigus foliaceus complicated by KVE have been reported (2,4-6). Among the reported cases, one case had a poor prognosis because of multiple organ failure (6). The diagnosis of KVE is sometimes difficult to make when the pre-existing disease is pemphigus since the new lesions may be interpreted as deterioration or relapse of pemphigus, which is when immunosuppression should be enhanced. In summary, early diagnosis and prompt systemic antiviral treatment for KVE before lab confirmation is cr

  2. Lateral Lumbar Interbody Fusion: Indications, Outcomes, and Complications.

    PubMed

    Kwon, Brian; Kim, David Hanwuk

    2016-02-01

    Lateral lumbar interbody fusion is a minimally invasive spinal fusion technique that uses the retroperitoneal approach to the anterior spinal column. Mechanical and technical results of the technique compare favorably with those of anterior lumbar interbody fusion in regard to large graft placement, graft volumes, and early initial stability. Lateral lumbar interbody fusion uses the transpsoas approach and traverses near the lumbar plexus. It is not, however, without its unique complications. Groin pain or numbness is well tolerated and often temporary; however, quadriceps palsy can be long-lasting and debilitating. Rarer but serious complications include vascular and visceral injury. Lateral lumbar interbody fusion has been used successfully to treat common degenerative spinal conditions such as spinal instability, stenosis, scoliosis, and degenerative disk disease. While understanding of the lumbar plexus and the technical challenges of the procedure improves, lateral lumbar interbody fusion will continue to provide safe and successful clinical outcomes with less morbidity than traditional procedures. PMID:26803545

  3. The function of heparanase in diabetes and its complications.

    PubMed

    Wang, Fang; Wan, Andrea; Rodrigues, Brian

    2013-10-01

    Heparan sulfate proteoglycans are ubiquitous glycoproteins that contain several heparan sulfate polysaccharide side chains attached to a core protein. They function not only as a primary structural component of the extracellular matrix, but also provide a storage depot for bioactive molecules, such as basic fibroblast growth factor, vascular endothelial growth factor and lipoprotein lipase. Heparanase is an endoglycosidase that specifically hydrolyzes heparan sulfate into oligosaccharides. Recent studies have indicated that heparanase is engaged in the initiation and progression of diabetes, in addition to its associated complications. This review focuses on the participation of heparanase in the cleavage of heparan sulfate proteoglycans in pancreatic islets promoting beta cell death, promotion of atherosclerosis, and its role in cardiac metabolic switching in the early stage of cardiomyopathy during diabetes. Understanding the mechanisms by which heparanase is regulated in diabetes could provide a drug target to prevent diabetes and its complications. PMID:24500561

  4. Cardiovascular risk in women after metabolic complications in pregnancy

    PubMed Central

    Maas, A.H.E.M.; van t Hof, A.W.J.; de Boer, M.J.

    2007-01-01

    Hypertensive pregnancy disorders complicate 10% of all pregnancies. In this article we discuss the spectrum of hypertensive conditions that may occur during pregnancy. Recent studies have consistently shown that hypertensive disorders in pregnancy implicate a two-fold higher risk for the development of hypertension and cardiovascular disease later in life. To optimise preventive management of cardiovascular disease in women with previous complicated pregnancies, we therefore recommend monitoring of hypertension and other cardiac risk factors at an early stage in life. Furthermore, the obstetric history should be routinely incorporated in cardiovascular risk assessment in women who seek medical attention for hypertension and/or cardiac symptoms. (Neth Heart J 2007;15:415-7.18239738) PMID:18239738

  5. Video-assisted thoracic surgery complications

    PubMed Central

    Kozak, Jzef

    2014-01-01

    Video-assisted thoracic surgery (VATS) is a miniinvasive technique commonly applied worldwide. Indications for VATS are very broad and include the diagnosis of mediastinal, lung and pleural diseases, as well as large resection procedures such as pneumonectomy. The most frequent complication is prolonged postoperative air leak. The other significant complications are bleeding, infections, postoperative pain and recurrence at the port site. Different complications of VATS procedures can occur with variable frequency in various diseases. Despite the large number of their types, such complications are rare and can be avoided through the proper selection of patients and an appropriate surgical technique. PMID:25561984

  6. Imaging the Complications of Lung Transplantation.

    PubMed

    Jokerst, Clinton; Sirajuddin, Arlene; Mohammed, Tan-Lucien H

    2016-03-01

    Imaging plays a key role in the diagnosis and management of complications following lung transplantation. This article outlines the imaging modalities available for evaluation of posttransplant complications with a focus on major indications and key strengths and weaknesses of each modality. A brief description of surgical technique and relevant anatomy is included. Descriptions of some of the more commonly encountered complications are outlined with a focus on imaging findings. Complications are grouped by anatomic or imaging-based findings and subcategorized chronologically to help order the differential diagnosis. PMID:26896229

  7. Discovering Diabetes Complications: an Ontology Based Model

    PubMed Central

    Daghistani, Tahani; Shammari, Riyad Al; Razzak, Muhammad Imran

    2015-01-01

    Background: Diabetes is a serious disease that spread in the world dramatically. The diabetes patient has an average of risk to experience complications. Take advantage of recorded information to build ontology as information technology solution will help to predict patients who have average of risk level with certain complication. It is helpful to search and present patient’s history regarding different risk factors. Discovering diabetes complications could be useful to prevent or delay the complications. Method: We designed ontology based model, using adult diabetes patients’ data, to discover the rules of diabetes with its complications in disease to disease relationship. Result: Various rules between different risk factors of diabetes Patients and certain complications generated. Furthermore, new complications (diseases) might be discovered as new finding of this study, discovering diabetes complications could be useful to prevent or delay the complications. Conclusion: The system can identify the patients who are suffering from certain risk factors such as high body mass index (obesity) and starting controlling and maintaining plan. PMID:26862251

  8. Opioid complications and side effects.

    PubMed

    Benyamin, Ramsin; Trescot, Andrea M; Datta, Sukdeb; Buenaventura, Ricardo; Adlaka, Rajive; Sehgal, Nalini; Glaser, Scott E; Vallejo, Ricardo

    2008-03-01

    Medications which bind to opioid receptors are increasingly being prescribed for the treatment of multiple and diverse chronic painful conditions. Their use for acute pain or terminal pain is well accepted. Their role in the long-term treatment of chronic noncancer pain is, however, controversial for many reasons. One of the primary reasons is the well-known phenomenon of psychological addiction that can occur with the use of these medications. Abuse and diversion of these medications is a growing problem as the availability of these medications increases and this public health issue confounds their clinical utility. Also, the extent of their efficacy in the treatment of pain when utilized on a chronic basis has not been definitively proven. Lastly, the role of opioids in the treatment of chronic pain is also influenced by the fact that these potent analgesics are associated with a significant number of side effects and complications. It is these phenomena that are the focus of this review. Common side effects of opioid administration include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression. Physical dependence and addiction are clinical concerns that may prevent proper prescribing and in turn inadequate pain management. Less common side effects may include delayed gastric emptying, hyperalgesia, immunologic and hormonal dysfunction, muscle rigidity, and myoclonus. The most common side effects of opioid usage are constipation (which has a very high incidence) and nausea. These 2 side effects can be difficult to manage and frequently tolerance to them does not develop; this is especially true for constipation. They may be severe enough to require opioid discontinuation, and contribute to under-dosing and inadequate analgesia. Several clinical trials are underway to identify adjunct therapies that may mitigate these side effects. Switching opioids and/or routes of administration may also provide benefits for patients. Proper patient screening, education, and preemptive treatment of potential side effects may aid in maximizing effectiveness while reducing the severity of side effects and adverse events. Opioids can be considered broad spectrum analgesic agents, affecting a wide number of organ systems and influencing a large number of body functions. PMID:18443635

  9. Pulmonary Hypertension Complicating Fibrosing Mediastinitis.

    PubMed

    Seferian, Andrei; Steriade, Alexandru; Jas, Xavier; Planch, Olivier; Savale, Laurent; Parent, Florence; Amar, David; Jovan, Roland; Fadel, Elie; Sitbon, Olivier; Simonneau, Grald; Humbert, Marc; Montani, David

    2015-11-01

    Fibrosing mediastinitis is caused by a proliferation of fibrous tissue in the mediastinum with encasement of mediastinal viscera and compression of mediastinal bronchovascular structures. Pulmonary hypertension (PH) is a severe complication of fibrosing mediastinitis caused by extrinsic compression of the pulmonary arteries and/or veins.We have conducted a retrospective observational study reviewing clinical, functional, hemodynamic, radiological characteristics, and outcome of 27 consecutive cases of PH associated with fibrosing mediastinitis diagnosed between 2003 and 2014 at the French Referral Centre for PH.Fourteen men and 13 women with a median age of 60 years (range 18-84) had PH confirmed on right heart catheterization. The causes of fibrosing mediastinitis were sarcoidosis (n?=?13), tuberculosis-infection confirmed or suspected (n?=?9), mediastinal irradiation (n?=?2), and idiopathic (n?=?3). Sixteen patients (59%) were in NYHA functional class III and IV. Right heart catheterization confirmed moderate to severe PH with a median mean pulmonary artery pressure of 42 mm Hg (range 27-90) and a median cardiac index of 2.8 L/min/m (range 1.6-4.3). Precapillary PH was found in 22 patients, postcapillary PH in 2, and combined postcapillary and precapillary PH in 3. Severe extrinsic compression of pulmonary arteries (>60% reduction in diameter) was evidenced in 2, 8, and 12 patients at the main, lobar, or segmental levels, respectively. Fourteen patients had at least one severe pulmonary venous compression with associated pleural effusion in 6 of them. PAH therapy was initiated in 7 patients and corticosteroid therapy (0.5-1?mg/kg/day) was initiated in 3 patients with sarcoidosis, with 9 other being already on low-dose corticosteroids. At 1-year follow-up, 3 patients had died and among the 21 patients evaluated, 3 deteriorated, 14 were stable, and only 4 patients with sarcoidosis improved (4 receiving corticosteroids and 1 receiving corticosteroids and PAH therapy). Survival was 88%, 73%, and 56% at 1, 3, and 5 years, respectively.We found no clear clinical improvement with the use of specific PAH therapy. Corticosteroid therapy may be associated with clinical improvement, in some patients with fibrosing mediastinitis due to sarcoidosis. Although never performed for this indication, lung transplantation may be proposed in eligible patients with severe PH and fibrosing mediastinitis. PMID:26554778

  10. Bleeding complications in immune thrombocytopenia.

    PubMed

    Arnold, Donald M

    2015-12-01

    Bleeding manifestations in patients with immune thrombocytopenia (ITP) range from mild skin bruises to life-threatening intracranial hemorrhage (ICH). Severe bleeding is distinctly uncommon when the platelet count is >30 10(9)/L and usually only occurs when the platelet count falls <10 10(9)/L. Based on estimates from clinical studies, ITP registries and administrative databases, the frequency of ICH in patients with ITP is ?0.5% in children and 1.5% in adults. Estimates of severe (non-ICH) bleeding are difficult to obtain because of the lack of standardized case definitions; the lack of a universally accepted, ITP-specific bleeding assessment tool; and the omission of reporting bleeding outcomes in many clinical studies. In practice, the presence of bleeding should dictate whether or not treatment is needed because many patients, especially children, can be safely managed with observation alone. Guiding principles for the management of ITP, based on the bleeding risk are: (1) Decide when treatment is needed and when it can safely be withheld; (2) for patients with chronic ITP, use the least toxic treatment at the lowest dose; (3) emergency treatment of severe thrombocytopenia-associated bleeding requires combination therapy; and (4) early aggressive therapy may result in durable platelet count responses. PMID:26637728

  11. Complications associated with adjustable gastric banding for morbid obesity: a surgeons guide

    PubMed Central

    Eid, Iyad; Birch, Daniel W.; Sharma, Arya M.; Sherman, Vadim; Karmali, Shahzeer

    2011-01-01

    Laparoscopic adjustable gastric banding (LAGB) is considered to be a safe and effective method of weight loss and reduction of comorbidities associated with obesity. Despite its improved early safety profile compared with Roux-en-Y gastric bypass, patients with LAGB can manifest unique complications that must be recognized and managed appropriately to achieve good outcomes. This review will prepare the general surgeon to identify, diagnose and manage the common complications encountered in patients presenting following LAGB. PMID:21251434

  12. Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis.

    PubMed

    Sagrini, Elisabetta; Pecorelli, Anna; Pettinari, Irene; Cucchetti, Alessandro; Stefanini, Federico; Bolondi, Luigi; Piscaglia, Fabio

    2016-02-01

    Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis. PMID:26078199

  13. Complications of implantation of synthetic fibers into scalps for "hair" replacement: experience with fourteen cases.

    PubMed

    Lepaw, M I

    1979-03-01

    Fourteen cases of complications from implantation of acrylic fibers into scalps for correction of male-pattern baldness were studied. The complications were severe enough in all of them to force attempts to remove the fibers, many of which from the nature of their knotted insertion could not be extracted. Thus, immediate complications were encountered and serious, delayed, bad effects are anticipated. Among the early complications already observed are marked edema of the face; hemorrhagic oozing; microbial infection; foreign-body reactions; scarring; acneform comedones and pustules; pain, pruritus, and numbness; and loss of natural hair. Complications in the furture are likely to be progressive sclerosis from irretrievable fragments and knots of the artificial materials and conceivably malignant degeneration of tissues of the scalp. For all of these known and possible bad effects, implantation of present-day synthetic fibers into the scalp must be judged to be a dangerous practice that must be stopped at once. PMID:429673

  14. Complications with Outpatient Angiography and Interventional Procedures

    SciTech Connect

    Young, Noel; Chi, Ka-Kit; Ajaka, Joe; McKay, Lesa; O'Neill, Diane; Wong, Kai Ping

    2002-03-15

    Purpose: To prospectively identify the complications, and rates of complication, in outpatient angiography and interventional procedures. Methods: There were 1050 consecutive patients, 646 men and 404 women, aged 17-89 years, with a total of 1239 procedures studied in a 2-year period, 1997 to 1999. Results: There were 560 cases of aorto-femoral angiography,resulting in 124 complications (22%), with pain or hematoma in 110.There were 206 cases of neck and cerebral angiography, resulting in 51 complications (25%), with pain and hematoma in 34, transient ischemic attack in 2 and cerebrovascular accident in 1. There were 197 interfentional procedures, with 177 being balloon dilatations, resulting in 68 complications (35%), with 2 having hematomas and 1 having hematoma/abscess requiring active treatment. There were 276 cases having various 'other' procedures (e.g., renal angiography),resulting in 65 complications (24%), with pain and hematoma in 61. No procedure-related death occurred. Eighteen cases (1.5%) had significant complications, with contrast allergy in eight. Conclusion: Outpatient angiography and intervention are relatively safe, with low significant complication rates.

  15. A very unusual complication of amniocentesis

    PubMed Central

    Hayat, Munawar; Hill, Michael; Kelly, David; Tubbs, R Shane; Loukas, Marios

    2015-01-01

    Key Clinical Message The uses of amniocentesis are numerous, including determination of chromosomal abnormalities, lung maturity, and infections. A common complication of amniocentesis is loss of the pregnancy, but rare complications should be considered. The role of patient history and clinical observation of uncommon presentations are critical in the management of the patient. PMID:26185625

  16. Sedation-related complications in gastrointestinal endoscopy

    PubMed Central

    Amornyotin, Somchai

    2013-01-01

    Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patients age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management. PMID:24255744

  17. Melioidosis mycotic aneurysm: An uncommon complication of an uncommon disease

    PubMed Central

    Li, Philip H.; Chau, Chi Hung; Wong, Poon Chuen

    2014-01-01

    Melioidosis is often considered an exotic and uncommon disease in most parts of the world. However it is an endemic disease in Southeast Asia and Northern Australia with an expanding distribution. Melioidosis can involve almost any organ and can deteriorate rapidly. In this report, we describe a rapidly fatal case of a mycotic aneurysm associated with melioidosis despite aggressive antibiotic therapy. The morbidity and mortality of this uncommon complication remains high despite prompt diagnosis and treatment. Especially when treating persistent/recurrent melioidosis, the physician's caution to the development of mycotic aneurysms is imperative so that early treatment and surgical intervention may be considered. PMID:26029577

  18. Complications of equine wound management and dermatologic surgery.

    PubMed

    Hanson, R Reid

    2008-12-01

    Complications of wounds and cosmetic surgery can be accurately managed with a combination of timely surgical and medical intervention to ensure the best possible outcome. The lack of soft tissue protection and a large quantity of susceptible synovial, tendon, ligament, and neurovascular structures make early and meticulous evaluation of limb wounds critical. Skin grafting is usually used following a period of open wound management and after healthy granulation tissue formation. Penetrating wounds of the abdomen or thorax have a guarded prognosis resulting from the ensuing potential for infection and pneumothorax. Gunshot wounds limited to the skeletal muscles have a good prognosis, whereas injuries that involve vital organs decreased survivability. PMID:19203707

  19. The Use of Delta Neutrophil Index and Myeloperoxidase Index for Predicting Acute Complicated Appendicitis in Children

    PubMed Central

    Kim, Oh Hyun; Cha, Yong Sung; Hwang, Sung Oh; Jang, Ji Young; Choi, Eun Hee; Kim, Hyung Il; Cha, KyoungChul; Kim, Hyun; Lee, Kang Hyun

    2016-01-01

    Background In children with acute appendicitis, 30% to 75% present with a complication, such as perforation, and the early diagnosis of complications is known to improve outcomes. Serum delta neutrophil index (DNI) and myeloperoxidase index (MPXI) are new inflammatory markers, and thus, in the present study, the authors evaluated the predictive values of these two markers for the presence of a complication in children with acute appendicitis. Methods This retrospective observational study was conducted on 105 consecutive children (<12 years old) with acute appendicitis treated over a 31-month period. DNI, MPXI, C-reactive protein (CRP), and white blood cells (WBCs) were measured in an emergency department and investigated with respect to their abilities to predict the presence of acute complicated appendicitis. Results Twenty-nine of the 105 patients (median age, 9 years) were allocated to the complicated group (27.6%) and 76 to the non-complicated group (72.4%). Median serum DNI and CRP were significantly higher in the complicated group [0% vs. 2.2%, p<0.001 and 0.65 mg/dL vs. 8.0 mg/dL, p<0.001], but median MPXI was not (p = 0.316). Area under curve (AUC) for the ability of serum DNI and CRP to predict the presence of acute complicated appendicitis were 0.738 and 0.840, respectively. Multiple logistic regression analyses showed initial CRP [odds ratio 1.301, 95% confidence interval (1.092–1.549), p = 0.003] significantly predicted the presence of a complication. The optimal cutoff for serum CRP was 4.0 mg/dL (sensitivity 69%, specificity 83%, AUC 0.840). Conclusions Although serum DNI values were significantly higher in children with acute complicated appendicitis, no evidence was obtained to support the notion that serum DNI or serum MPXI aid the differentiation of acute complicated and non-complicated appendicitis in the ED setting. PMID:26859663

  20. Common post-operative complications in children

    PubMed Central

    Pawar, Dilip

    2012-01-01

    The exact incidence of common post-operative complications in children is not known. Most common one is post-operative nausea and vomiting followed by respiratory complications leading to hypoxia. Cardiac complications are less in children without associated congenital cardiac anomaly. Post-operative shivering, agitation and delirium are seen more often in children anaesthetised with newer inhalational agents like sevoflurane and desflurane. Urinary retention in the post-operative period could be influenced by anaesthetic drugs and regional blocks. The purpose of this article is to review the literature and present to the postgraduate students comprehensive information about the current understanding and practice pattern on various common complications in the post-operative period. Extensive literature was searched with key words of various complications from Pubmed, Google scholar and specific journal, namely paediatric anaesthesia. The relevant articles, review article meta-analysis and editorials were the primary source of information for this article. PMID:23293390

  1. Nutritional and metabolic complications of bariatric surgery.

    PubMed

    Malinowski, Scott S

    2006-04-01

    Bariatric surgery is an effective treatment for patients with clinically severe obesity. In addition to significant weight loss, it is also associated with improvements in comorbidities. Unfortunately, bariatric surgery also has the potential to cause a variety of nutritional and metabolic complications. These complications are mostly due to the extensive surgically induced anatomical changes incurred by the patient's gastrointestinal tract, particularly with roux-en-Y gastric bypass and biliopancreatic diversion. Complications associated with vertical banded gastroplasty are mostly due to decreased intake amounts of specific nutrients. Macronutrient deficiencies can include severe protein-calorie malnutrition and fat malabsorption. The most common micronutrient deficiencies are of vitamin B12, iron, calcium, and vitamin D. Other micronutrient deficiencies that can lead to serious complications include thiamine, folate, and the fat-soluble vitamins. Counseling, monitoring, and nutrient and mineral supplementation are essential for the treatment and prevention of nutritional and metabolic complications after bariatric surgery. PMID:16617238

  2. [Complications in the therapy of spontaneous pneumothorax].

    PubMed

    Eggeling, S

    2015-05-01

    The therapy of spontaneous pneumothorax is a common necessity in hospitals of all care hierarchies In addition to sufficient primary treatment by placement of a thorax drainage, knowledge of complicationg constellations, recognition of complications and irregular courses during the therapy of spontaneous pneumothorax are of fundamental importance for achieving a satisfactory treatment outcome. Furthermore, the enlightenment of patients regarding the pathogenesis of the disease, possible measures for influencing the recurrence rate and information about future behavioral and lifestyle modifications are important. The principal complications during hospital treatment can be subdivided into complications of the surgical placement of the thorax drain and relief of the pleural cavity, problems in the management of treatment of the pleural negative pressure, the possibly demanding management of a persisting air leak and the individualized decision-making with respect to an interventional or operative procedure. The most common complicating constellations and possible complications during the inpatient hospital stay are described, the. PMID:25995086

  3. Wisdom tooth--complications in extraction.

    PubMed

    Agrawal, Amiya; Yadav, Arvind; Chandel, Siddhartha; Singh, Nishi; Singhal, Ankita

    2014-01-01

    The purpose of this study is to analyze the incidence of complications in a group of 171 patients in whom extractions of impacted mandibular third molar have been performed by two oral surgeons between the period April 2010 and March 2012. This retrospective study comprises evaluation of 270 impacted mandibular third molars which were classified into two groups A and B on the basis of procedure of osteotomy only and osteotomy and odontotomy both respectively. Total no of complications reported were 40 (14.81%). Maximum no of cases reported alveolar osteitis (AO) (11.11%) while other complications reported root tip fractures (2.22%), lingual nerve parasthesia and TMJ problems (each 0.74%) in descending frequency. Conclusion drawn is that the risk of complications in extractions of impacted mandibular third molars always exists, and extractions associated with both osteotomy and odontotomy are associated with higher risk of complications. PMID:24939262

  4. Complications of surgery for radiotherapy skin damage

    SciTech Connect

    Rudolph, R.

    1982-08-01

    Complications of modern surgery for radiotherapy skin damage reviewed in 28 patients who had 42 operations. Thin split-thickness skin grafts for ulcer treatment had a 100 percent complication rate, defined as the need for further surgery. Local flaps, whether delayed or not, also had a high rate of complications. Myocutaneous flaps for ulcers had a 43 percent complication rate, with viable flaps lifting off radiated wound beds. Only myocutaneous flaps for breast reconstruction and omental flaps with skin grafts and Marlex mesh had no complications. The deeper tissue penetration of modern radiotherapy techniques may make skin grafts and flaps less useful. In reconstruction of radiation ulcers, omental flaps and myocutaneous flaps are especially useful, particularly if the radiation damage can be fully excised. The pull of gravity appears detrimental to myocutaneous flap healing and, if possible, should be avoided by flap design.

  5. Ocular Complications of Inflammatory Bowel Disease

    PubMed Central

    Mady, Rana; Grover, Will; Butrus, Salim

    2015-01-01

    Though inflammatory bowel disease (IBD) has a specific predilection for the intestinal tract, it is a systemic inflammatory disorder affecting multiple organs, including the eye. Ocular complications directly related to IBD are categorized as primary and secondary. Primary complications are usually temporally associated with IBD exacerbations and tend to resolve with systemic treatment of the intestinal inflammation. These include keratopathy, episcleritis, and scleritis. Secondary complications arise from primary complications. Examples include cataract formation due to treatment with corticosteroids, scleromalacia due to scleritis, and dry eye due to hypovitaminosis A following gut resection. Some ocular manifestations of IBD can lead to significant visual morbidity and temporally associated complications can also be a herald of disease control. Furthermore, ocular manifestations of IBD can occasionally manifest before the usual intestinal manifestations, leading to an earlier diagnosis. Thus, it is important to understand the clinical presentation of possible ocular manifestations in order to initiate appropriate treatment and to help prevent significant visual morbidity. PMID:25879056

  6. Current State of Art Management for Vascular Complications after Liver Transplantation

    PubMed Central

    Hejazi Kenari, S. Kamran; Zimmerman, Asha; Eslami, Mohammad; F. Saidi, Reza

    2014-01-01

    Vascular complications by compromising the blood flow to the allograft can have significant and sometimes life-threating consequences for the patient. High level of suspicion and aggressive utilization of diagnostic modalities can lead to early diagnosis and salvage of the allograft. This review will summarize the current trends in the management of vascular complications after liver transplantation. Current trends show an increase in the utilization of endovascular interventions initially to address vascular complications after liver transplantation. Operative repair still has its major role, especially if endovascular procedures fail. PMID:25093059

  7. Acute Complications of Myocardial Infarction in the Current Era: Diagnosis and Management.

    PubMed

    Bajaj, Anurag; Sethi, Ankur; Rathor, Parul; Suppogu, Nissi; Sethi, Arjinder

    2015-10-01

    Coronary heart disease is a major cause of mortality and morbidity worldwide. The incidence of mechanical complications of acute myocardial infarction (AMI) has gone down to less than 1% since the advent of percutaneous coronary intervention, but although mortality resulting from AMI has gone down in recent years, the burden remains high. Mechanical complications of AMI include cardiogenic shock, free wall rupture, ventricular septal rupture, acute mitral regurgitation, and right ventricular infarction. Detailed knowledge of the complications and their risk factors can help clinicians in making an early diagnosis. Prompt diagnosis with appropriate medical therapy and timely surgical intervention are necessary for favorable outcomes. PMID:26295381

  8. [Diagnosis and treatment of complications after laparoscopic Roux-en-Y gastric bypass].

    PubMed

    Mao, Zhong-qi

    2012-11-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) has become the gold standard operation for morbid obesity, because effects of LRYGB are quick and lasting. However, there are many potential risks due to the operative complexity and long learning curve. There are early and late complications after LRYGB. If the complications are not diagnosed and treated in time and correctly, serious results even death, may occur. Mortality after LRYGB is 0.87%. It is important for the continous and healthy development of LRYGB that postoperative complications can be diagnosed and managed in time and effectively. PMID:23326916

  9. Candida vascular complication in a liver transplant recipient due to yeast contamination of preservation solution.

    PubMed

    Levesque, E; Suet, G; Merle, J C; Compagnon, P; Amathieu, R; Feray, C; Botterel, F; Foulet, F; Azoulay, D; Dhonneur, G

    2014-10-01

    Infections remain a major cause of morbidity and mortality after liver transplantation. One possible cause of infection is preservation fluid contamination. Donor-derived pathogens, such as Candida albicans, have occasionally produced life-threatening complications in organ recipients, already described in renal transplantation. In the present case, we report the loss of a liver graft secondary to vascular complications because of C.albicans found in the preservation fluid. Our case report raises the question of implementing procedures, similar to those in renal transplantation, including early antifungal treatment and repeated radiological monitoring for the prevention and detection of vascular complications. PMID:24981194

  10. Postoperative Complications in the Tube Versus Trabeculectomy (TVT) Study During Five Years of Follow-up

    PubMed Central

    Gedde, Steven J.; Herndon, Leon W.; Brandt, James D.; Budenz, Donald L.; Feuer, William J.; Schiffman, Joyce C.

    2013-01-01

    Purpose To describe postoperative complications encountered in the Tube Versus Trabeculectomy (TVT) Study during 5 years of follow-up. Design Multicenter randomized clinical trial. Methods Settings Seventeen clinical centers. Study Population Patients 18 to 85 years of age who had previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure (IOP) ?18 mm Hg and ?40 mm Hg on maximum tolerated medical therapy. Interventions Tube shunt (350-mm2 Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC 0.4 mg/mL for 4 minutes). Main Outcome Measures Surgical complications, reoperations for complications, visual acuity, and cataract progression. Results Early postoperative complications occurred in 22 patients (21%) in the tube group and 39 patients (37%) in the trabeculectomy group (P = .012). Late postoperative complications developed in 36 patients (34%) in the tube group and 38 patients (36%) in the trabeculectomy group during 5 years of follow-up (P = .81). The rate of reoperation for complications was 22% in the tube group and 18% in the trabeculectomy group (P = .29). Cataract extraction was performed in 13 phakic eyes (54%) in the tube group and 9 phakic eyes (43%) in the trabeculectomy group (P = .43). Conclusions A large number of surgical complications were observed in the TVT Study, but most were transient and self-limited. The incidence of early postoperative complications was higher following trabeculectomy with MMC than tube shunt surgery. The rates of late postoperative complications, reoperation for complications, and cataract extraction were similar with both surgical procedures after 5 years of follow-up. PMID:22244522

  11. Complications of immobilization and bed rest. Part 1: Musculoskeletal and cardiovascular complications.

    PubMed Central

    Dittmer, D. K.; Teasell, R.

    1993-01-01

    Prolonged bed rest and immobilization inevitably lead to complications. Such complications are much easier to prevent than to treat. Musculoskeletal complications include loss of muscle strength and endurance, contractures and soft tissue changes, disuse osteoporosis, and degenerative joint disease. Cardiovascular complications include an increased heart rate, decreased cardiac reserve, orthostatic hypotension, and venous thromboembolism. Images Figures 1-2 Figures 3-4 PMID:8324411

  12. [Clinical and bacteriological characteristic of infectious purulent complications in patients after related renal transplantation].

    PubMed

    Volynchik, E P; Bol'shakov, L V; Bogomolova, N S; Kuznetsova, S M

    2014-01-01

    We investigated the frequency and characteristics of infectious purulent and non-infectious complications in living related renal transplant recipients in early postoperative period. It was identified the prevalent microorganisms in urinary tract infections and its antibiotic sensitivity: Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Citrobacter freundii, Staphylococcus epidermidis, Enterococcus faecalis, Candida albicans. 182 strains of bacteria and Candida were isolated from urine of renal graft patients in early postoperative period (from 2 days to 3 months). The prevention and treatment schemes, antimicrobial drugs dosing regimen were developed. It leads to decrease the infectious complications rate. PMID:25327674

  13. Gastrointestinal variant of Lemierre's syndrome complicating ruptured appendicitis

    PubMed Central

    Akhrass, Fadi Al; Abdallah, Lina; Berger, Steven; Sartawi, Rami

    2015-01-01

    Fusobacterium necrophorum is a non-spore-forming, obligate anaerobic, filamentous, gramnegative bacillus that frequently colonizes the human oral cavity, respiratory tract, and gastrointestinal tract. Fusobacterium species have rarely been implicated in cases of gastrointestinal variant of Lemierre's syndrome. We describe a case of F. necrophorum bacteremia associated with suppurative porto-mesenteric vein thrombosis (PVT) following acute ruptured appendicitis. In addition, we list the documented twelve cases of Fusobacterium pylephlebitis. Recanalization of the porto-mesenteric veins and relief of the extrahepatic portal hypertension were achieved with early empiric antibiotic and local thrombolytic therapy. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of suppurative PVT after disruption of the gastrointestinal mucosa following an acute intraabdominal infectious process. Early treatment of this condition using anticoagulation and endovascular thrombolysis as adjunctive therapies may prevent PVT complications. PMID:26793462

  14. COMPLICATIONS OF JOINT, TENDON, AND MUSCLE INJECTIONS.

    PubMed

    Cheng, Jianguo; Abdi, Salahadin

    2007-07-01

    Prevention of complications is one of the most important aspects of patient care in pain management. The objective of this study is to review documented complications in medical literature that are associated with interventional pain management, specifically those associated with joint, tendon, and muscle injections. We conducted Medline research from 1966 to November 2006 using keywords complication, injection, radiofrequency, closed claim, facet, zygophyseal joint, sacroiliac joint, shoulder, hip, knee, carpel tunnel, bursa, and trigger point. We found over 35 relevant papers in forms of original articles, case reports, and reviews. The most common complications appear to be infections that have been associated with virtually all of these injections. These infections include spondylodiscitis, septic arthritis, epidural abscess, necrotizing fasciitis, osteomyelitis, gas gangrene, and albicans arthritis. Other complications include spinal cord injury and peripheral nerve injuries, pneumothorax, air embolism, pain or swelling at the site of injection, chemical meningism, granulomatous inflammation of the synovium, aseptic acute arthritis, embolia cutis medicamentosa, skeletal muscle toxicity, and tendon and fascial ruptures. We suggest that many of the infectious complications may be preventable by strict adherence to aseptic techniques and that some of the other complications may be minimized by refining the procedural techniques with a clear understanding of the relevant anatomies. PMID:18591992

  15. Epidemiology of Intratemporal Complications of Otitis Media

    PubMed Central

    Maranhão, André; Andrade, José; Godofredo, Valéria; Matos, Rafaela; Penido, Norma

    2014-01-01

    Introduction Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC) were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33%) individuals, the diagnosis was chronic otitis media; for 1,224 (67%), the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis). Labyrinthine fistulae were diagnosed in 7 (36.8%) individuals, mastoiditis in 5 (26.3%), facial palsy in 4 (21.1%), and labyrinthitis in 3 (15.8%). Conclusion The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication. PMID:25992087

  16. Management of chronic pancreatitis complicated with a bleeding pseudoaneurysm

    PubMed Central

    Chiang, Kun-Chun; Chen, Tsung-Hsing; Hsu, Jun-Te

    2014-01-01

    Chronic pancreatitis is an ongoing disease characterized by persistent inflammation of pancreatic tissues. With disease progression, patients with chronic pancreatitis may develop troublesome complications in addition to exocrine and endocrine pancreatic functional loss. Among them, a pseudoaneurysm, mainly induced by digestive enzyme erosion of vessels in proximity to the pancreas, is a rare and life-threatening complication if bleeding of the pseudoaneurysm occurs. At present, no prospective randomized trials have investigated the therapeutic strategy for this rare but critical situation. The role of arterial embolization, the timing of surgical intervention and even surgical procedures are still controversial. In this review, we suggest that dynamic abdominal computed tomography and angiography should be performed first to localize the bleeders and to evaluate the associated complications such as pseudocyst formation, followed by arterial embolization to stop the bleeding and to achieve early stabilization of the patients condition. With advances and improvements in endoscopic devices and techniques, therapeutic endoscopy for pancreatic pseudocysts is technically feasible, safe and effective. Surgical intervention is recommended for a bleeding pseudoaneurysm in patients with chronic pancreatitis who are in an unstable condition, for those in whom arterial embolization of the bleeding pseudoaneurysm fails, and when endoscopic management of the pseudocyst is unsuccessful. If a bleeding pseudoaneurysm is located over the tail of the pancreas, resection is a preferential procedure, whereas if the lesion is situated over the head or body of the pancreas, relatively conservative surgical procedures are recommended. PMID:25473165

  17. Nutrition in the Management of Cirrhosis and its Neurological Complications

    PubMed Central

    Bémeur, Chantal; Butterworth, Roger F.

    2013-01-01

    Malnutrition is a common feature of chronic liver diseases that is often associated with a poor prognosis including worsening of clinical outcome, neuropsychiatric complications as well as outcome following liver transplantation. Nutritional assessment in patients with cirrhosis is challenging owing to confounding factors related to liver failure. The objectives of nutritional intervention in cirrhotic patients are the support of liver regeneration, the prevention or correction of specific nutritional deficiencies and the prevention and/or treatment of the complications of liver disease per se and of liver transplantation. Nutritional recommendations target the optimal supply of adequate substrates related to requirements linked to energy, protein, carbohydrates, lipids, vitamins and minerals. Some issues relating to malnutrition in chronic liver disease remain to be addressed including the development of an appropriate well-validated nutritional assessment tool, the identification of mechanistic targets or therapy for sarcopenia, the development of nutritional recommendations for obese cirrhotic patients and liver-transplant recipients and the elucidation of the roles of vitamin A hepatotoxicity, as well as the impact of deficiencies in riboflavin and zinc on clinical outcomes. Early identification and treatment of malnutrition in chronic liver disease has the potential to lead to better disease outcome as well as prevention of the complications of chronic liver disease and improved transplant outcomes. PMID:25755550

  18. Nutrition in the management of cirrhosis and its neurological complications.

    PubMed

    Bmeur, Chantal; Butterworth, Roger F

    2014-06-01

    Malnutrition is a common feature of chronic liver diseases that is often associated with a poor prognosis including worsening of clinical outcome, neuropsychiatric complications as well as outcome following liver transplantation. Nutritional assessment in patients with cirrhosis is challenging owing to confounding factors related to liver failure. The objectives of nutritional intervention in cirrhotic patients are the support of liver regeneration, the prevention or correction of specific nutritional deficiencies and the prevention and/or treatment of the complications of liver disease per se and of liver transplantation. Nutritional recommendations target the optimal supply of adequate substrates related to requirements linked to energy, protein, carbohydrates, lipids, vitamins and minerals. Some issues relating to malnutrition in chronic liver disease remain to be addressed including the development of an appropriate well-validated nutritional assessment tool, the identification of mechanistic targets or therapy for sarcopenia, the development of nutritional recommendations for obese cirrhotic patients and liver-transplant recipients and the elucidation of the roles of vitamin A hepatotoxicity, as well as the impact of deficiencies in riboflavin and zinc on clinical outcomes. Early identification and treatment of malnutrition in chronic liver disease has the potential to lead to better disease outcome as well as prevention of the complications of chronic liver disease and improved transplant outcomes. PMID:25755550

  19. Switching antiretroviral therapy to minimize metabolic complications

    PubMed Central

    Lake, Jordan E; Currier, Judith S

    2011-01-01

    Advances in HIV therapy have made living with HIV for decades a reality for many patients. However, antiretroviral therapy has been associated with multiple long-term complications, including dyslipidemia, fat redistribution, insulin resistance and increased cardiovascular risk. As newer agents with improved metabolic profiles have become available, there is growing interest in the safety and efficacy of switching ART as a strategy to reduce long-term complications. This article reviews recently published data on switching ART to minimize the contributions of specific agents to these complications. PMID:22171239

  20. Pregnancy complications and neuropsychological outcomes: A review.

    PubMed

    Gerner, Gwendolyn; Baron, Ida Sue

    2015-01-01

    Pregnancy complications elevate risk of associated adverse medical, socioenvironmental, and behavioral outcomes in children. These are likely to have a substantial impact on neuropsychological functioning and mental health across the child's lifespan. Thus, an understanding of the complex relationships between pregnancy complications and neuropsychological outcomes is critical for both practitioners and researchers. This review summarizes prevalent pregnancy complications and the associated psychological and neuropsychological findings, highlighting methodological challenges that have restricted investigations of these outcomes and identifying opportune areas for future study. PMID:24801883

  1. Management of complications in glaucoma surgery

    PubMed Central

    Vijaya, Lingam; Manish, Panday; Ronnie, George; Shantha, B

    2011-01-01

    Surgical option for glaucoma is considered when other modalities are not working out to keep the intraocular pressure under control. Since the surgical procedures for glaucoma disrupt the integrity of the globe, they are known to produce various complications. Some of those complications can be vision-threatening. To minimize the morbidity, it is very important that one should know how to prevent them, recognize them and treat them. The objective of this article is to provide insight into some of those complications that will help the ophthalmologists in treating glaucoma patients in their clinical practice. PMID:21150025

  2. Complications of 1303 central venous cannulations.

    PubMed

    Yilmazlar, A; Bilgin, H; Korfali, G; Eren, A; Ozkan, U

    1997-06-01

    Central venous catheterization (CVC), now a common procedure, has several major complications. We assessed their incidence in a prospective study of 1303 cannulations done in the intensive care unit or operating theatre. Chest radiographs were obtained to verify proper catheter placement and to detect pneumothorax. Complications were arterial puncture in 68 (5.2%) patients, arrhythmias in 21 (1.6%), cardiopulmonary arrest in 1 (0.1%), and pneumothorax in 5 (0.5%). The tip of the CVC was incorrectly located in 149 (11.2%). The chest radiograph was a valuable method for detecting complications of central venous catheterization. PMID:9227379

  3. Complications of 1303 central venous cannulations.

    PubMed Central

    Yilmazlar, A; Bilgin, H; Korfali, G; Eren, A; Ozkan, U

    1997-01-01

    Central venous catheterization (CVC), now a common procedure, has several major complications. We assessed their incidence in a prospective study of 1303 cannulations done in the intensive care unit or operating theatre. Chest radiographs were obtained to verify proper catheter placement and to detect pneumothorax. Complications were arterial puncture in 68 (5.2%) patients, arrhythmias in 21 (1.6%), cardiopulmonary arrest in 1 (0.1%), and pneumothorax in 5 (0.5%). The tip of the CVC was incorrectly located in 149 (11.2%). The chest radiograph was a valuable method for detecting complications of central venous catheterization. Images Figure 1 Figure 2 Figure 3 PMID:9227379

  4. Surgical Management of Complicated Colon Cancer.

    PubMed

    Lee-Kong, Steven; Lisle, David

    2015-12-01

    The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management. Adherence to traditional surgical oncologic principles must often be balanced with the patients' clinical presentation and other parameters. While the goal of an R0 (no residual microscopic disease) resection must always be kept in mind, situations sometimes arise which can make this difficult to achieve. Recognition of complicated disease and availability of varied therapeutic modalities is important to ensure favorable patient outcomes. This review will discuss the surgical management of complicated colon cancer, with special focus on locally advanced disease. PMID:26648793

  5. Medical Complications of Anorexia Nervosa and Bulimia.

    PubMed

    Westmoreland, Patricia; Krantz, Mori J; Mehler, Philip S

    2016-01-01

    Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders. PMID:26169883

  6. Esophagectomy and Gastric Pull-through Procedures: Surgical Techniques, Imaging Features, and Potential Complications.

    PubMed

    Flanagan, Jennifer C; Batz, Richard; Saboo, Sachin S; Nordeck, Shaun M; Abbara, Suhny; Kernstine, Kemp; Vasan, Vasantha

    2016-01-01

    Esophagectomy takes the center stage in the curative treatment of local and local-regional esophageal cancer. It is a complex procedure with a high postoperative complication rate. When interpreting imaging studies, radiologists must understand the surgical techniques used and their potential complications. The most common surgical techniques are transthoracic esophagectomies, such as the Ivor Lewis and McKeown techniques, and transhiatal esophagectomy. Variations of these techniques include different choices of conduit (ie, stomach, colon, or jejunum) to serve in lieu of the resected esophagus. Postoperative imaging and accurate interpretation is vital in the aftercare of these patients. Chest radiographs, esophagrams, and computed tomographic images play an essential role in early identification of complications. Pulmonary complications and anastomotic leaks are the leading causes of postoperative morbidity and mortality secondary to esophagectomy. Other complications include technical and functional problems and delayed complications such as anastomotic strictures and disease recurrence. An esophagographic technique is described that is performed by using hand injection of contrast material into an indwelling nasogastric tube. Familiarity with the various types of esophagectomy and an understanding of possible complications are of utmost importance for radiologists and allow them to be key participants in the treatment of patients undergoing these complicated procedures. (©)RSNA, 2016. PMID:26761533

  7. Complications and Continuation of Intrauterine Device Use Among Commercially Insured Teenagers

    PubMed Central

    Berenson, Abbey B.; Tan, Alai; Hirth, Jacqueline M.; Wilkinson, Gregg S.

    2014-01-01

    Objective Many U.S. providers remain reluctant to prescribe intrauterine devices (IUDs) to teenagers due to concerns about serious complications. This study examined whether 1519 year-old IUD users were more likely to experience complications, failure, or early discontinuation than adult users aged 2024 and 2544 years and whether there were differences in between users of levonorgestrel-releasing intrauterine systems and copper IUDs. Methods A retrospective cohort study was conducted using health insurance claims obtained from a private insurance company of 90,489 women who had an IUD inserted between 2002 and 2009. Logistic regression models were used to estimate the odds of experiencing complications, method failure, or early discontinuation within 12 months of insertion by age group and type of IUD inserted. Results Serious complications, including ectopic pregnancy and pelvic inflammatory disease, occurred in less than 1% of patients regardless of age or IUD type. Women aged 1519 years were more likely than those aged 2544 years to have a claim for dysmenorrhea OR=1.4, CI=1.1, 1.6), amenorrhea (OR=1.3, CI=1.1, 1.5), or normal pregnancy (OR=1.4, CI=1.1, 1.8). Overall, early discontinuation did not differ between teenagers and women aged 2544 years (13% vs. 11%, p>.05). However, use of the levonorgestrel-releasing intrauterine system was associated with fewer complications and less early discontinuation than the copper IUD in all age groups. Conclusions The IUD is as appropriate for teenagers to use as it is for older women, with serious complications occurring infrequently in all groups. The levonorgestrel-releasing intrauterine system may be a better choice than copper IUD due to lower odds of complications, discontinuation, and failure. PMID:23635730

  8. Superior mesenteric artery syndrome complicating staged corrective surgery for scoliosis.

    PubMed

    Pan, Chee-Huan; Tzeng, Shiau-Tzu; Chen, Chiang-Sang; Chen, Po-Quang

    2007-02-01

    Superior mesenteric artery syndrome (SMAS) is a rare complication following correction of scoliosis with either nonoperative or operative methods. If the patient diagnosed with this syndrome is not managed timely and adequately, mortality may result. We report two cases of SMAS complicating staged corrective surgery for scoliosis using modern segmental derotation instrumentation system. The aim of this report is to highlight the clinical presentations, laboratory findings, radiologic features, and management of the syndrome. The first patient had the syndrome after two-staged scoliosis surgery with halo traction between two stages, and the second patient after three-staged scoliosis surgery with halo traction between the first and second surgeries. The first patient responded well to conservative treatment. However, the second patient failed to respond to conservative treatment and needed a gastrojejunostomy operation to bypass the duodenal obstruction. Clinicians treating post scoliosis surgery patients should always have a high index of suspicion for this potential life-threatening condition. Early diagnosis will enable a multidisciplinary team approach to be initiated early to provide optimal care for the patient. Nutritional and fluid supplementation is mandatory during conservative treatment. The duration for trial of conservative treatment should not exceed 1 week. PMID:17493895

  9. Haemophilus influenzae Disease (Including Hib) Complications

    MedlinePLUS

    ... Links Global Hib Vaccination Hib Vaccination Meningitis Pneumonia Sepsis Complications Recommend on Facebook Tweet Share Compartir Most ... Links Global Hib Vaccination Hib Vaccination Meningitis Pneumonia Sepsis File Formats Help: How do I view different ...

  10. Severe Burn Injuries Complicating Psychogenic Polydipsia

    PubMed Central

    Xin, G.; Zhang, Y.; Zeng, Y.; Zou, L.; Zou, X.; Wang, S.; He, Y.

    2009-01-01

    Summary In rare cases, psychogenic polydipsia may develop as a post-burn complication, prevalently concerning females. Two such cases are reported, both in female patients. Their treatment and outcome are described. PMID:21991155

  11. Long-Term Complications of Diabetes

    MedlinePLUS

    ... vessel problems, as well as other diabetes complications. Gum Disease People with diabetes are more likely than others to develop gum disease (also called periodontal disease) because they may ...

  12. Late Complication of Laparoscopic Sleeve Gastrectomy

    PubMed Central

    Assalia, Ahmad; Kluger, Yoram

    2013-01-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested. PMID:23662218

  13. Late complication of laparoscopic sleeve gastrectomy.

    PubMed

    Dakwar, Anthony; Assalia, Ahmad; Khamaysi, Iyad; Kluger, Yoram; Mahajna, Ahmad

    2013-01-01

    Laparoscopic sleeve gastrectomy (LSG) is gaining popularity for the treatment of morbid obesity. It is a simple, low-cost procedure resulting in significant weight loss within a short period of time. LSG is a safe procedure with a low complication rate. The complications encountered nevertheless can result in morbidity and even mortality. The most significant complications are staple-line bleeding, stricture, and staple-line leak. The purpose of this paper is to present a patient who suffered from a staple-line leak presenting 16 months after LSG. Review of the current literature regarding this complication as well as outline of a strategy for the management of post-LSG gastric leaks is suggested. PMID:23662218

  14. [Temporal bone surgery. Surgical sequelae and complications].

    PubMed

    Linder, T E; Lin, F

    2011-10-01

    The saying "no surgery, no surgical complications" is certainly true for all specialties. Three categories of undesired events may occur following surgery: surgical sequelae, failure to cure and complications. A critical self-analysis of surgical complications often reveals that these arise in vexing fashion according to Murphy's law, i.e. "what can go wrong, will go wrong". Incomplete preoperative evaluation, insufficient exposure of the surgical field, failure to identify surgical landmarks and misjudgment of the patient's preoperative complaints may culminate in an undesired surgical outcome. Modern preoperative radiology, the possibilities of actual or even virtual temporal bone drilling in the laboratory and the surgeon's level of experience all ensure the relative rarity of relevant surgical complications in otology. PMID:21858517

  15. Avoidance and Management of Stomal Complications

    PubMed Central

    Kwiatt, Michael; Kawata, Michitaka

    2013-01-01

    The construction of an intestinal stoma is fraught with complications and should not be considered a trivial undertaking. Serious complications requiring immediate reoperations can occur, as can minor problems that will subject the patient to daily and nightly distress. Intestinal stomas undoubtedly will dramatically change lifestyles; patients will experience physiologic and psychologic detriment with stoma-related problems, however minor they may seem. Common complications include poor stoma siting, high output, skin irritation, ischemia, retraction, parastomal hernia (PH), and prolapse. Surgeons should be cognizant of these complications before, during, and after stoma creation, and adequate measures should be taken to avoid them. In this review, the authors highlight these often seen problems and discuss management and prevention strategies. PMID:24436659

  16. Cirrhosis and its complications: Evidence based treatment

    PubMed Central

    Nusrat, Salman; Khan, Muhammad S; Fazili, Javid; Madhoun, Mohammad F

    2014-01-01

    Cirrhosis results from progressive fibrosis and is the final outcome of all chronic liver disease. It is among the ten leading causes of death in United States. Cirrhosis can result in portal hypertension and/or hepatic dysfunction. Both of these either alone or in combination can lead to many complications, including ascites, varices, hepatic encephalopathy, hepatocellular carcinoma, hepatopulmonary syndrome, and coagulation disorders. Cirrhosis and its complications not only impair quality of life but also decrease survival. Managing patients with cirrhosis can be a challenge and requires an organized and systematic approach. Increasing physicians’ knowledge about prevention and treatment of these potential complications is important to improve patient outcomes. A literature search of the published data was performed to provide a comprehensive review regarding the management of cirrhosis and its complications. PMID:24833875

  17. Urinary Protein Profiles in a Rat Model for Diabetic Complications*

    PubMed Central

    Schlatzer, Daniela M.; Dazard, Jean-Eudes; Dharsee, Moyez; Ewing, Rob M.; Ilchenko, Serguei; Stewart, Ian; Christ, George; Chance, Mark R.

    2009-01-01

    Diabetes mellitus is estimated to affect ?24 million people in the United States and more than 150 million people worldwide. There are numerous end organ complications of diabetes, the onset of which can be delayed by early diagnosis and treatment. Although assays for diabetes are well founded, tests for its complications lack sufficient specificity and sensitivity to adequately guide these treatment options. In our study, we employed a streptozotocin-induced rat model of diabetes to determine changes in urinary protein profiles that occur during the initial response to the attendant hyperglycemia (e.g. the first two months) with the goal of developing a reliable and reproducible method of analyzing multiple urine samples as well as providing clues to early markers of disease progression. After filtration and buffer exchange, urinary proteins were digested with a specific protease, and the relative amounts of several thousand peptides were compared across rat urine samples representing various times after administration of drug or sham control. Extensive data analysis, including imputation of missing values and normalization of all data was followed by ANOVA analysis to discover peptides that were significantly changing as a function of time, treatment and interaction of the two variables. The data demonstrated significant differences in protein abundance in urine before observable pathophysiological changes occur in this animal model and as function of the measured variables. These included decreases in relative abundance of major urinary protein precursor and increases in pro-alpha collagen, the expression of which is known to be regulated by circulating levels of insulin and/or glucose. Peptides from these proteins represent potential biomarkers, which can be used to stage urogenital complications from diabetes. The expression changes of a pro-alpha 1 collagen peptide was also confirmed via selected reaction monitoring. PMID:19497846

  18. Complications and Outcomes of Primary Phacotrabeculectomy with Mitomycin C in a Multi-Ethnic Asian Population

    PubMed Central

    Sng, Chelvin; Aquino, Maria C.; Chew, Paul

    2015-01-01

    Purpose To determine the occurrence of intraoperative and postoperative complications up to three years after primary phacotrabeculectomy with intraoperative use of Mitomycin C (MMC) in primary open angle (POAG) and primary angle closure glaucoma (PACG) patients, and the effect of postoperative complications on surgical outcome. Methods Retrospective review of 160 consecutive patients with POAG (n = 105) and PACG (n = 55), who underwent primary phacotrabeculectomy with MMC at the National University Hospital, Singapore, from January 1, 2008 to December 31, 2010. Data was collected using a standardized form that included patient demographic information, ocular characteristics and postoperative complications, including hypotony (defined as intraocular pressure < 6 mmHg), shallow anterior chamber (AC) and hyphema. Results The mean age standard deviation (SD) of patients was 68.2 8.2 years. No patient lost light perception during duration of follow-up. 77% of the postoperative complications occurred within the first month only. The commonest complications were hypotony (n = 41, 25.6%), hyphema (n = 16, 10.0%) and shallow AC (n = 16, 10.0%). Five patients (3.1%) required reoperation for their complications. Early hypotony (defined as hypotony < 30 days postoperatively) was an independent risk factor for surgical failure (hazard ratio [HR], 5.1; 95% CI, 1.616.2; p = 0.01). Hypotony with another complication was also a risk factor for surgical failure (p < 0.02). Conclusions Hypotony, hyphema and shallow AC were the commonest postoperative complications in POAG and PACG patients after phacotrabeculectomy with MMC. Most complications were transient and self-limiting. Early hypotony within the first month was a significant risk factor for surgical failure. PMID:25775362

  19. Neurologic Complications of Extracorporeal Membrane Oxygenation

    PubMed Central

    Rabinstein, Alejandro A

    2015-01-01

    Background and Purpose The rate and outcomes of neurologic complications of patients receiving extracorporeal membrane oxygenation (ECMO) are poorly understood. The purpose of this study was to identify these parameters in ECMO patients. Methods All patients receiving ECMO were selected from the Nationwide Inpatient Sample between 2001-2011. The rate and outcomes of neurologic complications [acute ischemic stroke, intracranial hemorrhage (ICH), and seizures] among these patients was determined. Discharge status, mortality, length of stay, and hospitalization costs were compared between patients with and without neurologic complications using chi-squared tests for categorical variables and Student's t-test for continuous variables. Results In total, 23,951 patients were included in this study, of which 2,604 (10.9%) suffered neurologic complications of seizure (4.1%), stroke (4.1%), or ICH (3.6%). When compared to patients without neurologic complications, acute ischemic stroke patients had significantly higher rates of discharge to a long-term facility (12.2% vs. 6.8%, p<0.0001) and a significantly longer mean length of stay (41.6 days vs. 31.9 days, p<0.0001). ICH patients had significantly higher rates of discharge to a long-term facility (9.5% vs. 6.8%, p=0.007), significantly higher mortality rates (59.7% vs. 50.0%, p<0.0001), and a significantly longer mean length of stay (41.8 days vs. 31.9 days) compared to patients without neurologic complications. These outcomes did not differ significantly between seizure patients and patients without neurologic complications. Conclusions Given the increasing utilization of ECMO and the high costs and poor outcomes associated with neurologic complications, more research is needed to help determine the best way to prevent these sequelae in this patient population. PMID:26320848

  20. Complication Avoidance in Endoscopic Skull Base Surgery.

    PubMed

    Horowitz, Peleg M; DiNapoli, Vincent; Su, Shirley Y; Raza, Shaan M

    2016-02-01

    Endoscopic endonasal approaches to the skull base pathology have developed and evolved dramatically over the past 2 decades, particularly with collaboration between neurosurgery and otolaryngology physicians. These advances have increased significantly the use of such approaches beyond just resection of pituitary adenomas, including a variety of skull base pathologies. As the field has evolved, so has our understanding of the complications accompanying endoscopic skull base surgery, as well as techniques to both avoid and manage these complications. These are discussed here. PMID:26614840

  1. Emergency complications of labor and delivery.

    PubMed

    Gianopoulos, J G

    1994-02-01

    The care of the pregnant patient presenting to the emergency department with labor or delivery complications requires an understanding of signs and symptoms of disease for the maternal and fetal patient. This article reviews management of common labor and delivery complications that may occur in the emergency department. The management of premature labor, premature rupture of the membranes, emergency delivery procedure, resolution of shoulder dystocia, prolapsed umbilical cord, and perimortem cesarean section are discussed. PMID:8306932

  2. Cervical plate fracture: a rare complication

    PubMed Central

    Veli, Citisli; Muhammet, Ibrahimoglu; Serkan, Civlan; Murat, Kocaoglu

    2015-01-01

    In traumatic and degenerative diseases cervical fusion with anterior cervical plate are commonly used. The increase in the use of cervical plate segment level is also increased risk of developing complications. This case report shows that the increase in the use of cervical plate segment level and also the complications in cervical spinal instrumentation, short-segment cervical plate rare case reported to be broken. PMID:26161189

  3. Complications of pericardiocentesis: A clinical synopsis

    PubMed Central

    Kumar, Rajan; Sinha, Archana; Lin, Maggie J; Uchino, Reina; Butryn, Tracy; OMara, M Shay; Nanda, Sudip; Shirani, Jamshid; Stawicki, Stanislaw P

    2015-01-01

    Pericardiocentesis (PC) is both a diagnostic and a potentially life-saving therapeutic procedure. Currently echocardiography-guided pericardiocentesis is considered the standard clinical practice in the treatment of large pericardial effusions and cardiac tamponade. Although considered relatively safe, this invasive procedure may be associated with certain risks and potentially serious complications. This review provides a summary of pericardiocentesis and a focused overview of the potential complications of this procedure. PMID:26557491

  4. Pleural space complications associated with lung transplantation.

    PubMed

    Arndt, Andrew; Boffa, Daniel J

    2015-01-01

    Lung transplantation represents a life-saving option for some end-stage lung diseases. Despite the magnitude of anatomic manipulation and the fragility of the patient population, the procedures have become progressively safer. Perioperative morbidity, however, remains high. Pleural space complications are particularly common. This article discusses hemothorax, chylothorax, air leak or pneumothorax, recurrent effusion, empyema, trapped lung, and chronic pleural complications. PMID:25430432

  5. Complications of selective laser trabeculoplasty: a review

    PubMed Central

    Song, Julia

    2016-01-01

    Selective laser trabeculoplasty is a laser treatment to treat glaucoma. It was initially indicated for open-angle glaucoma but has been proven to be efficacious for various types of glaucoma. This review article summarizes the few rare complications that can be seen with selective laser trabeculoplasty. It also makes recommendations on how to avoid these problems and how to treat patients when these rare complications arise. PMID:26834456

  6. Complications of selective laser trabeculoplasty: a review.

    PubMed

    Song, Julia

    2016-01-01

    Selective laser trabeculoplasty is a laser treatment to treat glaucoma. It was initially indicated for open-angle glaucoma but has been proven to be efficacious for various types of glaucoma. This review article summarizes the few rare complications that can be seen with selective laser trabeculoplasty. It also makes recommendations on how to avoid these problems and how to treat patients when these rare complications arise. PMID:26834456

  7. Early Earth

    NASA Astrophysics Data System (ADS)

    Brown, M.

    2015-05-01

    Earth has continents, subduction and mobile lid plate tectonics, but details of the early evolution are poorly understood. Here I summarize the Hadean-Archean record, review evidence for a hotter Earth and consider geodynamic models for early Earth.

  8. Early Intervention.

    ERIC Educational Resources Information Center

    Abery, Brian, Ed.; McConnell, Scott, Ed.

    1989-01-01

    This "feature issue" focuses on early intervention with handicapped children, with an emphasis on: Project EDGE (Expanding Developmental Growth through Education), an early intervention research project initiated in 1968; strategies for developing family-friendly early intervention services; and progress reports from various states and programs.

  9. Early Intervention.

    ERIC Educational Resources Information Center

    Nathanson, Jeanne H., Ed.

    1992-01-01

    This theme issue focuses on early intervention. The four articles presented on this theme are: (1) "Deaf Infants, Hearing Mothers: A Research Report" (Kathryn P. Meadow-Orlans, and others), reporting findings on effects of auditory loss on early development; (2) "Maintaining Involvement of Inner City Families in Early Intervention Programs through

  10. Common long-term complications of adult congenital heart disease: avoid falling in a H.E.A.P.

    PubMed

    Ministeri, M; Alonso-Gonzalez, R; Swan, L; Dimopoulos, K

    2016-04-01

    Advances in cardiology and cardiac surgery have transformed the outlook for patients with congenital heart disease (CHD) so that currently 85% of neonates with CHD survive into adult life. Although early surgery has transformed the outcome of these patients, it has not been curative. Heart failure, endocarditis, arrhythmias and pulmonary hypertension are the most common long term complications of adults with CHD. Adults with CHD benefit from tertiary expert care and early recognition of long-term complications and timely management are essential. However, it is as important that primary care physicians and general adult cardiologists are able to recognise the signs and symptoms of such complications, raise the alarm, referring patients early to specialist adult congenital heart disease (ACHD) care, and provide initial care. In this paper, we provide an overview of the most commonly encountered long-term complications in ACHD and describe current state of the art management as provided in tertiary specialist centres. PMID:26678842

  11. Vascular complications after adult living donor liver transplantation: Evaluation with ultrasonography

    PubMed Central

    Ma, Lin; Lu, Qiang; Luo, Yan

    2016-01-01

    Living donor liver transplantation (LDLT) has been widely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrast-enhanced ultrasound (CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional gray-scale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT. PMID:26819527

  12. Vascular complications after adult living donor liver transplantation: Evaluation with ultrasonography.

    PubMed

    Ma, Lin; Lu, Qiang; Luo, Yan

    2016-01-28

    Living donor liver transplantation (LDLT) has been widely used to treat end-stage liver disease with improvement in surgical technology and the application of new immunosuppressants. Vascular complications after liver transplantation remain a major threat to the survival of recipients. LDLT recipients are more likely to develop vascular complications because of their complex vascular reconstruction and the slender vessels. Early diagnosis and treatment are critical for the survival of graft and recipients. As a non-invasive, cost-effective and non-radioactive method with bedside availability, conventional gray-scale and Doppler ultrasonography play important roles in identifying vascular complications in the early postoperative period and during the follow-up. Recently, with the detailed vascular tracing and perfusion visualization, contrast-enhanced ultrasound (CEUS) has significantly improved the diagnosis of postoperative vascular complications. This review focuses on the role of conventional gray-scale ultrasound, Doppler ultrasound and CEUS for early diagnosis of vascular complications after adult LDLT. PMID:26819527

  13. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series *

    PubMed Central

    Cillóniz, Catia; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Torres, Antoni; Nicolini, Antonello

    2015-01-01

    Abstract Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. PMID:26398760

  14. Section 8. Management of portal venous complications in pediatric living donor liver transplantation.

    PubMed

    Cheng, Yu-Fan; Ou, Hsin-You; Yu, Chun-Yen; Tsang, Leo Leung-Chit; Huang, Tung-Liang; Chen, Tai-Yi; Concejero, Allan; Wang, Chih-Chi; Wang, Shih-Ho; Lin, Tsan-Shiun; Liu, Yueh-Wei; Yang, Chin-Hsiang; Yong, Chee-Chien; Chiu, King-Wah; Jawan, Bruno; Eng, Hock-Liew; Chen, Chao-Long

    2014-04-27

    Portal vein (PV) complications after living donor liver transplant (LDLT) have been a major concern in pediatric liver transplantation. The incidence of PV complications is more in pediatric (0%-33%) than in adult recipients. Early diagnosis and treatment of PV complications may ensure optimal graft function and good recipient survival. Small preoperation PV size (<4 mm) and slow portal flow (<10 cm/s) combined with lower hepatic artery resistance index (<0.65) are strong warning signs that may predict the development of post LDLT PV complications. Portal vein angioplasty/stenting is conventionally performed through the percutaneous transhepatic approach; however, this can also be performed through transjugular, trans-splenic, and intraoperative approaches. Depending on the situation, using optimal method is the key point to minimize complication (5%) and gain high success rate (80%). PV occlusion of greater than 1 year with cavernous transformation seems to be a factor causing technical failure. Good patency rate (100%) with self-expandable metallic stents was noted in long-term follow-up. In conclusion, PV stent placement is an effective, long-term treatment modality to manage PV complications after pediatric LDLT. Early diagnosis and treatment are essential to maximize the use of stent placement and achieve good success rates. PMID:24849830

  15. Growth hormone and early treatment.

    PubMed

    Antoniazzi, F; Cavarzere, P; Gaudino, R

    2015-06-01

    Growth hormone (GH) treatment is approved by the US Food and Drug Administration (FDA) not only for GH deficiency (GHD) but also for other childhood growth disorders with growth failure and/or short stature. GHD is the most frequent endocrine disorder presenting with short stature in childhood. During neonatal period, metabolic effects due to congenital GHD require a prompt replacement therapy to avoid possible life-threatening complications. In childhood and adolescence, growth impairment is the most evident effect of GHD and early treatment has the aim of restore normal growth and to reach normal adult height. We reassume in this review the conditions causing GHD and the diagnostic challenge to reach an early diagnosis, and an early treatment, necessary to obtain the best results. Finally, we summarize results obtained in clinical studies about pediatric patients with GHD treated at an early age, in which a marked early catch-up growth and a normalization of adult height were obtained. PMID:25734895

  16. A surgeons nightmare: Complications

    PubMed Central

    Gemici, Kaz?m; Oku?, Ahmet; Y?ld?z, Melda; ?ahin, Mustafa; Bilgi, Mustafa

    2015-01-01

    Objective: Our study aimed to determine the physically and psychologically most difficult complication resulting in chronic discomfort and occurring sensationally in the postoperative period of operations performed frequently in the daily surgical routine. Material and Methods: We performed a survey among surgeons who participated in the 19th National Surgery Congress. The questions were related to the complications encountered in the frequent procedures performed in the daily general surgery routine and resulting in chronic life discomfort but which are not life threatening. Three hundred and sixty general surgeons participated in the survey and they were asked which complication among the given ones was the most difficult for a surgeon to manage physically and psychologically. The received answers were recorded and evaluated with descriptive statistical analysis. Results: Among the surgeons who participated in the survey, 345 were male (96%) and 15 female (4%); 218 (61%) general surgeons served in universities whereas 112 (30%) surgeons served in other public institutes and 30 (9%) served in private hospitals. With regard to the ranking of the complications that are most difficult to manage by the surgeons, pain and hemorrhage developing after hemorrhoidectomy were in the first place with 90 (25%) votes, whereas persistent hypocalcemia after total thyroidectomy was in the second place with 73 (20%) votes. Furthermore, 286 (80%) surgeons stated that the complications did not discourage them from performing the same operation again. Conclusion: Our results indicated that among the determined complications of operations performed in daily surgery routine, pain and hemorrhage developing after hemorrhoidectomy were the most difficult to manage. In addition, it was observed that complications did not discourage surgeons to perform the same operation again, contrary to popular belief. PMID:26170757

  17. Complications related to pubic hair removal

    PubMed Central

    DEMARIA, Andrea L.; FLORES, Marissa; HIRTH, Jacqueline M.; BERENSON, Abbey B.

    2014-01-01

    Objectives We investigated the prevalence and correlates of complications related to pubic hair removal among a diverse clinical sample of women attending a public clinic. Study Design Women (aged 16 to 40 years) who received care from April to June 2012 at two publicly funded clinics completed an anonymous, self-administered questionnaire (n=369). After excluding women with missing data, analyses were conducted on 333 women. Additional measures were retrieved through a medical chart review. Chi-square and multivariable logistic regression were used to analyze participant characteristics, pubic hair removal behaviors, and complications related to pubic hair removal. Results Most women (87%) admitted to current removal of at least some pubic hair, while the remainder responded that they had removed pubic hair in the past. Under or normal weight women were more likely to report total pubic hair removal than overweight or obese women. The majority (60%) had experienced at least one health complication due to removal, of which the most common were epidermal abrasion and ingrown hairs. Black and Hispanic women were less likely than white women to report complications. Overweight or obese women were almost twice as likely to report a complication and almost 3 times as likely if they were also total removers. Only 4% had seen a healthcare provider for a complication related to hair removal and only 4% discussed safe removal practices with their doctor. Conclusions Minor complications commonly occur as a result of pubic hair removal. Gynecological visits could provide a safe environment for women to discuss pubic hair removal practices. PMID:24486227

  18. Screening for Metabolic and Reproductive Complications in Obese Children and Adolescents

    PubMed Central

    Irizarry, Krystal A.; Brito, Valerie; Freemark, Michael

    2015-01-01

    Childhood obesity is associated with a number of metabolic comorbidities. These include glucose intolerance and type 2 diabetes mellitus, hyperlipidemia, fatty liver disease, and reproductive complications, such as polycystic ovary syndrome. The occurrence of these complications in a child or adolescent may result in progressive health decline at an early age. We, therefore, advocate screening and early diagnosis. This purpose of this review is to outline a rational, evidence-based approach to screening obese children and adolescents for metabolic and reproductive complications. In each section, the aim is to provide the primary care provider with a review of the literature supporting current screening practices. As such, this review is designed to assist the primary care provider in the selection and interpretation of screening tests and to make recommendations regarding the referral of patients for subspecialty care. PMID:25198445

  19. Acute Kidney Injury Complicated Epstein-Barr Virus Infection in Infancy

    PubMed Central

    Ozgurhan, Gamze; Ozcetin, Mustafa; Vehapoglu, Aysel; Karakaya, Zeynep; Aygun, Fatih

    2015-01-01

    Infectious mononucleosis is an acute lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) and seen most commonly in children and young adults. Clinical presentation of the disease is characterized by fever, tonsillopharyngitis, lymphadenopathy, and hepatosplenomegaly, whereas serological findings of this benign disorder include positive heterophilic antibody formation (transient increase in heterophilic antibodies) and prominence of hematological lymphocytosis of more than 10% of atypical lymphocytes. An EBV infection is usually asymptomatic in childhood, but acute kidney injury can be a rare complication during its course. Most cases recover from the disease completely. Early recognition of EBV infection and estimation of its complication are important for its prognosis. In light of previous literature, we discuss the case evaluated as an EBV infection complicated by acute kidney injury in early childhood and results of tubulointerstitial nephritis shown on a renal biopsy that was later diagnosed as an EBV infection by serological examination. PMID:26064752

  20. From Pre-Clinical Studies to Clinical Trials: Generation of Novel Therapies for Pregnancy Complications

    PubMed Central

    Cottrell, Elizabeth C.; Sibley, Colin P.

    2015-01-01

    Complications of pregnancy represent a significant disease burden, with both immediate and lasting consequences for mother and baby. Two key pregnancy complications, fetal growth restriction (FGR) and preeclampsia (PE), together affect around 10%–15% of all pregnancies worldwide. Despite this high incidence, there are currently no therapies available to treat these pregnancy disorders. Early delivery remains the only intervention to reduce the risk of severe maternal complications and/or stillbirth of the baby; however early delivery itself is associated with increased risk of neonatal mortality and morbidity. As such, there is a pressing need to develop new and effective treatments that can prevent or treat FGR and PE. Animal models have been essential in identifying and screening potential new therapies in this field. In this review, we address recent progress that has been made in developing therapeutic strategies for pregnancy disorders, some of which are now entering clinical trials. PMID:26062129

  1. Clinical Factors Associated with Development of Severe-Complicated Clostridium difficile Infection

    PubMed Central

    Shivashankar, Raina; Khanna, Sahil; Kammer, Patricia P.; Harmsen, W. Scott; Zinsmeister, Alan R.; Baddour, Larry M.; Pardi, Darrell S.

    2013-01-01

    Background & Aims Clostridium difficile infection (CDI) can cause life-threatening complications. Severe complicated CDI is characterized by hypotension, shock, sepsis, ileus, megacolon, and colon perforation. We created a model to identify clinical factors associated with severe complicated CDI. Methods We analyzed data from 1446 inpatient cases of CDI (48.6% female, median age 62.5 y, range 0.1–103.7 y) at the Mayo Clinic from June 28, 2007 through June 25, 2010. Patients with severe complicated CDI (n=487) were identified as those who required admission to the intensive-care unit (ICU) or colectomy, or died, within 30 days of CDI diagnosis. Logistic regression models were used to identify variables that were independently associated with the occurrence of severe complicated CDI in 2 cohorts. One cohort comprised all hospitalized patients; the other comprised a subset of these inpatients who were residents of Olmsted County, MN, to assess the association of comorbid conditions with the development of severe complicated infection in a population-based cohort. The linear combinations of variables identified using logistic regression models provided scores to predict the risk of developing severe-complicated CDI. Results In a multivariable model that included all inpatients, increasing age, leukocyte count >15×109/L, increase in serum level of creatinine >1.5-fold from baseline, and use of proton pump inhibitors or narcotic medications were independently associated with severe complicated CDI. In the secondary analysis, which included only patients from Olmsted County, comorbid conditions were not significantly associated with severe complicated CDI. Conclusion Older age, high numbers of leukocytes in blood samples, an increased serum level of creatinine, gastric acid suppression, and use of narcotic medications were independently associated with development of severe complicated CDI in hospitalized patients. Early aggressive monitoring and intervention could improve outcomes. PMID:23702192

  2. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity.

    PubMed

    Griffith, P S; Birch, Daniel W; Sharma, Arya M; Karmali, Shahzeer

    2012-10-01

    Obesity has become a major health concern in Canada. This has resulted in a steady rise in the number of bariatric surgical procedures being performed nationwide. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is not only the most common bariatric procedure, but also the gold standard to which all others are compared. With this in mind, it is imperative that all gastrointestinal surgeons understand the LRYGB and have a working knowledge of the common postoperative complications and their management. Early postoperative complications following LRYGB that demand immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain and nutritional deficiencies. We discuss the principles involved in the management of each complication and the timing of referral to specialist bariatric centres. PMID:22854113

  3. Managing complications associated with laparoscopic Roux-en-Y gastric bypass for morbid obesity

    PubMed Central

    Griffith, P. Sahle; Birch, Daniel W.; Sharma, Arya M.; Karmali, Shahzeer

    2012-01-01

    Obesity has become a major health concern in Canada. This has resulted in a steady rise in the number of bariatric surgical procedures being performed nationwide. The laparoscopic Roux-en-Y gastric bypass (LRYGB) is not only the most common bariatric procedure, but also the gold standard to which all others are compared. With this in mind, it is imperative that all gastrointestinal surgeons understand the LRYGB and have a working knowledge of the common postoperative complications and their management. Early postoperative complications following LRYGB that demand immediate recognition include anastomotic or staple line leak, postoperative hemorrhage, bowel obstruction and incorrect Roux limb reconstructions. Later complications may be challenging to differentiate from other gastrointestinal disorders and include anastomotic stricture, marginal ulceration, fistula formation, weight gain and nutritional deficiencies. We discuss the principles involved in the management of each complication and the timing of referral to specialist bariatric centres. PMID:22854113

  4. Management of Mesh Complications after SUI and POP Repair: Review and Analysis of the Current Literature

    PubMed Central

    Deng, D. Y.

    2015-01-01

    Purpose. To evaluate the surgical treatment concepts for the complications related to the implantation of mesh material for urogynecological indications. Materials and Methods. A review of the current literature on PubMed was performed. Results. Only retrospective studies were detected. The rate of mesh-related complications is about 15–25% and mesh erosion is up to 10% for POP and SUI repair. Mesh explantation is necessary in about 1-2% of patients due to complications. The initial approach appears to be an early surgical treatment with partial or complete mesh resection. Vaginal and endoscopic access for mesh resection is favored. Prior to recurrent surgeries, a careful examination and planning for the operation strategy are crucial. Conclusions. The data on the management of mesh complication is scarce. Revisions should be performed by an experienced surgeon and a proper follow-up with prospective documentation is essential for a good outcome. PMID:25973425

  5. Complications Following Arthroscopic Rotator Cuff Tear Repair

    PubMed Central

    Audig, Laurent; Blum, Raphael; Mller, Andreas M.; Flury, Matthias; Durchholz, Holger

    2015-01-01

    Background Valid comparison of outcomes after surgical procedures requires consensus on which instruments and parameters should be used, including the recording and evaluation of surgical complications. An international standard outlining the terminology and definitions of surgical complications in orthopaedics is lacking. Purpose This study systematically reviewed the literature for terms and definitions related to the occurrence of negative events or complications after arthroscopic rotator cuff repair (ARCR) with specific focus on shoulder stiffness. Study Design Systematic review; Level of evidence, 4. Methods PubMed, EMBASE, Cochrane Library, and Scopus databases were searched for reviews, clinical studies, and case reports of complications associated with ARCR. Reference lists of selected articles were also screened. The terminology of complications and their definitions were extracted from all relevant original articles by a single reviewer and verified by a second reviewer. Definitions of shoulder stiffness or equivalent terms were tabulated. Results Of 654 references published after 2007 and obtained from the search, 233 full-text papers (44 reviews, 155 studies, 31 case reports, and 3 surgical technique presentations) were reviewed. Twenty-two additional references cited for a definition were checked. One report defined the term surgical complication. There were 242 different terms used to describe local events and 64 to describe nonlocal events. Furthermore, 16 definitions of terms such as frozen shoulder, shoulder stiffness, or stiff painful shoulder were identified. Diagnosis criteria for shoulder stiffness differed widely; 12 various definitions for restriction in range of motion were noted. One definition included a gradation of stiffness severity, whereas another considered the patients subjective assessment of motion. Conclusion The literature does not consistently report on complications after ARCR, making valid comparison of the incidence of these events among published reports impossible. Specifically, the variation in criteria used to diagnose shoulder stiffness is problematic for valid and accurate reporting of this event. A standard for reporting this event and other complications after ARCR is needed. Clinical Relevance This review serves as the basis for the development of a uniform documentation process for shoulder stiffness and the standardization of complication definitions in ARCR following international consensus. PMID:26665096

  6. Acute complications of spinal cord injuries

    PubMed Central

    Hagen, Ellen Merete

    2015-01-01

    The aim of this paper is to give an overview of acute complications of spinal cord injury (SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperature control and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation. PMID:25621207

  7. Complications of Microsurgery of Vestibular Schwannoma

    PubMed Central

    Zv??ina, Eduard; Balogov, Zuzana; Sk?ivan, Ji?; Kraus, Josef; Syka, Josef; Chovanec, Martin

    2014-01-01

    Background. The aim of this study was to analyze complications of vestibular schwannoma (VS) microsurgery. Material and Methods. A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup. Results. In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225) removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB IIIVI) was observed in 124 cases (45%) immediately after surgery and in 104 cases (33%) on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IXXI) deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%), headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis. Conclusions. Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery. PMID:24987677

  8. Avoiding Complications in Endoscopic Third Ventriculostomy.

    PubMed

    Yadav, Yad Ram; Parihar, Vijay Singh; Ratre, Shailendra; Kher, Yatin

    2015-11-01

    Endoscopic neurosurgical techniques hold the potential for reducing morbidity. But they are also associated with limitations such as the initial learning curve, proximal blind spot, visual obscurity, difficulty in controlling bleeding, disorientation, and loss of stereoscopic image. Although some of the surgical techniques in neuroendoscopy and microsurgery are similar, endoscopy requires additional skills. A thorough understanding of endoscopic techniques and their limitations is required to get maximal benefit. Knowledge of possible complications and techniques to avoid such complications can improve results in endoscopic third ventriculostomy (ETV). The surgeon must be able to manage complications and have a second strategy such as a cerebrospinal fluid shunt if ETV fails. It is better to abandon the procedure if there is disorientation or a higher risk of complications such as bleeding or a thick and opaque floor without any clear visualization of anatomy. Attending live workshops, practice on models and simulators, simpler case selection in the initial learning curve, and hands-on cadaveric workshops can reduce complications. Proper case selection, good surgical technique, and better postoperative care are essential for a good outcome in ETV. Although it is difficult to make a preoperative diagnosis of complex hydrocephalus (combination of communicating and obstructive), improving methods to detect the exact type of hydrocephalus before surgery could increase the success rate of ETV and avoid an unnecessary ETV procedure in such cases. PMID:26140421

  9. Liver biopsy: complications and risk factors

    PubMed Central

    Thampanitchawong, Pornpen; Piratvisuth, Teerha

    1999-01-01

    AIM: To study the complications and the risk factors of percutaneous liver biopsy, and to compare the complication rate between the periods o f 1987-1993 and 1994-1996. METHODS: Medical records of all patients undergoing percutaneous liver biopsy between January 1, 1987 to September 31, 1996 in Songklanagarind Hospital were reviewed retrospectively. RESULTS: There were 484 percutaneous liver biopsies performed. The total complication rate was 6.4%, of which 4.5% were due to major bleeding; the death rate was 1.6%. The important risk factors correlated with bleeding complications and deaths were a platelet count of 70 109/L or less, a prolonged prothrombin time of > 3 s over control, or a prolonged activated partial thromboplastin time of > 10 s over control. Although physician inexperience was not statistically significantly associated with bleeding complications and deaths, there was a reduction of death rate from 2.2% in 1987-1993 to 0% in 1993-1996. This reduction is thought to result from both increased experience o f senior staff and increased supervision of residents. CONCLUSIONS: Screening of platelet count, prothrombin time, and activated partial thromboplastin time should be done and need to be corrected in case of abnormality before liver biopsy. Percutaneous liver biopsy should be performed or supervised by an expert in gastrointestinal diseases, especially in high risk cases. PMID:11819452

  10. Gut microbiota-related complications in cirrhosis

    PubMed Central

    Gómez-Hurtado, Isabel; Such, José; Sanz, Yolanda; Francés, Rubén

    2014-01-01

    Gut microbiota plays an important role in cirrhosis. The liver is constantly challenged with commensal bacteria and their products arriving through the portal vein in the so-called gut-liver axis. Bacterial translocation from the intestinal lumen through the intestinal wall and to mesenteric lymph nodes is facilitated by intestinal bacterial overgrowth, impairment in the permeability of the intestinal mucosal barrier, and deficiencies in local host immune defences. Deranged clearance of endogenous bacteria from portal and systemic circulation turns the gut into the major source of bacterial-related complications. Liver function may therefore be affected by alterations in the composition of the intestinal microbiota and a role for commensal flora has been evidenced in the pathogenesis of several complications arising in end-stage liver disease such as hepatic encephalopathy, splanchnic arterial vasodilatation and spontaneous bacterial peritonitis. The use of antibiotics is the main therapeutic pipeline in the management of these bacteria-related complications. However, other strategies aimed at preserving intestinal homeostasis through the use of pre-, pro- or symbiotic formulations are being studied in the last years. In this review, the role of intestinal microbiota in the development of the most frequent complications arising in cirrhosis and the different clinical and experimental studies conducted to prevent or improve these complications by modifying the gut microbiota composition are summarized. PMID:25400446

  11. Neurologic complications of valvular heart disease.

    PubMed

    Cruz-Flores, Salvador

    2014-01-01

    Valvular heart disease (VHD) is frequently associated with neurologic complications; cerebral embolism is the most common of these since thrombus formation results from the abnormalities in the valvular surfaces or from the anatomic and physiologic changes associated with valve dysfunction, such as atrial or ventricular enlargement, intracardiac thrombi, and cardiac dysrhythmias. Prosthetic heart valves, particularly mechanical valves, are very thrombogenic, which explains the high risk of thromboembolism and the need for anticoagulation for the prevention of embolism. Infective endocarditis is a disease process with protean manifestations that include not only cerebral embolism but also intracranial hemorrhage, mycotic aneurysms, and systemic manifestations such as fever and encephalopathy. Other neurologic complications include nonbacterial thrombotic endocarditis, a process associated with systemic diseases such as cancer and systemic lupus erythematosus. For many of these conditions, anticoagulation is the mainstay of treatment to prevent cerebral embolism, therefore it is the potential complications of anticoagulation that can explain other neurologic complications in patients with VHD. The prevention and management of these complications requires an understanding of their natural history in order to balance the risks posed by valvular disease itself against the risks and benefits associated with treatment. PMID:24365289

  12. Acute complications of spinal cord injuries.

    PubMed

    Hagen, Ellen Merete

    2015-01-18

    The aim of this paper is to give an overview of acute complications of spinal cord injury (SCI). Along with motor and sensory deficits, instabilities of the cardiovascular, thermoregulatory and broncho-pulmonary system are common after a SCI. Disturbances of the urinary and gastrointestinal systems are typical as well as sexual dysfunction. Frequent complications of cervical and high thoracic SCI are neurogenic shock, bradyarrhythmias, hypotension, ectopic beats, abnormal temperature control and disturbance of sweating, vasodilatation and autonomic dysreflexia. Autonomic dysreflexia is an abrupt, uncontrolled sympathetic response, elicited by stimuli below the level of injury. The symptoms may be mild like skin rash or slight headache, but can cause severe hypertension, cerebral haemorrhage and death. All personnel caring for the patient should be able to recognize the symptoms and be able to intervene promptly. Disturbance of respiratory function are frequent in tetraplegia and a primary cause of both short and long-term morbidity and mortality is pulmonary complications. Due to physical inactivity and altered haemostasis, patients with SCI have a higher risk of venous thromboembolism and pressure ulcers. Spasticity and pain are frequent complications which need to be addressed. The psychological stress associated with SCI may lead to anxiety and depression. Knowledge of possible complications during the acute phase is important because they may be life threatening and/ or may lead to prolonged rehabilitation. PMID:25621207

  13. Pathogenesis of diabetic cerebral vascular disease complication.

    PubMed

    Xu, Ren-Shi

    2015-02-15

    Diabetes mellitus is one of the most potent independent risk factors for the development of diabetic cerebral vascular disease (CVD). Many evidences suggested that hyperglycemia caused excess free fatty acids, the loss of endothelium-derived nitric oxide, insulin resistance, the prothrombotic state, endothelial dysfunction, the abnormal release of endothelial vasoactivators, vascular smooth muscle dysfunction, oxidative stress, and the downregulation of miRs participated in vessel generation and recovery as well as the balance of endotheliocytes. In turn, these abnormalities, mainly via phosphatidylinositol 3 kinase, mitogen-activated protein kinase, polyol, hexosamine, protein kinase C activation, and increased generation of advanced glycosylation end products pathway, play an important role in inducing diabetic CVD complication. A deeper comprehension of pathogenesis producing diabetic CVD could offer base for developing new therapeutic ways preventing diabetic CVD complications, therefore, in the paper we mainly reviewed present information about the possible pathogenesis of diabetic CVD complication. PMID:25685278

  14. Neurological Complications of Solid Organ Transplantation

    PubMed Central

    Pruitt, Amy A.; Graus, Francesc; Rosenfeld, Myrna R.

    2013-01-01

    Solid organ transplantation (SOT) is the preferred treatment for an expanding range of conditions whose successful therapy has produced a growing population of chronically immunosuppressed patients with potential neurological problems. While the spectrum of neurological complications varies with the type of organ transplanted, the indication for the procedure, and the intensity of long-term required immunosuppression, major neurological complications occur with all SOT types. The second part of this 2-part article on transplantation neurology reviews central and peripheral nervous system problems associated with SOT with clinical and neuroimaging examples from the authors institutional experience. Particular emphasis is given to conditions acquired from the donated organ or tissue, problems specific to types of organs transplanted and drug therapy-related complications likely to be encountered by hospitalists. Neurologically important syndromes such as immune reconstitution inflammatory syndrome (IRIS), posterior reversible encephalopathy syndrome (PRES), and posttransplantation lymphoproliferative disorder (PTLD) are readdressed in the context of SOT. PMID:24167649

  15. [Septic complications of penetrating thoracic injuries].

    PubMed

    Danielian, Sh N; Abakumov, M M; Voskresenskiĭ, O V; Radchenko, Iu A; Chernen'kaia, T V

    2010-01-01

    224 cases of septic complications after penetrating thoracic injuries were analyzed. Pleura empyem was observed in 105 of 7572 patients (overall number of the injured), lung abscess - in 22 cases, pericarditis was diagnosed in 108 patients, costal and sternal osteomyelitis - in 26 and mediastinitis - in 21 patients. Overall frequency of septic complication was 2,96%. Main reasons of septic complications were: massive blood loss, initial contamination, thoracotomy through the initially infected wound, long -lasting and coagulated hemothorax and late diagnosis and hospitalization. Staphylococcus aureus was the most frequent microbe detected - 29,4%. Lethality rate was 9,8% (22 patients). Adequate drainage of the wound allowed rehabilitation of the majority of patients. Cases with costal osteomyelitis required major surgical dissection in 73,1%. PMID:21169927

  16. Complications of anaesthesia in neuromuscular disorders.

    PubMed

    Klingler, Werner; Lehmann-Horn, Frank; Jurkat-Rott, Karin

    2005-03-01

    The purpose of this review is to alert non-anaesthesiologists to the various complications from which patients with neuromuscular disorders and those susceptible to malignant hyperthermia can suffer during anaesthesia. The patient's outcome correlates with the quality of consultation between anaesthesiologists, surgeons, neurologists and cardiologists. Special precautions must be taken, since many anaesthetics and muscle relaxants can aggravate the clinical features or trigger life-threatening reactions. Complications frequently occur in these patients, although anaesthetic procedures have become safer by the reduced administration of suxamethonium and the use of total intravenous anaesthesia, new volatile anaesthetics and non-depolarising relaxants. This review provides a synopsis of pre-operative anaesthetic considerations and adverse drug effects on skeletal, cardiac and smooth muscle tissue. It describes the pathogenetic aspects of typical complications and introduces anaesthetic procedures for the various neuromuscular disorders, including regional anaesthesia for patients in whom a restriction of respiratory and/or cardiac function is predicted. PMID:15725581

  17. Curcumin: a pleiotropic phytonutrient in diabetic complications.

    PubMed

    Jeenger, Manish Kumar; Shrivastava, Shweta; Yerra, Veera Ganesh; Naidu, V G M; Ramakrishna, Sistla; Kumar, Ashutosh

    2015-02-01

    Curcumin is the major polyphenolic constituent of an indigenous herb, Curcuma longa, found to have a wide range of applications right from its kitchen use as a spicy ingredient to therapeutic and medicinal applications in various diseases. Curcumin has been identified to have a plethora of biologic and pharmacologic properties owing to its antioxidant and anti-inflammatory activities. This pleiotropic regulation of redox balance of cell and inflammation might be the basis of curcumin's beneficial activities in various pathologic conditions including diabetic complications. This review summarizes various invitro, invivo studies done on curcumin and its therapeutic utility in diabetic micro-vascular complications. This review also emphasizes the importance of curcumin in addition to the existing therapeutic modalities in diabetic complications. PMID:25441584

  18. An unusual complication of a myoelectric prosthesis.

    PubMed

    Selvarajah, K; Datta, D

    2001-12-01

    This clinical note describes an unusual and previously unreported complication of wearing a myoelectric prosthesis in a child with congenital upper limb deficiency. After an initial period of wearing a cosmetic prosthesis, he was provided with a child's trans-radial myoelectric prosthesis with a Steeper Scamp Electric hand at the age of 21 months. After successful and uncomplicated use of this prosthesis for 2 years--a sudden onset of burns of the skin of the stump underlying the single electrode site was noted. The cause of the burns was thought to be due to heat generated from electrical failure possibly from ingress of moisture. This complication has not before been experienced in the authors' centre, nor has it been reported in the literature. While constant improvements are being made in the field of electrically powered prosthesis, the rehabilitation team should be aware of this unusual complication. PMID:11860099

  19. Management of gallstones and its related complications.

    PubMed

    Portincasa, P; Di Ciaula, A; de Bari, O; Garruti, G; Palmieri, V O; Wang, Dq-H

    2016-01-01

    The majority of gallstone patients remain asymptomatic; however, interest toward the gallstone disease is continuing because of the high worldwide prevalence and management costs and the development of gallstone symptoms and complications. For cholesterol gallstone disease, moreover, a strong link exists between this disease and highly prevalent metabolic disorders such as obesity, dyslipidemia, type 2 diabetes, hyperinsulinemia, hypertriglyceridemia and the metabolic syndrome. Information on the natural history as well as the diagnostic, surgical (mainly laparoscopic cholecystectomy) and medical tools available to facilitate adequate management of cholelithiasis and its complications are, therefore, crucial to prevent the negative outcomes of gallstone disease. Moreover, some risk factors for gallstone disease are modifiable and some preventive strategies have become necessary to reduce the onset and the severity of complications. PMID:26560258

  20. Complications of laparoscopic hysterectomy: the Monash experience.

    PubMed

    Tsaltas, J; Lawrence, A; Michael, M; Pearce, S

    2002-08-01

    A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates. PMID:12230068

  1. Neurological complications associated with epidural steroid injections.

    PubMed

    Manchikanti, Laxmaiah; Hirsch, Joshua A

    2015-05-01

    Multiple case reports of neurological complications resulting from intraarterial injection of corticosteroids have led the Food and Drug Administration (FDA) to issue a warning, requiring label changes, warning of serious neurological events, some resulting in death. The FDA has identified 131 cases of neurological adverse events, including 41 cases of arachnoiditis. A review of the literature reveals an overwhelming proportion of the complications are related to transforaminal epidural injections, of which cervical transforaminal epidural injections constituted the majority of neurological complications. Utilization data of epidural injections in the Medicare population revealed that cervical transforaminal epidural injections constitute only 2.4% of total epidural injections and <5% of all transforaminal epidural injections. Multiple theories have been proposed as the cause of neurological injury including particulate steroid, arterial intimal flaps, arterial dissection, dislodgement of plaque causing embolism, arterial muscle spasm, and embolism of a fresh thrombus following disruption of the intima. PMID:25795154

  2. Complications and follow up of subarachnoid hemorrhages.

    PubMed

    Danire, F; Gascou, G; Menjot de Champfleur, N; Machi, P; Leboucq, N; Riquelme, C; Ruiz, C; Bonaf, A; Costalat, V

    2015-01-01

    Complications of subarachnoid hemorrhage are the major life threatening and functional components of the follow up of a ruptured aneurysm. Knowing how to identify these is a key challenge. They vary in type throughout the postoperative follow up period. The aim of this article is firstly to list the main complications of the acute phase (rebleeding, acute hydrocephalus, acute ischemic injury and non-neurological complications), the subacute phase (vasospasm) and the chronic phase of subarachnoid hemorrhages: (chronic hydrocephalus and cognitive disorders) and to describe their major clinical and radiological features. Secondly, we describe the long-term follow up strategy for patients who have suffered a subarachnoid hemorrhage and have been treated endovascularly or by surgery. This follow up involves a combination of clinical consultations, cerebral MRI and at least one review angiogram. PMID:26119863

  3. Late complications of Hodgkin's disease management

    SciTech Connect

    Young, R.C.; Bookman, M.A.; Longo, D.L. )

    1990-01-01

    In the past several decades, Hodgkin's disease has been transformed from a uniformly fatal illness to one that can be treated with the expectation of long-term remission or cure in the majority of patients. Because patients now survive for long periods after curative intervention, various complications have been identified. The spectrum of complications following curative therapy is quite diverse and includes immunologic, cardiovascular, pulmonary, thyroid, and gonadal dysfunction. In addition, second malignant neoplasms in the form of acute leukemia as well as secondary solid tumors have now been documented to occur with increased frequency in patients cured of Hodgkin's disease. 80 references.

  4. Omental and extraperitoneal abscesses complicating cholecystocolic fistula

    PubMed Central

    Gardiner, K

    2003-01-01

    Background Acute cholecystitis resolves with conservative treatment in most patients, but empyema or perforation of an ischaemic area may develop, resulting in a pericholecystic abscess, bile peritonitis or a cholecysto-enteric fistula. Case outline A 63-year-old man presented with extraperitoneal and omental abscess formation complicating a cholecystocolic fistula secondary to gallbladder disease. Histological examination of the gallbladder and omentum showed xanthogranulomatous inflammation. Conclusion A detailed literature review failed to demonstrate a previous report of this combination of rare complications of gallbladder disease. PMID:18332986

  5. Cell-Based Therapies for Diabetic Complications

    PubMed Central

    Bernardi, Stella; Severini, Giovanni Maria; Zauli, Giorgio; Secchiero, Paola

    2012-01-01

    In recent years, accumulating experimental evidence supports the notion that diabetic patients may greatly benefit from cell-based therapies, which include the use of adult stem and/or progenitor cells. In particular, mesenchymal stem cells and the circulating pool of endothelial progenitor cells have so far been the most studied populations of cells proposed for the treatment of vascular complications affecting diabetic patients. We review the evidence supporting their use in this setting, the therapeutic benefits that these cells have shown so far as well as the challenges that cell-based therapies in diabetic complications put out. PMID:21822425

  6. Cell-based therapies for diabetic complications.

    PubMed

    Bernardi, Stella; Severini, Giovanni Maria; Zauli, Giorgio; Secchiero, Paola

    2012-01-01

    In recent years, accumulating experimental evidence supports the notion that diabetic patients may greatly benefit from cell-based therapies, which include the use of adult stem and/or progenitor cells. In particular, mesenchymal stem cells and the circulating pool of endothelial progenitor cells have so far been the most studied populations of cells proposed for the treatment of vascular complications affecting diabetic patients. We review the evidence supporting their use in this setting, the therapeutic benefits that these cells have shown so far as well as the challenges that cell-based therapies in diabetic complications put out. PMID:21822425

  7. Endocrine and Metabolic Complications After Bariatric Surgery

    PubMed Central

    Jammah, Anwar A.

    2015-01-01

    Bariatric surgery is the most effective therapeutic option for obese patients; however, it carries substantial risks, including procedure-related complications, malabsorption, and hormonal disturbance. Recent years have seen an increase in the bariatric surgeries performed utilizing either an independent or a combination of restrictive and malabsorptive procedures. We review some complications of bariatric procedures more specifically, hypoglycemia and osteoporosis, the recommended preoperative assessment and then regular follow up, and the therapeutic options. Surgeon, internist, and the patient must be aware of the multiple risks of this kind of surgery and the needed assessment and follow up. PMID:26458852

  8. Idiopathic pulmonary hemosiderosis complicated by Down syndrome.

    PubMed

    Watanabe, Hirofumi; Ayusawa, Mamoru; Kato, Masataka; Chou, Ami; Komori, Akiko; Abe, Yuriko; Matsumura, Masaharu; Kamiyama, Hiroshi; Izumi, Hiroyuki; Takahashi, Shori

    2015-10-01

    We report the case of a 9-year-old girl with Down syndrome (DS) diagnosed with idiopathic pulmonary hemosiderosis (IPH). Although acute pneumonia complicated by hemolytic anemia was suspected, IPH was finally diagnosed on bronchoscopy. Treatment with prednisolone achieved good clinical response. An association between IPH and DS was not able to be identified, but immunological issues in DS may contribute to the onset of IPH. Recurrent and intractable respiratory symptoms with marked infiltrative shadows in the bilateral lungs and complicated by severe anemia in patients with DS should suggest IPH. PMID:26508184

  9. Cancer and the kidney: complications of neoplasms

    SciTech Connect

    Fer, M.F.; McKinney, T.D.; Richardson, R.L.; Hande, K.R.; Oldham, R.K.; Greco, F.A.

    1981-10-01

    Various renal complications occur during the course of neoplastic disease. The therapeutic and prognostic implications differ according to the reversibility of both the underlying malignancy and the superimposed complications in the kidney. Since the mechanisms of renal failure vary significantly in patients with different types of malignancy, it is essential to avoid generalizations about etiologic factors or likely outcomes of the disease processes. The pathophysiologic abnormalities should be determined in each patient, and the reversibility of both the neoplastic and problems assessed before therapeutic decisions are made. This often requires a team effort by the internist, oncologist, nephrologist, urologist and, most importantly, the patient.

  10. Complications when augmenting the posterior maxilla.

    PubMed

    Fugazzotto, Paul; Melnick, Philip R; Al-Sabbagh, Mohanad

    2015-01-01

    The maxillary posterior edentulous region presents a challenge when planning for restoring missing teeth with a dental implant. The available bone in such cases is often not dense and not adequate for the placement of a properly sized implant because of maxillary sinus pneumatization and alveolar bone loss. Maxillary sinus lift is a predictable procedure to provide adequate bone height for the purpose of implant placement. However, complications are encountered during or after the execution of the sinus lift procedure. In this article, the prevention and management of maxillary sinus complications are discussed. PMID:25434561

  11. Care of patients with peristomal skin complications.

    PubMed

    Burch, Jennie

    2014-05-20

    Stoma formation is common and may be necessary in the management of certain diseases and as a result of surgery to the gastrointestinal tract or urinary tract. Because stomas provide an alternative route for the excretion of faeces and urine, they can have a significant effect on the individual's physical, psychological and social functioning. Stomas require careful management and patients need to be taught how to self-care for the stoma and how to recognise common complications. This article focuses on the signs, symptoms and management of peristomal skin complications. PMID:24823592

  12. [Incidence of postoperative complications in geriatric gynecology].

    PubMed

    Rummler, S

    1984-01-01

    The results of a retrospective-study concerning postoperative complications after gynecologic geriatric surgery (506 patients, aged 60 years and over) at the Departement of Gynecology and Obstetrics of the District Hospital Stralsund/GDR are presented. In 106 patients (10,94 per cent) we have registered post-operative complications, in particular anaemia, fever and wound-period (1967 to 1971 = 8,22%, 1977 to 1981 = 13,29%). Gynecologic surgery in the aged requires a carefully clinical management in preoperative diagnostic and an intensive postoperative care. PMID:6475112

  13. The Heimlich maneuver: breaking down the complications.

    PubMed

    Chillag, Shawn; Krieg, Jake; Bhargava, Ranjana

    2010-02-01

    The very young and the very old are vulnerable to choking, and there are over 4000 choking-related deaths annually in the United States. Complications from the Heimlich maneuver (HM), as reported in infrequent case reports, predominantly relate to the elderly. It is doubtful that the denominator, numerator, appropriateness, expertise, and problems of maneuvers applied to choking victims will ever be known. This case report and literature review suggests that the treatment for acute elderly choking victims should be applied carefully and that esophageal food impaction, which should be rapidly distinguishable from choking, can have serious complications with application of the HM. PMID:20065901

  14. Imaging ACL reconstructions and their complications.

    PubMed

    Kulczycka, P; Larbi, A; Malghem, J; Thienpont, E; Vande Berg, B; Lecouvet, F

    2015-01-01

    Examination of ligament reconstructions, particularly of the anterior cruciate ligament (ACL), are common situations in everyday knee imaging practice. Knowledge of normal appearances, the expected changes over time and the potential complications of these plasties are essential. MRI is the imaging method of choice. This article illustrates the main complications specific to this procedure: suboptimal positioning of the femoral or tibial tunnels, impingement between the graft and bony contours, rupture (partial or complete) of the plasty due to friction or injury, arthrofibrosis and particularly the "Cyclops" syndrome, fragmentation or migration of the fixation materials and a granulomatous reaction to biomaterials. PMID:24910463

  15. [Early anemia in diabetic nephropathy].

    PubMed

    Nagy, Judit; Kiss, István; Wittmann, István

    2005-02-27

    The number of diabetic patients with renal disease increased significantly in the last years worldwide. Anemia is an important and frequent component of diabetic nephropathy that may begin early in the course of the chronic renal disease of diabetics, and is more severe in diabetic patients with renal disease than in non - diabetic renal patients controlled for the same level of renal function. The reason for the anemia is decreased erythropoietin level caused by diminished production and, in a lesser degree, by increased excretion of erythropoietin in the urine. There is a close connection between diabetic nephropathy, anemia and cardiovascular complications. On the basis of small studies correction of anemia may decrease the progression of diabetic nephropathy and cardiovascular complications. However, the result of ongoing large randomised controlled studies are required to get "evidence-based" data to prove that correction of anemia has beneficial effects on microvascular and macrovascular diabetic complications, particularly cardiac disease, and on progression of diabetic nephropathy. PMID:15830606

  16. Measuring Leakage From Large, Complicated Machinery

    NASA Technical Reports Server (NTRS)

    Bottemiller, S.

    1987-01-01

    Test chamber improvised from large bag. Cumulative sizes of leaks in large, complicated machinery measure with relatively simple variation of helium leak-checking technique. When used to check Space Shuttle main engine, new technique gave repeatable and correct results within 0.5 stdin.3/min (1.4 x 10 negative to the seventh power stdm3/s).

  17. Unusual complication after aortic valve replacement.

    PubMed

    Frigg, Christoph; Cassina, Tiziano; Siclari, Francesco; Mauri, Romano

    2008-02-01

    We present a report of a postoperative left ventricular-right atrial (LV-RA) communication after aortic valve replacement. Such intracardiac defects are rare but encountered occasionally after valve surgery. The diagnosis was made by use of transesophageal echocardiography with echo-Doppler and color-flow imaging. Complications of LV-RA shunts and differential diagnosis are discussed. PMID:18042564

  18. Percutaneous Lung Biopsy: Technique, Efficacy, and Complications

    PubMed Central

    Winokur, Ronald S.; Pua, Bradley B.; Sullivan, Brian W.; Madoff, David C.

    2013-01-01

    Computed tomography-guided percutaneous needle biopsy of the lung is an indispensable tool in the evaluation of pulmonary abnormalities due to its high diagnostic accuracy in the detection of malignancy. Percutaneous biopsy in the lung plays a critical role in obtaining pathologic proof of malignancy, guiding staging and planning treatment. This article reviews biopsy techniques and their related efficacy and complications. PMID:24436527

  19. Neurological complications in kidney transplant recipients.

    PubMed

    Ponticelli, Claudio; Campise, Maria Rosaria

    2005-01-01

    Neurological complications are frequent in renal transplant recipients and may largely contribute to morbidity and mortality. The postransplant neurological complications may be categorized into five areas: 1) Immunosuppressive medications, 2) stroke, 3) peripheral neuropathies, 4) infection, and 5) malignancies. A number of complications are directly caused by the neurotoxicity of immunosuppressive agents. Calcineurin-inhibitors may cause mild symptoms, such as tremors and paresthesia, or severe symptoms, such as disabling pain syndrome and leukoencephalopathy. Severe neurological syndromes may also be caused by the monoclonal antibody OKT3. Stroke may occur in about 8% of renal transplant patients. It may be favored by hypertension, diabetes, and accelerated atherosclerosis which may be acquired during dialysis or after transplantation. Peripheral mononeuritis and polyneuritis may also occur. An acute femoral neuropathy may occur in about 2% of patients as a result of nerve compression after operation. Guillain-Barr syndrome may also develop, triggered in some cases by cytomegalovirus (CMV) or Campylobacter jejuni infection. Lymphomas are the most frequent brain tumors. They are usually associated to a Epstein Barr virus (EBV) infection and are more frequent in patients who received an aggressive immunosuppressive therapy. Infection represents the most frequent neurological complication. Acute meningitis usually caused by Listeria monocytogenes, subacute and chronic meningitis caused by Cryptococcus neoformans, focal brain infection caused by Aspergillus fumigatus, Toxoplasma gondii or Nocardia asteroids, and progressive dementia caused by polyoma J virus or other viruses are the most frequent types of neurological infections. PMID:16299677

  20. Cardiovascular complications of pediatric chronic kidney disease

    PubMed Central

    2006-01-01

    Cardiovascular disease (CVD) mortality is a leading cause of death in adult chronic kidney disease (CKD), with exceptionally high rates in young adults, according to the Task Force on Cardiovascular Disease. Recent data indicate that cardiovascular complications are already present in children with CKD. This review summarizes the current literature on cardiac risk factors, mortality and morbidity in children with CKD. PMID:17120060

  1. Lymphatic Leak Complicating Central Venous Catheter Insertion

    SciTech Connect

    Barnacle, Alex M. Kleidon, Tricia M.

    2005-12-15

    Many of the risks associated with central venous access are well recognized. We report a case of inadvertent lymphatic disruption during the insertion of a tunneled central venous catheter in a patient with raised left and right atrial pressures and severe pulmonary hypertension, which led to significant hemodynamic instability. To our knowledge, this rare complication is previously unreported.

  2. Management of Complications of Prostate Cancer Treatment

    PubMed Central

    Michaelson, M. Dror; Cotter, Shane E.; Gargollo, Patricio C.; Zietman, Anthony L.; Dahl, Douglas M.; Smith, Matthew R.

    2010-01-01

    Prostate cancer is the most commonly diagnosed noncutaneous cancer in men in the United States. Treatment of men with prostate cancer commonly involves surgical, radiation, or hormone therapy. Most men with prostate cancer live for many years after diagnosis and may never suffer morbidity or mortality attributable to prostate cancer. The short-term and long-term adverse consequences of therapy are, therefore, of great importance. Adverse effects of radical prostatectomy include immediate postoperative complications and long-term urinary and sexual complications. External beam or interstitial radiation therapy in men with localized prostate cancer may lead to urinary, gastrointestinal, and sexual complications. Improvements in surgical and radiation techniques have reduced the incidence of many of these complications. Hormone treatment typically consists of androgen deprivation therapy, and consequences of such therapy may include vasomotor flushing, anemia, and bone density loss. Numerous clinical trials have studied the role of bone antiresorptive therapy for prevention of bone density loss and fractures. Other long-term consequences of androgen deprivation therapy may include adverse body composition changes and increased risk of insulin resistance, diabetes, and cardiovascular disease. Ongoing and planned clinical trials will continue to address strategies to prevent treatment-related side effects and improve quality of life for men with prostate cancer. PMID:18502900

  3. Rare complications of pediatric diabetic ketoacidosis

    PubMed Central

    Bialo, Shara R; Agrawal, Sungeeta; Boney, Charlotte M; Quintos, Jose Bernardo

    2015-01-01

    The incidence of type 1 diabetes (T1D) among youth is steadily increasing across the world. Up to a third of pediatric patients with T1D present with diabetic ketoacidosis, a diagnosis that continues to be the leading cause of death in this population. Cerebral edema is the most common rare complication of diabetic ketoacidosis in children. Accordingly, treatment and outcome measures of cerebral edema are vastly researched and the pathophysiology is recently the subject of much debate. Nevertheless, cerebral edema is not the only sequela of diabetic ketoacidosis that warrants close monitoring. The medical literature details various other complications in children with diabetic ketoacidosis, including hypercoagulability leading to stroke and deep vein thrombosis, rhabdomyolysis, pulmonary and gastrointestinal complications, and long-term memory dysfunction. We review the pathophysiology, reported cases, management, and outcomes of each of these rare complications in children. As the incidence of T1D continues to rise, practitioners will care for an increasing number of pediatric patients with diabetic ketoacidosis and should be aware of the various systems that may be affected in both the acute and chronic setting. PMID:25685287

  4. Pituitary Macroadenoma Presenting with Multiple Psychiatric Complications

    PubMed Central

    Sood, Mamta; Patra, Bichitra Nanda; Agrawal, Alok; Khandelwal, Sudhir K.

    2015-01-01

    We report a case of pituitary macroadenoma with multiple physical and psychiatric complications, which posed a significant diagnostic dilemma and management challenge for the treating teams of neurosurgery, endocrinology and psychiatry. A pragmatic approach comprising of interdisciplinary collaboration resulted in satisfactory management of the case.

  5. Selecting a Principal: Keep It Complicated!

    ERIC Educational Resources Information Center

    Naso, Paul A.

    2011-01-01

    When searching for a new principal, many search committees tend to use the lists of competencies published in the literature and provided by state departments of education as if they were checklists. Instead, they should focus on more complicated competencies, such as acumen, judgment, and ability to manage the dilemmas of practice.

  6. Minimal Brain Dysfunction: Associations with Perinatal Complications.

    ERIC Educational Resources Information Center

    Nichols, Paul L.

    Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:

  7. Fournier gangrene: rare complication of rectal cancer.

    PubMed

    Ossibi, Pierlesky Elion; Souiki, Tarik; Ibn Majdoub, Karim; Toughrai, Imane; Laalim, Said Ait; Mazaz, Khalid; Tenkorang, Somuah; Farih, My Hassan

    2015-01-01

    Fournier's Gangrene is a rare complication of rectal cancer. Its discovery is often delayed. It's incidence is about 0.3/100,000 populations in Western countries. We report a patient with peritoneal perforation of rectal cancer revealed by scrotal and perineal necrotizing fasciitis. PMID:26161211

  8. Fournier gangrene: rare complication of rectal cancer

    PubMed Central

    Ossibi, Pierlesky Elion; Souiki, Tarik; Majdoub, Karim Ibn; Toughrai, Imane; Laalim, Said Ait; Mazaz, Khalid; Tenkorang, Somuah; Farih, My Hassan

    2015-01-01

    Fournier's Gangrene is a rare complication of rectal cancer. Its discovery is often delayed. It's incidence is about 0.3/100 000 populations in Western countries. We report a patient with peritoneal perforation of rectal cancer revealed by scrotal and perineal necrotizing fasciitis. PMID:26161211

  9. Maternal postoperative complications after nonobstetric antenatal surgery

    PubMed Central

    Erekson, Elisabeth A.; Brousseau, E. Christine; Dick, Madeline A.; Ciarleglio, Maria M.; Lockwood, Charles J.; Pettker, Christian M.

    2013-01-01

    Objective Our primary objective is to estimate the occurrence of major maternal 30 day postoperative complications after nonobstetric antenatal surgery. Methods We analyzed the 2005-2009 data files from the American College of Surgeons National Surgical Quality Improvement Program to assess outcomes for pregnant women undergoing nonobstetric antenatal surgery during any trimester of pregnancy as classified by CPT-4 codes. T-tests, ?2, logistic regression and other tests were used to calculate composite 30-day major postoperative complications and associations of preoperative predictors with 30 day postoperative morbidity. Results The most common non-obstetric antenatal surgical procedure among the 1,969 included women was appendectomy (44.0%). The prevalence of composite 30-day major postoperative complications was 5.8% (n=115). This included (not exclusive categories): return to the surgical operating room within 30 days of surgery 3.6%, infectious morbidity 2.0%, wound morbidity 1.4%, 30 day respiratory morbidity 2.0%, venous thromboembolic event morbidity 0.5%, postoperative blood transfusion 0.2%, and maternal mortality 0.25%. Conclusion Major maternal postoperative complications following nonobstetric antenatal surgery were low (5.8%). Maternal postoperative mortality was rare (0.25%). PMID:22735069

  10. [The embolization of complicated renal angiomyolipoma].

    PubMed

    Nobre, I; Fernandes, O; Garcia, V; Martins, J M; Pisco, J M

    1999-01-01

    A case of complicated renal angiomyolipoma with tumoral bleeding in a 44-year-old woman is presented. The contribution of angiography to the diagnosis helped clarify the degree of vascularity, and the contribution of embolization treatment (safe and well tolerated) is discussed. PMID:10481328

  11. [Prophylaxis of thromboembolic complications in bariatric surgery].

    PubMed

    Lavrik, A S; Tyvonchuk, A S; Bubalo, A F; Zgonnik, A Iu

    2007-08-01

    The efficacy of prophylaxis of tromboembolic complications in surgical treatment of 331 patients with morbid obesity, who underwent different bariatric operations, is estimated. The comparative analysis and results of application of non-fractionized heparin and low molecular weight heparins (Fraxiparin) in patients, suffering morbid obesity, are presented. PMID:18318070

  12. Chylothorax as a complication of oesophageal sclerotherapy.

    PubMed Central

    Nygaard, S D; Berger, H A; Fick, R B

    1992-01-01

    Chylothorax is an unusual complication of sclerotherapy for oesophageal varices. A patient is described in whom a massive chylous effusion followed sclerotherapy with repeated injections of 1.5% sodium tetradecyl sulphate. The thoracic duct traverses the posterior mediastinum in close proximity to the oesophagus, and may be disrupted by injections at mid oesophageal level. PMID:1549822

  13. Mersilene mesh brow suspension: efficiency and complications.

    PubMed Central

    Hintschich, C R; Zrcher, M; Collin, J R

    1995-01-01

    The use of the Mersilene mesh sling brow suspension procedure for the correction of severe blepharoptosis in 76 lids of 54 patients is presented. After a median follow up of 20 months functional and cosmetic results and complications were evaluated. The method is considered to be an alternative for those cases not primarily suitable for autogenous fascia lata brow suspension. PMID:7742284

  14. Pericardiectomy for Pleuropericardial Effusion Complicating Bacterial Pneumonia

    PubMed Central

    Quarti, Andrea; de Benedictis, Fernando Maria; Soura, Elli; Pozzi, Marco

    2010-01-01

    Severe pericardial effusion is a rare complication of bacterial pneumonia and it usually disappears under medical treatment. Herein we report a case of a girl with a congenital immunodeficient syndrome and bacterial pneumonia, who developed recurrent and life-threatening pericardial effusion refractory to medical treatment. She was finally treated with pericardiectomy. PMID:20585369

  15. A Complication of Posterior Malleolar Fracture Fixation.

    PubMed

    Patel, Ankit; Charles, Loren; Ritchie, James

    2016-01-01

    We present a case of tibial nerve impingement by an anteroposterior screw inserted for stabilization of a posterior malleolar fracture. This specific complication has not previously been described in published studies, although numerous reports have described various forms of peripheral nerve entrapment. We discuss the merits of fixation of these fractures using a posterolateral approach. PMID:25907349

  16. Diabetes Complications - Multiple Languages: MedlinePlus

    MedlinePLUS

    ... List of All Topics All Diabetes Complications - Multiple Languages To use the sharing features on this page, please enable JavaScript. Chinese - Simplified (简体中文) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) ...

  17. Considerations and complications after Bells' palsy.

    PubMed

    Nemet, Arie Y; Vinker, Shlomo

    2015-12-01

    We present a retrospective, observational study of all patients diagnosed with Bells' palsy (BP) at the Central District of Clalit Health Services from 2003 through to 2012. BP is associated with several complications. We evaluated clinical characteristics including the number of patient visits to general physicians (GP), otolaryngologists, ophthalmologists and neurologists, medications prescribed in the acute phase of BP (steroids and antiviral agents), and the ophthalmic diagnoses. A total of 4463 patients with the diagnosis of BP were included. The incidence per 100,000/year was 87.0, and it increased with age. Patients had significantly more visits to all specialists at 6 months after the BP event. Steroid treatment was prescribed to 50.4% of the patients and antiviral agents to 65.5%. Both treatments were associated with older patient age and female sex. The rate of post BP lagophthalmos and keratitis was 3.45% and 0.63% at 1-3 months, respectively, and both were more likely to develop in older patients. Steroid and/or antiviral treatments were not associated with a decrease in ophthalmic complications. BP may cause ophthalmic complications at a low rate, which are associated with older age. Steroids and antiviral agents appeared to have no effect on ophthalmic complications. PMID:26314659

  18. Postoperative Complications in Craniomaxillofacial Reconstruction With Medpor.

    PubMed

    de Moraes Ferreira, Ana Carulina Rezende; Muoz, Xiomara Mnica Johanna Palacio; Okamoto, Roberta; Pellizer, Eduardo Piza; Garcia, Idelmo Rangel

    2016-03-01

    Bone reconstruction in craniofacial surgery is a challenge for surgeons, who most commonly adopt the autogenous bone grafting and alloplastic implants in such procedures. Among the alloplastic materials, the high-density porous polyethylene is highlighted-Medpor (Medpor, Porex Surgical Inc, Newman, GA), considered to be pure polyethylene, with only 1 manufacturing process and standard pore size. The purpose of the current study has been to present through a review of literature and the types of complications derived from the use of Medpor in craniomaxillofacial bone surgery. A specific and sensitive database was initially created via PubMed, focusing on studies published in English peer-reviewed journals between 2004 and 2014, including case reports, experimental studies in humans, and prospective and retrospective studies. Forty articles were found at PubMed database. After analyzing their abstracts, 19 were selected, totaling 1453 patients and 121 complications, being the most commonly reported diplopia with 56 patients and infection with 6 patients. Most of the complications reported in the articles used for the development of the current review are not directly related to the use of the Medpor implant. The only complications directly related to the use of this biomaterial were cases of infection. PMID:26963299

  19. Long-term complications of JJ stent and its management: A 5 years review

    PubMed Central

    Ray, Rajendra Prasad; Mahapatra, Rajkumar Singha; Mondal, Partha Pratim; Pal, Dilip Kumar

    2015-01-01

    Objectives: To assess the long term complications of JJ stent, the management of complications and the role of endoscopic approach to manage these complications. Materials and Methods: Nineteen patients with indwelling JJ stent for a duration of more than 6 months were included in this study. Patients were assessed with X-ray KUB, USG KUB, blood urea, creatinine and DTPA renogram. Data were analyzed by Microsoft excel 2007. Results: Out of 19 patients 12 (63.16%) were male and 7 (36.84%) were female. The mean age was 39.78 13.69 years., Mean duration for which the stent was in situ was 29.56 months. The most common complication was broken stent, in 11 cases (57.89%). Other complications were migration in 5 (26.32%), encrustation in 2 (10.52%) and 1 case of (5.26%) stone formation. Eighteen cases were managed by endoscopic approaches. A total of 22 procedures were performed to treat the complications. Eleven cases were managed by a single procedure and 8 patients required multiple procedures. All were managed successfully with no death reported. Post-operative complications were seen in eight cases (42.11%). Conclusions: JJ stent related long-term complications are not uncommon and are usually seen after 6 months of indwelling time. Endourological procedure should be the initial approach with a high success rate. Coordinated use multimodality and technology helps in management of difficult cases. Open surgery is rarely required. Prevention of the complication by judicious use and early removal is the cornerstone. PMID:25657542

  20. Complications from Stereotactic Body Radiotherapy for Lung Cancer

    PubMed Central

    Kang, Kylie H.; Okoye, Christian C.; Patel, Ravi B.; Siva, Shankar; Biswas, Tithi; Ellis, Rodney J.; Yao, Min; Machtay, Mitchell; Lo, Simon S.

    2015-01-01

    Stereotactic body radiotherapy (SBRT) has become a standard treatment option for early stage, node negative non-small cell lung cancer (NSCLC) in patients who are either medically inoperable or refuse surgical resection. SBRT has high local control rates and a favorable toxicity profile relative to other surgical and non-surgical approaches. Given the excellent tumor control rates and increasing utilization of SBRT, recent efforts have focused on limiting toxicity while expanding treatment to increasingly complex patients. We review toxicities from SBRT for lung cancer, including central airway, esophageal, vascular (e.g., aorta), lung parenchyma (e.g., radiation pneumonitis), and chest wall toxicities, as well as radiation-induced neuropathies (e.g., brachial plexus, vagus nerve and recurrent laryngeal nerve). We summarize patient-related, tumor-related, dosimetric characteristics of these toxicities, review published dose constraints, and propose strategies to reduce such complications. PMID:26083933